The Greening of Canadian Campuses

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Photo: Owen Egan, via McGill University  —  McGill University students working on a site outside Montreal where vegetables are grown for dining halls in the city center.

 

The New York Times
By ELAINE SMITH
Published: July 25, 2013

 

TORONTO — Athletes at the University of Toronto shower with water heated by solar panels. Hundreds of elderly Montreal residents eat meals prepared from food grown by students on a McGill University campus.

Sustainability has become more than a fashionable buzzword on Canadian campuses; it has become enshrined both in university policy and in daily student life.

McGill’s Sustainability Projects Fund, for example, imposes a student fee of 50 Canadian cents per credit that is matched by the university.

“That’s an amazing level of support at a time of economic hardship when everyone is cutting back,” said Martin Krayer von Krauss, manager of the McGill Office of Sustainability. “Students stepped up and put their own money into it.”

“There is a general sense that as one of Canada’s leading universities, we have a responsibility,” he said. “Manifesting excellence means finding solutions to Canada’s most pressing problems.”

McGill Feeding McGill has responded to student demand for more organic, locally sourced food by bringing together dormitory cafeteria services and the Plant Science Department.

The agriculture program, based at the Macdonald campus in Sainte-Anne-de-Bellevue, about 40 minutes outside the city of Montreal, produces 40,000 kilograms, or more than 88,000 pounds, of vegetables annually for student dining halls downtown. Meanwhile, downtown students taking part in the Edible Campus project grow vegetables that are used by a Meals on Wheels program that serves mobility-impaired residents in a low-income neighborhood.

At the McGill Life Sciences Complex, students spearheaded a Shut Your Sash program, which encouraged lab users to close their fume hoods when they were not in use.

“The students set out to create behavior change in one campus building and they reduced energy consumption per hood by 80 percent,” said Dr. Krayer von Krauss, adding that the change saved 77,000 Canadian dollars, or $75,800, a year.

Students are now considering how the project can be rolled out in other laboratories, with the potential for another 1.3 million dollars in savings if they achieve the same rate of success.

Susanna Klassen, a fourth-year environmental science student, has been involved with sustainability projects since her freshman year, when she became one of the coordinators of the McGill Farmers’ Market, which is held on campus during the autumn. It offers a program in which shareholders preorder a weekly box of food before the harvest, with the funds going to farmers during the time of year when their expenses are the highest.

“You share in the risks of agriculture,” she said. “Some crops aren’t as available in some years, depending on the weather. But you always get your money’s worth, are introduced to new varieties and eat more seasonally.”

The program also helped broaden the appeal of the market. “It has been a way to reach out to professionals in the city,” Ms. Klassen said.

Neil Connelly, director of the Office of Campus Planning and Sustainability at the University of Victoria in British Columbia, said he saw increased interest in environmental matters among young people. “We were the first in Western Canada to offer a transit pass for all students, and we’ve seen a major shift in travel patterns and a reduction of cars on campus,” he said. In 1996, about 75 percent of the faculty, staff and students arrived on campus by car; today 50 percent do, according to campus transit surveys. Now, former parking lots are being transformed into new buildings.

“We have 1,000 fewer parking spaces than a decade ago, and new buildings have shower facilities for cyclists,” Mr. Connelly said. “There’s more awareness at the high-school level, and students coming onto campus have higher expectations of how the campus operates.”

At the University of Toronto, students are encouraged to take simple energy-saving measures, like turning off the lights when they leave a room.

“The projects we lead are on the behavioral and cultural side of sustainability,” said Tyler Hunt, a project coordinator at the university’s Sustainability Office.

The university is celebrating 25 years of sustainability initiatives. But Paul Leitch, director of sustainability for the facilities and services department at the central St. George campus, says that energy conservation on campus dates back a century.

“In 1977, the university brought on board its first energy manager, which was way ahead of its time,” Mr. Leitch said. “But 100 years ago, the university converted its coal-fired energy system to a district heating-cooling loop, which was leading edge at the time and still is.”

The university created an automated system to control building temperatures. It also has one of the highest recycling rates — 74 percent — of any institution in Canada.

“We recycle paper, glass and metals and it’s very successful all across campus,” Mr. Leitch said. “When you conserve resources, you have to sustain that.”

Sustainability has gone beyond ad hoc student projects to become a part of official university policy.

At McGill, there is a 2010 sustainability policy, with work under way on Vision 2020: Creating a Sustainable McGill.

It is a core element of the 2007 strategic plan at the University of Victoria, whose president was one of the original signatories to the University and College Presidents’ Climate Change Statement of Action for Canada in 2008.

Dalhousie University in Nova Scotia, which signed on in 2010, will issue a president’s sustainability plan every five years. The University of Alberta has created a sustainability commitment and guiding principles.

The focus is on encouraging a new generation to think about the environment before they hit the workplace.

“Why education, when it includes only 3 percent or so of environmental users in the world?” said Niles Barnes, senior programs coordinator for the Association for the Advancement of Sustainability in Higher Education, which counts 61 Canadian colleges and universities among its 892 members.

“We may have a small energy footprint, but we have a 100 percent educational footprint. All of our future teachers, doctors and other professionals pass through the educational system.”

 

For best viewing, click the bottom right corner for full screen.

 

By David Pittman, Washington Correspondent, MedPage Today

July 24, 2013

 

 

Physicians feel that other major players in healthcare — lawyers, insurance companies, hospitals, drug companies, and patients — bear greater responsibility for reducing healthcare costs than doctors do, a survey found.

Furthermore, doctors are hesitant to back substantial financing reforms such as eliminating fee-for-service, but they support reducing unnecessary treatments, Jon Tilburt, MD, MPH, of the Mayo Clinic in Rochester, Minn., and colleagues found.

“More aggressive — and potentially necessary — financing changes may need to be phased in with careful monitoring to ensure that they do not infringe on the integrity of individual clinical relationships,” the authors wrote in the July 23 issue of the Journal of the American Medical Association.

The researchers mailed surveys to U.S. physicians randomly selected from the American Medical Association’s Masterfile to assess physicians’ attitudes on addressing healthcare costs. A total of 2,556 of 3,897 replied.

Respondents said trial lawyers (60%), health insurance companies (59%), hospitals and health systems (56%), pharmaceutical and device manufacturers (56%), and patients (52%) have a “major responsibility” for reducing healthcare costs. However, just 36% reported practicing physicians have the same duty.

Only employers (19%) and physician professional societies (27%) bear less responsibility than individual physicians, the survey found.

“This is a denial of responsibility,” Ezekiel Emanuel, MD, PhD, and Andrew Steinmetz, both of the University of Pennsylvania in Philadelphia, wrote in an accompanying editorial. “Of course, physicians do not want to be blamed for the country’s major problem. But can they really be both the captain of the healthcare ship and cede responsibility for cost control to almost everyone else?”

Emanuel, a noted thought leader in health reform efforts, has spoken before about and pushed for physicians taking the lead on changing healthcare in light of the nation’s financial crisis.

“Unless physicians want to be marginalized — unless they are willing to become just another deckhand — they must accept and affirm that they are responsible for controlling healthcare costs,” Emanuel and Steinmetz wrote.

However, despite their other views, 85% of respondents agreed with the statement that “trying to contain costs is the responsibility of every physician.”

Also, three-quarters reported they were “very enthusiastic” for promoting the continuity of care. A majority support expanding quality and safety data (51%), promoting head-to-head trials of competing treatments (50%), and limiting access to expensive treatments with little net benefit (51%). Nearly four out of five respondents support the discouraging of interventions that have a small advantage but cost much more.

Doctors were decidedly less supportive of efforts that impact the way they are paid. For example, 70% weren’t supportive of eliminating fee-for-service payment models, 65% opposed bundled payments, and 59% opposed penalties to providers for avoidable hospital readmissions.

“The findings of Tilburt et al. confirm this ingrained human behavior by showing that physicians are hesitant, if not unequivocally opposed, to taking bold steps to re-engineer incentives in the system — steps that may well have the most meaningful effects on controlling costs,” Emanuel and Steinmetz wrote.

Tilburt said his findings suggest policymakers may want to start with less dramatic reform efforts such as reducing fraud and abuse and promoting chronic disease care coordination before moving to more extreme physician payment reforms.

“[Physicians] are most enthusiastic about those cost-containing strategies that improve the quality of care, that bring evidence to the bedside, and that are a clear win-win for the doctor, the patient, and the health system,” Tilburt told MedPage Today in a video interview. “They get more nervous when their bottom line is at stake.”

More than three-quarters of physicians reported being aware of the costs of the tests they ordered, while 78% said they should be devoted to their patients’ best interests even if that is expensive.

Other findings included:

  • 43% reported they generally order more tests when they don’t know the patient well
  • 70% worried about malpractice liability
  • 55% agreed that following cost-conscious guidelines in practice would be the right thing to do
  • 70% said decision support tools that show costs would be helpful

Tilburt said respondents were slightly older than nonrespondents, but reported no other differences in sex, region, race, or specialty.

“Our results suggest there are subgroups within the profession with distinct identities and professional self-conceptualizations that shape their judgments about addressing healthcare costs,” the authors wrote. “In particular, physicians who share a common way of receiving payment, a common type of work context, may share a similar sense of professional obligation. Such relationships are worthy of further investigation.”


1

Primary source: Journal of the American Medical Association
Source reference:
Tilburt JC, et al “Views of U.S. physicians about controlling health care costs” JAMA 2013; 310(4): 380-388.

Additional source: Journal of the American Medical Association
Source reference:
Emanuel EJ, Steinmetz A “Will physicians lead on controlling health care costs?” JAMA 2013; 310(4): 374-375.

20130725-1

Photo: Suzanne DeChillo/The New York Times  —  MelaFind’s imaging system uses pattern-recognition algorithms to help a dermatologist decide whether to do a biopsy on a skin spot 

 

The New York Times

By NATASHA SINGER

Published: July 20, 2013

 

TO the casual observer’s eye, the small brownish mole on Tanna Oppel’s upper left arm looks like an insignificant, ovoid blotch. But on the screen of MelaFind, a new computer vision system for imaging skin lesions, a jagged blue line shows the actual border of the mole, revealing an irregular lesion roughly the shape of Texas.

 

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Photo: Suzanne DeChillo/The New York Times  —  A spot is checked in Dr. Doris Day’s office.

 

 

Ms. Oppel is a medical assistant in Manhattan in the office of Dr. Doris Day, one of the first dermatologists to buy the machine. Developed by Mela Sciences of Irvington, N.Y., the system uses pattern-recognition algorithms to help a dermatologist who has picked out a suspicious pigmented spot to decide whether to perform a biopsy. The device may find an audience among sun-seekers worried about developing an aggressive skin cancer: the National Cancer Institute estimates that about 9,500 Americans this year will die of melanoma of the skin.

Yet the device is polarizing the field of skin-cancer detection.

For decades, dermatologists have used their eyes, along with a magnifier called a dermatoscope, to try to distinguish abnormal but benign lesions from potential melanoma in order to avoid unneeded biopsies. Some dermatologists argue that these low-tech tools are still the most useful and worry that their colleagues are falling for expensive, cool-looking gadgets that may simply offer extraneous, and perhaps incorrect, data.

“This technology should still be considered to be in the developmental stage,” said Dr. Roberta Lucas, an instructor of clinical dermatology at the Northwestern University Feinberg School of Medicine in Chicago. “We are better off when the system supports doctors who are thorough and unhurried; who examine and listen carefully and who empower patients to practice good surveillance and sun protection.”

In fact, some members of an expert medical panel asked to review MelaFind a few years ago for the Food and Drug Administration warned that the device had the potential to give doctors and patients a false sense of security. While MelaFind can analyze small pigmented spots identified by dermatologists as having signs of melanoma, it is not designed to evaluate other problems: large melanomas, colorless melanomas or two other types of skin cancer — basal and squamous cell carcinoma.

Dr. Amy E. Newburger, a dermatologist in Scarsdale, N.Y., who was a member of that F.D.A. panel, told me that she was concerned that a doctor could inadvertently use MelaFind on a non-melanoma skin cancer, receive a score indicating that the spot was not irregular, and erroneously decide not to biopsy it. She voted against recommending the device for F.D.A. approval.

Some biostatisticians are also critical of MelaFind, saying the device can recognize a high percentage of melanomas correctly because it also falsely scores as positive so many non-melanomas — potentially prompting doctors to perform unnecessary biopsies.

To help me visualize that issue, Jason Connor, a biostatistician at Berry Consultants, a biostatistics consulting firm, compared the accuracy of MelaFind in distinguishing non-melanomas to a hypothetical pregnancy test which, used on 100 nonpregnant women, would mistakenly conclude that 90 of them were pregnant.

“My concern with MelaFind is that it just says everything is positive,” Mr. Connor said. A member of the F.D.A. panel, he abstained on a vote about whether the device’s intended uses outweighed the risks.

“I don’t think this helps an aggressive doctor,” Mr. Connor told me, “and unaggressive doctors could do just as well if they were more diligent without the device.”

To develop MelaFind’s current algorithm, researchers trained the system on digital images of more than 10,000 pigmented lesions, programming it to recognize irregularities like asymmetry, color variability and cellular disorganization characteristic of melanomas. Company executives said Mela Sciences deliberately calibrated the machine to catch as many melanomas as possible, understanding that such a high setting could lead doctors to biopsy normal tissue.

“It will err on the side of caution,” said Claudia Beqaj, director of commercialization at Mela Sciences. “We wanted to set the system to have such a high sensitivity that we didn’t miss any melanomas.”

(In a company-financed study submitted to the F.D.A., the device missed two out of 127 evaluable melanomas. One F.D.A. reviewer concluded: “There is inadequate data to determine any true value added for MelaFind for use by a dermatologist or other provider.”)

Ms. Beqaj emphasized that MelaFind was intended as a supplementary test that provided extra information about a mole, not as a substitute for a dermatologist’s own expertise.

“If they blindly followed MelaFind, they would be biopsying more,” Ms. Beqaj said. “The doctor has to make their own clinical judgment.”

Dr. Day finds the system quite informative. Last week, she gave me a demonstration in her office on the Upper East Side of Manhattan.

Dr. Day picked out what she called an “ugly duckling” mole on the left arm of Ms. Oppel, who had kindly agreed to play the role of patient. Another medical assistant removed a hand-held scanner from the MelaFind console and pressed it against the mole.

The device uses 10 different wavelengths of light to see up to 2.5 millimeters deep into the skin and capture images of its different layers. Within a minute, the machine displayed a numerical score, indicating that Ms. Oppel’s mole was irregular, but not highly likely to be a melanoma. Since the images on the screen indicated that the darkest part of the mole was concentrated around a hair follicle, an expected pigmentation pattern, Dr. Day concluded there was no immediate need for a biopsy.

“It helps me see what I cannot see with my eye,” Dr. Day said. “I have great comfort that I am not missing a melanoma.”

(Dr. Day has been a paid device investigator and speaker for Mela Sciences; she appears in promotional videos on the MelaFind Web site).

In late 2011, the F.D.A. approved MelaFind for sale in the United States. But, given the concerns that general physicians not trained as skin experts might miss a skin cancer, the agency restricted the use of the device to dermatologists — and then only after the doctors had successfully completed a MelaFind training program. So far, Ms. Beqaj says, the company had sold about 150 of the devices, which cost about $10,000, in the United States and Germany.

Since health insurance does not currently cover the service, patients are paying $25 to $175 for the first mole evaluation and around $25 for subsequent moles, doctors say.

WHETHER or not MelaFind eventually gains traction among dermatologists, the device is nevertheless significant, said Dr. Hensin Tsao, the director of the melanoma and pigmented lesion center at Massachusetts General Hospital in Boston, because it introduces the idea of artificial intelligence in dermatology.

Unlike an X-ray or mammography device that requires a medical professional to read the images and identify abnormalities, Dr. Tsao said, MelaFind both captures images and analyzes the likelihood of melanoma. That extra intelligence, its accuracy notwithstanding, is bound to change doctors’ interactions with patients.

Dr. Tsao’s clinic is participating in a post-marketing study of MelaFind, financed by Mela Sciences. And he said he and his colleagues were thinking hard about how to develop a role for such new devices in informing physicians and patients.

“Until now, you trusted the doctor to make the decision,” Dr.  Tsao said. “Now you’ve got a three-way interaction. It’s a brand new paradigm.”

Link Seen in Age at Retirement and Risk of Alzheimer’s

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By John Gever, Deputy Managing Editor, MedPage Today

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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  • Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
  • French retirees who had stopped working relatively late in life were less likely to develop Alzheimer’s disease.
  • Point out that the results are consistent with the growing body of evidence for the benefit of maintaining cognitive and social stimulation in seniors.

 

July 23, 2013, BOSTON — French retirees who had stopped working relatively late in life were less likely to develop Alzheimer’s disease, a researcher reported here.

Analysis of a French healthcare insurer’s records indicated that, for each year after age 60 at which a person retired, the risk of subsequently developing Alzheimer’s disease was lower by 3.2% (HR 0.968, 95% CI 0.962-0.973), said Carole Dufouil, PhD, of INSERM in Bordeaux, France.

After adjusting for certain other risk factors, individuals retiring at 65 were 14.6% less likely to develop Alzheimer’s disease than those retiring at 60, she said at a press briefing held prior to her formal presentation at the Alzheimer’s Association International Conference.

The results were “in line with the use-it-or-lose-it hypothesis,” she said, which holds that people who remain mentally active develop dementia at lower rates than those who don’t.

Data for the study came from an insurance provider for self-employed workers in France, mainly shopkeepers and craft workers, Dufouil explained. Records for some 430,000 pensioners as of December 2010 were analyzed, including 11,397 who were considered to have developed Alzheimer’s disease or related dementias after retirement.

The analysis excluded individuals whose records indicated a Parkinson’s disease diagnosis at any time and also those with apparent dementia at retirement.

Onset of Alzheimer’s disease was defined as a diagnostic code of ALD15 in the French healthcare system, which refers to “Alzheimer’s disease and related disorders,” or purchase of anti-dementia drugs such as memantine (Namenda) or acetylcholinesterase inhibitors.

Because they had such a large data set to work with, Dufouil and colleagues also conducted analyses to determine if the relationship between retirement age and Alzheimer’s risk differed among subgroups.

There were statistically significant differences in two groups — men versus women and craft workers versus shopkeepers — but all still showed a significant decrease in risk of at least 2% for each year beyond age 60 for retirement.

Stratification by age of birth or age at Alzheimer’s disease diagnosis also did not make a great difference in results, Dufouil said.

She added that sensitivity analyses in which some individuals were excluded — such as those with diagnoses within 5 or 10 years of retirement, those retiring after age 75, and those with relatively short periods of self-employment before retirement — also confirmed the topline results.

Dufouil noted several limitations to the study: The findings might not be applicable to other occupational types, the definition of new-onset dementia could be questioned, and the data lacked information on formal educational attainment and certain other important risk factors, she said.

Nevertheless, she said the results added to the growing body of evidence that “maintaining high levels of cognitive and social stimulation” is beneficial in seniors.

David Knopman, MD, of the Mayo Clinic in Rochester, Minn., who moderated the press briefing, cautioned that the findings may not entirely be an expression of “cognitive reserve,” the idea that individuals who exercise their brains regularly throughout life can retain normal cognitive function despite physical injuries and insults.

He noted that other factors that co-associate with mental activity — such as the ability to avoid other health risks, and the consequent lower risk of cardiovascular disease that can independently impair cognitive function — also have to be considered.

“All of these things bear on the ability of the brain to withstand the onslaught of something like Alzheimer’s disease,” he said. “[They] make the risk of Alzheimer’s disease a little more complex and these things can’t be ignored.”

 

The study had no commercial funding.

Dufouil had no disclosures. Knopman had relationships with Eli Lilly, TauRx, Janssen, Merck, Baxter, and Forest.


Primary source: Alzheimer’s Association International Conference
Source reference:
Dufouil C, et al “Older age at retirement is associated with decreased risk of dementia: Analysis of a healthcare insurance database of self-employed workers” AAIC 2013; Abstract O2-13-01.

 

20130724-1

THE NEW YORK TIMES
By HILLARY ROSNER
Published: July 23, 2013

 

For his master’s thesis research, Andrew Martin, an evolutionary biologist, studied the periodical cicada, an insect that lives underground and emerges once every 13 or 17 years. Traveling the United States from Georgia to Illinois to New York, Dr. Martin, now a professor at the University of Colorado, spent a summer up close with the cicadas. At each site, he would handle anywhere from 30 to 50 of them.

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Graphic: Ellen Weinstein

The cicadas’ bodies were greasy to the touch, he recalled, and their abdomens were often coated with a whitish-green powder. It is a fungus that sterilizes and ultimately kills the insects.

A month into the research, the cicadas weren’t the only ones the green powder had afflicted. Whenever Dr. Martin touched it, his eyes itched and watered — symptoms that grew worse every time.

“When there were lots of the fungi, my eyes wanted to pop out of my head,” Dr. Martin recalled. “I wanted to scratch my eyes out.”

Dr. Martin had developed an allergy to his research subject, a fact that made finishing the project a grueling task. “I was always on something,” he said, referring to allergy medication, “but it was still bad.”

Becoming allergic to your research may sound like a classic avoidance strategy — like coming down with the flu (cough, cough) right before that big exam, or having to work (what a drag) on the weekend the in-laws come to visit. But it turns out to be a little-discussed but fairly common occupational hazard of science.

An estimated 15 to 20 percent of researchers who work with mice and rats, for instance, may eventually become allergic to the animals, said Dr. Karin A. Pacheco, an assistant professor of environmental and occupational health sciences at National Jewish Health in Denver. The real number could be even higher, because some people who become allergic may never report it, valuing their job above their health or comfort, Dr. Pacheco said.

Allergies are caused when our immune systems become overly sensitive to otherwise inoffensive substances. “The very first time you’re stung by a bee, you won’t be allergic,” said Dr. Pacheco. “You have to be exposed to the antigen and then develop an immune response to it.” Because scientific research often involves frequent and lengthy contact with a substance or creature, it’s something of a perfect vehicle for allergies.

Charlotte R. Hewins, a research specialist at the Holden Arboretum in Kirtland, Ohio, used to spend six months a year working with witch hazel plants, pollinating the flowers by hand.

Witch hazel, used as a garden shrub and medicinally as an astringent, grows tiny hairs on its leaves and twigs. When Dr. Hewins handled the plants, those hairs would come loose and float through the air.

Before long, she remembers, “I’d be getting rashes and hives on my hands and forearms. My eyes would be itchy and watery, and I’d be sneezing.”

For Burk Dehority , a microbiologist and professor emeritus at Ohio State University, the offending substance was formaldehyde. Dr. Dehority was studying protozoa that live in the stomachs of cattle.

“After using formaldehyde in liberal quantities for a number of years and getting splashed with it, I started to develop small blisters all over my hands,” Dr. Dehority said. He tried using rubber gloves, but that proved an incomplete solution. The chemical’s fumes were partially responsible for the allergy. So Dr. Dehority installed a fume hood — a similar device to the fan system that sits above a stove.

That seemed to make the work bearable, though the allergy persisted through 40 years of research. “I made a career out of studying protozoa,” he said. “It never occurred to me to switch.”

For Dr. Martin, too, abandoning the cicada project seems never to have entered his mind. “I was getting such cool data,” said Dr. Martin, who eventually earned his first publication in the journal Nature from the cicadas. “You become myopic about what you need to do.”

In fact, even a pre-existing allergy may not be enough to deter an obsessed scientist from a particular line of inquiry. Monica Raveret Richter, a behavioral ecologist at Skidmore College, developed a severe allergy to bees, wasps and mosquitoes as a child. Yet she has since spent much of her career studying the foraging behavior of wasps — aided by EpiPens and a supply of antihistamines. “If I get a lot of stings, I have issues,” she admitted. Still, she said, “I’ve learned to work around it.”

 

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Ben Solomon for The New York Times
Sadio Diakite received trachoma surgery in rural Mali. The 15-minute eye surgery costs less than $40 per person and can be performed by a public nurse.

 

 

By NICHOLAS D. KRISTOF

The New York Times, Published: July 17, 2013

 

BAMAKO, Mali — When you begin to go blind from trachoma, the first thing you feel is an eyelash scraping your eye.  As for the horror of leprosy, it often begins with a puzzling rash. Among the first signs of polio are fatigue, vomiting and back pain.  Yet these diseases are on their way out. We in journalism mostly focus on problems, but one of the remarkable changes in the developing world has been the decline of these ancient scourges.

When I first traveled through West Africa, as a student backpacker more than 30 years ago, I was haunted by the beggars disabled by blindness, leprosy and polio. Now I’m on my annual win-a-trip journey with a university student, Erin Luhmann of the University of Wisconsin, and she is encountering a fundamentally improved landscape than the one I saw when I was her age.

Take blindness. It has many causes, but one of the most painful is trachoma, which turns the eyelid inward. The lashes then continuously scrape the cornea.

“My eyes felt as if someone had thrown a handful of sand in them,” Nawara Souko, who suffered from trachoma for years, told us. Her husband is dead, and, without sight, she found it difficult to farm or care for her five children. Three died.

Then Nawara received a 15-minute surgery from a public nurse trained by Helen Keller International, an American aid group. Sometimes the surgery, which straightens the eyelid, comes too late to restore vision. In Nawara’s case, the operation ended the pain — and she could see again.

Erin and I watched trachoma surgeries in a village 100 miles west of the Malian capital of Bamako. Villagers who for years had endured agony — one woman compared it to childbirth, except that it goes on for years — had their lives transformed.

Yagare Traoré said she had spent years in her hut, unable to farm or care for her 11 children, six of whom died. Then she received the surgery, and, after the bandage was removed, a boy stepped forward to guide her home.

“Get out of my way!” she recalled telling him. “I can see! I can walk by myself!”

The cost of this surgery here in Mali is less than $40 per person, according to Shawn Baker of Helen Keller International. So the next time you hear that humanitarian aid is “money down a rat hole,” well, think of Yagare Traoré.

Prevention of trachoma is even cheaper. Train villagers in improving hygiene and distribute antibiotics at a cost of less than $1 per person, and trachoma disappears so that people don’t even need surgery.

Then there’s polio: Only 223 cases were reported last year, down from 350,000 in 1988. Islamist extremists in Nigeria and Pakistan have murdered vaccination workers, but the disease is still inching toward eradication.

A third triumph is leprosy. It can cause hideous disfigurement, including the loss of fingers, toes, ears and the nose, as well as blindness.

Yet a cheap three-drug therapy cures leprosy easily, and a new blood test simplifies diagnosis. The progress is stunning. In 1985, there were 5.2 million people worldwide with leprosy, and now there are fewer than 200,000.

Unfortunately, not everyone gets treated in time. One of our saddest encounters on this win-a-trip journey with Erin was with a 10-year-old boy named Muhammad Bako who had already lost toes and fingers to leprosy.

“I’m fine,” Muhammad told us, but he didn’t look it. He walks awkwardly with crutches, and his eyes burn with fear and the unfairness of it all.

Muhammad is being treated at a 57-year-old leprosy hospital in Niger run by SIM, a Christian missionary organization. The hospital receives about one new leprosy case a month, down from more than 500 a quarter-century ago.

The progress goes far beyond these three ailments. The number of children dying worldwide before the age of 5 has plunged from 12 million in 1990 to 6.9 million in 2011.

As the disease burden declines, the economy surges. Africa is now booming economically, and six of the 10 fastest-growing economies in the world are on the continent. Don’t think of Africa as a place to pity, but as a place to invest.

Journalists and humanitarians understandably focus on unmet needs, and that can leave the impression that the story of global health is a depressing one of failure. In fact, it’s an inspiring story of progress. We need to do more, especially against AIDS, malaria and tuberculosis, but one of the great achievements of humanity in recent decades has been the marginalization of ancient and dreaded diseases.

That’s why it’s possible for me to travel with Erin in some of the most impoverished countries in the world, and feel a glow of hope.

TechnoSTAT Ltd (Israel) and Target Health Inc. (USA) Partner in EDC and the Paperless Clinical Trial

 

New York, NY, Ra’anana, Israel, 21 July, 2013 – Target Health Inc., and TechnoSTAT Ltd., are pleased to announce a strategic collaboration to provide high quality and competitively priced 21 CRF Part 11 compliant electronic data capture (EDC) and paperless clinical trial solutions to Israeli life science companies. TechnoStat will utilize Target e*Studio® to develop, deploy, and maintain clinical trial applications using Target e*CRF® for data collection. In addition to Target e*Studio, TechnoSTAT will also offer Target e*CTR®, which allows clinical study sites to perform direct data entry at the time of the office visit, thus eliminating/minimizing the need for paper source records. TechnoSTAT will also incorporate Target Document® as a solution to the eTrial Master File (eTMF); Target Encoder® for coding of adverse events, medications and medical histories using MedDRA and WHO Drug and other types of dictionaries, and; Target e*Pharmacovigilance™ which generates an FDA approved facsimile of MedWatch Form 3500A and the international CIOMS Form 1. Both forms can be used for regulatory submissions, with the ability to control the original and followup versions of the forms within the EDC application.

 

The partnership will provide US FDA regulatory services by Target Health to Israeli life sciences clients of TechnoSTAT, and to US-based life science companies, additional biostatistical consulting and programming services by TechnoSTAT.  Both companies will also collaborate in the management and execution of clinical trials both in Israel and in the USA under common SOPs.

 

“We are very enthusiastic about expanding our existing market in Israel with TechnoSTAT and working closely with our colleagues at TechnoSTAT to assist them in becoming the leading provider of EDC and paperless clinical trial services in Israel.” comments Target Health’s President, Dr. Jules T. Mitchel. “With over 20 years of clinical trial and clinical trial information systems developed and implemented at Target Health, coupled with the in-depth experience of TechnoSTAT in clinical management, data management and biostatistics, this partnership is a natural,” Dr. Mitchel added.

 

“TechnoSTAT, in joining forces with Target Health, will bring to the Israeli Life Sciences Industry, a new level of sophistication consistent with Israel being known as the Startup Nation” explains Maya Talmon, CEO of TechnoSTAT.  Ms. Talmon added that “It is clear that the paperless clinical trial is here to stay and collaborating with the Target Health team and their electronic toolbox, will allow us to be on that path.”

 

For more information about Target Health contact Warren Pearlson (212-681-2100 ext. 104). For additional information about software tools for paperless clinical trials, please also feel free to contact Dr. Jules T. Mitchel or Ms. Joyce Hays. The Target Health software tools are designed to partner with both CROs and Sponsors. Please visit the Target Health Website.

Body’s Response to Repetitive Laughter Is Similar to the Effect of Repetitive Exercise

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A new study looks at the effect that mirthful laughter and distress have on modulating the key hormones that control appetite. (Credit: iStockphoto/Wouter Van Caspel)

 

 

Laughter is a highly complex process. Joyous or mirthful laughter is considered a positive stress (eustress) that involves complicated brain activities leading to a positive effect on 1) ___. Norman Cousins first suggested the idea that humor and the associated laughter can benefit a person’s health in the 1970s. His ground-breaking work, as a layperson diagnosed with an autoimmune disease, documented his use of laughter in treating himself — with medical approval and oversight — into remission. He published his personal research results in the New England Journal of Medicine and is considered one of the original architects of mind-body 2) ___.

 

Dr. Lee S. Berk, a preventive care specialist and psychoneuroimmunology researcher at Loma Linda University’s Schools of Allied Health (SAHP) and Medicine, and director of the molecular research lab at SAHP, and Dr. Stanley Tan have picked up where Cousins left off. Since the 1980s, they have been studying the human body’s response to mirthful laughter and have found that laughter helps optimize many of the functions of various body systems. Berk and his colleagues were the first to establish that laughter helps optimize the hormones in the 3) ___ system, including decreasing the levels of cortisol and epinephrine, which lead to stress reduction. They have also shown that laughter has a positive effect on modulating components of the immune system, including increased production of antibodies and activation of the body’s protective cells, including T-cells and especially Natural Killer cells’ killing activity of tumor cells.

 

Their studies have shown that repetitious “mirthful laughter,” which they call Laughercise©, causes the body to respond in a way similar to moderate physical exercise. Laughercise enhances your mood, decreases stress hormones, enhances immune activity, lowers bad cholesterol and systolic blood pressure, and raises good 4) ___ (HDL). As Berk explains, “We are finally starting to realize that our everyday behaviors and emotions are modulating our bodies in many ways.” His latest research expands the role of laughter even further.

 

A New Study: Humor versus Distress, Effect on Appetite Hormones

 

The study, presented at the Experimental Biology conference) recruited 14 healthy volunteers to examine the effects that eustress (mirthful 5) ___) and distress have on modulating the key hormones that control appetite. During the 3-week study, each subject was required to watch one 20-minute video at random that was either upsetting (distress) or humorous (eustress) in nature. The study was a cross-over design, meaning that the volunteers waited one week after watching the first video to eliminate its effect, then watched the opposite genre of video.

 

For a distressing video clip, the researchers had the volunteer subjects watch the tense first 20 minutes of the movie Saving Private Ryan. This highly emotional video clip is known to distress viewers substantially and equally. For the eustress video, each volunteer chose a 20-minute video clip from a variety of humorous options including stand-up comedians and movie comedies. Allowing the volunteers to “self-select” the eustress that most appealed to them guaranteed their maximum humor response. During the study, the researchers measured each subject’s blood 6) ___ and took blood samples immediately before and after watching the respective videos. Each blood sample was separated out into its components and the liquid serum was examined for the levels of two hormones involved in appetite, leptin and ghrelin, for each time point used in the study.

 

When the authors compared the hormone levels pre- and post-viewing, they found that the volunteers who watched the distressing video showed no statistically significant change in their 7) ___ hormone levels during the 20-minutes they spent watching the video. In contrast, the subjects who watched the humorous video had changes in blood pressure and also changes in the leptin and ghrelin levels. Specifically, the level of leptin decreased as the level of ghrelin increased, much like the acute effect of moderate physical exercise that is often associated with increased appetite. Berk explained that this research does not conclude that humor increases appetite. He stated that “The ultimate reality of this research is that laughter causes a wide variety of modulation and that the body’s response to repetitive laughter is similar to the effect of repetitive 8) ___. The value of the research is that it may provide for those who are health care providers with new insights and understandings, and thus further potential options for patients who cannot use physical activity to normalize or enhance their appetite.”

 

Appetite Loss may have a new Treatment Option

 

Many elderly patients often suffer from what is known as “wasting disease.” They become depressed and, combined with a lack of physical activity, lose their appetite and jeopardize their health and well-being. Based on Berk’s current research, these patients may be able to use Laughercise as an alternative, initially less strenuous, activity to regain their appetite. A similar loss of appetite is often seen in widowers, who typically suffer 9) ___ after the loss of a spouse. This often results in decreased immune-system function and subsequent illness in the surviving spouse. Chronic pain patients also suffer from appetite loss due to the chemical changes in their body that cause intolerable discomfort. While laughter may seem unimaginable in the face of deep depression or intense chronic pain, it may be an accessible alternative starting point for these patients to regain appetite and consequently, improve and enhance their recovery to health.

 

Berk’s current research expands the role of laughter on the human 10) ___ and whole-person care, but also complicates an already complicated emotion. He acknowledges, “I am more amazed by the interrelatedness of laughter and body responses with the more evidence and knowledge we collect. It’s fascinating that positive emotions resulting from behaviors such as music playing or singing, and now mirthful laughter, translate into so many types of [biological] mechanism optimizations. As the old biblical wisdom states, it may indeed be true that laughter is a good medicine.”

 

ANSWERS: 1) health; 2) medicine; 3) endocrine; 4) cholesterol; 5) laughter; 6) pressure; 7) appetite; 8) exercise; 9) depression; 10) body

Norman Cousins, Pioneer of Laughter-as-Medication (1915-1990)

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The healing properties of laughter have been extolled since biblical times; in the book of Proverbs, you’ll find this quote: “A merry heart doeth good like a medicine.” When it comes to modern day laughter therapy, however, you’ll want to consider the book of Cousins. More precisely, the tome “Anatomy of an Illness (As Perceived by the Patient),” written by Norman Cousins in 1979.

 

When Cousins was diagnosed with ankylosing spondylitis, an incurable and fatal spinal column illness of unknown cause, he was given very slim odds of recovery. He was unable to move and in constant pain. However, in the midst of this dire situation, Cousins didn’t lose his sense of humor. He credits his recovery to a prescription of “Candid Camera” episodes, Marx Brothers movies and funny stories read by nurses. With 10 minutes of laughter, he wrote, two hours of pain-free sleep could be procured. He wrote original jokes which he would read aloud to himself then laugh like crazy. He noticed that every time he laughed, his pain was eased.

 

Norman Cousins was given a few months to live in 1964. With his rare disease of the connective tissues, he was told by doctors that he had a 1 in 500 chance of survival and to ‘get his affairs in order’. But Cousins would have none of it. A journalist, he was used to research and set himself to find a solution. He read and discovered that both his disease and the medicines were depleting his body of vitamin ‘C’, among other things. He did three things that would be usual today and were unheard of then.

 

1. He fired his doctor and left the hospital to check into a hotel. He ascertained that the cultural of defeatism, and controversy over medication, in the hospital was not going to be good for his health. He found a doctor who would work with him as a team member as opposed to insisting on being in charge.

 

2. He began to get injections of massive doses of vitamin ‘C’.

 

3. He obtained a movie projector, no small feat in those days, and a pile of funny movies including the Marx Brothers and ‘Candid Camera’ shows. He spent a great deal of time watching these films and laughing. And he didn’t just laugh. In spite of being in a lot of constant pain, he made a point of laughing until his very stomach hurt from it.

 

After Norman Cousins went into remission, he returned to the hospital for a checkup. To the surprise of the medical staff who examined him, they found no trace of the dreaded disease. He was completely cured! They asked Cousins what medicines he took that cured him. They would not believe him when he replied he had not taken any medicine, since he had been told his ailment was incurable. They said, “You must have done something you never did before.” He finally replied, “All I did was to laugh myself to health.” He became known as the man who cured himself through laughter, and was even appointed a faculty member of the University of California Los Angeles School of Medicine, although he was not a doctor.

 

Later he told his incredible story in a book, “Anatomy of an Illness,” which was made into a movie. At that time, medical science did not believe there was any connection between the mind, the emotions and the immune system. The immune system was thought to be independent of and not subject to the directions of the mind or the vagaries of human emotions. Since then, numerous studies have found that laughter is definitely tied to the healing process. For example, a study conducted at UCLA found that watching funny shows increased children’s tolerance for pain, which could be helpful when tiny patients have to undergo big procedures. At the University of Maryland, researchers found that groups that watched humorous films experienced an increase in blood flow compared to groups that watched downers. That could be because laughter has been called internal jogging, and it may confer all the psychological benefits of a good workout. The act of laughing stimulates hormones called catecholamines, which in turn release endorphins. With endorphins surging through our bloodstream, we’re more apt to feel happy and relaxed. With each laugh, therefore, we’re relieving stress, reducing anxiety and increasing our stores of personal energy. All of these psychological and physiological results are wonderful tools in coping with illness, a hospital stay or even just a cranky coworker.

 

Researchers at Texas A&M University found that humor leads to increased hopefulness. The researchers believe that laughter can help fight negative thoughts in the brain, and with an increase of positive emotions, people begin to see a way out of their misery. Free from the shackles of negativity, people begin to see how to form a plan of attack to deal with the given situation. Technically speaking laughter is a release of tension, much like sneezing or orgasm. Comics know this well. Watch a good one, no matter what the style you will see that he or she will build up tension and then give some form of punchline to release that tension.

 

Dr. Lee S. Berk, a preventive care specialist and psychoneuroimmunology researcher at Loma Linda University’s Schools of Allied Health (SAHP) and Medicine, and director of the molecular research lab at SAHP, Loma Linda, CA, has shown in studies that the physiological response produced by belly laughter is opposite of what is seen in classical stress, supporting the conclusion that mirthful laughter is a eustress state — a state that produces healthy or positive emotions. His research results indicate that, after exposure to humor, there is a general increase in activity within the immune system, including the following:

 

1. An increase in the number and activity level of natural killer cells that attack viral infected cells and some types of cancer and tumor cells.

 

2. An increase in activated T cells (T lymphocytes). There are many T cells that await activation. Laughter appears to tell the immune system to “turn it up a notch.”

 

3. An increase in the antibody IgA (immunoglobulin A), which fights upper respiratory tract insults and infections.

 

4. An increase in gamma interferon, which tells various components of the immune system to “turn on.”

 

5. An increase in IgB, the immunoglobulin produced in the greatest quantity in body, as well as an increase in Complement 3, which helps antibodies to pierce dysfunctional or infected cells. The increase in both substances was not only present while subjects watched a humor video; there also was a lingering effect that continued to show increased levels the next day

 

The results of Berk’s study also supported research indicating a general decrease in stress hormones that constrict blood vessels and suppress immune activity. These were shown to decrease in the study group exposed to humor. For example, levels of epinephrine were lower in the group both in anticipation of humor and after exposure to humor. Epinephrine levels remained down throughout the experiment. In addition, dopamine levels (as measured by dopac) were also decreased. Dopamine is involved in the “fight or flight response” and is associated with elevated blood pressure.

 

Laughing is aerobic, providing a workout for the diaphragm and increasing the body’s ability to use oxygen. Laughter brings in positive emotions that can enhance – not replace — conventional treatments. Hence it is another tool available to help fight the disease.

 

Experts believe that, when used as an adjunct to conventional care, laughter can reduce pain and aid the healing process. For one thing, laughter offers a powerful distraction from pain. In a study published in the Journal of Holistic Nursing, patients were told one-liners after surgery and before painful medication was administered. Those exposed to humor perceived less pain when compared to patients who didn’t get a dose of humor as part of their therapy. At Swedish Covenant Hospital in Chicago, patients are literally forcing themselves to laugh. The theory is laughter, even if forced, enhances overall well-being and aids in the healing process, using it as a therapeutic tool and not just an emotion. Along with traditional therapies, this is offered as part of their treatment.

 

Researchers are gathering evidence that laughter can directly affect chemicals in our bodies that influence everything from our brain to our heart. Laughter is thought to decrease stress hormones and lower blood pressure. It may also increase blood flow, even act as a natural pain killer. “For people undergoing chemo, it helps them take the stress and scariness out of it, opens blood flow, and oxygenates the blood so the treatment is flowing a little better throughout their veins,” said Tim Nelson, laughter yoga leader.

 

At the Chicago Institute of Neurosurgery and Neuroresearch, there is more laughter. Certified laughter therapist Colleen Caron is working with a mix of back patients and health care professionals. “The theory is 10 minutes of laughing can give you up to two hours of pain free,” said Caron. “It’s energizing. It releases the neurotransmitters in the brain, it exercises the same muscles and organs we use for breathing, it stimulates the immune system.”

 

Even some doctors who deal with high-tech medicine are making room for this low-tech treatment. Dr. Dan Hurley believes in the power of mind and body. He says, in the right situations, a little well placed humor can impact a patient’s outcome. “I think laughter is one of the more magic things we as humans can do innately. It also happens to be therapeutic,” said Dan Hurley, M.D., physiatrist, CINN.

 

Swedish Covenant says the laughter therapy has been so successful among cancer patients it is now offering the classes to those going through cardiac rehabilitation. This type of therapy is not just reserved for those fighting disease. Therapists such as Colleen Caron also bring their seminars to the work setting as an easy way to help employees relieve stress. The elation you feel when you laugh is a great way of combating the physical effects of stress. When we laugh, our body relaxes and endorphins (natural painkillers) are released into the blood stream. Researchers at the University of Michigan have also calculated that just 20 seconds of laughter could be as good for the lungs as three minutes spent on a rowing machine. Perhaps, the biggest benefit of laughter is that it is free and has no known negative side effects.

 

Norman Cousins, the pioneer of this form of personalized medical treatment, received the Albert Schweitzer Prize in 1990. He died of heart failure on November 30, 1990, in Los Angeles, California, having survived years longer than his doctors predicted: 10 years after his first heart attack, 26 years after his collagen illness, and 36 years after his doctors first diagnosed his heart disease. He was a courageous medical hero.

 

The Open Mind: Norman Cousins

 

Look at this video and don’t laugh

Study Suggests That Moving More May Lower Stroke Risk

 

A stroke can occur when a blood vessel in the brain gets blocked. As a result, nearby brain cells will die after not getting enough oxygen and other nutrients. A number of risk factors for stroke have been identified, including smoking, high blood pressure, diabetes and being inactive.

 

According to the NIH, “Here’s yet another reason to get off the couch: new research findings suggest that regularly breaking a sweat may lower the risk of having a stroke.”

 

For this study, published in the journal Stroke (July 18, 2013), data were obtained from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. REGARDS is a large, long-term study funded by the NIH National Institute of Neurological Disorders and Stroke (NINDS) to look at the reasons behind the higher rates of stroke mortality among African-Americans and other residents living in the Southeastern United States.

 

Over 30,000 participants supplied their medical history over the phone. The authors also visited study participants to obtain health measures such as body mass index and blood pressure. At the beginning of the study, the authors asked participants how many times per week they exercised vigorously enough to work up a sweat. The authors contacted participants every six months to see if they had experienced a stroke or a mini-stroke known as a transient ischemic attack (TIA). To confirm their responses, the authors reviewed participants’ medical records.

 

The authors reported data for over 27,000 participants who were stroke-free at the start of the study and followed for an average of 5.7 years. One-third of participants reported exercising less than once a week. Study subjects who were inactive were 20% more likely to experience a stroke or TIA than participants who exercised four or more times a week. The findings revealed that regular, moderately vigorous exercise, enough to break a sweat, was linked to reduced risk of stroke. Part of the protective effect was due to lower rates of known stroke risk factors such as hypertension, diabetes, obesity and smoking.

 

The authors also looked at the data according to gender. After the authors accounted for age, race, socioeconomic factors (education and income) and stroke risk factors, the results revealed that men who exercised at least four times a week still had a lower risk of stroke than men who exercised one to three times per week. In contrast, there was no association between frequency of exercise and stroke risk among women in the study. However, there was a trend towards a similar reduction in stroke risk for those who exercised one to three times a week and four or more times a week compared to those who were inactive.

 

REGARDS will continue to assess stroke risk factors to look for long-term patterns in the study population. According to the authors, findings from this study, including the current physical activity results, will ultimately help to identify potential targets for immediate intervention as well as for future clinical trials aimed at preventing stroke and its consequences.

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