Using Magnetism To Turn Drugs On, Off

Many medical conditions, such as chronic pain, cancer and diabetes, require medications that cannot be taken orally, but must be dosed intermittently, on an as-needed basis, over a long period of time. A few delivery techniques have been developed, using an implanted heat source, an implanted electronic chip or other stimuli as an "on-off" switch to release the drugs into the body. But thus far, none of these methods can reliably do all that's needed: repeatedly turn dosing on and off, deliver consistent doses and adjust doses according to the patient's need.

Researchers led by Daniel Kohane, MD, of Children's Hospital Boston, funded by the National Institutes of Health, have devised a solution that combines magnetism with nanotechnology.

The team created a small implantable device, less than one-half inch in diameter, that encapsulates the drug in a specially engineered membrane, embedded with nanoparticles (approximately 1/100,000 the width of a human hair) composed of magnetite, a mineral with natural magnetic properties. When a magnetic field is switched on outside the body, near the device, the nanoparticles heat up, causing the gels in the membrane to warm and temporarily collapse. This opens up pores that allow the drug to pass through and into the body. When the magnetic force is turned off, the membranes cool and the gels re-expand, closing the pores back up and halting drug delivery. No implanted electronics are required.

The device, which Kohane's team is continuing to develop for clinical use, is described in the journal Nano Letters.

"A device of this kind would allow patients or their physicians to determine exactly when drugs are delivered, and in what quantities," says Kohane, who directs the Laboratory for Biomaterials and Drug Delivery in the Department of Anesthesiology at Children's.

In animal experiments, the membranes remained functional over multiple cycles. The size of the dose was controllable by the duration of the "on" pulse, and the rate of release remained steady, even 45 days after implantation.

Testing indicated that drug delivery could be turned on with only a 1 to 2 minute time lag before drug release, and turned off with a 5 to 10 minute time lag. The membranes remained mechanically stable under tensile and compression testing, indicating their durability, showed no toxicity to cells, and were not rejected by the animals' immune systems. They are activated by temperatures higher than normal body temperatures, so would not be affected by the heat of a patient's fever or inflammation.

"This novel approach to drug delivery using engineered 'smart' nanoparticles appears to overcome a number of limitations facing current methods of delivering medicines," says Alison Cole, who oversees anesthesia grants at the National Institutes of Health's National Institute of General Medical Sciences (NIGMS). "While some distance away from use in humans, this technology has the potential to provide precise, repeated, long-term, on-demand delivery of drugs for a number of medical applications, including the management of pain."

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Health Journalists Utilize Audience, Other Media To Build News Agenda, Researchers Find

Approximately one-fifth of Americans follow health news very closely, according to the Pew Research Center. To identify how the demand for health stories is met, University of Missouri researchers surveyed national health journalists about their development of story ideas and use of expert sources and public relations materials. The researchers found that health journalists determine what information is newsworthy by examining the work of their peers and the issues raised by their colleagues and audiences.


“What does this mean for health news consumers? It means that health journalists work together to filter information and select what they believe is most important for their audiences,” says Maria Len-Rios, assistant professor in the Missouri School of Journalism. “They try to provide readers with accurate information and evaluate sources so that there isn’t undue influence by those who have vested interests in the information. This is the value that health journalists add to their news that may not be present in information from non-journalistic sources.”


Len-Rios and Amanda Hinnant, assistant professor in the Missouri School of Journalism, and other MU researchers surveyed 774 health journalists. They found that health journalists used non-public relations resources (other news media, self-interests, news audiences) more frequently than medical journals or public relations sources.


“Health journalists utilize other media, news audiences and their personal interests as resources for story ideas,” Len-Rios says. “When journalists do use public relations sources, they are likely to rely on universities, nonprofits or government sources that are less likely to appear to have profit-based interests. The fact that journalists aren’t looking to medical journals for health stories ideas – perhaps the source that contains the most detailed information – suggests a greater need to look to these primary sources.”


According to the survey, journalists who used public relations sources more for story ideas tended to believe they should get information to the public quickly and advocate for their readers to improve their health. Conversely, other journalists view themselves as watchdogs of institutions and are wary of public relations sources, Len-Rios says.


“The reliance on other media for story ideas is worth more exploration because it brings up questions of content diversity,” Hinnant says. “How many stories are not making it into the intermedia agenda and for what reasons?”


The study, “Health News Agenda Building: Journalists’ Perceptions of the Role of Public Relations,” was published recently in the summer 2009 issue of Journalism and Mass Communication Quarterly. The research was funded by the Missouri Foundation for Health, Missouri Health Literacy Enhancement Priority Area Grant.

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Array Of Health-related Activity Occurs In Virtual World Of Second Life

Researchers at the University of Toronto and the University Health Network's Centre for Innovation in Complex Care (CICC) have found that a wide array of health-related activity occurs in the 3 dimensional virtual world of Second Life. Second Life is free for users with basic accounts, and reported over 16 million registered users worldwide in 2008.

The web-based platform, which is often associated with pornography and "cheating" spouses, is also used to educate people about illness, train physicians, nurses and medical students with virtual simulations, enable disease-specific support and discussion groups, fundraise real-life dollars for medical research, and to conduct research.

The group found that health-related activities in the virtual world have significant implications in the real world. Dante Morra, medical director of the CICC, says "virtual worlds and the social networks that populate the Internet offer a new domain for healthcare. Although it is early in the development, there is a great opportunity to use these platforms for education, research and even disease surveillance."

Jennifer Keelan, principal investigator on the project, suggests that a major feature for users is the "relative anonymity where patients can seek out information and share health experiences in a safe environment. There is also a great potential for patients to "practice being patients" by virtually experiencing a mammogram or navigating a hospital's virtual ward—they can gain insight into medical procedures and processes to become more informed."

"There is a great opportunity here to understand the design features of social media that make it so appealing and accessible to people," says Leslie Beard, the designer on the team. "Once we understand what pulls people to Web 2.0, we can design and apply more effective communication strategies both within and beyond the Internet."

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Video of the Day: Cow Urine Soda

ViroPOP - A Green Video Network -- In India, the RSS will soon market cow urine soda as a health elixir.

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Nanotechnology Boosts War on Superbugs

This week the Nature Nanotechnology journal reveals how scientists from the London Centre for Nanotechnology (LCN) at UCL are using a novel nanomechanical approach to investigate the workings of vancomycin, one of the few antibiotics that can be used to combat increasingly resistant infections such as MRSA. The researchers, led by Dr Rachel McKendry and Professor Gabriel Aeppli, developed ultra-sensitive probes capable of providing new insight into how antibiotics work, paving the way for the development of more effective new drugs.

During the study Dr McKendry, Joseph Ndieyira, Moyu Watari and coworkers used cantilever arrays – tiny levers no wider than a human hair – to examine the process which ordinarily takes place in the body when vancomycin binds itself to the surface of the bacteria. They coated the cantilever array with mucopeptides from bacterial cell walls and found that as the antibiotic attaches itself, it generates a surface stress on the bacteria which can be detected by a tiny bending of the levers. The team suggests that this stress contributes to the disruption of the cell walls and the breakdown of the bacteria.

The interdisciplinary team went on to compare how vancomycin interacts with both non-resistant and resistant strains of bacteria. The 'superbugs' are resistant to antibiotics because of a simple mutation which deletes a single hydrogen bond from the structure of their cell walls. This small change makes it approximately 1,000 times harder for the antibiotic to attach itself to the bug, leaving it much less able to disrupt the cells' structure, and therefore therapeutically ineffective.

"There has been an alarming growth in antibiotic-resistant hospital 'superbugs' such as MRSA and vancomycin-resistant Enterococci (VRE)," says Dr McKendry. "This is a major global health problem and is driving the development of new technologies to investigate antibiotics and how they work.

"The cell wall of these bugs is weakened by the antibiotic, ultimately killing the bacteria," she continued. "Our research on cantilever sensors suggests that the cell wall is disrupted by a combination of local antibiotic-mucopeptide binding and the spatial mechanical connectivity of these events. Investigating both these binding and mechanical influences on the cells' structure could lead to the development of more powerful and effective antibiotics in future."

"This work at the LCN demonstrates the effectiveness of silicon-based cantilevers for drug screening applications," adds Professor Gabriel Aeppli, director of the LCN. "According to the Health Protection Agency, during 2007 there were around 7,000 cases of MRSA and more than a thousand cases of VRE in England alone. In recent decades the introduction of new antibiotics has slowed to a trickle but without effective new drugs the number of these fatal infections will increase."

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Soy Industry Says Soyfoods Do Not Impact Sperm Count

Headlines claiming "soy products lower sperm count" do not tell the whole story, according to the Soyfoods Association of North America. The study that Dr. Jorge Chavarro, published online in Human Reproduction, is based on recollected intake of soyfoods and not on specific diets containing soyfoods, the organization says.

"This study is confounded by many issues, thus I feel the results should be viewed with a great deal of caution," says Dr. Tammy Hedlund, a researcher in prostate cancer prevention from the University of Colorado Health Sciences Center, Department of Pathology.

Dr. Chavarro found that "soyfood and soy isoflavone intakes were unrelated to total sperm count, ejaculate volume, sperm motility, or sperm morphology" which are the important measures of sperm quality and male fertility, the soy association says. The study also did not determine directly what other foods, medications, supplements, existing medical conditions,
sexual activities or environmental factors may have directly affected the drop in sperm count, it adds. The study also classified high intakes of soyfoods as less than 3 ounces of a beverage per day -- about one 8 ounce glass of a beverage every three days. This is not considered a high intake of any food under most circumstances, according to the soy association.

Dr. Larry Ross, past president of the American Urology Association says that "Like most epidemiological reports, this study is retrospective and is therefore inherently subject to a variety of biases. The total study population was small (100 subjects) and little is known or reported about other dietary, stress factors, medications, or lifestyle issues that might
also affect sperm counts in these men. It is well known that of all semen parameters, variation in count (numbers of sperm/cc seminal fluid) is highly variable from day to day and seasonally in all men. This is most clear when one considers the 'range' of 'normal' sperm count accepted in our field (20-200,000 million.)"

Chavarro found that the men with the highest soyfood intake produced more ejaculate fluid volume with equivalent amounts of sperm count as those with lower intakes, neither the volume or the number of sperm was significantly different, however this larger volume lead to the lower sperm concentrations (millions per millimeter) in the higher intake individuals. This watering-down effect of sperm concentration should not be mistakenly associated with a decrease in fertility.

Obesity may be the explanation for the negative findings of this study, the soy association says. Dr. Chavarro found high soyfood intakes are associated with lower sperm concentration but "the association was more pronounced among overweight and obese men than among lean men." Men with high levels of body fat are likely to produce more estrogen than their slimmer counterparts, the association says.

Chavarro's study conflicts with the large body of U.S. government and National Institute of Health-sponsored human and primate research, in which controlled amounts of isoflavones from soy were fed and no effect on quantity, quality or motility of sperm were observed, the soy association says. Upon hearing of Chavarro's findings, Dr. Stephen Barnes, a pharmacologist at the University of Alabama at Birmingham, said, "This study is the first to find this correlation. The research on soy in men has not found a negative impact on male hormones but rather has suggested a preventive effect in prostate cancer."

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Fish Oil, Red Yeast Rice Studied for Lowering Blood Cholesterol

A great deal of scientific evidence shows that cholesterol-reducing medications known as statins can help prevent coronary artery disease. Although the safety of these medications has been well documented, as many as 40 percent of patients who receive a prescription for statins take the drug for less than one year. Doctors believe that several factors -- including cost, adverse
effects, poor understanding of statin benefits and patients' reluctance to take prescription medications long term -- may explain why some patients stop taking these medicines.

In the July issue of Mayo Clinic Proceedings, a group of researchers from Pennsylvania examine whether an alternative approach to treating high blood cholesterol may provide an effective
treatment option for patients who are unable or unwilling to take statins.

Study design

Researchers followed 74 patients with high blood cholesterol who met standard criteria for using statin therapy. Patients were randomly assigned to either the alternative treatment group or the statin group and followed for three months.

The alternative treatment group participants received daily fish oil and red yeast rice supplements, and they were enrolled in a 12-week multidisciplinary lifestyle program that involved weekly 3.5-hour educational meetings led by a cardiologist, dietitian, exercise
physiologist and several alternative or relaxation practitioners. Red yeast rice is the product of yeast grown on rice. A dietary staple in some Asian countries, it contains several compounds known to inhibit cholesterol production.

The statin group participants received 40 milligrams (mg) of Zocor (simvastatin) daily, as well as printed materials about diet and exercise recommendations. At the end of the three-month period, participants from both groups underwent blood cholesterol testing to determine the percentage change in LDL cholesterol.

Results

The researchers noted that there was a reduction in LDL cholesterol levels in both groups. The alternative treatment group experienced a 42.4 percent reduction, and the statin group experienced a 39.6 percent reduction. Members of the alternative therapy group also had a substantial reduction in triglycerides, another form of fat found in the blood, and
lost more weight.

"Our study was designed to test a comprehensive and holistic approach to lipid lowering," notes the study's lead author, David Becker, M.D., a Chestnut Hill Hospital and University of Pennsylvania Health System cardiologist. "These results are intriguing and show a potential benefit of an alternative, or naturopathic, approach to a common medical condition."

Dr. Becker acknowledges that a larger, multicenter trial with longer follow-up is necessary to determine long-term compliance with the alternative regimen, because previous studies involving diet and exercise have found a high rate of patients unable or unwilling to follow lifestyle recommendations.

"The excellent adherence in the alternative group was undoubtedly related to the intensive follow-up, education and support provided for this group," says Dr. Becker.

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Virtual Health Care Worker Could Save Patient Time, Nursing Resources

With search engine companies establishing online personal health records for their users and surgeons on the brink of making robotic surgery routine, it makes sense to have a remote medical care system that can support nursing staff, care managers and other healthcare workers. Writing in the International Journal of Web and Grid Services, a Japanese team describes a proposal for such a system.

Akio Koyama of Yamagata University, Japan, and colleagues there and at Yamagata College of Industry and Technology, and Fukuoka Institute of Technology, have drafted a proposal for a remote healthcare system with three main functions. The first function acts as a multipoint communication system with video images and voice. The second automatically uploads vital signs data and referencing. The third function involves remote monitoring of drip infusions that provide the patient with a controlled supply of medication or nutrients. The team has already carried out successful field trials with their prototype remote medical care support center.

The researchers point out that their system could address some of important socioeconomic problems, such as providing quality medical care for all citizens, even those living in small towns and rural areas.

Currently, access to sophisticated healthcare is often restricted to those in major conurbations and people in sparsely populated areas are usually required to seek healthcare some distance from their homes. "These trips can require hours of travel time for a relatively short examination, and thus are neither convenient nor an efficient use of the patient's time," says the team. Conversely, having healthcare workers with specialist knowledge travel to remote areas is equally wasteful of resources at various levels. The optimum solution, the team says, is to provide a medical consultancy solution using information and communications technology.

Their remote system brings together technologies that allow video conferencing between patient or local caregiver and healthcare workers, which also allows medical care data to be uploaded to a database. The vital signs data uploading and referencing subsystem likewise would operate via the internet or via cellular phone and allow a remote doctor to advise local caregivers on patient requirements. Finally, a subsystem that monitors the progress of a drip infusion using a sensor network would notify remote nursing staff of further requirements, which could then be passed on to a local carer.

There are several technical aspects of the proposed system that require attention prior to such a remote medical care approach being widely adopted, the researchers add. For instance, delays and throughput of video transfer during communications must be improved as well as diagnosis accuracy of the doctor agent and the prediction accuracy of the drip infusion finishing time.

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NASA Summer School Students Explore How to Protect Against Health Risks in Space Travel

Childhood dreams and mentor encouragement, paired with scientific expertise in areas ranging from biology to physics, have united an elite group of students and scientists from around the world who will participate in the fifth annual NASA Space Radiation Summer School at the U.S. Department of Energy's Brookhaven National Laboratory. The group will work in Brookhaven Lab's Medical Department and NASA Space Radiation Laboratory (NSRL) -- a unique
facility that simulates the harsh radiation environment of outer space -- to study ways to protect against possible risks astronauts may face during future long-term space flights. The three-week course will be held May 28 to June 20. Fifty-eight students have participated in the program to date.

As NASA gears up for an outpost on the Moon, plans for exploration of near-Earth asteroids, and prepares for a mission to Mars, many potential health risks to human space travelers remain unknown. It is vitally important to learn how astronauts will be affected by deep-space radiation and how to best protect them from harm. To tackle these challenges and help make space travel as safe as possible, the NASA Summer Program provides an opportunity for top graduate
students and post-doctoral fellows from various scientific backgrounds, as well as scientists trained in the discipline of space radiobiology, to work together.

"The radiation environment in space contains numerous types of charged particles of high energies, and the NSRL enables researchers to perform studies here on earth to examine the biological effects of exposure to these charged particles," says Peter Guida, Medical Department Liaison Scientist for this program at Brookhaven Lab. "This type of research is essential to help determine the possible risks that space travelers may encounter."

Fifteen graduate students, post-doctoral fellows, and working scientists, along with two auditing professionals, are participating in this year's summer school. The program has three scientific modules: physics/dosimetry (led by Lawrence Heilbronn of Lawrence Berkeley National Laboratory), cell-molecular-animal biology (led by Gregory Nelson of Loma Linda University Medical Center), and experimental methods (led by Betsy Sutherland of Brookhaven Lab). The program is sponsored by NASA and organized and managed by Brookhaven Lab, Loma Linda, and Universities Space Research Association (a consortium of universities, research
organizations, and governmental groups involved in space research).

"Our goal is to attract the highest quality students and fellows from diverse scientific backgrounds and help train them to be the next wave of space radiation researchers," says Eleanor Blakely of Lawrence Berkeley, 2008 NASA Summer School director.

The intensive, three-week course offers a unique physical and intellectual environment not duplicated in the nation's universities, medical schools, or research institutes. Students participate in both classroom activities and scientific experiments, working side-by-side with top space scientists from research organizations such as NASA, Brookhaven Lab, Lawrence Berkeley, Loma Linda University, Columbia University, University of Pennsylvania, California
Institute of Technology, University of Texas Southwestern Medical Center, and University of Maryland, Baltimore County. Experimental creativity and interdisciplinary approaches are emphasized.

Studies at NSRL simulate space radiation to learn how the intense rays may promote the development of cancer, as well as how this radiation can affect the central nervous system and other organ systems of the body. NSRL researchers are also looking at ways to protect
against these dangers through shielding and other strategies to minimize the risk to space travelers.

NSRL is a $34-million facility that was built by Brookhaven Lab with funding from NASA with the cooperation of the Office of Nuclear Physics within the U.S. Department of Energy's Office of Science. Operational since 2003, the facility is part of the lab's collider-accelerator complex, which is maintained by the DOE Office of Science's nuclear physics program and receives incremental operations and maintenance funding from NASA.

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Carbon Nanotubes That Look Like Asbestos, Behave Like Asbestos

A major study published today in Nature Nanotechnology suggests some forms of carbon nanotubes -- a poster child for the "nanotechnology revolution" -- could be as harmful as asbestos if inhaled in sufficient quantities.

Carbon nanotubes are atom-thick sheets of graphite formed into cylinders. They may be formed from a single layer of graphite or they may consist of multiple concentric layers of graphite, resulting in multi-walled carbon nanotubes. While the diameter of a nanotube can vary
from a few nanometers up to tens of nanometers, they can be hundreds or even thousands of nanometers long. Carbon nanotubes come in many forms, with different shapes, different atomic arrangements, and varying amounts and types of added chemicals -- all of which affect their properties and might influence their impact on human health and the environment.

The study used established methods to see if specific types of nanotubes have the potential to cause mesothelioma -- a cancer of the lung lining that can take 30 to 40 years to appear following exposure. The results show that long, thin multi-walled carbon nanotubes that look like asbestos fibers, behave like asbestos fibers.

Discovered nearly 20 years ago, carbon nanotubes have been described as the wonder material of the 21st Century. Light as plastic and stronger that steel, they are being developed for use in new drugs, energy-efficient batteries and futuristic electronics. But since their discovery, questions have been raised about whether some of these nanoscale materials may cause
harm and undermine a nascent market for all types of carbon nanotubes, including multi- and single-walled carbon nanotubes. Leading forecasting firms say sales of all nanotubes could reach $2 billion annually within the next four to seven years, according to an article in the U.S. publication Chemical & Engineering News.

"This study is exactly the kind of strategic, highly focused research needed to ensure the safe and responsible development of nanotechnology," says Andrew Maynard, chief science advisor to the Project on Emerging Nanotechnologies and a co-author on the paper. "It looks at a specific nanoscale material expected to have widespread commercial applications and asks specific questions about a specific health hazard. Even though scientists have been raising concerns about the safety of long, thin carbon nanotubes for over a decade, none of the research needs in the current U.S. federal nanotechnology environment, health and safety risk research
strategy address this question."

Widespread exposure to asbestos has been described as the worst occupational health disaster in U.S. history and the cost of asbestos-related disease is expected to exceed $200 billion, according to major U.S. think tank RAND Corporation.

Dr Anthony Seaton, MD, a co-author on the paper and a professor emeritus at the University of Aberdeen in the United Kingdom, says, "The toll of asbestos-related cancer, first noticed in the 1950s and 1960s, is likely to continue for several more decades even though usage reduced rapidly some 25 years ago. While there are reasons to suppose that nanotubes can be used
safely, this will depend on appropriate steps being taken to prevent them from being inhaled in the places they are manufactured, used and ultimately disposed of. Such steps should be based on research into exposure and risk prevention, leading to regulation of their use. Following this study, the results of which were foreseen by the Royal Society in the U.K. in 2004, we
can no longer delay investing in such research."

Researchers, led by Kenneth Donaldson at the University of Edinburgh in the United Kingdom, examined the potential for long and short carbon nanotubes, long and short asbestos fibers, and carbon black to cause pathological responses known to be precursors of mesothelioma. Material was injected into the abdominal cavity of mice -- a sensitive predictor of long fiber response in the lung lining.

"The results were clear," says Donaldson. "Long, thin carbon nanotubes showed the same effects as long, thin asbestos fibers."

Asbestos fibers are harmful because they are thin enough to penetrate deep into the lungs, but sufficiently long to confound the lungs' built-in clearance mechanisms for getting rid of particles.

Donaldson stresses there are still pieces of the puzzle to fill in. "We still don't know whether carbon nanotubes will become airborne and be inhaled, or whether, if they do reach the lungs, they can work their way to the sensitive outer lining. But if they do get there in sufficient
quantity, there is a chance that some people will develop cancer -- perhaps decades after breathing the stuff," says Donaldson.

There is a silver lining to this research. According to Donaldson, "Short or curly carbon nanotubes did not behave like asbestos, and by knowing the possible dangers of long, thin carbon nanotubes, we can work to control them. It's a good news story, not a bad one. It shows that carbon nanotubes and their products could be made to be safe."

But Donaldson adds that the present study only tested for fiber-like behavior and did not exonerate carbon nanotubes from damaging the lungs in other ways. "More research is still needed if we are to understand how to use these materials as safely as possible," he notes.

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Medical Errors Cost $8.8B, Result in 238,337 Potentially Preventable Deaths: Study

Patient safety incidents cost the federal Medicare program $8.8 billion and resulted in 238,337 potentially preventable deaths during 2004 through 2006, according to HealthGrades' fifth annual Patient Safety in American Hospitals Study. HealthGrades' analysis of 41 million Medicare patient records found that patients treated at top-performing hospitals had, on average, a 43 percent lower chance of experiencing one or more medical errors compared to the poorest-performing hospitals.

The overall incident rate was approximately three percent of all Medicare admissions evaluated, accounting for 1.1 million patient safety incidents during the three years studied. With the Centers for Medicare and Medicaid Services scheduled to stop reimbursing hospitals for the treatment of eight major preventable errors, including objects left in the body after surgery and certain post-surgical infections, starting October 1, the financial implications for hospitals are substantial.

The HealthGrades study, which also identifies those hospitals with patient-safety incidence levels in the lowest five percent in the nation, also found:

• Medicare patients who experienced a patient-safety incident had a one-in-five chance of dying as a result of the incident during 2004 to 2006.
• Overall death rate among Medicare beneficiaries that developed one or more patient safety incidents decreased almost five percent from 2004 through 2006.
• However, four indicators, post-operative respiratory failure, post-operative pulmonary embolism or deep vein thrombosis, post-operative sepsis, and post-operative abdominal wound separation/splitting, increased when compared to 2004.
• Medical errors with the highest incidence rates were bed sores, failure to rescue, and post-operative respiratory failure and accounted for 63.4 percent of incidents. Failure to rescue improved 11.1 percent during the study period, while both bed sores and post-operative respiratory failure worsened during the study period.
• Of the 270,491 deaths that occurred among patients who developed one or more patient safety incidents, 238,337 were potentially preventable.

If all hospitals performed at the level of Distinguished Hospitals for Patient Safety, approximately 220,106 patient safety incidents and 37,214 Medicare deaths could have been avoided while saving the U.S. approximately $2.0 billion during 2004 to 2006.

“While many U.S. hospitals have taken extensive action to prevent medical errors, the prevalence of likely preventable patient safety incidents is taking a costly toll on our health care systems – in both lives and dollars,” says Dr. Samantha Collier, HealthGrades' chief medical officer and the primary author of the study. “HealthGrades has documented in numerous studies the significant and largely unchanging gap between top- performing and poor-performing hospitals. It is imperative that hospitals recognize the benchmarks set by the Distinguished Hospitals for Patient Safety are achievable and associated with higher safety and markedly lower cost. ”

The fifth annual HealthGrades Patient Safety in American Hospitals Study applies methodology developed by the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality to identify the incident rates of 16 patient safety indicators among Medicare patients at virtually all of the nation's nearly 5,000 nonfederal hospitals. Additionally, HealthGrades applied its methodology using 13 patient safety indicators to identify the best-performing hospitals, or Distinguished Hospitals for Patient Safety, which represent the top five percent of all U.S. hospitals.

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Study: iPods, Similar Devices Don't Affect Pacemakers

Last May, a widely reported study concluded that errant electronic noise from iPods can cause implantable cardiac pacemakers to malfunction. This just didn't sound right to the cardiac electrophysiologists at Children's Hospital Boston, who've seen hundreds of children, teens and young adults with heart conditions requiring pacemakers.

"Many of our pacemaker patients have iPods and other digital music players, and we've never seen any problem," says Dr. Charles Berul, MD, director of the Pacemaker Service at Children's. "But kids and parents bring up this concern all the time, prompting us to do our own study."

Between September and December, 2007, Gregory Webster, MD, a cardiac fellow in training at Children's, along with the electrophysiology nurses and physicians, ran tests on 51 patients coming in for appointments. Whereas last year's study was done in patients averaging 77 years of age, the average age in the Children's study was 22 (ranging from 6 to 60). All patients had active pacemakers or implantable cardioverter-defibrillators (ICDs), which were tested against four digital music players -- two kinds of iPods (Apple Nano and Apple Video), SanDisk Sansa and Microsoft Zune. All patients were lying down during the tests (in case an arrhythmia occurred, causing them to faint), and each digital player was placed directly over the pacemaker or ICD.

As reported in the April 2008 issue of the journal Heart Rhythm, accompanied by an editorial, there was no interference with intrinsic device functioning - patients' EKG (electrocardiographic) recordings showed no change in any of 255 separate tests, and no patients had symptoms. "This provides reassuring evidence that should allay the fears of people using iPods and other digital music players," says Berul, the study's senior investigator.

However, in 41 percent of patients, the music players interfered with telemetry, or communications between the programmer and the pacemaker or ICD itself. (The programmer is a computerized device used by physicians to check and recalibrate the pacemaker/ICD - patients do not carry it.) This interference, picked up in 29 of 204 tests, went away when the digital player was moved six inches or more from the device, and did not compromise device function. The larger digital players (Zune and Apple Video) caused more interference with telemetry than the small players.

Patients should not use digital music players while the doctor is trying to reprogram their device, Webster and the electrophysiology team conclude. "If the iPod is right in the field, the programmer might not be able to communicate with the pacemaker or ICD effectively," Webster says.

The findings of interference with the pacemaker itself, reported last May, are published and updated in the same issue of Heart Rhythm. The editorial discusses possible reasons for the discrepancy between the two studies, which mainly relate to the testing methods and interpretation of the pacemaker recordings. Importantly, the music players did not stop pacemakers from pacing (regulating the heartbeat) in either the Children's study or the previously reported study, though the previous study did find interference with pacemaker sensing.

Berul and colleagues are reassured by their own findings, but acknowledge that their testing was only short-term. "We can't conclude that it's completely safe to have an iPod right on top of the device for hours at a time," Berul says. "That's why we suggest the precaution of keeping it at least six inches away."

The study was supported by the Boston Children's Heart Foundation.

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Mayo Clinic, Microsoft Announce Agreement to Develop Consumer Health Tools

Mayo Clinic Health Solutions and Microsoft Corporation's Health Solutions Group announced today that they have entered into a strategic agreement to collaboratively develop tools that will empower people to manage their health and become engaged partners with their providers in a new model of health care.

As leaders in their respective industries, both organizations recognize the potential for technology solutions to help bridge the gaps in the health care system, to facilitate closer patient-to-physician connections, and to allow patients and consumers to better manage their health and wellness information. The collaboration will benefit from Microsoft's significant technology expertise and Mayo Clinic's experience in health care.

The organizations hope to announce further details of the project before the end of 2008.

"We are committed to finding new technology solutions that put the patient and consumer in control," says Brooks Edwards, M.D., chief medical officer, Mayo Clinic Health Solutions. "Our work with Microsoft is an exciting opportunity to create tools that empower patients to be in the very center of their own health care environment."

"Consumers demand and deserve tools that make their lives easier, facilitate communication, and help them take action to manage their health," says Peter Neupert, corporate vice president, Microsoft Health Solutions Group. "Building on the Microsoft HealthVault platform, our groups are committed to providing individuals with solutions that are dynamic, secure, and focused on the needs of the user, in order to effectively improve health and well-being."

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Rural Patients' Cancers Diagnosed Earlier

Rural patients are often assumed to be the top truants in American medicine, not seeking medical attention until a condition is more advanced and less treatable. However, a new study by Dartmouth researchers suggests that urban, not rural, patients are most likely to slip through the cracks—at least when it comes to colorectal and lung cancer.

Looking at national data on those two types of cancer, the study found that urban patients tend to be diagnosed at a later stage than their rural counterparts—even when the study controlled for other factors associated with late-stage presentation, such as age, race, gender, marital status, income level, and level of education.

The paper, "Rural Versus Urban Colorectal and Lung Cancer Patients: Differences in Stage at Presentation," was published in the November 2007 Journal of the American College of Surgeons. The authors are Ian Paquette, a general surgery resident at the Dartmouth-Hitchcock Medical Center (DHMC), and Sam Finlayson, a DHMC surgeon and vice chair for academic affairs for the Department of Surgery of the Dartmouth Medical School.

The team's findings fly in the face of the anecdotal evidence, including the sorts of tales traded in the corridors of DHMC, which serves a rural slice of New Hampshire and Vermont. "Where we practice, most doctors can tell stories about patients who have presented at a very late stage of a disease, and we find it hard to imagine that they could have ignored their symptoms for so long," says Paquette.

Knowing which types of patients are more likely to present with more advanced cancers helps doctors better implement screening efforts, allowing them to diagnose patients at earlier stages and improve their prognoses, said Paquette. The study focused on colorectal and lung cancer because these are types that surgeons see frequently in their day-to-day practice.

The team looked at more than 125,000 people with colorectal cancer and more than 160,000 people with lung cancer, drawing on 2000-03 data.

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Rapid Communication Networks Less Likely to Shape Individual Behavior

The increasingly interconnected world has made it easier for information and disease to spread. However a new study from Harvard University and Cornell University shows that fewer “degrees of separation” can make social networks too weak to disseminate behavioral change.

The finding that “small world” networks are limited in their power to shape individual behavior could have implications for health care policy and the treatment of epidemics.

Published in the November American Journal of Sociology, the study was led by Damon Centola, a Robert Wood Johnson Fellow with the Institute for Quantitative Social Science in Harvard’s Faculty of Arts and Sciences, with Michael Macy of Cornell. The work was done while Centola was a doctoral candidate at Cornell.

“Our research shows that the difference between contagions that spread through simple contact, such as diseases and information, and the spread of behavior, which requires multiple contacts, has important consequences,” says Centola. “We find that while making the world smaller increases the speed at which diseases and information can spread, it can actually slow down, and even prevent, the spread of health behaviors.”

Social networks consist of connections between individuals, whether they are short ties among family or good friends or long ties, as among acquaintances. Long ties are good for hearing about a job opening or housing opportunity since they provide new information that is not already circulating in your closely connected social network. However, when it comes to getting a cholesterol screening or going on a diet, you are more likely to get reinforcing signals from co-workers or neighbors who know each other and can collectively encourage you to change your behavior.

Previous studies have shown that long ties are highly effective at rapidly diffusing information among disparate social groups, and relatively few long ties are necessary to create the effect. Called the “small world theory,” this is exemplified in the idea that everyone on earth is connected by “six degrees of separation.” Extensions of the small world theory have argued that anything to be diffused can travel faster as the world becomes smaller, but this study disproves that generalization.

Most information and diseases have a threshold of one, meaning that contact with one network neighbor is sufficient to pass the contagion to another. Information or diseases can be spread along long ties because reinforcement from multiple sources is not required. However, many changes in behavior have a threshold of greater than one, such as the adoption of a new technology, diet, or exercise routine. In these cases, social affirmation or reinforcement from multiple sources is frequently required, making an isolated contact insufficient to persuade an individual to change her habits.

Using the “small world” model of social networks, the researchers showed that as the connectedness of the world increases, the level of local social reinforcement decreases. While people can get more information from more sources (and are susceptible to contact with greater numbers of germs), they simultaneously have fewer contacts who are connected to each other who can coordinate to provide social reinforcement for desired behavior change.

Closely knit ties are less effective for spreading information because of the increased likelihood that these individuals will know the same people, causing redundancy and repetition of information. However, the same redundancy that inhibits the spread of information provides vital channels of reinforcement for fostering changes in behavior. If social clustering is reduced too much, it may altogether prevent coordination on behaviors that require social reinforcement.

“As the world becomes smaller, these changes in social networks can reduce the ability to spread behaviors that are hard to adopt,” says Centola. “For health agencies, this suggests that the spanning networks that allow disease to spread so rapidly may not be as good for changing behavior. Rather, it may be better to focus on building and extending local, community networks, and encouraging grass roots support for desired behaviors.”

Current research extends these findings into the realm of “virtual” communities. At Harvard, Centola is investigating how building online networks affects the diffusion of health behaviors, while Macy at Cornell is using online data to study the spread of innovations.

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Genetic Study May Help Predict Diseases

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U.K. Study Finds No Health Effects of Cell Phone Use

Mobile phones have not been found to be associated with any biological or adverse health effects, according to the UK's largest investigation into the possible health risks from mobile telephone technology.

The Mobile Telecommunications and Health Research (MTHR) Program published its conclusions on September 12 as part of its 2007 Report.

The six-year research programme, chaired by Lawrie Challis, emeritus professor of physics at the University of Nottingham, has found no association between short term mobile phone use and brain cancer. Studies on volunteers also showed no evidence that brain function was affected by mobile phone signals or the signals used by the emergency services (TETRA).

The MTHR program management committee believes there is no need to support further work in this area.

The research programme also included the largest and most robust studies of electrical hypersensitivity undertaken anywhere in the world. These studies have found no evidence that the unpleasant symptoms experienced by sufferers are the result of exposure to signals from mobile phones or base stations.

The situation for longer-term exposure is less clear as studies have so far only included a limited number of participants who have used their phones for ten years or more. The committee recommends more research be conducted in this area.

The MTHR program also investigated whether mobile phones might affect cells and tissue beyond simply heating them. The results so far show no evidence for this and the committee believes there is no need to support further work in this area.

Challis says: “This is a very substantial report from a large research programme. The work reported today has all been published in respected peer-reviewed scientific or medical journals.

“The results are so far reassuring but there is still a need for more research, especially to check that no effects emerge from longer-term phone use from adults and from use by children.”

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Patients with Depression Seeing Primary Care Physicians Frequently Don't Receive High Quality Care

Most patients with depression who are treated by primary care physicians do not receive care consistent with quality standards, according to a new RAND Corporation study.

Physicians had high rates of adherence to just one-third of the 20 measures of quality that researchers examined and had low rates of adherence to nearly half of the treatment recommendations studied, according to the report in the Sept. 4 edition of the Annals of Internal Medicine.

“These findings are important for patients since most cases of depression are diagnosed and treated in primary care settings,” says senior author Dr. Lisa Rubenstein, the study's senior author, and a senior scientist at RAND, a nonprofit research organization, and a physician at the Veterans Affairs Greater Los Angeles Healthcare System. “This shows that additional efforts are needed to improve the treatment of depression.”

The study also found that patients who received better-quality care reported fewer symptoms of depression up to two years after the start of treatment. The findings are among the first linking quality guidelines for depression treatment with improved patient outcomes in community settings.

“These are initial findings, but they suggest that programs that encourage doctors to follow treatment guidelines can help improve the long-term outlook for people with depression,” says Rubenstein, who also is affiliated with the David Geffen School of Medicine at UCLA.

Previous studies have shown that primary care providers do a poor job following guidelines for antidepressant use or psychotherapy. The RAND study is one of the first to assess primary care providers' adherence to a comprehensive set of treatment guidelines for depression.

Researchers from RAND Health examined the experiences of health care providers and patients who took part from 1996 to 1998 in the Quality Improvement for Depression collaboration, which was designed to encourage primary care providers to adopt comprehensive depression treatment guidelines developed by the U.S. Agency for Healthcare Research and Quality.

The RAND study examined the experiences of 1,131 patients with depression who were treated in 45 primary care practices across 13 states. Study sites ranged from small private practices to large managed care organizations. About 10 percent of patients in the study were from Veterans Affairs practices.

Researchers examined whether physicians and other health providers followed 20 different measures of quality, as well as analyzing patients' reports about the status of their depression at 12, 18 and 24 months after starting treatment.

The study found that most primary care physicians did a good job of diagnosing and beginning treatment for depression, with guidelines aimed at these issues followed more than 70 percent of the time. These guidelines includes items such as talking to patients about depression and closely monitoring patients newly placed on antidepressant medication.

But researchers found that primary care clinicians did less well following up with treatment over time. Fewer than half of the patients in the study completed the minimal course of treatment for either antidepressant drugs or psychotherapy, and only slightly more than half the depressed patients who were not treated were monitored closely.

The lowest quality of care occurred among the patients who exhibited the most serious symptoms, including patients who showed evidence of suicide or substance abuse. For example, among patients who had a previous suicide attempt, just 35 percent were referred to a mental health specialist over the next six months.

“Primary care physicians were good at diagnosing depression, but they did not do as good a good job of managing the sickest patients,” Rubenstein says. “Right now, primary care physicians don't have the tools necessary to decide which patients to treat and which to refer on to specialized mental health care.”

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Video: New Orleans Health

In this only-on-the-Web video, New Orleans is having trouble holding enough health providers to meet the needs of the area. The region is still recovering from Hurricane Katrina which slammed the U.S. Gulf Coast two years, flooding most of the city.

Katie Couric interviews the chief of staff of a New Orleans hospital.

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Michael J. Fox Foundation for Parkinson's Research Announces $1.2 Million to Advance Development of Drug Targets

The Michael J. Fox Foundation for Parkinson's Research (MJFF) announced $1.2 million in total awards to four research teams working to advance potentially disease-modifying therapeutic targets for PD along the drug development pipeline. The funding was awarded under the Novel Approaches to Drug Discovery for Parkinson's Disease program, made possible by funding from Elan Corp., plc, a
neuroscience-based biotechnology company.

"For successful translation into real-world PD therapies, early stage therapeutic approaches must be chaperoned through the necessary preclinical and clinical stages of drug development," says Sarah Orsay, MJFF's CEO. "The Foundation uses creative strategies to provide the opportunity for researchers working on novel therapeutic strategies to partner with first class, large industry organizations. If projects funded under Novel Approaches to Drug Discovery for Parkinson's Disease warrant further development, Elan has the option to participate more actively and further
the progress made by the awardees -- taking us that much closer to our
shared goal of delivering new treatments to patients."

Novel Approaches complements the foundation's annual Target Validation initiative, whose awardees were announced last month. Whereas the latter program supports initial work to determine the validity of cellular proteins and pathways as potentially promising drug targets, Novel Approaches seeks to push work forward in developing therapies against targets that already have some promising initial data. Both programs provide critical resources for underfunded stages of the drug development process and reflect the Foundation's emphasis on bridging early discovery work and late-stage translational research to reduce industry's risk around investment in new PD therapeutics.

The Novel Approaches program is also an important element of the foundation's increasing engagement with pharmaceutical and biotech company partners. This engagement is multi-pronged, including not only funding industry researchers under any Foundation initiative, but also working with companies as strategic partners to accelerate the rate at which new PD therapeutics are brought to market. Awardees under Novel Approaches include both academic and industry scientists.

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