Washington, D.C. 5/30/07- Asserting that the U.S. Department of Health and Human Services has failed to advance President Bush’s goal of widespread electronic medical record adoption, U.S. Rep. Bart Gordon, D-Tenn., has introduced a bill that would require a federal technology agency to accelerate the integration of healthcare information technology.

If enacted, the measure would require the National Institute of Standards and Technology to increase its efforts to support the integration of healthcare IT in the United States. The legislation, known as H.R. 2406, says NIST is “well equipped to address the technical challenges posed by healthcare information enterprise integration.”

Under the bill, the director of NIST – now William Jeffrey – would establish an initiative for advancing healthcare IT enterprise integration within the U.S.

The bill also states that it’s in the national interest for the institute to develop standards, standard conformance tests, and enterprise integration processes necessary to increase efficiency and the quality of care, and lower costs in the healthcare industry.

It also calls on NIST to ensure that all components of the U.S. healthcare infrastructure are part of a “reliable, interoperable, and secure” electronic information network. WTN News

Knee Flexion
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Not only does exercise make most people feel better and perform physical tasks better, it now appears that exercise – specifically, resistance training — actually rejuvenates muscle tissue in healthy senior citizens.

A recent study, co-led by Buck Institute faculty member Simon Melov, PhD, and Mark Tarnopolsky, MD, PhD, of McMaster University Medical Center in Hamilton, Ontario, involved before and after analysis of gene expression profiles in tissue samples taken from 25 healthy older men and women who underwent six months of twice weekly resistance training, compared to a similar analysis of tissue samples taken from younger healthy men and women. The results of the study appear in the May 23 edition of the on-line, open access journal PLoS One.

The gene expression profiles involved age-specific mitochondrial function; mitochondria act as the “powerhouse” of cells. Multiple studies have suggested that mitochondrial dysfunction is involved in the loss of muscle mass and functional impairment commonly seen in older people. The study was the first to examine the gene expression profile, or the molecular “fingerprint”, of aging in healthy disease-free humans.

Results showed that in the older adults, there was a decline in mitochondrial function with age. However, exercise resulted in a remarkable reversal of the genetic fingerprint back to levels similar to those seen in the younger adults. The study also measured muscle strength. Before exercise training, the older adults were 59% weaker than the younger adults, but after the training the strength of the older adults improved by about 50%, such that they were only 38% weaker than the young adults.

“We were very surprised by the results of the study,” said Melov. “We expected to see gene expressions that stayed fairly steady in the older adults. The fact that their ‘genetic fingerprints’ so dramatically reversed course gives credence to the value of exercise, not only as a means of improving health, but of reversing the aging process itself, which is an additional incentive to exercise as you get older.”

The study participants were recruited at McMaster University. The younger (20 to 35 with an average age of 26) and older (older than 65 with an average age of 70) adults were matched in terms of diet and exercise; none of them took medication or had diseases that can alter mitochondrial function. Tissue samples were taken from the thigh muscle. The six month resistance training was done on standard gym equipment. The twice-weekly sessions ran an hour in length and involved 30 contractions of each muscle group involved, similar to training sessions available at most fitness centers. The strength test was based on knee flexion.

The older participants, while generally active, had never participated in formal weight training said co-first author Tarnopolsky, who directs the Neuromuscular and Neurometabolic Clinic at McMaster University. In a four month follow up after the study was complete, he said most of the older adults were no longer doing formal exercise in a gym, but most were doing resistance exercises at home, lifting soup cans or using elastic bands. “They were still as strong, they still had the same muscle mass,” said Tarnopolsky. “This shows that it’s never too late to start exercising and that you don’t have to spend your life pumping iron in a gym to reap benefits.”

Future studies are being designed to determine if resistance training has any genetic impact on other types of human tissue, such as those that comprise organs; researchers also want to determine whether endurance training (running, cycling) impacts mitochondrial function and the aging process. The most recent study also points to particular gene expressions that could be used as starting points for chemical screenings that could lead to drug therapies that would modulate the aging process.

“The vast majority of aging studies are done in worms, fruit flies and mice; this study was done in humans,” said Melov. “It’s particularly rewarding to be able to scientifically validate something practical that people can do now to improve their health and the quality of their lives, as well as knowing that they are doing something which is actually reversing aspects of the aging process.”

Source : Buck Institute for Age Research, Hamilton, Ontario
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by Matthew Herper
Forbes.com
voigt_christopher.jpgChristopher Voigt, 30
Synthetic Biologist
University of California, San Francisco

“We program cells like robots,” says Christopher Voigt.

Voigt is at the forefront of a group of young researchers working to deliver on the profound promise of genetic engineering: Rebuilding living organisms to fight disease, make bio-fuels and solve industrial problems.

To do this, Voigt works hard to understand what “commands” are programmed on the DNA of simple organisms like the E. coli bacteria. Then he changes the commands so the organism does his bidding.

Like most “synthetic biologists,” Voigt began his career with simple “toy” problems. For instance, he designed photographic film made out of living cells that changed color when they were exposed to light. But he is already moving to more practical applications.

One of his custom-built E. coli is designed to hunt down cancer cells. Tumors create an environment where there is very little oxygen; the bacteria detect these low-oxygen areas and release chemicals that could kill the tumor. Voigt has started testing these cancer-hunting bugs in mice.

Another goal, kick-started by a grant from British Petroleum, is to create bacteria that can efficiently turn corn and other plants into bio-fuels. To that end, Voigt is experimenting on bacteria with plant-digesting genes, including those found in termites, sheep and bacteria that live on your lawn. Another project would use bacteria to create super-strong silk.

All this, Voigt says, is just the “low-hanging fruit.” Nature has had billions of years to design life–we are just getting started.

Researchers at Harvard University and Princeton University have made a crucial step toward building biological computers, tiny implantable devices that can monitor the activities and characteristics of human cells. The information provided by these “molecular doctors,” constructed entirely of DNA, RNA, and proteins, could eventually revolutionize medicine by directing therapies only to diseased cells or tissues.

The results will be published this week in the journal Nature Biotechnology.

“Each human cell already has all of the tools required to build these biocomputers on its own,” says Harvard’s Yaakov (Kobi) Benenson, a Bauer Fellow in the Faculty of Arts and Sciences’ Center for Systems Biology. “All that must be provided is a genetic blueprint of the machine and our own biology will do the rest. Your cells will literally build these biocomputers for you.”

Evaluating Boolean logic equations inside cells, these molecular automata will detect anything from the presence of a mutated gene to the activity of genes within the cell. The biocomputers’ “input” is RNA, proteins, and chemicals found in the cytoplasm; “output” molecules indicating the presence of the telltale signals are easily discernable with basic laboratory equipment.

“Currently we have no tools for reading cellular signals,” Benenson says. “These biocomputers can translate complex cellular signatures, such as activities of multiple genes, into a readily observed output. They can even be programmed to automatically translate that output into a concrete action, meaning they could either be used to label a cell for a clinician to treat or they could trigger therapeutic action themselves.”

Benenson and his colleagues demonstrate in their Nature Biotechnology paper that biocomputers can work in human kidney cells in culture. Research into the system’s ability to monitor and interact with intracellular cues such as mutations and abnormal gene levels is still in progress.

Benenson and colleagues including Ron Weiss, associate professor of electrical engineering at Princeton, have also developed a conceptual framework by which various phenotypes could be represented logically.

A biocomputer’s calculations, while mathematically simple, could allow researchers to build biosensors or medicine delivery systems capable of singling out very specific types or groups of cells in the human body. Molecular automata could allow doctors to specifically target only cancerous or diseased cells via a sophisticated integration of intracellular disease signals, leaving healthy cells completely unaffected. Source : Harvard University

Medieval medicine [ 1000-1500 ]

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Astrology played an important part in Medieval medicine; most educated physicians were trained in at least the basics of astrology to use in their practice. Medieval medicine was a mixture of existing ideas from antiquity, spiritual influences and the “shamanistic complex” and “social consensus.”In this era, there was no tradition of scientific medicine, and observations went hand-in-hand with spiritual influences. In the early Middle Ages, following the fall of the Roman Empire, standard medical knowledge was based chiefly upon surviving Greek and Roman texts, preserved in monasteries and elsewhere. Ideas about the origin and cure of disease were not, however, purely secular, but were also based on a world view in which factors such as destiny, sin, and astral influences, played as great a part as any physical cause. The efficacy of cures was similarly bound in the beliefs of patient and doctor rather than empirical evidence, so that remedia physicalia (physical remedies) were often subordinate to spiritual intervention.

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A dentist with silver forceps and a necklace of large teeth, extracting the tooth of a seated man. London; England, 1360-1375.

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13th century illustration showing the veins.

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Female physician: women practised all branches of medicine during the Middle Ages.

As the Earth’s temperatures continue to rise, we can expect a signficant change in infectious disease patterns around the globe. Just exactly what those changes will be remains unclear, but scientists agree they will not be for the good.

“Environmental changes have always been associated with the appearance of new diseases or the arrival of old diseases in new places. With more changes, we can expect more surprises,” says Stephen Morse of Columbia University, speaking May 22, 2007, at the 107th General Meeting of the American Society for Microbiology in Toronto.

In its April 2007 report on the impacts of climate change, the Intergovernmental Panel on Climate Change (IPCC) warned that rising temperatures may result in “the altered spatial distribution of some infectious disease vectors,” and will have “mixed effects, such as the decrease or increase of the range and transmission potential of malaria in Africa.”

“Diseases carried by insects and ticks are likely to be affected by environmental changes because these creatures are themselves very sensitive to vegetation type, temperature, humidity etc. However, the direction of change – whether the diseases will increase or decrease – is much more difficult to predict, because disease transmission involves many factors, some of which will increase and some decrease with environmental change. A combination of historical disease records and present-day ground-based surveillance, remotely sensed (satellite) and other data, and good predictive models is needed to describe the past, explain the present and predict the future of vector-borne infectious diseases,” says David Rogers of Oxford University, also speaking at the meeting.

One impact of rising global temperatures, though, can be fairly accurately predicted, says Morse. In the mountains of endemic areas, malaria is not transmitted above a certain altitude because temperatures are too cold to support mosquitoes. As temperatures rise, this malaria line will rise as well.

“One of the first indicators of rising global temperatures could be malaria climbing mountains,” says Morse.

Another change could be the flu season. Influenza is a year-round event in the tropics. If the tropical airmass around the Earth’s equator expands, as new areas lose their seasons they may also begin to see influenza year-round.

And extreme weather events will also lead to more disease, unless we are prepared. As the frequency, intensity, and duration of extreme weather events change, water supplies become more at risk, according Joan Rose of Michigan State University.

“Hurricanes, typhoons, tornados and just high intensity storms have exacerbated an aging drinking and wastewater infrastructure, enhanced the mixing of untreated sewage and water supplies, re-suspended pathogens from sediments and displaced large populations to temporary shelters. We are at greater risk than ever before of infectious disease associated with increasing extreme weather events,” says Rose.
There will also be indirect effects of climate change on infectious disease as well. For instance, says Morse, the effect of global warming on agriculture could lead to significant changes in disease transmission and distribution.

“If agriculture in a particular area begins to fail due drought, more people will move into cities,” says Morse. High population densities, especially in developing countries, are associated with an increased transmission of a variety of diseases including HIV, tuberculosis, respiratory diseases (such as influenza) and sexually transmitted diseases.

“I’m worried about climate change and agree that something needs to be done,” says Morse. “Otherwise, we can hope our luck will hold out.”

Source : American Society for Microbiology

By Marty Graham, 05.22.07

Wired.com/science
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This transcranial magnetic stimulation device is made by Neuralieve, based in Sunnyvale, California.

SAN DIEGO — The next time you visit a psychiatrist, don’t be put off by the helmet-shaped device crawling with electrodes in the corner of the office. It’s there to help.

Transcranial magnetic stimulation, a technique for treating clinical depression, uses a device placed on a patient’s head that delivers a pulse to the gray matter. Psychiatrists at the American Psychiatric Association meeting here are unabashedly optimistic about its potential for treating tough cases. It’s in the final stages of FDA review, and could come to market as soon as the end of the year.

“It’s much less invasive — patients can go home or go back to work afterwards,” says Shirlene Sampson, an assistant professor at the Mayo Clinic College of Medicine. “And patients aren’t exposed to social risk with their insurance companies and employers.”

TMS works by creating an electromagnetic pulse that doesn’t disturb the skull or scalp, but can reach two to three centimeters into the brain to stimulate the prefrontal cortex and paralimbic blood flow, increasing the serotonin output and the dopamine and norepinephrine functions.

“We have to be sure to get really good contact with the scalp so we reach the most effective areas of the brain,” says Sampson. “In older patients where the brain has shrunk, we have to be very careful to get any results.”

TMS can be done in an office setting and doesn’t require anesthesia, which is needed for traditional ECT. Side effects include post-application headaches, muscle twitches and pain at the application site. The risk of seizure remains, but researchers worked very hard to avoid them, and they occurred very rarely.

Ten companies — including five based in Europe, two American companies and two in Korea — are now lined up to produce TMS headgear, which ranges in appearance from something like an ultrasound sensor mounted on a dental-drill arm to a cap resembling a beauty-parlor hair dryer.

Depression is increasingly recognized as a destructive, disabling, chronic illness with treatments that often fail patients. Studies yield conflicting results — patients can respond well to placebos and exercise, while drugs can fail some and succeed for others. And short-term results often don’t translate into long-term results as patients bolt from treatment because of side effects or lack of effect.

One of big problems in treating depression, where a bout is likely to lead to other bouts, is getting patients to stay on their therapy, studies show. And, while combinations of therapies initially seem to help the 30 percent and 40 percent of patients whose depression resists drug treatment, remission rates remain low and cures are elusive.

The downside is that it takes 20 to 30 sessions of 40 minutes each for at least six weeks to get a good result. But patients stick with TMS treatment better than with medication or electroshock, researchers say. It’s also being tested for treating migraines.

NewScientist.com

Fifty years from now, if I avoid crashing my motorcycle in the interim, I will be 106. If the advances that I envision from the genome revolution are achieved in that time span, 180px-francis_collins.jpgmillions of my comrades in the baby boom generation will have joined Generation C to become healthy centenarians enjoying active lives.

How do we get from here to there? For starters, we must develop technologies that can sequence an individual’s genome for $1000 or less. This will enable healthcare providers to identify the dozens of glitches that we each have in our DNA that predispose us to certain diseases. In addition, we need to unravel the complex interactions among genetic and environmental risk factors, and to determine what interventions can reduce those risks. With such information in hand, new treatments will be developed, and our “one-size-fits-all” approach to healthcare will give way to more powerful, individualised strategies for predicting and treating diseases – and, eventually, preventing them.

The challenge doesn’t stop there. We are already setting our sights on the ultimate nemesis of Generation C: ageing. Genomic research will prove key to discovering how to reprogram the mechanisms that control the balance between the cell growth that causes cancer and the cell death that leads to ageing. It is possible that a half-century from now, the most urgent question facing our society will not be “How long can humans live?” but “How long do we want to live?”

Francis S. Collins, M.D., Ph.D.
Director, National Human Genome Research Institute
Genome Technology Branch
Head, Molecular Genetics Section

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May 22, 2007

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About 25,000 inventors from all walks of life entered the Modern Marvels/Invent Now annual contest, which is run by the History Channel and the National Inventors Hall of Fame.

The grand prize ($25,000) went to the Enertia house, which was invented by an engineer and former log-home architect, Michael Sykes. It’s a design for a home that heats and cools itself, which benefits both the homeowner and the environment.

Two factors contribute to this effect. First, the entire house is made of southern yellow pine. According to Mr. Sykes, this wood is especially efficient at maintaining a constant temperature; it absorbs heat during the day and releases it at night.

Second, air circulates in a convection cycle from top to bottom of the house, constantly redistributing the heat.

Mr. Sykes, who has built 80 of these homes, was inspired by the way the earth’s own atmosphere keeps the planet at a relatively constant comfortable temperature despite the frigidity of space. It occurred to him that a house could have its own atmosphere, which might work the same way. As a side benefit, he says, one Enertia house has an environmental impact akin to taking 50 cars off the road.

Interview with Michael Sykes

Q: What is the “sunspace?” It looks like a sort of windowed atrium the full height of the house, but how does it play into the envelope concept?

A: The sunspace is always on the south, or the side that’s within 35 degrees of south. It connects to the attic, which connects to the space between the double north walls, which connects to the basement. There are metal grilles in the sunspace floor to complete the convection loop.

The space in the north double wall is also a great place to put pipes and wires, which would otherwise be a problem, since the walls are solid glulams [glued wooden blocks].

Q: How did you get into this? Where did you pick up all the science?

A: I built houses to pay my way through engineering school, and I was asked to build a log house for a friend. We used the resinous local southern yellow pine; everybody else used white pine or cedar, which are lighter. To my amazement, it was more energy-efficient than anything I had built — but it was getting too hot on the sunspace side. I could have put in ducts and fans to move the heat, but that takes energy.

At the Equator, the sun creates what’s called a Hadley cell; the weather equalizes temperatures, rushing warmth to the polar regions. What I needed was a Hadley cell [for the house], and that required an atmosphere. The house already had a sunspace, an attic, and a basement; simply add a space in the north wall, and you have an atmosphere. Short-wave sun comes in, but long-wave heat energy cannot get back out. It’s like the greenhouse effect that warms the earth, but in miniature.

We started building houses, one by one. I would design, draw, and chart them. Emily, my partner, would cut and number the wood blocks (she listed her occupation as “homemaker”). Each one was tweaked, better than he last.

Q: Which part of the system does your patent protect?

A: The patent is on a process to enhance the energy storage of the wood by seeding the natural resin with crystals to enhance the phase-change effect [from liquid to solid as the temperature changes].

Interestingly, resin is a waste product of the paper-making industry, and most paper mills would pay us to take it. But we don’t have the equipment to do this yet, so for now, we seek out lumber that’s dense with resin, and grown on clay soils from which the trees take up minerals. There is plenty of this in the South.

Q: Does geothermal energy play a part in the Enertia system?

A: It plays the biggest part in the summer: the convection effect draws air from the cooler basement. But even in the winter, it plays a part: the 55-degree earth tempers the house’s atmosphere (the envelope) because the sun only has to raise the temperature from 55 degrees, not -30 or whatever the outside temperature is. The interior shell will never freeze, and pipes are protected.

Q: On your Web site, you say that these homes are *not* sealed up tightly, which is the usual approach to insulating, but that the constant airflow helps them “breathe.” Is that why, in the photos on your Web site, none of the homes are painted? Because that would stop the “breathing”?

A: You can stain the house, but you should not paint it, for that reason. There are opaque stains that offer all the colors of paint if you want to do that, but a lot of clients just like the [all-wood] look.

Q: Is there any insulation, vapor barrier, sheeting, or drywall in these homes?

A: There is no traditional insulation in the walls, because the wood, because of its cells, is insulative. There is traditional insulation in the roof, the inner shell floor, the inner shell ceiling, and around the foundation. There is a vapor barrier in the inner shell ceiling. There can be drywall on the interior, and in the partition walls that divide up the rooms in the inner shell.

Q: If these homes are self-heating and self-cooling, why do they also have heating and cooling systems?

A: Most banks won’t give you a mortgage unless you have at least a minimal heating system, even in the Western states where the sun shines so much that some homes could do without.

Only the houses in hot humid climates have AC, and it’s for dehumidifying more than cooling.

Q: What do the critics say?

A: Two questions always come up. First, there is a group that thinks using wood for houses is bad for the environment — that using trees for any reason is bad.

Actually, nothing could be further from the truth. Wood is the only structural building material that is renewed on a scale vast enough to assure there will always be more than needed. And all of our wood comes from tree farms. No virgin wood was harmed to build this house!

There is also a large group that thinks that using wood for energy is good only if you burn the wood or distill it into ethanol or biodiesel. Again, nothing could be further from the truth; when you burn the wood, or wood-distilled liquid or gas, you release the carbon dioxide again.

Second, I often hear: “Concrete, brick, and stone are better for storing heat energy.”

They do store energy — but only *specific* energy, which means that as energy is put into the stone, brick, or concrete, the materials get hotter. While wood stores some specific energy, it also stores latent energy, which means the temperature is constant while the wood resins, lignins and cellulose goes through a phase-change. Luckily, that temperature is around 70 degrees F. In a house, you want the temperature to be constant.

Q: What will you do with your prize winnings?

A: The guy you saw following me around, Frank Weller, is a documentary filmmaker. He has filmed us for five years, and is pitching his film to “Nova” and similar venues. Broke like us, of course. So we’re going to use the $25K to finish the film and take it to PBS.

We all think this is a major, clean solution to a major world problem, or we would not have stuck with it for 25 years. The sooner people learn about it, the better. Let’s see where it takes us.

image0013.jpgClick on the image or here for full size
New Scientist Magazine, May 9, 2007

A delivery system that directs cancer drugs to tumours virtually anywhere in the body could dramatically reduce the side effects of chemotherapy. The technique, which uses fragments of bacteria to target a tumour, avoids the need to flood the patient’s system with toxic drugs.

Himanshu Brahmbhatt and Jennifer MacDiarmid of the company Engeneic in Sydney, Australia, have found that they can make bacteria such as Salmonella enterica and E. coli divide at their ends, instead of at their centres, to produce small buds of cytoplasm which they call “Engeneic delivery vehicles” (EDVs). The EDVs are washed repeatedly to remove any toxins. “They look like bacteria but have no chromosomes and are non-living,” MacDiarmid says.

These mini-bacteria are easy to make and can be loaded with chemicals. “We haven’t yet found a drug that you couldn’t load,” MacDiarmid says. “Because they have a rigid membrane they won’t break down when injected, so they carry their payload happily to the target site,” she adds.

The next step was to make the EDVs target specific tissues. They did this using two monoclonal antibodies connected via a linker molecule. One of the antibodies attaches to the EDV’s surface, while its partner is specific to a protein on the target tumour. The Her2 receptor on breast cancer cells, which is targeted by the drug Herceptin, is such a target.

Targeting is also aided by the fact that blood vessels supplying cancer cells are often slightly porous, and the 400-nanometre-wide EDVs are the perfect size to fall through these holes into the tumour tissue. After binding to the receptor, ERVs enter the cell, where they are broken down and release their payload. “Within 2 hours of intravenous administration more than 30 per cent of the dose ends up in the tumour micro-environment,” says Brahmbhatt, who presented the findings at the RNAi 2007 conference in Boston last week.

To test the technique, MacDiarmid and Brahmbhatt packaged the cancer drug doxorubicin into EDVs targeted at human breast cancer tissue, leukaemia and ovarian tumours, and injected them into mice with these types of tumours ( Cancer Cell, vol 11, p 431). The treatment significantly slowed the growth of tumours compared with those in untreated mice. What’s more, far less of the drug was needed when delivered by EDVs compared with when it was injected directly.

Also, dogs with advanced non-Hodgkin’s lymphoma showed a significant reduction in tumour size when treated with EDVs carrying doxorubicin.

Safety tests in pigs and monkeys have so far shown no sign of toxicity or significant immune reaction against the EDVs, Engeneic says. The company hopes to begin human trials this year.

Engeneic says that EDVs may allow tumours to be zapped by more drugs than is normally possible, thus increasing the odds that the therapy will work. Oncologists tend to be reluctant to prescribe multiple drugs because of the risk of side effects – and when they do, they usually reduce the dosage to limit toxicity.

Preliminary tests in mice suggest that EDVs could also be used to deliver therapies such as RNA interference (RNAi), in which one of the major hurdles has been getting the active strands of RNA to the target. The team tested this using a form of RNAi designed to prevent the production of a protein that causes multi-drug resistance in cancer cells. Sure enough, the treatment reversed resistance to doxorubicin in mice with human uterine cancer tumours.

Johannes Fruehauf, who studies cancer and RNAi at Beth Israel Deaconess Medical Centre in Boston, is impressed by Engeneic’s approach. “Previous efforts to develop targeted nanoparticles have focused on synthetic methods, which are very expensive,” he says. “Here they are using bacteria like little biorobots.”

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