Medscape.com, March 4, 2009 — – A growing proportion of American women with unilateral ductal carcinoma in situ are choosing to undergo contralateral prophylactic mastectomy, researchers report in a February 17th on-line publication in the Journal of Clinical Oncology.

As lead investigator Dr. Todd M. Tuttle told Reuters Health, “Our findings indicate that women with noninvasive breast cancer are increasingly choosing to undergo double mastectomy.”

“Importantly,” he added, “removal of the opposite normal breast will not improve the survival rates for these patients who have an excellent prognosis.”

Dr. Tuttle and colleagues at the University of Minnesota Medical School, Minneapolis, examined data on more than 51,000 women diagnosed with unilateral ductal carcinoma in situ from 1998 to 2005.

The rate of contralateral prophylactic mastectomy was 4.1% for all surgically treated patients and 13.5% for those who had mastectomy. All patients underwent surgery within 6 months of diagnosis.

For all surgically treated patients, including those who underwent breast-conserving surgery, the rate of contralateral prophylactic mastectomy more than doubled from 2.1% in 1998 to 5.2% in 2005. Excluding those who had breast-conserving surgery, the rate almost tripled from 6.4% to 18.4%.

In an accompanying editorial, Dr. Abram Recht of Harvard Medical School, Boston, observes that although patients with BRCA1 or BCRA2 mutations appear to be at increased risk, the effect of contralateral prophylactic mastectomy is not completely clear.

“Regardless of any survival benefit,” he adds, “some patients may feel contralateral prophylactic mastectomy will give them greater peace of mind.”

J Clin Oncol 2009;27.

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P. Dendritiformis Colony: Eshel Ben-Jacob

New research shows that some strains of bacteria can be tricked into killing off their own kind; it may have future applications in medicine

By Brooke Borel

March 2009, by Brooke Borel — Bacterial infections are the number one killer in hospitals, and while most can be treated with antibiotics, there are many strains that have developed resistance to the drugs. New research from Tel Aviv University and Texas University suggests that bacteria can be outsmarted by turning their natural defense mechanisms against them, which can completely wipe them out without using antibiotics.

When bacteria are starved or exposed to other stressors, they release a chemical that kills off some of the colony so that the rest can survive. But, according to Eshel Ben-Jacob of TAU, co-author of the study, they exhibit a kind of “rudimentary social intelligence” which prevents them from killing the entire colony. The new research exploits that idea by exposing two neighboring sibling colonies to the same chemical signal.

The result was that the siblings—which came from the same original colony—killed each other off. And, when the chemical messages between the sibling colonies were cut off, the bacteria stopped dying.

Custom-Made Bacteria
The bacteria used in the study, Paenibacillus dendritiformis, was developed by Ben-Jacob specifically for this type of experiment. According to Ben-Jacob, P. dendritiformis have a complex social life and display relatively large, striking patterns that make reactions to the chemicals easy to observe. The bacteria have genes specific to cannibalism, communication, and have a highly developed defense system, which makes them ideal for exploring ways in which to exploit these features.

P. dendritiformis is not pathogenic, so there is no risk of infection for the researchers. The bacteria are also representative of many strains that are resistant to antibiotics, which makes them a good model for experimentation.

Smart Bugs
According to Ben-Jacob, bacteria are surprisingly intelligent: “In the medical community, they perceive the bacteria as a collection of dumb creatures, but they actually not.” This collective intelligence can and should be used to turn the bacteria against itself, rather than spending time and money developing antibiotics, he says.

In this study, each bacteria colony is around four inches in diameter, and the number of bacteria is around ten times the world’s human population. Every individual bacterial cell is in constant communication with all the rest. “Think of it as if ten times the number of people on earth were all connected by SMS to every other one, sending messages all the time. It is even better than fastest kid texting today,” said Ben-Jacob.

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P. Dendritiformis Colony

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P. Dendritiformis Colony

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P. Dendritiformis Colony

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P. Dendritiformis Colony

Medscape.com, March 5, 2009, by Laurie Barcley MD — Patients experiencing lower patient–physician connectedness are less likely to receive guideline-consistent care, according to an article published in the March 3 issue of the Annals of Internal Medicine.

“Valid measurement of physician performance requires accurate identification of patients for whom a physician is responsible,” write Steven J. Atlas, MD, MPH, from the Massachusetts General Hospital in Boston, and colleagues. “Among all patients seen by a physician, some will be more strongly connected to their physician than others, but the effect of connectedness on measures of physician performance is not known.”

The goal of this population-based cohort study was to assess whether patient–physician connectedness affects measures of clinical performance. The study cohort consisted of 155,590 adults with 1 or more visits from 2003 to 2005 to an academic network of 4 community health centers and 9 hospital-affiliated primary care practices.

Patients were connected to either 1 of 181 physicians or 1 of 13 practices in which they received most of their care, using a validated algorithm. Performance outcomes included screening for breast, cervical, and colorectal cancer in eligible patients; measurement and control of hemoglobin A1c in diabetic patients; and measurement and control of low-density lipoprotein cholesterol in diabetic patients with coronary artery disease.

Of the 155,590 participants, 92,315 (59.3%) were connected to a specific physician, 53,669 patients (34.5%) were connected only to a specific practice, and 9606 patients (6.2%) were not connected to a physician or practice. There was considerable range in the proportion of patients in a practice who could be connected to a physician (45.6% – 71.2% of patients per practice; P < .001). Compared with practice-connected patients, physician-connected patients were significantly more likely to receive guideline-consistent care. For example, adjusted mammography rates were 78.1% vs 65.9% (P < .001), and adjusted hemoglobin A1c rates were 90.3% vs 74.9% (P < .001). Physician connectedness was a better predictor of receipt of preventive care than was race or ethnicity. "Patients seen in primary care practices seem to be variably connected with a specific physician, and less connected patients are less likely to receive guideline-consistent care," the study authors write. Limitations of this study include that patient–physician connectedness was evaluated in only 1 primary care network; limited access to tests obtained outside of the network, with possible underreporting of performance measures; and a lack of data collection directly from patients and physicians. "The concept of connectedness and its relationship to performance measures suggest strategies to efficiently organize quality-improvement interventions," the study authors conclude. "Although one could simply hold physicians and practices accountable for assuring connectedness, this does not address relevant patient preferences. Alternatively, strategies could be implemented that take advantage of established connectedness patterns." The National Cancer Institute and Massachusetts General Hospital Primary Care Operations Improvement Program supported this study. One of the study authors is supported by a National Institute of Diabetes and Digestive and Kidney Diseases Career Development Award, and another was supported in part by the Agency for Healthcare Research and Quality. The authors have disclosed no relevant financial relationships.

Survey names 100 wealthiest investors across the globe putting big bucks into the green sector.

The UK’s Sunday Times, March 2009 — unveiled its inaugural list of the richest 100 investors who are putting money into clean technologies, cleantech businesses and environmental causes.

No surprises up top, with Warren Buffett and Bill Gates getting first and second positions, respectively.

In September, Buffett’s MidAmerican Energy Holdings paid $230 million for a 9.89 percent stake in Shenzhen, China-based BYD (HK: 1211) (see Warren Buffett goes electric and China’s BYD sells first mass-produced plug-in cars).

Also in September, Gates joined a Series B round of financing for San Diego algae to biofuel developer Sapphire Energy (see Bill Gates gets slimed). His Cascade Investments formed a JV with PNM Resources called EnergyCo, and Gates previously invested in ethanol producer Pacific Ethanol (see More money for your biofuel co.? Sure!).

The No. 6 wealthiest investor was New York City Mayor Michael Bloomberg, who has made cleantech a priority for the Big Apple (see NYC puts out call for renewable power).

Google co-founders Sergey Brin and Larry Page tied at No. 10. Both have invested in electric carmaker Tesla Motors (see Google creates renewable R&D group and Tesla’s new convertible).

And natural-gas and wind advocate T. Boone Pickens made the list at No. 25 (see Could Obama fire up CNG cars? and Wind power going strong down south).

In all, the top 100 are worth £267 billion ($373 billion), with each worth at least £200 million ($279 million).

The article noted a few financing trends related to geography:

The Chinese rich on our list are definitely about mass production of green technologies. … The 17 Chinese tycoons in the Top 100 are concentrated at the bottom end of the list and they are almost exclusively involved in solar and electric-car technology.

American money may be chasing smarter and greener technologies. … America’s wealthy … are also spending their fortunes on direct environmental activism.

There is little evidence of any appetite among Britain’s super-rich for this approach. Firmly rooted in property, finance or retailing, they have little time or surplus wealth for anything other than lip service to green issues.

The seven German tycoons are largely involved in wind turbines and the like. This is a bespoke market — meat and drink to the German industrial sector. German entrepreneurs who have made their fortunes elsewhere are also moving into green technology in a serious way, defying the prevailing economic gloom.

Here are the top ten cleantech investors, according to the Sunday Times:

1. Warren Buffett, wind power

2. Bill Gates, Renewable fuel

3. Ingvar Kamprad, renewable energy

4. Marcel Brenninkmeijer, natural power (see 2007 Cleantech Awards recipients)

5. Mukesh Ambani, life sciences

6. Michael Bloomberg, natural energy

7. Michael Otto, green products

8. Paul Allen, natural fuels

9. Donald Bren, environmental research

10. (tie) Sergey Brin, green energy, and Larry Page, green energy

Eco Barons Lead the Way

TimesOnline.co.uk, March 2009, by Dr. Philip Beresford — THE global rich are going green as never before. This first Sunday Times Green Rich List shows that the enthusiasm among the world’s wealthiest for investments in areas as diverse as electric cars, solar power and geothermal energy is unaffected by the recession.

The Green List has unearthed 100 tycoons or wealthy families worth £200m or more who have made either serious investments in green technology and businesses or hefty financial commitments to environmental causes. In total, the Green 100 are worth nearly £267 billion.

This enormous sum demonstrates that many of the world’s richest tycoons and entrepreneurs have embraced environmentalism. Indeed, our list is dominated by America’s wealthiest financiers and entrepreneurs such as Warren Buffett (worth £27 billion) and Bill Gates (worth £26 billion).

These two canny investors, who regularly swap places at the top of Forbes magazine’s annual list of world billionaires, have spent some of their financial firepower on areas such as wind power and electric cars in Buffett’s case, while Gates has backed alternative fuels such as oil from algae. We are not talking trifling sums here. Buffett has invested $230m in the Hong Kong battery-maker BYD.

Many of the 35 Americans in the Top 100 are drawn from Silicon Valley. Having made their first fortunes in microchips, the internet or software, the likes of Google’s Larry Page and Sergey Brin (each worth £7.5 billion) are turning to green investments with all the entrepreneurial zeal that made their first fortunes.

It helps that the Obama administration is committed to a huge stimulus package involving the very technologies that investors are focusing on.

Even tycoons who are not in President Barack Obama’s camp have moved into alternative energy, none more so than T Boone Pickens, oil explorer, corporate raider and a Texan Republican to his core. He is using part of his £1.8 billion fortune on filling the huge and windy Texas Panhandle with turbines as part of his Pickens Plan to wean America off its dependence on foreign energy.

American money may be chasing smarter and greener technologies, while the Chinese rich on our list are definitely about mass production of green technologies.

The 17 Chinese tycoons in the Top 100 are concentrated at the bottom end of the list and they are almost exclusively involved in solar and electric-car technology. It is a ferociously competitive market with unremitting pressure to cut costs and gain market share.

As such, all the Chinese fortunes have been hammered as share prices have fallen sharply. A year ago, many would have been in the Top 50, but not now. Indeed, some of them will not survive the steep downturn they are now battling through. But out of it will emerge winners selling much cheaper and more technically advanced products to a huge market worldwide.

There are 10 British or British-based tycoons on the list. None is going head-to-head with the Chinese in mass production. And they are not taking the German route. The seven German tycoons are largely involved in wind turbines and the like. This is a bespoke market — meat and drink to the German industrial sector.

The pity is that aside from Sir Richard Branson, who is investing in alternative fuels, there are no real British equivalents of Aloys Wobben. A German engineering graduate, Wobben started Enercon in 1984, building his first wind turbine in his back garden. Today the company employs 6,000 staff and exports sophisticated turbines all over the world.

German entrepreneurs who have made their fortunes elsewhere are also moving into green technology in a serious way, defying the prevailing economic gloom.

Twins Andreas and Thomas Strungmann built a £6.8 billion pharmaceutical fortune. Having sold their pharma business, they put many millions into saving a German solar company early last year just as the economic outlook worsened.

America’s wealthy are not just investing in new technology, they are also spending their fortunes on direct environmental activism, saving large tracts of wilderness from developers, endowing university research into green energy, climate change and the like.

This can have a huge impact in changing the mood in favour of more green activism on the political front, making the climate right for Obama to push through radical green initiatives that would not have been contemplated in George Bush’s presidency.

There is little evidence of any appetite among Britain’s super-rich for this approach. Firmly rooted in property, finance or retailing, they have little time or surplus wealth for anything other than lip service to green issues.

They are also involved in firefighting to keep their businesses afloat. When the recession is over, there are precious few forecasters who think the City and the like will return to its glory days.

With traditional factories and industries closing in record numbers, where will Britain’s future prosperity come from? It is a sobering thought.

………………………………………………

The Green Rich List

A special survey of how the world’s wealthiest people are turning into eco-pioneers

TimesOnline.co.uk, March 2009, by Philip Beresford

The global rich are going green as never before. This first Sunday Times Green Rich List shows that the enthusiasm among the world’s wealthiest for investments in areas as diverse as electric cars, solar power and geothermal energy is unaffected by the recession. Read the full article