Critically ill patients with glucose in their airways seem to be at double the risk of picking up serious hospital acquired infections, including MRSA, suggests research in Thorax.

The authors base their findings on a study of 98 critically ill patients in intensive care who required mechanical help with their breathing for more than 48 hours. The patients were drawn from medical and surgical specialties.

Levels of glucose were measured in their blood samples and lung secretions (bronchial aspirates). The lung secretions were also routinely tested twice weekly, or whenever an infection was suspected, for the presence of harmful bacteria, including methicillin resistant Staphylococcus aureus (MRSA).

Glucose was found in the bronchial aspirates of 58 of the 98 patients, and blood glucose levels in these patients also tended to be higher than those of patients with no glucose in their aspirates. Fifteen of the patients were diabetic.

The aspirates of 87 patients were tested for the presence of harmful bacteria. Aspirates containing glucose were also twice as likely to contain harmful bacteria, and twice as likely to contain MRSA, as those with no detectable glucose.

Patients with MRSA spent seven days longer in intensive care, had higher levels of an inflammatory marker (C reactive protein), and evidence of inflammation on their chest X rays than those in whom MRSA was not found. This suggests that they were more than just carriers of the bacteria, say the authors.

In most cases, the detection of glucose preceded MRSA, suggesting that glucose could have either caused or promoted growth of the bacteria, they add.

Staphylococcus aureus goes through a period of rapid growth during which it uses supplies of glucose. And glucose may also interfere with local immune responses in the airway.

An accompanying editorial suggests that a link between an increased risk of infection and abnormally high levels of glucose is biologically plausible. Too much glucose also tends to give immune cells the equivalent of a “hangover.”

But the author cautions that further research will be needed to confirm whether an increase in glucose levels in lung secretions boosts the risk of infection, and whether lowering these levels will cut the risk of infection with harmful bacteria, including MRSA.

[Glucose in bronchial aspirates increases the risk of respiratory MRSA in intubated patients Thorax 2005; 60: 761-4]

Emma Dickinson
edickinsonbmj
44-207-383-6529
BMJ Specialty Journals
bmj Continue reading →

New treatment options for the millions of people who suffer from obesity could be just around the corner, according to new research presented this week at ENDO 2004, the 86th Annual Meeting of The Endocrine Society. The meeting, which is the largest annual gathering of endocrinologists in the world, will have a special focus on “Obesity, Endocrinology and the future.”

During a press conference on Wednesday, June 16, 2004, leading obesity researchers from around the world will discuss some of the latest obesity research, which shows how different body systems, such as the brain, impact overeating as well as possible new treatments options for obesity. The new findings could help doctors and researchers uncover the causes of obesity and identify new ways to treat the growing epidemic and related health conditions.

“With obesity affecting the health of a growing number of people worldwide, researchers and clinicians are working to understand the causes and identify new treatments for this condition. To highlight the important research that is being conducted in the area of obesity, ENDO 2004 will have a special focus on ‘Obesity, Endocrinology and the Future.’ Throughout the meeting, presentations and activities will highlight the important contributions that the endocrine community is making towards the fight against obesity,” noted Endocrine Society President, E. Chester Ridgway, M.D. The five abstracts highlighted below will be discussed in the June 16 press conference, which will take place at 10:00 a.m. CT in the Ernest Morial Convention Center in New Orleans.

Study proves effectiveness of Rimonabant in treating obesity

Scientists have confirmed that rimonabant, a new class of medications, may be a possible new treatment for obesity. The findings could offer a new option to the 64 percent of Americans who suffer from obesity. Dr. Xavier Pi-Sunyer and colleagues at sites around the United States randomized 287 subjects (both men and women between the ages of 18 and 65 with a body mass index of 29 to 41) to receive five, 10 or 20 mg of rimonabant or a placebo, while on a mild hypocaloric diet.

After 16 weeks, patients who took rimonabant lost an average of two to four times (five to eight pounds) more weight than the patients on the placebo. In addition, waist circumference in the patients taking rimonabant also decreased from more than twice as much as the placebos.

“Our findings demonstrate that rimonabant is a safe and effective treatment for obesity,” explained Dr. Pi-Sunyer. “These findings may help provide an option for the growing number of people who suffer from obesity, but do not respond to traditional weight loss options such as diet and exercise. Longer and larger studies are needed to confirm these findings.”

Drug combination reduces cravings, causes weight loss in rats

Combining two pre-market drugs, which block cravings for tasty, but unhealthy foods, causes weight loss in rats. While researchers know that two drugs–cannabinoid-1 receptor SR141716A (SR) and opioid antagonist LY255582 (LY)–reduce the intake of rewarding food, the effects of combining these two drugs over time has, until now, been unknown.

Dr. Dana Kevin Sindelar and colleagues at Eli Lilly and Co. evaluated the effects of giving SR alone and in combination with LY on body weight and food intake for 14 days in obese rats. One group received oral SR, a second received SR and LY and a third group served as controls.

The study, led by Joelle Dill, found that rats on the SR/LY combination had a greater decrease in food intake and a greater degree of decrease in body weight. Researchers note that weight loss for both groups was maintained at the end of the study and was entirely due to a decrease in fat mass.

Two other groups were given SR for two weeks but this time LY was added for the first week only or for the second week only. Again, body weight and food intake decreased more with the combination, but increased when LY was removed. Likewise, body weight decreased when the LY was added during the second week.

While several studies had suggested that targeting both the cannabinoid-1 and opioid systems could reduce food intake and body weight after one day of dosing, this is the first data indicating that the combination of both could effectively reduce weight, and especially fat mass, over a longer treatment period.

Obese men at risk for infertility

While researchers already know that obesity is an infertility factor in females, new research shows that obese males may also be at risk for infertility. After hypothesizing that obesity impacts hypothalamic and gonadal function in men, which impacts infertility, Dr. Eric Pauli and doctors at Pennsylvania State University College of Medicine investigated fertility markers, such as reproductive history, inhibin B levels, testosterone and semen analysis, in 87 adult males with a range of BMI levels.

Results showed lower testosterone, free testosterone and follicle stimulating hormone (FSH) levels, which indicates mild hypogonadotropic hypogonadism, in men with a higher BMI. Additionally, men with children had a lower BMI.

“These results indicate that obesity is an infertility factor in men as well as women,” notes Dr. Pauli. “Our research provides evidence of another risk associated with obesity. At the same time, it may help to identify a cause of infertility in men.”

Lack of gut hormone causes obese people to need more food to feel full

British researchers have discovered that people who are obese do not produce enough of the gut hormone PYY3-6 (PYY), which helps people feel full and helps to limit food intake. The results could help explain why some obese people need to eat more food to feel full.

Dr. Carel le Roux, Dr. Simon Aylwin and researchers at Imperial College and King’s College Hospital in London provided a series of different sized meals to 20 obese and 21 lean individuals to find out whether obese people experience a PYY deficiency. The researchers measured the release of PYY for 180 minutes after the meal and asked participants to record how full they felt.

While both groups experienced an increase in PYY levels at each size meal, the obese subjects had a lower level of PYY and recorded lower levels of fullness for every size meal, compared with the lean group.

“We found that obese people needed a meal twice the size to achieve the same blood levels of PYY as the lean group,” explains Dr. Aylwin. In a second part of the study, the researchers gave 12 lean volunteers graded doses of PYY to examine how different levels of PYY influence the size of a meal. Following each infusion of PYY, subjects were given a buffet meal with no limitations. Again, as PYY levels increased, the subjects ate less food.

“Reduced PYY levels in obese people following a meal could contribute to a reduced feeling of fullness and a larger-sized next meal,” notes Dr. Aylwin. “By finding a way to reverse or overcome this deficiency, we may be able to help patients lose weight and maintain the weight loss.”

Food taste causes elevated brain activity in obese people

Tasting food causes elevated activity in brain regions involved in the recognition of taste and in the emotional response to ingestion of food in obese people. The new findings could help doctors understand why some people overeat. While taste plays an important role in overeating, scientists have not known whether a person’s experience of taste is related to the development of obesity.

Dr. Angelo Del Parigi and Antonio Tataranni at the National Institutes of Health and their colleagues at Good Samaritan Medical Center in Phoenix, Arizona, took pictures of the brains of 21 obese and 20 lean, hungry subjects, both before and after tasting a liquid meal (Ensure plus) following a 36 hour fast. The researchers found significantly elevated activity in the brain regions that are activated in response to the sensory and emotional aspects of food ingestion in the obese subjects.

“Abnormally high activity in the insular cortex region of the brain, which responds to the sensory experience of food, may put people at an increased risk for developing obesity,” explains Dr. Del Parigi. “Continued research in this area could help us understand why some people consistently overeat and are susceptible to gaining weight.” It is unknown whether the brains of obese people are especially sensitive to food stimuli or if other aspects of being obese change the way the brain responds to any stimulus, note the researchers.

Founded in 1916, The Endocrine Society is the world’s oldest, largest, and most active organization devoted to research on hormones, and the clinical practice of endocrinology. Endocrinologists are specially trained doctors who diagnose, treat and conduct basic and clinical research on complex hormonal disorders such as diabetes, thyroid disease, osteoporosis, obesity, hypertension, cholesterol and reproductive disorders.

Today, The Endocrine Society’s membership consists of over 11,000 scientists, physicians, educators, nurses and students, in more than 80 countries. Together, these members represent all basic, applied, and clinical interests in endocrinology. The Endocrine Society is based in Chevy Chase, Maryland. To learn more about the Society, and the field of endocrinology, visit the Society’s web site at endo-society

Contact: Marisa Lavine
mlavineendo-society
504-670-7851
Endocrine Society Continue reading →

Scientists at the Stanford University School of Medicine have identified a cancer-initiating cell in human melanomas. The finding is significant because the existence of such a cell in the aggressive skin cancer has been a source of debate. It may also explain why current immunotherapies are largely unsuccessful in preventing disease recurrence in human patients.

“These cells lack the traditional melanoma cell surface markers targeted by these treatments,” said post-doctoral fellow Alexander Boiko, PhD. “Without wiping out the cells at the root of the cancer, the treatment will fail.”

Boiko is the first author of the research, which will be published in the July 1 issue of Nature. He works in the laboratory of Irving Weissman, MD, the director of Stanford’s Institute for Stem Cell Biology and Regenerative Medicine. Weissman is the medical school’s Virginia & D.K. Ludwig Professor for Clinical Investigation in Cancer Research and the senior author of the research. He is also a member of the Stanford Cancer Center.

The cancer stem cell theory holds that, like queen bees in a hive, only a subset of cancer cells are at the root of the tumor’s growth. These cells can both self-renew (that is, make more of themselves) and differentiate into other tumor cell types.

Any therapy that doesn’t wipe out these elite cancer stem, or initiating, cells has no chance of completely eradicating the disease even if it destroys nearly all other tumor cells. That’s why, say proponents, it can be relatively easy to get a patient into remission, but extremely difficult to prevent the cancer stem cells from roaring back and causing a relapse months or years later.

Cancer stem cells were first identified in blood cancers, but have since been identified in a number of solid tumors including bladder, brain, breast and colon cancers. Previous studies in the laboratory of assistant professor of radiation oncology Maximilian Diehn, MD, PhD, in collaboration with the laboratories of Weissman and Stanford colleague Michael Clarke, MD, have indicated that cancer stem cells may be more resistant than other cancer cells to many common treatments like radiation and some chemotherapies. Clarke is the Karel H. and Avice N. Beekhuis Professor in Cancer Biology at the medical school and both Diehn and Clarke are members of the Stanford Cancer Center.

Although a growing body of evidence seems to support the cancer stem cell hypothesis, melanoma has remained a conundrum. A University of Michigan study in 2008 found that as many as one in four melanoma cells could cause cancers in immune compromised mice, suggesting that there may not be a particularly privileged subset of cancer stem cells in this tumor type. Boiko set out to solve the mystery.

“I didn’t know if melanoma would in fact have the cancer-initiating cells,” said Boiko. “I was completely unbiased, so I was actually sort of surprised to find such a clear-cut answer. It fits exactly what’s been discovered in the studies of other solid tumors.”

To conduct the study, Boiko analyzed cell surface markers on primary melanoma tumor samples taken directly from patients at the Stanford Cancer Center. In this way, he avoided having to grow the cells for a long period of time in the lab. Continuous culturing, or passage, of cancer cells often gives the cells time to evolve and change in ways that might not accurately reflect their composition in melanoma patients.

He found that one protein, called CD271, was always expressed on only a fraction of the cells in the human melanoma samples tested: The proportion of cells expressing CD271 varied in the samples from 2.5 to 41 percent of the total cell population; the marker appeared on a mean of 16.7 percent of cells in the samples.

This was interesting because CD271 was previously identified as a marker that identifies a group of cells called the neural crest stem cells. These cells are unique in that they are a multipotent, migratory cell population that becomes many cell types during development including melanocytes (cells responsible for skin pigmentation), bone, smooth muscle, neurons, and cartilage in the head and face.

When Boiko transplanted the melanoma cells from nine human samples into laboratory mice with severely compromised immune systems, he found that the cells expressing CD271 on their surface were much more likely to cause cancers in the recipients than those from the same tumor that didn’t express the marker (70 percent versus 7 percent, respectively). And all but one of the newly induced tumors arising from the transplantation of the CD271-positive cells went on to develop a population of a mixture of CD271-expressing and non-expressing cells – indicating that the cells with the marker were both self-renewing and differentiating into other types of tumor cells.

Boiko then collaborated with researchers in the medical school laboratories of professor of surgery Michael Longaker, MD, and assistant professor of surgery George Yang, MD, to further test the tumor initiating properties of the cells expressing CD271. They transplanted normal human skin on to the backs of the immunocompromised mice and injected the skin with the melanoma cells. Only cells expressing CD271 (isolated from melanomas from two patients) gave rise to tumors and lung metastasis in the mice.

Finally, the researchers looked to see whether the cancer-initiating cells also expressed common cellular antigens currently used for melanoma therapy. They found that melanoma cells expressing CD271 either completely or partially lacked expression of three common therapeutic targets – TYR, MART and MAGE – in 86 percent, 69 percent and 68 percent of melanoma patients, respectively.

“This could be the reason why we often see melanoma patients relapsing and coming back to the clinic,” said Boiko. “Our research indicates that it may be more appropriate to also target cells expressing CD271.” Such a combination therapy might work to kill both types of cells in the tumor and, hopefully, prevent disease recurrence.

So why do some melanoma tumors seem to have such a large proportion of cancer-initiating cells? Boiko and his colleagues speculate that the answer might lie in the rapidly evolving, aggressive nature of the disease. It’s possible that a kind of natural selection among the dividing cancer cells occurs which, in extreme cases selects for one clone, or cell lineage, that for the most part fails to differentiate into non-tumor-initiating cells.

“Extreme care should be taken to identify the origin and the past laboratory history of the cells under study,” said Boiko. “Our work was done on primary and minimally passaged patient samples. The variations that we saw in terms of CD271 prevalence in these samples could depend on the stage of the disease the patient was in, and the aggressiveness of that individual cancer.”

In addition to Boiko, Weissman, Longaker and Yang, other Stanford researchers involved in the work include post-doctoral fellows Olga Razorenova, PhD, and Daphne Ly, MD; professor of pathology Matt van de Rijn, MD; professor of dermatology Susan Swetter, PhD; associate professor of surgery Denise Johnson, MD; Paris Butler, MD; otolaryngologist Benzion Joshua, MD; and professor of otolaryngology and neurosurgery Michael Kaplan, MD.

The research was supported by the National Institutes of Health, the American Cancer Society, the Virginia & D.K. Ludwig Fund for Cancer Research, the Oak Foundation and the Ellenburg Faculty Scholar Endowment.

Source:
Krista Conger
Stanford University Medical Center Continue reading →

METABOLISM: Keeping food consumption under control, a new role for the protein PrP

Tatsushi Onaka and colleagues, at Jichi Medical University, Japan, have provided new insight into the network of signals that emanate from the gut and the brainstem of rodents to regulate food intake.

In the study, neurons in the region of the rat brainstem known as the nucleus tractus solitarii that express the protein prolactin-releasing peptide (PrP) were found to be activated following food intake. Consistent with PrP functioning as a satiety signal (a signal that suppresses food intake), mice lacking PrP became obese in adulthood as a result of increased food intake and decreased responsiveness to other satiety signals. Similarly, obesity as a result of increased food intake was observed in rats in which an antibody that blocks PrP was administered directly into the brain. In both cases the increased food intake was reflected by an increase in meal size. Thus, PrRP acts as a satiety signal in the brain of rodents, and disruption of this important signal can cause obesity.

TITLE: Endogenous prolactin-releasing peptide regulates food intake in rodents

AUTHOR CONTACT:
Tatsushi Onaka
Jichi Medical University, Shimotsuke, Tochigi, Japan.

View the PDF of this article at: http:www.the-jci/article.php?id=34682

CARDIOLOGY: The protein FHL1 helps heart muscle cells respond to high pressure

High blood pressure puts stress on the heart, which responds by increasing in size, a process known as cardiac hypertrophy. This is a leading cause of heart failure and understanding the molecular pathways involved is important for identifying potential therapeutic targets. New data, generated in mice by Ju Chen and colleagues, at the University of California, San Diego, La Jolla, have now identified the protein FHL1 as part of the complex in heart muscle cells (cardiomyocytes) that senses the high pressure-induced stress that triggers cardiac hypertrophy. Specifically, cardiac hypertrophy triggered by experimentally induced high blood pressure was markedly diminished in mice lacking FHL1. Further analysis shed light on other important molecules and signaling pathways involved in the process of sensing high pressure-induced cardiac stress, leading the authors to suggest that further analysis of these might reveal a new target for drugs to treat heart disease characterized by cardiac hypertrophy.

TITLE: An FHL1-containing complex within the cardiomyocyte sarcomere mediates hypertrophic biomechanical stress responses in mice

AUTHOR CONTACT:
Ju Chen
University of California, San Diego, La Jolla, California, USA.

View the PDF of this article at: http:www.the-jci/article.php?id=34472

VASCULAR BIOLOGY: A new regulator of blood vessel formation: the protein AIP1

AIP1 is a recently identified protein known to be highly expressed in the cells that line blood vessels (endothelial cells) and to regulate the death (by a process known as apoptosis) of these cells in vitro . However, the in vivo function of AIP1 in endothelial cells has not been determined. But now, Wang Min, Hong Chen, and colleagues, at Yale University Medical School, New Haven, have generated mice lacking AIP1 and found that AIP1 regulates new blood vessel formation (angiogenesis) under inflammatory conditions.

In the study, AIP1-deficient mice exhibited markedly enhanced angiogenesis in two models of inflammatory angiogenesis. In one model this was associated with increased VEGF-VEGFR2 signaling. Further analysis determined the mechanism by which AIP1 regulates angiogenesis under inflammatory conditions: AIP1 is recruited to VEGFR2 signaling complexes formed after VEGF binds VEGFR2 and that AIP1 inhibits VEGFR2 signaling, leading to decreased endothelial cell migration and therefore decreased angiogenesis.

TITLE: AIP1 functions as an endogenous inhibitor of VEGFR2-mediated signaling and inflammatory angiogenesis in mice

AUTHOR CONTACT:
Wang Min
Yale University School of Medicine, New Haven, Connecticut, USA.

Hong Chen
Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA.

View the PDF of this article at: https://www.the-jci/article.php?id=36168

###

Source: Karen Honey

Journal of Clinical Investigation Continue reading →

Researchers at MIT are eagerly anticipating the summer delivery of Elekta Neuromag®, a system that uses magnetoencephalography or MEG to explore brain function. MEG can detect the very weak magnetic fields arising from electrical activity in the brain, and allows researchers to monitor the timing of brain activity with millisecond precision. MIT researchers will use MEG to study normal cognition in children and adults, as well as the neural basis of autism, depression, schizophrenia and other brain disorders.

“MIT is exceptionally well positioned to benefit from a MEG facility on our campus,” says Charles Jennings, Ph.D., director of neurotechnology at the McGovern Institute for Brain Research. “MIT is among the country’s leading centers for neuroscience research, with a community of investigators that studies the brain at every level, from molecules and cells to human cognition and computational modeling. We also have strong programs to study a wide range of brain disorders, which will benefit greatly from access to MEG technology.”

“MIT’s worldwide reputation for advancing knowledge in science and technology for nearly 150 years makes its acquisition of Elekta Neuromag particularly gratifying, and we’re proud to be a part of it,” says Stephen Otto, Chairman of Elekta’s Neuromag Business. “And it is fitting that this institution, especially, will become Elekta’s latest MEG site, as MEG was invented by David Cohen at MIT.”

The Elekta Neuromag system will be housed in the Martinos Imaging Center within the Brain and Cognitive Sciences complex, home to the McGovern Institute of Brain Research, the Picower Institute for Learning and Memory and the Department of Brain and Cognitive Sciences. Delivery of the system is expected in June and it should be operational by the fall of 2010.

The following are examples of planned MEG research projects at MIT:

– Prof. John Gabrieli, director of the Martinos Imaging Center, will use MEG to study the neural and genetic basis of autism, dyslexia and other developmental disorders. By combining MEG with other brain imaging modalities, such as magnetic resonance imaging (MRI) and electroencephalography (EEG), Dr. Gabrieli plans to search for differences in brain activation in subjects with different genetic variants that have been linked to these conditions. “Our goal is to correlate the changes in brain function with genetic risk factors, and in turn identify categories of patients for whom optimal treatment strategies could be tailored,” he says.

– Prof. Robert Desimone, director of the McGovern Institute, plans to study the neural basis of attention. Animal studies have indicated that high frequency brain waves known as gamma oscillations become synchronized across brain areas as these areas communicate with each other to control attention. He plans to extend this work to humans using MEG, and he hopes that this will provide new insights into the basis of diseases such as schizophrenia. “Gamma oscillations are disrupted in schizophrenia, and we think this may help explain why people with schizophrenia often experience difficulty organizing their thoughts and perceptions into a coherent and meaningful whole,” Dr. Desimone explains.

– Prof. Christopher Moore, an investigator at the McGovern Institute, seeks to understand how the cerebral cortex processes rapid sensory information. Based on his work on cortical circuitry, Dr. Moore has developed a biophysical model to account for the MEG signal. “Our aim is to link the signals that we can record from human subjects to the underlying brain mechanisms that give rise to those signals,” he says. “Arguably, we will never fully understand normal cognition or the ways that cognition fails in brain disorders unless we can achieve this deep circuit understanding.”

Other MIT faculty members expect to use the new MEG facility for a variety of studies, including MEG source localization; the neural basis of age-related changes in cognition; how individuals differ in their processing of social cues such as faces; cognitive deficits in autism spectrum disorder; the processing of complex visual scenes; neural mechanisms of speech and comprehension; how children and adults infer and reason about the mental states of other people; neural mechanisms of motor control and many other studies.

“In many ways the brain is a ‘black box.’ It is so complex — comprising 100 billion neurons and a trillion or more synapses — it’s not surprising it’s challenging to study,” Dr. Jennings notes. “But with MEG I think we’ll succeed in shining a little light in there.”

About Elekta

Elekta is a human care company pioneering significant innovations and clinical solutions for treating cancer and brain disorders. The company develops sophisticated, state-of-the-art tools and treatment planning systems for radiation therapy and radiosurgery, as well as workflow enhancing software systems across the spectrum of cancer care.

Stretching the boundaries of science and technology, providing intelligent and resource-efficient solutions that offer confidence to both healthcare providers and patients, Elekta aims to improve, prolong and even save patient lives, making the future possible today.

Today, Elekta solutions in oncology and neurosurgery are used in over 5,000 hospitals globally, and every day more than 100,000 patients receive diagnosis, treatment or follow-up with the help of a solution from the Elekta Group.

Elekta employs around 2,500 employees globally. The corporate headquarter is located in Stockholm, Sweden, and the company is listed on the Nordic Exchange under the ticker EKTAb.

About the McGovern Institute for Brain Research

The McGovern Institute for Brain Research at MIT is led by a team of world-renowned, neuroscientists committed to meeting two great challenges of modern science: understanding how the brain works and discovering new ways to prevent or treat brain disorders. The McGovern Institute was established in 2000 by Patrick J. McGovern and Lore Harp McGovern, who are committed to improving human welfare, communication and understanding through their support for neuroscience research. The director is Robert Desimone, formerly the head of intramural research at the National Institute of Mental Health.

Source: Elekta Continue reading →

NICE has today (21 June) launched a consultation on its draft quality standards and draft guidance on service user experience in adult mental health and patient experience in adult NHS services.

Over the past few years several documents and initiatives have highlighted the importance of the service user’s experience and the need to focus on improving these experiences where possible. These include Lord Darzi’s report ‘High quality care for all’ (2008)1, which highlighted the importance of the entire service user experience within the NHS, ensuring people are treated with compassion, dignity and respect within a clean, safe and well-managed environment. There have also been national initiatives introduced aimed at improving patients’ experience of healthcare including NHS Choices. The Government also signalled in its white paper, ‘Equity and excellence: liberating the NHS’ (2010)2 that more emphasis needs to be placed on improving service users’ experience of NHS care.

To deliver the best possible experience for patients who use NHS services, high quality care should be clinically effective and safe. These quality standards and clinical guidance, once finalised, will aim to ensure that patients have an excellent experience of care from the NHS.

The draft quality standard for service user experience in adult mental health contains a number of statements, which include ensuring that people have timely and efficient access to mental health services. It also states that people using mental health services are supported by mental health and social care professionals who are trained in cultural awareness by a programme which includes input from local voluntary organisations who work with black and minority ethnic (BME) communities. In addition the standard states that people using mental health services can be assured that services are combating the stigma associated with mental health problems, mental illness and mental health services.

The draft quality standard for improving the quality of patient experience includes ensuring that patients are given the opportunity to discuss their health beliefs, concerns and preferences in order to individualise their care. It also states that patients have their physical (such as nutrition, hydration and personal hygiene) needs and psychological (such as fear and anxiety) concerns assessed in an environment that maintains their dignity and confidentiality. In addition the standard states that patients have their requirements for continuity of care considered – this may involve seeing the same healthcare professional/team.

NICE is today also opening consultations on two draft pieces of clinical guidance, on service user experience in adult mental health, and improving the quality of patient experience. This guidance is, for the first time, being developed alongside the quality standards and aims to promote person-centred care that takes into account service users’ and patients’ needs, concerns and preferences.

Dr Fergus Macbeth, Director of the Centre for Clinical Practice at NICE said: “Patient and service user experience can be as important as clinical outcomes, therefore ensuring that there are standards in place that help improve that experience is crucial.

“Such experience is a good indicator of service delivery and can highlight key issues within the services. The draft standards and guidance will be available for consultation on the NICE website for one month, providing registered stakeholders with a good opportunity to submit their comments.”

These draft standards and guidance have been issued for consultation; NICE has not yet published the final quality standards and guidance to the NHS.

These draft standards/draft guidance are available for consultation on the NICE website from Tuesday 21 June until 5.00pm on Tuesday 19 July here.

This allows registered stakeholders to comment and help identify which statements and recommendations are most important to support service improvement. All eligible comments will be reviewed by the Guidance Development Group and the standards/guidance will be refined in light of this information. The final quality standards and guidance are expected to be published in October 2011.

NICE commissioned the National Collaborating Centre for Mental Health to develop the service user experience in adult mental health guidance and quality standard. The National Clinical Guideline Centre was commissioned to develop the patient experience in adult NHS services guidance and quality standard. The Centres established a Guidance Development Groups, which reviewed the evidence and developed the recommendations.

Notes

– NICE quality standards (QS) are a set of specific, concise statements and measures that act as markers of high-quality, clinical and cost-effective patient care. They are the only standards that apply nationally in health and social care, and are developed from the very best available evidence, such as NICE guidance or other NHS Evidence-accredited sources. Quality standards are produced with the NHS and social care, along with their partners, service users and carers. They are a pivotal part of the new NHS Outcomes Framework3, an overview of aims and objectives in improving patient outcomes in the NHS.

– There is more information on NICE quality standards here.

– Quality standard topics are referred to NICE by ministers on the advice of the National Quality Board, a group of representatives from health and social care, committed to improving quality in the NHS and overseeing the reforms aimed at improving care. Further information on the National Quality Board can be found here.

– NICE clinical guidance is recommendations on the appropriate treatment and care of people with specific diseases and conditions within the NHS in England and Wales. Clinical guidance is based on the best available evidence. Guidance helps healthcare professionals in their work, but does not replace their knowledge and skills.

References

1. Lord Darzi’s report High quality care for all (2008) can be found here.

2. The white paper, ‘Equity and excellence: liberating the NHS’ (2010) can be found here.

3. The recently announced Transparency in Outcomes framework for the NHS proposes using quality standards to produce more detailed commissioning guidance to meet the suggested outcome goals. The NHS Outcomes Framework can be found here.

Source:

NICE Continue reading →

Obesity is known to increase the risk of chronic disorders, such as diabetes (type 2). An international team of scientists with German participation through the Helmholtz Zentrum M??nchen identified six new obesity genes. Gene expression analyses have shown that all six genes are active in brain cells.

The international GIANT (Genetic Investigation of Anthropometric Parameters) consortium works on the discovery of obesity genes. So far, the scientists have analyzed two million DNA variations in 15 genome-wide association studies with a total of more than 32,000 participants. The hereby identified candidate genes were validated in 14 further studies including 59,000 participants. In addition to the FTO and MC4R genes already known, it was now possible for six more obesity genes to be identified: TMEM18, KCTD15, GNPDA2, SH2B1, MTCH2, and NEGR1.

Gene expression analyses have shown that all six genes are active in brain cells. Also the previously known two obesity genes, FTO and MC4R, show a similar expression pattern; in case of the MC4R gene, a genotype-dependant influence on the behavior of appetite is already established. Scientists of the German National Genome Research Network (NGFN), Prof. H.-Erich Wichmann and Dr. Iris Heid from the Helmholtz Zentrum M??nchen, Institute of Epidemiology, who lead the German participation of this consortium, emphasize: “Definitely, the two main causes for obesity are poor nutrition and lack of physical activity. But the biology of these genes suggests genetic factors underlying the different reaction of people to lifestyle and environmental conditions.”

With the exception of the SH2B1 gene, which plays a role in the leptin signalling and thus in the regulation of appetite, none of the other five genes was hitherto discussed as obesity genes. Iris Heid and her collegue Claudia Lamina from the Ludwigs-Maximilians-Universit?¤t M??nchen are enthused: “The purely statistical approach of the genome-wide association analysis can depict new aspects of the biology of weight regulation, which were previously unanticipated.”

As a next step, the scientists evaluate other anthropometric measures, in order to shed light on different aspects of obesity. In addition, they will expand and include further studies into their analysis as they have realized that the individual studies are all too small, and only by means of collaboration, is it possible to achieve further success here.

This project was financed by the German National Genome Research Network (NGFN, head of the Obesity Network: Prof. Johannes Hebebrand, University of Duisburg-Essen; Project Leader Helmholtz Zentrum M??nchen: PD Dr. Thomas Illig), the National Institutes of Health, USA, and the Munich Center of Health Sciences of the LMU Munich. The genotyping was carried out at the Institute for Human Genetics of the Helmholtz Zentrum M??nchen under the leadership of Prof. Thomas Meitinger.

###

Original publication:

Willer et al.: Six New Loci Associated with Body Mass Index Highlight a Neuronal Influence on Body Weight Regulation. Nature Genetics 2008. (DOI 10.1038/ng.287)
nature/ng/journal/v41/n1/abs/ng.287.html

Source: Ulrike Koller

Helmholtz Zentrum M??nchen – German Research Center for Environmental Health Continue reading →

The ability to leap tall buildings in a single bound used to be the stuff of comic-book fantasy. Nathan Ball, a 23-year-old graduate student at the Massachusetts Institute of Technology and this year’s winner of the $30,000 Lemelson-MIT Student Prize, has invented a device that makes the fantasy a reality.

With the help of Ball’s ATLAS Powered Rope Ascender, a fully loaded firefighter could reach the top of a 30-story building in only 30 seconds, compared to the six minutes or more it often takes to trudge up stairs with 80 to 100 pounds of equipment. The device, which is the size of a hand-held power tool, can lift a 250-pound load more than 600 feet into the air at nearly 10 feet per second, all on a single battery charge.

“Ingenuity, creativity and passion seem to course through Nate’s blood,” said Merton Flemings, director of the Lemelson-MIT Program, which sponsors the annual award. “His battery-powered rope ascender and needle-free injection technology both have life-saving capabilities and many commercial applications.”

“Nate is also an inspiring and committed mentor for young inventors. This combination of attributes made him our top choice for this year’s $30,000 Lemelson-MIT Student Prize,” Flemings added.

Up, Up and Away!

In November 2004, Ball and three colleagues entered the Soldier Design Competition sponsored by the MIT Institute for Soldier Nanotechnologies. The competition called for a high-powered device to enable rapid vertical mobility.

Ball called the challenge unprecedented, as the original specifications called for a device that weighed less than 25 pounds and could lift 250 pounds 50 feet into the air, in five seconds. “That’s more than five horsepower in a 25-pound package,” he explained. “That’s a power-to-weight ratio higher than a Dodge Viper’s – we did the math. To have that much power in that small of a package is a heck of a challenge.”

Through a combination of resourcefulness and “the highest-tech equipment we could afford,” such as drill batteries and a few high-power density motors, Ball and his colleagues invented a device that could hoist 250 pounds of weight 50 feet into the air in seven seconds – only two seconds slower than the competition’s specification.

The novel aspect of the ATLAS ascender is its rope-handling mechanism. Similar to the way an anchor is raised and lowered on a ship, the device relies on the capstan effect, which produces a tighter grip each consecutive time a rope is wrapped around a cylinder. The grip continues to tighten as more weight is applied to the line.

In his design, a standard-sized rope (between three-eighths and five-eighths of an inch) is weaved between a series of specially configured rollers that sit on top of a turning spindle. As the battery-powered spindle rotates, it continuously pulls rope through the device. “We currently have three patents pending for the rope interaction and other iterations on the device” said Ball.

Ball and his colleagues founded Atlas Devices, LLC to develop and market the ATLAS Powered Rope Ascender. He has upgraded the original design, and the device is now powered by high-density, lithium-ion batteries created by A123Systems. Ball said the new power system immediately dropped the device’s weight by several pounds and significantly increased its speed.

“The latest configuration weighs 20 pounds and peaks at 10 feet per second,” he said. “A123Systems has a 150-foot steam tower we were able to use for testing. We successfully completed a 100-foot continuous ascent to the tower’s platform in 14 seconds.”

Ball envisions his invention having practical applications in rescue work, recreational climbing and cave exploration, as well as urban warfare situations. “It can help people complete tasks more efficiently and without depleting energy they would otherwise use climbing ladders and carrying heavy gear,” he said.

Hit Me With Your Best Shot

Another of Ball’s stand-out inventions is an improvement in the needle-free injection technology developed at MIT’s BioInstrumentation Laboratory. Under the direction of his advisors Ian W. Hunter and Andrew Taberner in the BioInstrumentation Laboratory, Ball was challenged to use the lab’s novel Lorentz-force actuator to create a dual-action, rapid-fire delivery technology that increased drug volume delivery.

Within two months, he had not only come up with a solution to the problem, but had built and tested a prototype device.

“Nate’s achievement is simply breathtaking and will have potentially a huge impact on drug delivery and, hence, healthcare,” said Ball’s advisor Professor Hunter.

Now awaiting livestock trials, Ball and his colleagues anticipate the needle-free injection technology having applications in animal husbandry. Beyond that, they hope the device may someday be employed for safe, inexpensive, mass inoculation of humans in developing and developed countries. Commercialization of the work is funded in part by partner Norwood Abbey, Inc. of Melbourne, Australia.

Inventor, Student, Reality-Show Host

Ball’s interest in invention does not stop with his own creations; he also dedicates himself to mentoring and advising aspiring inventors.

“Coming from a family of teachers and having such strong support from my parents, I felt it imperative to share that with other young inventors,” he said. “My parents helped me find my passion early in life and instilled in me a way to maintain it. To help other young inventors discover science is amazing and watching their first moment of discovery is very rewarding.”

Ball has been deeply involved as a technical advisor and co-host of “Design Squad,” a new engineering-based reality show for kids ages 9-13 that will air nationally on PBS beginning in February 2007. He helped brainstorm and test challenge ideas that he said would “require clever problem solving, ingenuity, and some classic mess-making.” Ball hopes that through this program, kids will be empowered to explore and embrace the elements of engineering that surround them each day.

Program Expands to Recognize Other Exceptional Inventors

In its ongoing effort to expand its reach and recognize outstanding up-and-coming inventors, the Lemelson-MIT Program is offering two new $30,000 Student Prizes this year.

Michael Callahan is the inaugural winner of the Lemelson- Illinois Student Prize at the University of Illinois at Urbana-Champaign. He is a graduate student in Industrial and Enterprise Systems Engineering who has invented a method to intercept neurological signals near the source of vocal production and convert the signals into speech. He hopes to make it possible for people with limited speech or movement abilities to communicate.

On February 16, the first recipient of the Lemelson-Rensselaer Student Prize at Rensselaer Polytechnic Institute was announced by Lemelson Foundation chair Dorothy Lemelson, Rensselaer President Shirley Ann Jackson and Alan Cramb, dean of the School of Engineering. Details about the winner are posted on hrpi.edu/lemelson/.

On May 3, the winners of these Student Prizes will join together for a panel discussion at the Museum of Science, Boston. The 3:00 p.m. panel is open to the public and included in the Exhibit Hall admission.

###

ABOUT THE $30,000 LEMELSON-MIT STUDENT PRIZE

The $30,000 Lemelson-MIT Student Prize is awarded annually to an MIT senior or graduate student who has created or improved a product or process, applied a technology in a new way, redesigned a system, or demonstrated remarkable inventiveness in other ways. A distinguished panel of MIT alumni and associates including scientists, technologists, engineers and entrepreneurs chooses the winner.

ABOUT THE LEMELSON-MIT PROGRAM

The Lemelson-MIT Program recognizes outstanding inventors, encourages sustainable new solutions to real-world problems, and enables and inspires young people to pursue creative lives and careers through invention.

Jerome H. Lemelson, one of the world’s most prolific inventors, and his wife Dorothy founded the Lemelson-MIT Program at the Massachusetts Institute of Technology in 1994. It is funded by the Lemelson Foundation, a private philanthropy that celebrates and supports inventors and entrepreneurs in order to strengthen social and economic life. More information on the Lemelson-MIT Program is online at web.mit.edu/invent/.

Contact: Matt Paine

Lemelson-MIT Program Continue reading →

University of Pittsburgh researchers have developed the first natural, nontoxic method for biodegrading carbon nanotubes, a finding that could help diminish the environmental and health concerns that mar the otherwise bright prospects of the super-strong materials commonly used in products, from electronics to plastics.

A Pitt research team has found that carbon nanotubes deteriorate when exposed to the natural enzyme horseradish peroxidase (HRP), according to a report published recently in Nano Letters coauthored by Alexander Star, an assistant professor of chemistry in Pitt’s School of Arts and Sciences, and Valerian Kagan, a professor and vice chair of the Department of Environmental and Occupational Health in Pitt’s Graduate School of Public Health. These results open the door to further development of safe and natural methods-with HRP or other enzymes-of cleaning up carbon nanotube spills in the environment and the industrial or laboratory setting.

Carbon nanotubes are one-atom thick rolls of graphite 100,000 times smaller than a human hair yet stronger than steel and excellent conductors of electricity and heat. They reinforce plastics, ceramics, or concrete; conduct electricity in electronics or energy-conversion devices; and are sensitive chemical sensors, Star said. (Star created an early-detection device for asthma attacks wherein carbon nanotubes detect minute amounts of nitric oxide preceding an attack.)

“The many applications of nanotubes have resulted in greater production of them, but their toxicity remains controversial,” Star said. “Accidental spills of nanotubes are inevitable during their production, and the massive use of nanotube-based materials could lead to increased environmental pollution. We have demonstrated a nontoxic approach to successfully degrade carbon nanotubes in environmentally relevant conditions.”

The team’s work focused on nanotubes in their raw form as a fine, graphite-like powder, Kagan explained. In this form, nanotubes have caused severe lung inflammation in lab tests. Although small, nanotubes contain thousands of atoms on their surface that could react with the human body in unknown ways, Kagan said. Both he and Star are associated with a three-year-old Pitt initiative to investigate nanotoxicology.

“Nanomaterials aren’t completely understood. Industries use nanotubes because they’re unique??”they are strong, they can be used as semiconductors. But do these features present unknown health risks? The field of nanotoxicology is developing to find out,” Kagan said. “Studies have shown that they can be dangerous. We wanted to develop a method for safely neutralizing these very small materials should they contaminate the natural or working environment.”

To break down the nanotubes, the team exposed them to a solution of HRP and a low concentration of hydrogen peroxide at 4 degrees Celcius (39 degrees Fahrenheit) for 12 weeks. Once fully developed, this method could be administered as easily as chemical clean-ups in today’s labs, Kagan and Star said.

Source:
Morgan Kelly
University of Pittsburgh Continue reading →

Doctors need a comprehensive reference on nutrition. Ingrid Kohlstadt M.D., M.P.H., an associate faculty at Johns Hopkins School of Public Health, has accepted an author’s contract with one of the world’s largest medical publishers, Taylor & Francis Group, to develop a ground-breaking medical text entitled “Food and Nutrients in Disease Management.”

The invitation follows the successful publication and world-wide distribution of “Scientific Evidence for Musculoskeletal, Bariatric, and Sports Nutrition” (Taylor & Francis Group, CRC Press, 2006), also edited by Dr. Kohlstadt. “This outstanding and scholarly text is timely and very pertinent to clinicians involved in the primary and surgical care of patients with nutritional issues of every type,” says Robert R. Sholl, M.D., FAAFP, Founder and president of Wellspring Family Medical Associates and past chairman, Governors Council on Physical Fitness and Sports, State of Maine.

This is the first medical nutrition book to emphasize whole foods over isolated nutrients. “There is comparatively more research on nutrients than on foods, but a pile of vitamin pills is not a diet plan.” says Kohlstadt. She is assembling team of sixty contributing authors who will translate medical research on nutrients into practical dietary recommendations and offer evidence-based interventions for patients.

doctors for doctors, her new book will address sixty recurrent and chronic medical conditions where food and its nutrients have proven to be beneficial. In addition to heart disease, obesity and diabetes, the book will cover less well-known nutrient-associated conditions such as male infertility, kidney stones, prostate cancer, recurrent herpes infections, chronic viral hepatitis, preparing for surgery, and more. “The central importance of providing the body with optimal nutrition is clearly demonstrated.” says Susan Lord, M.D., Clinical assistant professor, Department of Family Medicine, and adjunct assistant professor, Department of Physiology and Biophysics, Georgetown University School of Medicine.

Doctors who have not billed a single visit for nutrition counseling could utilize this reference daily. It’s what doctors need to know about nutrition to treat diseases: Food-drug interactions, nutrient laboratory testing, dietary patterns which alter medication dosing, disease-related nutrient deficiencies, medication-induced nutrient deficiencies, adverse effects from certain herbs and supplements, toxin exposure through improper food and water preparation, food-gene interactions, and disease-responsiveness to improved food patterns.

Dr. Kohlstadt has been elected a Fellow of the American College of Nutrition and is also on the faculty of Food as Medicine™, a course for physicians offered through the Center for Mind Body Medicine. She has practiced nutritional medicine on every continent, including station physician in the Antarctic. She strives to bring the latest nutrition research to patient care as a lecturer and through her nutrition-information website www.INGRIDients.

Publication is scheduled for early 2009, and Dr. Kohlstadt is currently welcoming scientists and health care professionals interested in contributing to this text to contact her through her website at www.INGRIDients.

Continue reading →