Holland Gets an Interface Engine

Holland (Mich.) Hospital is using the Ensemble interface engine of InterSystems Corp. to link laboratory, radiology and other applications to the core hospital information system.

Physical Forces Shown as Central in Cancer Related Protein Signaling System

A team of researchers from Berkeley University and Lawrence Berkeley National Laboratory has discovered that the EphA2/ephrin-A1 signaling complex, known as a participant in a number of human cancers, can be influenced through the careful application of physical force. This is quite phenomenal considering that until now only chemical reactions were known to influence signaling systems. From a Berkeley Lab press release: Observations have indicated that mammalian cells are sensitive to the physical aspects of their environment, such as the texture or geometry of the surrounding tissue. However, evidence that physical forces impact freely-moving signaling molecules (as opposed to focal adhesion molecules) in the membranes of cells has been lacking because the cell membrane is an environment that has always been difficult to characterize and manipulate. Groves and his research group have found a way to overcome this obstacle with the development of unique synthetic membranes constructed out of lipids and assembled onto a substrate of solid silica that enables them to directly control cellular signaling activities. In this latest study, Groves and his colleagues worked with mammary epithelial cells from a library of 26 model human breast cancer cell lines that have been well-characterized by co-author Gray and his research groups at Berkeley Lab and UC San Francisco. To test the sensitivity of the EphA2/ephrin-A1 signaling complex to mechanical forces, Groves and his group patterned their silica substrates with chromium metal lines that were 10 nanometers in height and 100 nanometers wide. These metal lines acted as diffusion barriers that impeded the lateral mobility of the EphA2/ephrin-A1 complexes in the synthetic membrane. The movement and spatial organization of the complexes were subsequently tracked through a combination of Total Internal Reflection Fluorescence (TIRF), reflection interference and epifluorescence imaging techniques. “Without the barriers, the clusters of EphA2/ephrin-A1 signaling complexes were transported to the center of the cell–supported membrane junction, but with the barriers in place, there was an accumulation of clusters at the barrier boundaries,” Groves says. “This resulted in a spatial reorganization that altered the cell’s biochemical behavior.” Quantitative analysis of these changes to the spatial organization of the EphA2/ephrin-A1 signaling complexes across the library of breast cancer cell lines revealed a strong correlation with the potential for metastasis. Since the patterned metal lines in the silica substrate are analogous to the stiffness, texture and other elastic and mechanical properties of tissue, as well as to internal structures within the... Michael
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Duraspan Biomimetic Coated Hemodialysis Catheter

r4 Vascular out of Maple Grove, Minnesota has released a new catheter for patients on long-term hemodialysis. The Duraspan catheter aims to prevent thrombus accumulation thanks to its biomimetic coating that discourages clot formation. A novel coating on the catheter surface mimics the glycocalyx layer found on natural endothelial tissue surfaces in vessel walls. Laboratory tests of the Duraspan™ catheter have demonstrated an 87% reduction in platelet adhesion and thrombus accumulation compared to uncoated catheters. R4 is committed to improving dialysis patient catheter outcomes according to r4 Vascular's President, Don Geer, "physicians have long thought that if one was able to make the catheter less recognizable as a foreign object in the body it could revolutionize catheter-based hemodialysis. Developing the catheter, r4 Vascular engineers utilized stealth coating technologies, approaching the thrombus problem by camouflaging the catheter in a biomimetic coating." The catheter is available in either a 3.5cm tip stagger or a 7cm tip stagger version, providing reduced recirculation. Press release: New Dialysis Catheter Reduces Thrombus Accumulation... (.pdf) Product page: Duraspan™ Coated Dialysis Catheter ... Duraspan Coated Dialysis Catheter product brochure...... Michael
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VA shuts access to DoD medical records after data errors

Health information interoperability efforts between the Veterans Health Administration and the Military Health System suffered another setback, as the Department of Veterans Affairs cut off access to the Defense Department's AHLTA EMR after VA officials found errors in medical records downloaded from AHLTA.

No patients were injured as a result of the inaccurate data, according to the VA, but "the potential exists for decisions regarding patient care to be made using incorrect or incomplete data," the VA said in a patient-safety alert sent out last Wednesday.

VA officials first discovered problems with the data exchange late last month when a VA clinician found a record in AHLTA indicating that a female patient had been prescribed a drug for erectile dysfunction. NextGov reports that the clinician's query actually had returned the record of another patient. "The VA clinician may see the patient's data during one session, but another session may not display the data previously seen," the VA alert explains. "This problem occurs intermittently and has been reported when querying DoD laboratory, pharmacy and radiology reports."

For more on this computer glitch:
- read this NextGov story
- see the VA's safety alert (.pdf)

Related Articles:
VA, DoD will meet EMR interoperability deadline
Social Security to join VA, DoD interoperability effort

Breath Test Proving Effective for Detection of Pulmonary Tuberculosis

Menssana Research, Inc is touting results from a trial testing its Breathscanner for diagnosing patients with active pulmonary tuberculosis. Menssana has developed technology that may bring breath testing for a variety of conditions, including the already FDA approved breath test for heart transplant rejection. Some details about the technology from Menssana: The Mycobacteria that cause pulmonary TB generate a very distinctive pattern of volatile organic compounds (VOCs) when grown in the laboratory. If these VOCs could also be detected in the breath of infected patients, it might provide a new method for detecting active infection with pulmonary TB. The National Institutes of Health (NIAID) awarded Menssana Research a Phase I SBIR grant to test the feasibility of this idea. We analyzed breath VOCs in hospitalized patients who were being screened for pulmonary TB at New York University Medical Center, New York. We also analyzed the VOCs manufactured by Mycobacteria grown in the laboratory at Saint Vincents Medical Center, New York. We found that breath biomarkers of oxidative stress clearly distinguished between the "sick" hospitalized patients and normal controls. Also, breath VOCs accurately identified the patients whose sputum samples grew Mycobacteria - the VOC biomarkers in breath and in sputum cultures were very similar (see pdf). Based on these encouraging findings, NIH/NIAID awarded Menssana Research a Phase II SBIR grant to validate the breath test for pulmonary TB in a larger multicenter international study performed in San Diego, London, and two sites in the Philippines and Mexico. The results, soon to be published in the journal Tuberculosis showed that the breath test identified active pulmonary TB with 85% accuracy. The US Air Force is currently funding a new study of a point-of-care breath test for active pulmonary TB that delivers results in minutes. Abstract in journal Tuberculosis: Breath biomarkers of active pulmonary tuberculosis Link: Menssaba breath test for pulmonary tuberculosis... Press release: Breath Test for Pulmonary Tuberculosis ... Flashback: The Breathscanner 1.0...... Michael
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Assessing the "True Cost" of Clinical Lab Testing

Dr. Brian Jackson has raised a very interesting discussion topic, the "true cost" of clinical lab testing (see: ARUP Laboratories Launches Three Tools to Promote Cost-Effective Laboratory Testing). This goes to the very heart of the cost-effectiveness of lab testing. Below is an excerpt from the article which is self-explanatory:

According to Brian Jackson, MD, MS, ARUP’s medical director of medical informatics, the true cost of a diagnostic test includes many factors beyond the direct price of performing the test. For example, an apparently inexpensive test, ordered in the wrong clinical setting or at the wrong time, can sometimes lead to expensive follow-up testing and even therapy. “On the other hand, an apparently expensive test might turn out to be cost-saving if it averts costly procedures and/or therapy,” added Jackson. To demonstrate the power of this concept, ARUP has created three calculators for use by the general public. The consequences of improper lab utilization in any one of these areas can have a dramatic impact on patient well-being. They address testing concerns in three important areas:

• Chlamydia trachomatis screening
• Prostate-specific antigen (PSA ) screening in men over 75 years of age
• KRAS-mutation detection in patients with late-stage colorectal cancer

According to Jackson, the calculators address three very different ways in which laboratory testing can impact overall health care costs. “Chlamydia trachomatis testing can be cost-saving, and ordering a more expensive but more sensitive test can be even more cost-saving by reducing hospitalization, disease transmission, and infertility workups. Prostate cancer screening for men over 75 years of age, on the other hand, is unlikely to be cost-saving under any set of assumptions, and the calculator estimates the downstream costs due to biopsies that result from ordering this initially very inexpensive test. Finally, KRAS is an example of a relatively expensive test, which, when used appropriately, can be dramatically cost-saving due to reduction in chemotherapy use.”

I really can't add any comment of value to what has been already stated in this excerpt about the three ARUP calculators. They are very sophisticated and built on the basis of solid research information. Try them to better understand the points that Brian is making above. The effort will be well worth your time.

CMS Clarifies Exchange of Lab Data

The Centers for Medicare and Medicaid Services has issued guidance to clarify that laboratory results may be transmitted via health information exchanges.

ADM X3 Is Stryker's New Mobile Bearing Hip Solution

Active people of all ages, rejoice! On the heels of the New York Times' article about growing concerns associated with metal-on-metal hip implants, Stryker Orthopaedics has announced the release of the ADM X3 Mobile Bearing Acetabular System, a "next-generation technology for hip replacement surgery designed to minimize the risks associated with total hip replacement." The ADM X3 device is based on Stryker's proprietary X3 Advanced Bearing Technology, that features a polyethylene bearing material that has shown, according to the company, "excellent wear characteristics" while preserving mechanical strength of ortho implants. More about the new shiny hip implant: While total hip replacement is one of the most successful surgical procedures performed today, dislocation remains one of the top reported complications. To address dislocation, conventional designs focus on the use of metal-on-metal large head technologies which based on recent studies suggest added risk due to metal ion release. Combining an evolution in design with the only anatomic dual mobility acetabular system and its patented X3 Advanced Bearing Technology, Stryker Orthopaedics Mobile Bearing Hip addresses dislocation without the risk of metal ion release. "By developing an implant that addresses adverse outcomes associated with hip replacement surgery, we are not only helping surgeons to treat their patients more successfully, but we are also striving to reduce global healthcare costs by minimizing surgical complications," said Bill Huffnagle, Vice President and General Manager of Hip Reconstruction at Stryker Orthopaedics. This Mobile Bearing Hip system is made possible due to Stryker Orthopaedics' patented X3 Advanced Bearing Technology which is designed to increase the longevity of the implant. Laboratory tests have shown a 97% reduction in volumetric wear compared to conventional polyethylene. ADM's anatomic design also has the potential to increase mobility and reduce groin pain. Its dual points of articulation help accommodate multi-directional movement, which provide greater range of motion than fixed implant designs based on laboratory testing. In addition, the anatomic cup design has an iliopsoas tendon cut-out aimed at reducing iliopsoas tendon impingement(6), a key cause of post-operative groin pain. Product page: X3 Advanced Bearing Technology... Stryker Hip Replacement Systems... Press release: Stryker's New Mobile Bearing Hip Solution Marks Advancement In Large Head Technology...... Michael
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PEPID Clinical Assistant Now for Android Powered Devices

PEPID, one of the big names in clinical information for mobile devices, is gearing up to release an Android version of its popular software suite. To that end, PEPID is signing up doctors and nurses that are Android users to become beta testers of the new app. We somehow think that our readers are just a perfect audience to do the beta thing. From the announcement: We need your help to test the latest version of our software, designed specifically for the Android scheduled to be released in March. You don't need a current subscription to PEPID to become one of our beta testers, just a current mobile data plan so you can download the product and use certain modules and features. PEPID contains the most extensive drug database on the market today, along with thousands of disease profiles and medical conditions, medical and dosing calculators, a drug interactions checker, illustrations, laboratory values, and a differential diagnosis generator, all of which are available on the Google Android PEPID beta application. Link: PEPID Android Medical Software Beta Test... Press release: PEPID® RELEASES BETA APPLICATION FOR THE GOOGLE ANDROID PHONE ... Flashbacks: PEPID Is Embracing iPhone Platform ; PEPID Expands Support to The Palm Pre... Michael
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Now Mummified Crocs Getting Tomographed

Conservators from Phoebe A. Hearst Museum at UC Berkeley teamed up with Stanford physicists and clinicians to CT scan two Egyptian crocodile mummies that reside at the museum. Strangely, we're not seeing a CT scanner but a Siemens AXIOM Artis clinical fluoroscope in the images. Stanford's SCOPE blog, though, is reporting that the crocs were also put through a physics laboratory CT scanner that produces higher resolution images than clinical ones. From Rebecca Fahrig, a Stanford physicist: The scanner in my lab provides much higher resolution than the clinical CT scanner, on the order of 200 microns instead of 600 microns from the clinical scanner. It is possible to see smaller things using these C-arm CT images than using the clinical CT scanner. The system also provides another advantage - during the scanning process we get to see very high-resolution projection (or 2-D) images of the object being scanned. During the scanning of one of the crocodiles, we noticed something in the projection images from the C-arm system that we had not seen in the clinical CT images - a fish hook. We were then able to do a very high-resolution reconstruction of the fish hook, and see details about the shape and construction of the hook. Read on at SCOPE... More at Inside The Conservator's Art: Wrapping things up: stabilizing a crocodile mummy and CT scanning crocodile mummies at Stanford Flashbacks: 42,000 Year Old Baby Mammoth Gets CT, MRI Scanned ; Computed Tomography Images Ancient Egyptian Mummy; One of The Oldest Medical Mysteries May Have Been Solved; CT Suggests King Tutankhamen Died from an Infected Leg Wound; Siemens CT Scanner Reveals Contents of Bust of Nefertiti... Michael
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Device to Detect Melanoma Through High Resolution Infrared Imaging

Researchers at Johns Hopkins University are testing a new optical system to differentiate normal skin tissue from the more active cancerous variety. Because the skin is most adapt to external optical scanning, this technology of differentiating varying heat regions is thought best for detecting melanoma. From a Hopkins press release: Because cancer cells divide more rapidly than normal cells, they typically generate more metabolic activity and release more energy as heat. To detect this, Herman [Cila Herman, professor of mechanical engineering] uses a highly sensitive infrared camera on loan from the Johns Hopkins Applied Physics Laboratory. Normally, the temperature difference between cancerous and healthy skins cells is extremely small, so Herman and Pirtini devised a way to make the difference stand out. First, they cool a patient’s skin with a harmless one-minute burst of compressed air. When the cooling is halted, they immediately record infrared images of the target skin area for two to three minutes. Cancer cells typically reheat more quickly than the surrounding healthy tissue, and this difference can be captured by the infrared camera and viewed through sophisticated image processing. The current pilot study is designed to determine how well the technology can detect melanoma. To test it, dermatologist-identified lesions undergo thermal scanning with the new system, and then a biopsy is performed to determine whether melanoma is actually present. “Obviously, there is a lot of work to do,” Herman said. “We need to fine-tune the instrument—the scanning system and the software—and develop diagnostic criteria for cancerous lesions. When the research and refinement are done, we hope to be able to show that our system can find melanoma at an early stage before it spreads and becomes dangerous to the patient.” Alani [Rhoda Alani, adjunct professor at Johns Hopkins Kimmel Cancer Center and professor and chair of Dermatology at Boston University School of Medicine], the skin cancer expert, is also cautiously optimistic. “We, at this point, are not able to say that this instrument is able to replace the clinical judgment of a dermatologist, but we envision that this will be useful as a tool in helping to diagnose early-stage melanoma,” Alani said. “We’re very encouraged about the promise of this technology for improving our ability to prevent people from actually dying of melanoma.” The researchers envision a hand-held scanning system that dermatologists could use to evaluate suspicious moles. The technology also might be incorporated into a... Michael
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Mice With Chimeric Human Livers to Help Develop New Therapies

Researchers from Salk Institute for Biological Studies have created a methodology to repopulate the livers of immunodeficient mice with human hepatocytes. The new development should allow researchers to test liver disease therapies on animal models before moving to clinical trials. Salk Institute explains the implications of its human-mice chimeric liver research: Host-pathogen specificity is both a blessing and a curse-preventing widespread infection but making successful treatments harder to find. For example, Hepatitis B and Hepatitis C can only infect humans and chimpanzees, and although this species barrier prevents us from being susceptible to every infection out there, the flipside is that finding treatments for human infections can be extremely difficult. This is particularly true when it comes to liver infections. The usual approach is to grow human cells in a dish, to infect and try to treat them there, but this is not possible with liver cells or hepatocytes. "Human hepatocytes are almost impossible to work with as they don't grow and are hard to maintain in culture," explains senior author Inder Verma, Ph.D., a professor in the Laboratory of Genetics and holder of the Irwin and Joan Jacobs Chair in Exemplary Life Science. And since small animals cannot be infected with Hepatitis C, they cannot be used to test drugs that may cure this disease. What's more, species differences mean that drugs that appear to be effective and non-toxic in animal models sometimes prove to be toxic to humans, and vice versa. Mice whose own hepatocytes have been replaced with human liver cells provide a solution to all these hurdles. Explains Verma, "This robust model system opens the door to utilize human hepatocytes for purposes that were previously impossible. This chimeric mouse can be used for drug testing and gene therapy purposes, and in the future, may also be used to study liver cancers." The Salk team had previously generated a mouse with a partially "humanized" liver, but wanted to improve their method to achieve almost complete transformation. They use a special mouse that has liver problems of its own, but whose problems can be kept in check with a drug called NBTC. Taking away NBTC allows human hepatocytes to take hold and populate the mouse liver with human cells. The team perfected this system so that nearly 95% of the liver cells are of human origin, but the important question was whether they would behave like a human... Michael
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The Toyota Way, LEAN, and Six Sigma: A Possible Achilles Heel

My previous blog notes have been somewhat critical of one aspect of the Lean and Six Sigma approach to lab management. I have no problem with these management techniques as long as they are viewed as only one facet of a total lab management program and do not crowd out other approaches such as strategic planning. Here's a quote from a note I posted last October (see: Some Laboratory Managers Getting Carried Away by Lean/Six Sigma Projects):

...[L]ab personnel who spend most of their time worrying about "how" or "comment" questions may be too involved with improving daily work processes and perhaps avoiding some of the more challenging "why" or "pourquoi" questions....In order to begin to explore some of these strategic "why" questions, it might help to begin with consideration of the four rapidly developing fields that I think will pose the greatest challenges for labs in the upcoming years: (1) molecular diagnostics; (2) information technology; (3) digital pathology; and (4) ultra-fast histology processing. Here's another "why" question. Is your lab a regional or national leader in these four areas?

Toyota's recent car quality issues have put a spotlight on the "Toyota way" and elicited a new set of questions that previously went unanswered when this approach to management and quality was beyond reproach. Here is an excerpt from one article that takes this tack (see: Toyota’s Blind Spot, subscription required)

Comfortably preoccupied with rooting out internal weakness, the Toyota Way is lost when it comes to contending with outside threats. For such an intense system to function properly, employees have to blindly adhere to it; overconfidence is the natural outcome of this arrangement. Yes, any worker is empowered to stop the assembly line because he spots a flaw. But if a flaw does get through, the company as a whole is loath to admit that the system broke down. The drawbacks of the Toyota Way are unique, but the experience of rising to a peak in business, only to suffer a precipitous fall, isn’t. In the early ’90s, America Online leveraged its Everyman attitude toward the intimidating Internet into a dominant position, only to almost destroy itself in a disastrous merger with Time Warner. An aggressive Web pioneer couldn’t sustain innovation while simultaneously being the No. 1 destination for digital media.

All clinical lab executives need to attend to three key aspects of business: operations, strategy, and fiscal management. An effective strategy, in turn, requires attention to the "outside threats" mentioned in the article above. For me and focusing on the practice of surgical pathology, the major current opportunity/threat is digital pathology and the development of in-house histology labs (see: Corrected Definition for a Pod Lab and a Look at In-Office Labs). The latter are being developed by large clinical group practices, usually GI and GU, who then hire pathologists as contractors to diagnose all of the group's small biopsies. Bringing such work inside takes it away from local hospital-based pathologists and also from the for-profit national surgical pathology reference labs.

These two trends are linked in my mind because I believe that these large clinical groups will rapidly adopt digital pathology/telepathology in order to seek the services of reference lab pathologists for their in-house specimens. The groups will process these tissue specimens themselves, retaining the profitable technical component (TC). Such groups have ready access to capital and sophisticated managers. Their managers are paid to maximize practice revenue and will jump on any new technology that provides better margins and a strategic advantage for the group. Hospital-based pathology groups need to move in this same direction.

Dynamic Fluid Device Might Improve Pregnancy Outcomes of IVF

Clinical in vitro fertilization is typically done in a stationary culture dish before the embryo is transferred to the uterus. Researchers from the University of Michigan at Ann Arbor now discovered that motion of the environment where the embryo is growing is an important variable in improving fertilization rates. Using a specially developed microfluidic mechanism that moves around liquid of the growth environment, they were able to significantly increase pregnancy rates in laboratory mice. The device, the creation of which resulted in the formation of Incept BioSystems of Ann Arbor, MI, is now undergoing clinical trials with human embryos. [The] device holds early-stage embryos, which are about half the size of the period at the end of this sentence, in a thimble-sized funnel. The bottom of the funnel is lined with microscopic channels that allow fresh nutrient-rich fluid to flow in and waste products out. The funnel sits on rows of Braille pins that are programmed to pulse up and down, pushing the fluids in and out of the channels. The current the Braille pins generate simulates flows that occurs in the body due to muscle contractions and the motion of hair-like projections called cilia that line the oviducts. In the body, these motions help to push fertilized eggs to the uterus and flush out eggs' waste products. Compared with mouse embryos grown in a static dish, those incubated in the new dynamic device were healthier and more robust after four days. Those grown in static dishes contained an average of 67 cells. Those grown in the new device had an average of 109. Control embryos that had matured in the bodies of mice for the same amount of time had an average of 144 cells. Approximately 77 percent of the rocked mouse embryos led to ongoing pregnancies, compared with 55 percent of the statically-grown embryos. In a control group of mouse embryos conceived naturally and grown within the oviduct, 83 percent led to ongoing pregnancies. Press release: In vitro pregnancy rates improve with new device that mimics motions in the body ... Abstract in Human Reproduction: Dynamic microfunnel culture enhances mouse embryo development and pregnancy rates Link: Incept BioSystems...... Michael
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Ins and Outs

Researchers Discover First Genes for Stuttering... [National Institute on Deafness and Other Communication Disorders] First Blinded Study of Venous Insufficiency Prevalence in MS Shows Promising Results... [Univ at Buffalo] Drug exec to oversee research at Harvard Medical School... [Nature] Health Reform in Limbo, Top Drug Lobbyist Quits... [NYT] Europe 'has no mobile health policy'... [E-Health Europe] ADHD Diagnosis Revision Still Up in the Air... [MedpageToday] Questionable safety practices in nanotechnology labs around the world... [Nanowerk] What doctors need to know about Google Android and Nexus One... [KevinMD.com] SonoSite's Q4 net plunges on flat sales... [MassDevice] Chip maker Zarlink puts big bet on medical sector... [Reuters] German Appeals Court Says CoreValve Devices From Medtronic Do Not Infringe Edwards Lifesciences' Andersen Patent... [Medtronic] Biocartis acquires Philips technology platform for automated DNA/RNA molecular diagnostic testing... [Philips] St. Jude Medical Announces European Launch of USB Cellular Adaptor for Merlin@Home Transmitter... [St. Jude Medical] Broadcom® Bluetooth® Enables Mobile Phones to Keep Track of User's Health... [Broadcom] One in Five Physicians Likely To Purchase an iPad, More than 60 Percent Intrigued By New Device According to Epocrates Survey... [Epocrates] Boston Scientific Rebuts HeartRhythm Article... [Boston Scientific] Stem cell stroke trial gets final approval in UK... [Nature] Female Plasma May Be Better for Transfusions... [MedPageToday] FDA Approves New Indication for Crestor... [FDA] Neuro-Eye therapy recovers sight... [The Engineer] Anorexics Found to Have Excess Fat--In Their Bone Marrow... [Children's Hospital Boston] New Clue Why Autistic People Don't Want Hugs... [Northwestern] Grasping bacterial 'friending' paves the way to disrupt biofilm creation... [Cornell] Virus-free technique enables scientists to easily make stem cells pluripotent, moving closer to possible human therapies... [Stanford] Catching calcium waves could provide Alzheimer's insights... [UCSD] Scientists Control Chemical Reactions of Ultracold Molecules... [NIST] New sensor exploits traditional weakness of nano devices... [Oak Ridge National Laboratory] TED 2010: Death Star Laser Gun Zaps Mosquitoes Dead... [Wired] What goes around... [Boston Globe] Complex smells make food more filling... [New Scientist] Nature investigates: Brain surgery boosts spirituality... [Nature]... Michael
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Normal Lab Values – iPhone Medical app for doctors

Nanoparticles Create Tiny Explosions to Destroy Cancer Cells

New cancer targeting nanoparticles seem like daily news here at Medgadget. Today we have gold nanoparticles developed jointly by researchers at Rice University and A.V. Lykov Heat and Mass Transfer Institute in Minsk, Belarus that create plasmonic nanobubbles when targeted with a laser. These particles can be guided to a tumor by antibodies and then activated to generate tiny explosions, so clinicians one day will be able to stay back and enjoy. The short-lived bubbles are very bright and can be made smaller or larger by varying the power of the laser. Because they are visible under a microscope, nanobubbles can be used to either diagnose sick cells or to track the explosions that are destroying them. In laboratory studies published last year, Dmitri Lapotko and colleagues at the Laboratory for Laser Cytotechnologies at the A.V. Lykov Heat and Mass Transfer Institute in Minsk, Belarus, applied nanobubbles to arterial plaque. They found that they could blast right through the deposits that block arteries. In the current study, Lapotko and Rice colleague Jason Hafner, associate professor of physics and astronomy and of chemistry, tested the approach on leukemia cells and cells from head and neck cancers. They attached antibodies to the nanoparticles so they would target only the cancer cells, and they found the technique was effective at locating and killing the cancer cells. Lapotko said the nanobubble technology could be used for "theranostics," a single process that combines diagnosis and therapy. In addition, because the cell-bursting nanobubbles also show up on microscopes in real time, Lapotko said the technique can be used for post-therapeutic assessment, or what physicians often refer to as "guidance." Press release: Rice physicists kill cancer with 'nanobubbles' More at Nanowerk: Plasmonic nanobubbles combine diagnosis and treatment in one theranostic method... Abstract in Nanotechnology: Tunable plasmonic nanobubbles for cell theranostics Image: Ajda Gregorcic... Michael
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Book Talk: "The Immortal Life of Henrietta Lacks"

Getting human tissue cells to grow in a Petri dish was a long-sought goal of researchers in the early half of the last century. Until Henrietta Lacks, a poor cervical cancer patient, showed up at Johns Hopkins in 1951, it was nearly impossible to study human cell processes in a laboratory environment. The incredible thing about Henrietta Lacks was that cells harvested from her cervical tumor grew and multiplied outside the body with absolute ease. For sixty years now the so-called HeLa cells have been used across the world to study cellular physiology and pathology, to develop and test vaccines and drugs, to learn about radiation risks, and much more. National Public Radio yesterday aired an interview with Rebecca Skloot, author of a new book about the "immortal" Henrietta Lacks, and discussed HeLa cells' impact on her family, science, and the evolution of medical ethics. Rebecca Skloot's essay about Henrietta Lacks from 2000: Henrietta's Dance Link: A STATEMENT FROM JOHNS HOPKINS MEDICINE ABOUT HELA CELLS AND THEIR USE... Image: HeLa cells stained with Hoechst 33258 stain. Wikimedia Commons.... Michael
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Lab-on-a-Chip Sorts Through Virus Specimens at Low Cost

Researchers at Brigham Young University are reporting the development of a microfluidic device that is able to sort individual virus particles based on size. In addition to potentially being used one day in the clinical setting as a diagnosis modality, this technology should provide researchers with high speed sorting of pathogens for laboratory work. The chips work like coin sorters, only they are much, much smaller. Liquids flow until they hit a wall where big particles get stuck and small particles pass through a super-thin slot at the bottom. Each chip’s slot is set a little smaller than the size of the particle to be detected. After the particles get trapped against the wall, they form a line visible with a special camera. Capturing single particles has important applications besides simply knowing if a particular virus or protein is present. “One of the things I hope to see is for these chips to become a tool for virus purification,” said David Belnap, an assistant professor of chemistry and co-author on the paper. He explained that a tool like the BYU chip would advance the pace of his research, allowing him and other researchers to consistently obtain pure samples essential for close inspection of viruses. A huge barrier to making chips that can detect viruses is $100 million – that’s the cost of machinery precise enough to make chips with nano-sized parts necessary for medical and biological applications. The BYU group developed an innovative solution. First they used a simpler machine to form two dimensions in micrometers — 1,000 times larger than a nanometer. They formed the third dimension by placing a 50 nanometer-thin layer of metal onto the chip, then topping that with glass deposited by gasses. Finally they used an acid to wash away the thin metal, leaving the narrow gap in the glass as a virus trap. So far, the chips have one slot size. Hawkins [Aaron Hawkins, professor of electrical and computer engineering at BYU] says his team will make chips soon with progressively smaller slots, allowing a single channel to screen for particles of multiple sizes. Someone “reading” such a chip would easily be able to determine which proteins or viruses are present based on which walls have particles stacked against them. After perfecting the chips’ capabilities, the next step, Hawkins says, is to engineer an easy-to-use way for a lab technician to introduce the... Michael
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Paper Based Sensors and Other Solutions for Cheap Medical Care

At last year's TEDxBoston conference, renowned Harvard chemist George Whitesides discussed the development of paper based diagnostic sensors. The motivation for the research is the fact that current methods of testing sample fluids for disease markers require expensive, and therefore often distant laboratory equipment. Whitesides proposes that a paper sensor, perhaps with some help from a camera phone, can provide sophisticated diagnostics for remote points of care. Flashback: Paper-based Diagnostic Microfluidic Devices... Michael
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Attributes of 21st Century Healthcare Delivery According to Sir Muir Gray

The Dark Daily posted an article recently discussing the attributes that colored the practice of medicine and healthcare delivery during the last century and compared them with the drivers for this century. These ideas were offered by Sir Muir Gray to the attendees at the Frontiers in Laboratory Medicine (FiLM) conference that took place in Birmingham, England (see: Pathologists and Clinical Lab Professionals Urged to Think in “21st Century” Terms). Sir Muir Gray is the Chief Knowledge Officer for Great Britain’s National Health Service (NHS) National Library for Health.

Here's a key quote directly from the article: “In 20th Century Medicine, quality was the term most commonly used to describe the level of service,” explained Gray. “For 21st Century Medicine, value will be more important than quality.” Gray believes value is the term which communicates the worth of a specific health service, because value carries within it the attributes of quality, while addressing the other attributes that convey all the value that meets the expectations and needs of a patient.

1. Doctor centered    
2. Patient as passive complier    
3. Hospital    
4. Bureaucracy    
5. Driven by finance    
6. High carbon    
7. Focused on effectiveness
8. Challenges met by growth
   

21st Century Healthcare

1. Patient centered
2. Patient as co-producer
3. System
4. Network
5. Driven by knowledge
6. Low carbon
7. Focused on value, eliminating waste
8. Challenges met by transformation

I am having a few problems with the words "quality" and "value" because, as noted above, quality is a value. However, if you look at item #7 in the two lists above, it may be possible to achieve clarification. We are moving from an era of effectiveness (doing things right) to an era of efficiency (doing the right things). Both are components of quality care. In addition, many of the other comparisons above are also of great interest to me: Patient as passive complier vs. Patient as co-producer; Driven by finance vs. Driven by knowledge; Challenges met by growth vs. Challenges met by transformation.

I want to return to some of these ideas in the near future, particularly the idea of the patient as a co-producer of care and of improved outcomes. This change is powered by access to knowledge by the healthcare consumer/patient, often via the web. I also believe that this driver will be one of the key elements in reducing the cost of healthcare because, obviously, the consumers/patients do not charge for the services and value that they co-produce for themselves.

Biofunctionalized Nanoparticles Power Microfluidic Early Cancer Detector

Scientists at Fraunhofer Institute for Silicate Research ISC in Würzburg, Germany are developing a microfluidic device that can detect small concentrations of protein cancer biomarkers. The measured concentration of the tumor marker in the blood will help doctors to diagnose the disease at an early stage. Similar testing systems already exist but their measurements are not very precise and they can only detect molecules that are present in the blood in large quantities. What’s more, the tests have to be carried out in a laboratory, which is time-consuming and costly. Biofunctionalized nanoparticles developed by research scientists at the Fraunhofer Institute for Silicate Research ISC in Würzburg are the key element in the new sensor. "We have improved the detection limit compared with the present state of the art by a factor of one hundred," explains Dr. Jörn Probst, Head of the Business Unit Life Science at the ISC. "Whereas previously a hundred molecules were needed in a certain quantity of blood to detect tumor markers, we now need only one. This means that diseases can be diagnosed much earlier than with present methods." But how does the biosensor integrated in the chip register the few biomolecules swimming around in the blood that are indicative of a certain disease? "We have placed antibody-occupied nanoparticles on the sensor electrode which fish out the relevant proteins. For this purpose, we repeatedly pump the blood across the electrode surface. As with a river, the flow is fastest in mid-channel and the water runs more slowly near the bank. We have therefore made a sort of fishing rod using nanoparticles which registers the antibodies in the middle of the blood flow where most proteins swim by per unit of time." If an antibody catches the matching protein, a tumor marker, the electrical charge distribution shifts and this is picked up by the electrode. The researcher groups are now developing a first demonstrator combining four independent single-molecule-sensitive biosensors. The experts are also working on the simultaneous detection of several tumor markers, which will increase the clarity of tests. Press release: Detecting cancer early... Michael
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Magnetic Nanoparticles Latch On, Ferry Cancer Cells Out of Body

A couple years ago researchers from Georgia Tech tested the ability of special magnetic nanoparticles to actually remove cancer cells out diseased tissue of lab mice. Following up on that work, the team recently submitted positive results of a similar experiment performed using human ovarian cancer cells. Although currently still in the laboratory stage of development, the technique may one day help prevent the spread of metastatic cancer cells to healthy and unaffected organs. From the study abstract in Nanomedicine: A majority of ovarian cancer metastases result from the shedding of malignant cells from the primary tumor into the abdominal cavity. Free-floating cancer cells in serous effusions of late-stage ovarian cancer patients may spread to internal organs making effective treatment extremely difficult. Selective removal of ovarian cancer cells from serous fluids may abate metastasis and improve long-term prognoses. We have previously shown that superparamagnetic nanoparticles conjugated to an ephrin-A1 mimetic peptide with a high affinity for the EphA2 receptor can be used to capture and remove cultured human ovarian cancer cells from the peritonea of experimental mice. Here we demonstrate the potential clinical utility of the methodology by in vitro capture and isolation of cancer cells from the ascites fluid of ovarian cancer patients. Press release: Magnetic Nanoparticles Show Promise for Combating Human Cancer Abstract in Nanomedicine: Selective removal of ovarian cancer cells from human ascites fluid using magnetic nanoparticles Image: Nanoparticles, in brown, attach themselves to cancer cells, in violet, from the human abdominal cavity. Credit: Ken Scarberry/Georgia Tech... Michael
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Wii Balance Board Shown To Be a Practical Replacement for Clinical Force Platforms

Force platforms are commonly used by physical therapists for assessing the balance of patients' postures, and for tracking progress of rehabilitation. The devices typically cost thousands of dollars, hence they can be prohibitively expensive for many clinics. To see if clinical measurements can be performed using a cheaper solution, researchers at University of Melbourne tested Nintendo's Wii Balance Board (WBB) against a laboratory-grade force platform (FP), and concluded that the cheaper option can provide results "suitable for the clinical setting". Perhaps the Wii Balance Board can be used for some entertaining exercises when not utilized for posture assessment. From the study abstract: Thirty subjects without lower limb pathology performed a combination of single and double leg standing balance tests with eyes open or closed on two separate occasions. Data from the WBB were acquired using a laptop computer. The test–retest reliability for COP path length for each of the testing devices, including a comparison of the WBB and FP data, was examined using intraclass correlation coefficients (ICC), Bland–Altman plots (BAP) and minimum detectable change (MDC). Both devices exhibited good to excellent COP path length test–retest reliability within-device (ICC = 0.66–0.94) and between-device (ICC = 0.77–0.89) on all testing protocols. Examination of the BAP revealed no relationship between the difference and the mean in any test, however the MDC values for the WBB did exceed those of the FP in three of the four tests. These findings suggest that the WBB is a valid tool for assessing standing balance. Given that the WBB is portable, widely available and a fraction of the cost of a FP, it could provide the average clinician with a standing balance assessment tool suitable for the clinical setting. Abstract in Gain & Posture: Validity and reliability of the Nintendo Wii Balance Board for assessment of standing balance Image credit: serafini (hat tip: NewScientist)... Michael
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A Quick Look at The Status of Smart Pill Technology

The Economist is profiling the latest efforts to develop smart pills that can wirelessly communicate information about the state of their absorption in the GI tract, as well as be designed to deliver a pharmacological load at a precise time and location. We've written about a number of the technologies mentioned in the article, particularly Proteus Biomedical's chip on a pill that Novartis has recently invested in. A snippet from the article: Though Proteus is in the vanguard, it has rivals. Philips, a big Dutch electronics company, has just set up a commercial group to promote its “intelligent pill”, which is able to deliver drugs at precisely the right spot in the digestive tract. MicroCHIPS, an American start-up, is developing smart, implantable microchips which have reservoirs to hold drugs or tiny monitoring devices. John Santini, its boss, says his company is working on drug delivery with a big pharmaceuticals firm, and that his laboratory curiosity will be a commercial reality within three to five years. Terry Hisey of Deloitte, a consultancy, argues that the coupling of smart pills with wireless networks and mobile phones, allowing the information the pills capture to be beamed to doctors, patients and relatives, turns the technology into “a disruptive innovation about to happen”. The Economist: Potential encapsulated... Michael
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BIOFAB Aims to Bring Modular DNA Components to Synthetic Biology Labs

The maturing field of synthetic biology is just about due for a more modular, standardized system of cataloging genetic information. Currently, each research team around the world has to work from scratch to identify and implement relevant components of the genetic assembly process, leading to long development times and escalated costs spent on projects. But things are about to change. Now with funding from the National Science Foundation, Lawrence Berkeley National Laboratory, and the BioBricks Foundation, researchers from Stanford and Berkeley are setting up an "open-source" lab to develop a large set of interchangeable DNA parts. The organizers of the BIOFAB project (International Open Facility Advancing Biotechnology) are taking a lesson from the semiconductor industry that has standardized its production and development cycle to the point where the creation of a new device is essentially a matter of bringing known components together. From a statement by Stanford University: BIOFAB takes its name from the fabrication, or fab, service laboratories established in the early semiconductor industry to make it easier for academic and small industrial labs to design and manufacture small quantities of custom chips. Endy [Drew Endy, PhD, an assistant professor in Stanford's bioengineering department and president of the BioBricks Foundation --ed.] and Arkin [Adam Arkin, PhD, UC-Berkeley professor of bioengineering and head of Synthetic Biology for LBNL's Physical Biosciences Division --ed.] proposed a similar fab lab for biology more than 10 years ago, but only now, Endy said, is the time ripe for an open and cooperative full-scale production facility. Nevertheless, of the estimated 3,500 critical control elements in an E. coli bacterium, fewer than 100 have been seriously studied and characterized. Of the 500-plus promoters listed in current registries, for example, fewer than 50 have been measured, Endy said. BIOFAB is raising additional funds to hire 29 full-time staff who will systematically refine, standardize and characterize the activity of each genetic control element in E. coli, so that large-scale collections of genetic parts can be treated more like standardized components. What the researchers learn in working with E. coli, will then be applied to parts collections in other technologically useful microbes, such as yeast, and used to assemble engineered biological systems. BIOFAB also will promulgate standards for technical and professional practice through application of resources such as the BioBrick Public Agreement, a new legal framework supporting open technology platforms in genetic engineering. To best accomplish its goals, the... Michael
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New Approach Speeds Up Differentiation of Stem Cells

The business of turning stem cells into specific endothelial cells is now a fairly mature field of science, but bringing that knowledge into clinical use requires being able to do this quickly and on a large scale. With the help of green fluorescent protein markers, a group of scientists from a number of US institutions identified a compound that may increase the efficiency of producing endothelial cells 40-fold. Daylon James, a scientist in Rafii’s laboratory, engineered a new line of human embryonic stem cells that produce green fluorescent protein when they become vascular endothelial cells. The label allowed the scientists to rapidly and easily track when the stem cells morphed into this cell type. The researchers bathed the stem cells in a variety of different small molecules and looked for those that resulted in more green cells. They found the most green —and hence vascular endothelial – cells when the stem cells were exposed to a compound that blocks TGF-beta, a growth factor that helps control cell specialization. Blocking TGF-beta at just the right time during cell culturing dramatically increased the number of vascular endothelial cells produced. Previously, the researchers needed to start with five stem cells for every endothelial cell they hoped to generate. But with the new method, starting with five stem cells gave Rafii and his colleagues 40 endothelial cells. “We’ve turned the ratio around,” says James. Most importantly, the cells work. The researchers grew human vascular endothelial cells and injected them into mice. After a week, the new “humanized” cells had assimilated into the mouse circulatory system. The cells still glowed green, allowing the team to pick out the injected cells. In addition, a molecule that sticks to the walls of working blood vessels also stuck to the green cells, suggesting that the new cells functioned normally. Using a small molecule inhibitor of TGF-beta circumvents some problems of testing in humans. Other methods for generating endothelial cells from embryonic stem cells have required factors derived from animals, and because of safety concerns, cells produced in this way are not suited for clinical application. Rafii’s approach, however, avoids the use of animal-derived factors, making it appealing for therapeutic blood vessel formation in patients. Here's a 3D rendering of vessels being formed from newly created endothelial cells: Video: Embryonic stem cell -derived endothelial cells connecting to one another to form primitive vascular tubules... More from Howard Hughes Medical... Michael
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Definiens Takes Advantage of Social Media Sites for Marketing and CME

Dr. Keith Kaplan, who blogs over at Digital Pathology Blog recently alerted us to the fact that Definiens is taking advantage of social media like YouTube and Twitter to market their product as well as educate current and potential clients (see: Definiens on YouTube and Twitter):

Here's a brief description of Definiens copied from its web home page:

Automated Image Analysis: Definiens is the No.1 Enterprise Image Intelligence company. We support customers in analyzing and interpreting images on every scale, from microscopic cell structures to satellite images....At all powers of magnification, our technology enables customers to accomplish every task of image analysis, delivering deeper insights, faster results and better decisions.

I suspect that it's no accident that a relatively small digital pathology company like Definiens has been much quicker than, say, the large in-vitro diagnostic companies like Roche, Beckman Coulter, and Siemens, to understand the value of social media like YouTube and Twitter. I can only speculate about why this is so. Perhaps the executive leadership in the digital pathology companies is younger and more comfortable with the use of the social media. Perhaps they are attracted by the lower cost of viral marketing. Or perhaps they are more aware of the value of the digital videos posted on YouTube because "images" are an essential component of their business.

Webinars are a teaching resource that keep on giving after their initial creation because, as Definiens has quickly learned, they can be recorded and posted on Definiens Life TV for continuing training and eduction purposes. Recall that this is an era in which pathologists and medical technologists can watch YouTube videos at work with their smart phones. What a great opportunity to provide video's, for example, that can provide on-site specific guidance when troubleshooting problems with a laboratory instrument and perhaps avoid a service call.

PEPID Expands Support to The Palm Pre

PEPID, the popular mobile software platform for clinical information, is now available for the Palm Pre smartphone. The platform allows users to purchase data modules specific to their specialty and practice, including drug guides and specialty products for paramedics and medical students. PEPID’s reputable clinical and pharmacological content is designed to support clinicians through every stage of the decision support process, from the initial content, all the way through treatment and follow-up care — increasing patient safety through better-informed patient care. PEPID contains the most extensive drug database on the market today, thousands of disease profiles and medical conditions, medical and dosing calculators, a drug interactions checker, along with numerous illustrations, laboratory values, and a differential diagnosis generator, all available on the Palm Pre. Product page: PEPID for Palm Pre Press release: PEPID RELEASES ITS MEDICAL APPLICATION FOR THE PALM PRE Flashback: PEPID Is Embracing iPhone Platform... Michael
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Forging Stronger Diagnostic Links Between the Predisposition to Disease and Pre-Symptomatic Disease

Genomic testing will sometimes reveal a genetic predisposition to disease for an individual. This is both a strength and a weakness of this laboratory diagnostic approach because the person most frequently does not suffer from the actual disease. By way of contrast, serum biomarkers reveal the presence of disease, sometimes in a very early stage but, of course, provide only an indirect view of the genome (see: Wellness, Preventive Medicine, and the Classic Disease Model). This early stage view of disease provided by biomarkers is sometimes referred to as the pre-clinical or pre-disease stage. An individual exists in a state of wellness until a disease, sometimes in its early stage, is diagnosed. Predictive medicine takes advantage of various clinical lab tests (genomic, proteomic, and biomarkers, for example) to determine where a person falls on this continuous spectrum of wellness and disease. We look to the field of preventive medicine to take advantage of the numerous therapies known to medical science to forestall the onset of a disease or ameliorate its effects once it begins to take hold.

One of the criticisms of genomic testing is that it assesses a consumer/patient's predisposition to disease rather than the presence of early overt disease. Positive genomic test results are frequently a call for watchful waiting until such time as the disease that has revealed itself in the genome begins to manifest itself clinically. It understandable that some physicians and healthcare consumers alike shy away from such testing in that no therapeutic intervention is usually available or warranted as the result of such testing. It would be useful to develop more reliable links or relationships between genomic tests that indicate a predisposition to a disease and defined set of biomarkers that may provide definitive evidence that the early clinical stages of a disease have become manifest and may be treatable.

The need for such links is patently obvious to all physicians. What perhaps may be less obvious is how such links can be developed and then communicated to physicians or even to consumers who may want to take advantage of the genomic testing via the web sites that provide these services. The answer to this question is that a comprehensive set of genomic diagnostic tables need to be published on the web showing how a positive genomic test result can be confirmed by the measurement of individual or sets of serum biomarkers, the latter known as IVDMIAs. For the sake of this discussion, I will refer to such tables as genomic-biomarker interpretation tables (GBITs). Perhaps a reader of this blog can come up with a more suitable name.

The development of such tables is easier said than done because of the wide array of genomic tests and biomarkers that are available in the clinical lab market. Moreover, biomarkers are being described almost on a daily basis but the vast majority of them have never been validated in a clinical setting. Hence, the information that would be provided in such tables will need to be constantly updated. Moreover, such tables also need to be extensively annotated by physicians and lab scientists in order to accurately present the strengths and weakness of any conclusions that can be drawn from the information. The question of exactly what type of organizations would be tasked with the development of such tables will be the subject of subsequent notes. The GBIT authors and maintainers obviously need to be physicians and scientists free of any commercial biases.

Los Alamos' Acoustic Flow Cytometry Going to Market

Life Technologies recently released a flow cytometer, an analyzer to sort through large quantities of cells, that features acoustic focusing technology developed at Los Alamos National Laboratory. The device essentially creates a regulated stream of individual cells, allowing for fast and precise identification of each cell passing in front of the laser. From a LANL press release: The Attune Acoustic Focusing Cytometer is based on a portfolio of intellectual property developed at Los Alamos National Laboratory (LANL), for which Life Technologies holds the exclusive commercial license rights. The field of flow cytometry was originally invented at LANL in the 1960s. The Bioscience Division at LANL currently is home to the National Flow Cytometry Resource (NFCR), a center for the development and application of flow cytometry technology. From the product page: With the Attune™ instrument, you can control your sample concentration, the flow rate, the number of photons you detect, the length of your experiment, the number of samples you run, and more. Offers small footprint to fit in any lab and on all standard lab benches Accommodates standard tissue culture hoods for convenient aseptic work Provides a “greener” solution due to low sheath Eliminates need for a separate fluidics cart with fluidics on-board Includes change-it-yourself optical filters Offers added convenience by locating filter holder under the lid Provides violet and blue laser combination for choice of six analysis colors Here's a company promo video for the Attune cytometer: Press releases: Attune Acoustic Focusing Cytometer Brings Technology Developed at LANL to the Marketplace...; Applied Biosystems Debuts Industry's First Acoustic Flow Cytometer... Product page: Attune Acoustic Focusing Cytometer...... Michael
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Studies of Internal Brain Connections Point to Cause of Autism

The underlying physiological causes of autism continue to remain a mystery, but new research is helping to narrow down the field. Scientists at Children's Hospital Boston have been studying the brains of humans and mice with tuberous sclerosis complex, a rare disorder related to autism, and have discovered that during axon formation the nerve fibers seem to have difficulty in finding correct connection points to link to in the brain. Studying a well-characterized axon route--between the eye's retina and the visual area of the brain--Sahin [Mustafa Sahin, MD, PhD, of Children's Department of Neurology] and colleagues showed that when mouse neurons were deficient in TSC2, their axons failed to land in the right places. Further investigation showed that the axons' tips, known as "growth cones," did not respond to navigation cues from a group of molecules called ephrins. "Normally ephrins cause growth cones to collapse in neurons, but in tuberous sclerosis the axons don't heed these repulsive cues, so keep growing," says Sahin, the study's senior investigator. Additional experiments indicated that the loss of responsiveness to ephrin signals resulted from activation of a molecular pathway called mTOR, whose activity increased when neurons were deficient in TSC2. Axon tracing in the mice showed that many axons originating in the retina were not mapping to the expected part of the brain. Although the study looked only at retinal connections to the brain, the researchers believe their findings may have general relevance for the organization of the developing brain. Scientists speculate that in autism, wiring may be abnormal in the areas of the brain involved in social cognition. "People have started to look at autism as a developmental disconnection syndrome--there are either too many connections or too few connections between different parts of the brain," says Sahin. "In the mouse models, we're seeing an exuberance of connections, consistent with the idea that autism may involve a sensory overload, and/or a lack of filtering of information." Supporting the mouse data, a study by Sahin and his colleague Simon Warfield, PhD, in the Computational Radiology Laboratory at Children's, examined the brains of 10 patients with TSC, 7 of whom also had autism or developmental delay, and 6 unaffected controls. Using an advanced kind of MRI imaging called diffusion tensor imaging, they documented disorganized and structurally abnormal tracts of axons in the TSC group, particularly in the visual and social cognition areas of the brain (see... Michael
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HISPC Reports on State Health Information Law, Business Practice and Policy

The Office of the National Coordinator for Health Information Technology (ONC) has made available a compendium of reports which detail variations in state health information law, business practices and policy related to privacy and security of health information and the electronic exchange of health information.

The reports were developed in 2009 as a part of the ongoing efforts of the Health Information Security and Privacy Collaboration (HISPC) that started in 2006 when I had the the opportunity to work on the initial round of HISPC work as it related to West Virginia. The efforts by HISPC was to take a national look (at a state level) on the privacy and security challenges faced by the variation of state laws, policies and practices.

The reports will be a great resource for those who regularly look at state health information legal issues. Following are the summaries of the five reports along with links to the various tables/appendices:

• Report on State Medical Record Access Laws This report analyzes state laws that are intended to require health care providers (specifically, medical doctors and hospitals) to afford individuals access to their own health information and to identify potential barriers to the electronic exchange of health information. Specific state law provisions examined: scope of medical records to which patients are afforded access, format of information furnished, deadlines for responding to requests, fees for furnishing copies, record retention laws and access to records of minors.
• Report on State Law Requirements for Patient Permission to Disclose Health Information In Phase I of the HISPC project a majority of participants reported significant variation in the business practices and policies surrounding the need for and process of obtaining patient permission to use and disclose personal health information for a variety of purposes, including for treatment. This report furthers the initial work of this project by collating and analyzing state laws that govern the disclosure of identifiable health information for treatment purposes to identify commonalities and differences.
• Releasing Clinical Laboratory Test Results: Report on Survey of State Laws For this report, state statutes and regulations were analyzed to determine to whom clinical laboratories may release test results. This report focused on clinical laboratory and hospital licensing laws (that contain standards for hospital laboratories). It also examined general state medical record access laws to determine whether they provided an avenue for patients to access their clinical laboratory results directly.
• Report on State Prescribing Laws: Implications for e-Prescribing This report identifies and analyzes the impact and variation of state laws related to e-prescribing. The report addresses state laws related to the e-prescribing of controlled and non-controlled substances as well as topics such as record keeping and content requirements, out-of-state prescriptions, and generic substitution laws.
• Perspectives on Patient Matching: Approaches, Findings, and Challenges This report analyzes various approaches to matching patients to their health information in the context of electronic health information exchange. Current and potential methods for matching patients to their health records are discussed, challenges to performing patient matching such as scalability and ease of use are analyzed, and the types of information some HIOs use to match patients to their health records is described.

Sleep contribution to motor memory consolidation: a motor imagery study

Sleep contribution to motor memory consolidation: a motor imagery study.

Sleep. 2009 Dec 1;32(12):1559-65

Authors: Debarnot U, Creveaux T, Collet C, Doyon J, Guillot A

STUDY OBJECTIVES: Sleep is known to enhance performance following physical practice (PP) of a new sequence of movements. Apart from a pilot study, it is still unknown whether a similar sleep-dependent consolidation effect can be observed following motor imagery (MI) and whether this mnemonic process is related to MI speed. DESIGN: Counterbalanced within-subject design. SETTING: The laboratory. PARTICIPANTS: Thirty-two participants. INTERVENTIONS: PP, real-time MI, fast MI, and NoSleep (control) groups. MEASUREMENTS AND RESULTS: Subjects practiced an explicitly known sequence of finger movements, and were assigned to PP, real-time MI, or fast MI, in which they intentionally imagined the sequence at a faster pace. A NoSleep group subjected to real-time MI, but without any intervening sleep, was also tested. Performance was evaluated before practice, as well as prior to, and after a night of sleep or a similar time interval during the daytime. Compared with the NoSleep group, the results revealed offline gains in performance after sleep in the PP, real-time MI, and fast MI groups. There was no correlation between a measure of underestimation of the time to imagine the motor sequence and the actual speed gains after sleep, neither between the ease/difficulty to form mental images and performance gains. CONCLUSIONS: These results provide evidence that sleep contributes to the consolidation of motor sequence learning acquired through MI and further suggests that offline delayed gains are not related to the MI content per se. They extend our previous findings and strongly confirm that performance enhancement following MI is sleep dependent.

Pathology Informatics 2010; Merged APIII/LITS Conference to Launch in September

The two major general pathology informatics conferences in the U.S. over the past nearly three decades, APIII and Lab InfoTech Summit (LITS), will merge into a single event this September with a new name -- Pathology Informatics 2010. The former event that has been held in Pittsburgh for the past 14 years and the latter in Lab Vegas for the past six. Lab InfoTech Summit was a direct descendant of APIII that was presented in Ann Arbor for 21 years prior to the transition to Las Vegas.

The new, merged conference will convene at the Westin Copley Place hotel in Boston on September 19-22, 2010. On Sunday, September 19, a set of three workshops will be offered, one focusing on advanced informatics presented by the Association for Pathology Informatics (API) and a second on specialized imaging presented by Histology Image Analysis group (HIMA). The third will be the Informatics Boot Camp workshop designed as an intensive immersion in the field for novices.

The plenary conference, beginning on Monday, September 20, and adjourning at noon on Wednesday, September 22, will consist of three simultaneous and parallel tracks: Applied Pathology Informatics, Advanced and Experimental Pathology Informatics, and Pathology Imaging. A series of plenary lectures by nationally known figures in the field will punctuate these three tracks. This first track will closely replicate the Las Vegas LITS conference and the second will be similar to past APIII offerings. Digital pathology, one of the most exciting new trends in pathology, will be the sole focus of this third track. The Pathology Informatics 2010 web site will go live in about a month with more details.

Meanwhile, the conference planning committee has been actively recruiting exhibitors for Pathology Informatics 2010 and their efforts have met with great success. The following 20 companies have already committed to participation in the event and the planning committee expects to receive commitments from about an additional ten companies by the end of this month:

Apollo PACS, BioImagene, Cerner, Dawning Technologies, Elekta Impac Software, General Data, Halfpenny Technologies, IVD Industry Connectivity Consortium (IICC), Lifepoint Informatics, McKesson, MITEM (Blue Iris), Orchard Software, Psyche Systems, SCC Soft Computer, Siemens Healthcare Diagnostics, Sysmex America, Sunquest, Technidata Medical Software, Telcor, and Voicebrook.

Be sure to get Pathology Informatics 2010 into your calendars now. This blog will provide you with additional details about the event as soon as they become available.

Could India-Based Wipro GE Healthcare Compete in the U.S. EMR/LIS Market?

I recently received an email from Birlamedsoft, a vendor of an on-line LIS located in India, promoting the sale of its software to U.S. clients. Below is an excerpt from that message:

Birlamedisoft....,the Healthcare software Development Company, has pleasure to launch completely web based Online Diagnostics Centre/Laboratory Management Software today. We are No 1. Company in India providing LIMS/LIS software, having sold more than 10,500 LIS/LIMS software in the market. In today’s diagnostics world, online software is the only software for managing diagnostics centre /laboratories efficiently. There are many benefits of the online LIS software, some of them are given below.

• Can create any types of reports in Hematology, Biochemistry, Histopathology with pictures, Serology and any other tests in pathology.
• Can create any types of reports in Radiology Ultra-sound, X-ray, CT scan, MRI, Color Doppler and any other tests in radiology.
• Can create any other tests like ECG, TMT, Stress Test, and many more!!!
• All reporting is done online. You can do Lab reporting, Billing, Accounting, Inventory.
• You can open many numbers of branches and collection centers.
• You can operate software from any where, any time, 24*7 in real time using Internet.

This email piqued my curiosity about whether an Indian vendor of an on-line LIS could gain any traction in the U.S. market, particularly for physician office labs (POLs) and small hospital labs. I contacted an executive of a large U.S, lab software company and put this same question to him. He thought that a company like Birlamedsoft would have little chance competing with established U.S.-based incumbents like Orchard Software for the small lab business. Secondly, he asserted that switching clients from their current LIS vendor would require the conversion of their databases, which is both technically challenging and labor-intensive. However, my source also suggested that one Indian healthcare software company that might be successful in the U.S. market would be Wipro, which has now merged with GE Healthcare in India. Below is an excerpt from that announcement (see: Wipro GE Healthcare a single entity):

Wipro GE Healthcare, a joint venture between Wipro and GE's healthcare business, ...announced that all the standalone units and plants of GE Healthcare in India would be integrated into a single entity and it will be called as Wipro GE Healthcare. This amalgamation will simplify the structure through consolidation of GE Healthcare's life sciences and medical diagnostics business units and X-Ray manufacturing plants. Both Wipro and GE said that the planned move would help in effective management, resource mobilization and accelerating the development for GE Healthcare, the $17 b healthcare business of General Electric (GE), through Wipro GE Healthcare's large sharing network.

I will do another note on this same topic later, but an interesting entry point for a company like Wipro GE Healthcare into the U.S. healthcare software market could be inbound and outbound medical tourism. The notion of reverse or inbound medical tourism is partly embedded in the goals of the so-called destination programs that are being established in U.S. major medical centers (see: "Destination Programs" at Large Medical Centers).

Study Looks Into Potential Side Effects of Terahertz Full Body Scanner Technology

As new government directives are now mandating full body (terahertz) scanning (or pat down searches) of our private parts on all US inbound flights, a recent research article in arXiv points to potential negative health effects from the new technology. Terahertz waves penetrate non-conducting material like clothing, but then they deposit energy in the skin. Now researchers at the Center for Nonlinear Studies at Los Alamos National Laboratory have shown that terahertz radiation may be able to do some serious damage to the DNA it encounters when bouncing off your body Physics arXiv Blog explains: Alexandrov [Boian Alexandrov at the Center for Nonlinear Studies at Los Alamos National Laboratory in New Mexico --ed.] and co have created a model to investigate how THz fields interact with double-stranded DNA and what they've found is remarkable. They say that although the forces generated are tiny, resonant effects allow THz waves to unzip double-stranded DNA, creating bubbles in the double strand that could significantly interfere with processes such as gene expression and DNA replication. That's a jaw dropping conclusion. And it also explains why the evidence has been so hard to garner. Ordinary resonant effects are not powerful enough to do do this kind of damage but nonlinear resonances can. These nonlinear instabilities are much less likely to form which explains why the character of THz genotoxic effects are probabilistic rather than deterministic, say the team. More at Physics arXiv Blog... Full article in arXiv Biological Physics: DNA Breathing Dynamics in the Presence of a Terahertz Field... Michael
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Device Helps Adjust Artificial Legs for More Natural Walking Gait

The New York Times is profiling a novel leg prosthesis fitting technology that helps automate a process that is currently very much a manual affair. The Compas from Orthocare Innovations out of Oklahoma City is a wireless device that attaches to the prosthetic leg and constantly monitors its movement, sending data back to a computer for software analysis. From NYT: Doug Bourgoyne has been trying the Compas system for the last few months at the Raymond G. Murphy V.A. Medical Center in Albuquerque, where he is clinical supervisor of the orthotics and prosthetics laboratory. The metal plate looks like a standard metal plate used within a prosthesis, he said, “but it is smarter.” The plate has silicon strain gauges to measure forces going through the prosthesis, said David Boone, the chief technology officer at Orthocare, and electronics to convert the information to digital form and memory so measurements can be stored. The diagnostic module that is attached to the plate in the prosthesis during office visits contains a laser to project a line on the floor as the patient walks, and a gyroscope that measures the rotation of the limb, Dr. Boone said. Each module can be used with multiple patients. Here's a fairly involved video demonstrating the use of the system: Read on at the New York Times... Product page: Compas...... Michael
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ARRA EHR Stimulus Bill Benefits

In the press release I wrote about in my previous CCHIT certification post, they had a nice summary list of the meaningful use requirements as we know them today:
• Allow patients to access clinical information
• Comply with state and federal privacy, security and data sharing regulations
• Document patient progress and provide clinical summaries
• Exchange critical information with other care providers
• Implement drug interaction safeguards
• Send patient reminders about follow-up and preventive care
• Submit immunization and laboratory data to relevant public health registries
• Use computerized physician order entry systems to transmit prescription

Interestingly, this is what I think many doctors consider meaningful use of an EHR:
• Lower costs
• Increase revenue
• Lower charting time
• Oh yes, and better patient care

A bit of a generalization, but you get the point. The good news is that the benefits in my list are possible with an EMR. It’s just that the HITECH stimulus money may or may not promote those benefits.

Related posts:

1. Problems with ARRA EMR Stimulus Money I recently read a Healthcare IT article that talks about...
2. All I Want for Christmas is ARRA EHR Stimulus Answers One of my favorite bloggers, Will Weider, had a nice...
3. Myth: EHR Stimulus Bill Requires Doctors to Use EHR and Be Interoperable There are a bunch of myths being perpetuated right now...

Calorie Restriction Extends Lifespan of Normal Cells and Inhibits Atypical Cells

I have always been intrigued by the well-documented observation in lab animals that caloric restriction increases longevity, at least in lab rats. It would be interesting to isolate the physiologic basis for this observation that could lead to other less rigorous dietary interventions to produce this same effect. A recent article provides some hints about progress in this direction with a bonus about a possible mechanism to suppress the proliferation of atypical cells (see: Calorie Intake Linked To Cell Lifespan, Cancer Development). Below is an excerpt from it:

So, in a preliminary way, it now appears that restricting the consumption of dietary sugar extends the life of cultured lung cells and inhibits the growth of atypical (i.e., precancerous) cells. In a previous note, I commented about the "toxicity" of four chemicals/foods that we common are exposed to: sugar, fat, nicotine/tar from cigarettes, and ethyl alcohol (see: Federal Tax on Soda Pop Proposed: Can This Be Justified?). There are a number of good reasons to shun these substances. However, I was under the impression when I wrote this note that the ill effects of sugar ingestion, for example, was the result of obesity and altered circulating enzyme levels rather than any effects of the sugar on genes.

It's also interesting that, at least in this study, the observed effects of the sugar were mediated by telomerase and P16 that code for an enzyme and protein associated with aging and cell growth. The anti-aging movement will be a major driver for the clinical lab industry (see: Anti-Aging Medicine as a Major Driver of Complex Lab Testing) so it's important for lab professionals to pay attention to any research that is published in this area. I have also commented in the past about how leukocyte telomere length has been used as a measure of physical activity (see: Leukocyte Telomere Length as a Measure of Physical Activity).

DNA Used to Control Nanostructure Configurations

Researchers at Brookhaven National Laboratory have adapted DNA strands as switching mechanisms for organizing nanoparticles into specific structures. This ability to switch between different nanostructure configurations may allow for the creation of biosensors and nanodevices that can perform specific tasks within the body. The scientists achieved the goal of responsiveness by creating structures where the distance between nanoparticles could be carefully controlled with nanometer accuracy. In their previous studies, the scientists used single strands of DNA attached to individual nanoparticles as linker molecules. When the free ends of these DNA strands had complementary genetic code, they would bind to attach the particles. Constraining the interactions by anchoring some of the particles on a surface allowed the scientists to reliably form a variety of structures from two-particle clusters (called dimers) to more complex 3-D nanoparticle crystals. In the new work, the scientists have added more complicated double-stranded DNA structures. Unlike the single strands, which coil in uncontrollable ways, these double-stranded structures are more rigid and therefore constrain the interparticle distances. Additionally, some of the strands making up the double-stranded DNA molecules have complicated structures such as loops, which pull the bound particles closer together than when both strands are exactly parallel. By varying the type of DNA device, between looped and unlooped strands, and measuring the interparticle distances using precision techniques at Brookhaven’s National Synchrotron Light Source (NSLS) and at the Center for Functional Nanomaterials (CFN), the scientists demonstrated that they could effectively control the distance between the particles and switch the system from one state to another at will. The approach resulted in two-configuration, switchable systems both in dimers and nanocrystals, with a distance change of about 6 nanometers — about 25 percent of the interparticle distance. By comparing kinetics in the two systems, they found that the switching between states is faster in the simpler, two-particle system. The dimers also retain their ability to return to their initial state more precisely than the 3-D crystals, suggesting that molecular crowding may be an issue to further investigate in the 3-D materials. Press release: Switchable Nanostructures Made with DNA... Abstract in Nature Nanotechnology: Switching binary states of nanoparticle superlattices and dimer clusters by DNA strands... Michael
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Buy will Boost Abbott's Lab Services

Abbott Laboratories, a manufacturer of pharmaceuticals and medical equipment, will acquire laboratory information management systems vendor STARLIMS Technologies Ltd. for $123 million in cash. The companies expect the acquisition to close during the first quarter of 2010.

More Speculation About the Value and Feasibility of an IVD Managed Cloud-LIS

In a recent note, I speculated about a possible strategy that Abbott executives may be pursuing relating to their purchase of Starlims (Abbott Acquires Starlims; Speculation About a Future Direction for the Product). In the note, I made the following observation:

...I think that it's possible that Abbot has the following scenario in mind as a long-term goal: sell to clinical labs, as an integrated package, analytic instruments, reagents, and test result management supported by a cloud-based LIS/LIMS. Pricing would be on a per-click or taxi-meter basis. This would be the first PaaS offering for the clinical lab industry.

For the sake of this discussion, I will refer to the integrated environment provided by an IVD vendor (lab testing plus a web-based LIS) as a cloud-LIS. One of the key questions pertaining to the practicality of such an environment is whether the reports generated by such a system are "integratable" into the workflow and database of a classic LIS running locally in that same lab. This new model will receive little attention in the market absent such functionality. To get an answer for this question, I turned to my colleague Dr. Ulysses Balis who is Director of Pathology Informatics in the Department of Pathology, University of Michigan Medical School. Here is his response:

Firstly and looking at the internal Starlims relational architecture, it is clear that the architects have elected to employ modern, best-practice programming and structural approaches including the use of XML, constrained name spaces (probably utilizing ISO-11179), and service oriented architecture (SOAs) to deliver a highly interoperable LIMS platform. Such a starting point represents an optimal minimal set construct for leveraging the significant asset-tracking requirements of the growing menu of molecular diagnostics tests. Specifically, features present in this environment and not present in the typical LIS environment include the need for expanded and real-time tracking for the entire range of test kits available in the market in addition to simply tracking work-center results. LIMS architectures are generally well-suited to this task and provide, additionally, workflow automation, bar code tracking, chain of custody, and domain-specific decision support tools for enhanced reporting. Consequently, limitations on the integration of LIS-cloud-generated test results into a hospital LIS data architecture are largely mitigated, if not completely removed, in the setting of several specific but common XML approaches.

The use of a constrained XML schema, in association with a LIMS-provided .XSLT file and a constrained name space, allow the purchaser to map the result data stream from the LIMS application into a legacy hospital-based LIS without resorting to the traditional HL7 multi-step approach. This latter method is typically associated with multiple developmental iterations and changes. It would thus appear, at a strategic level, that Abbott’s acquisition of Starlims may represent a practical strategy for rapid adoption of sophisticated molecular reporting capability without the requirement of extensive hospital LIS modifications. Moreover, it can also be expected that the final integration of the two disparate architectures will yield reports that are indistinguishable from those of a hospital LIS designed as a seamless solution. For this reason, we should expect the field of laboratory information systems to increasingly depend on XML, service oriented architectures, and the interoperability features that these technologies provide beyond currently available traditional HL7-based tools.

Given that test results generated in an IVD-vendor cloud LIS can be easily and rapidly integrated into the database and reporting capabilities of a traditional hospital-based LIS, the next question is why such a "package" would be appealing to a clinical lab director and IVD vendor alike. I will return to this question in future notes, but here's a brief answer to this question. In molecular, genomic, and proteomic testing, it is important that testing not be constrained by any limitations of hospital-based LISs. With a cloud-LIS, both lab test workflow and interpretation algorithms (i.e., rules) can be changed quickly and on-the-fly. This is one of the fundamental advantages of such a specialized web-based system. In essence, the "tyranny of the outdated or inadequate LIS" ceases to be a limiting factor for lab managers. This approach moves the goal line for molecular diagnostic testing from the quality of individual test results to the quality of the diagnoses rendered in the cloud and reported to clinicians.

Advanced Photon Source Used to Study Insect Survival Techniques During Freezing

Scientists from the University of Western Ontario used the Advanced Photon Source at Argonne National Laboratory to study why some insects survive being frozen while others do not. The researchers used the massive X-ray machine to specifically learn why Drosophila melanogaster dies when frozen while its close relatives do not. An assistant professor in Western’s Department of Biology, Sinclair explains that the physical processes of ice formation seem to be consistent among species that do and don’t survive freezing. However, it seems that the insects that survive freezing have some control over the process of ice formation. They freeze at consistently higher temperatures than those that don’t. Sinclair says this implies that the main adaptations required to survive freezing are at the cellular or biochemical level, rather than because of fundamental structural differences. “We’re comparing Chymomyza amoena, an insect native to Ontario that survives freezing, with Drosophila melanogaster, because they’re very close relatives,” says Sinclair. “The idea is to find the magic bullet which allows some bugs to survive freezing and some don’t. That’s the goal here.” Abstract in PLoS ONE: Synchrotron X-Ray Visualisation of Ice Formation in Insects during Lethal and Non-Lethal Freezing More here: The how and why of freezing the common fruit fly... Image source: Wikimedia Commons... Michael
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Bacteria Turn Microgears for Micropower Production

Researchers from Northwestern University, Princeton, and Argonne National Laboratory used bacteria swimming in liquid to turn tiny gears suspended in the same medium. Various gear designs have already been developed (side image) that can harness the power of the bacteria. We recently reported on a project out of the University of Rome that has achieved what seems like the same feat. If it proves to be practical, this technology may one day power implantable medical microdevices. The microgears, just 380 microns long with slanted spokes, are produced in collaboration with Northwestern University and placed in the solution along with the common aerobic bacteria Bacillus subtilis. Andrey Sokolov of Princeton University and Igor Aronson from Argonne, along with Bartosz A. Grzybowski and Mario M. Apodaca from Northwestern University, observed that the bacteria appeared to swim at random—but occasionally the organisms collided with the spokes of the gear and began turning it in a definite direction. A few hundred bacteria work together in order to turn the gear. When multiple gears are placed in the solution with the spokes connected as in a clock, the bacteria will turn both gears in opposite directions, causing the gears to rotate in synchrony—even for long stretches of time. The speed at which the gears turn can also be controlled through the manipulation of oxygen in the suspended liquid. The bacteria need oxygen in order to swim, and by decreasing the amount of oxygen available, researchers can slow down the gears' movement. Eliminating the oxygen halts the movement entirely. Once the oxygen is reintroduced into the system, the bacteria “wake up” and begin swimming once again. Press release: Argonne scientists use bacteria to power simple machines Flashback: Scientists Enslave Bacteria to Power Tiny Microsized Motor... Michael
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App Links Results to Smart Phones

Systems integrator Halfpenny Technologies Inc. has introduced software to enable physicians to access laboratory, pathology and radiology reports via iPhone, BlackBerry or Android-powered smart phones.

FDA Rushes Approval for New H1N1 PCR Test

While we're still waiting for the fabled sensitive, specific and fast point-of-care H1N1 test, here is a step in the right direction. You see, the burden of H1N1 is felt far beyond those stricken with the disease -- every day, hundreds if not thousands of patients with infections (that may or may not be swine flu) wait in US emergency departments while their inpatient bed assignments are determined by the results of a slow, unreliable swab test. Do they need an isolation bed? They'll wait hours to find out, and the results may not even be that accurate. But the FDA is helping the situation along, with this recent announcement: DxNA announced today that the United States Food and Drug Administration (FDA) has granted Emergency Use Authorization (EUA) for its 2009 H1N1 influenza virus diagnostic test for use in DxNA's GeneSTAT(TM) detection platform. The new platform enables fast detection of the 2009 H1N1 influenza virus with a portable device weighing less than 10 pounds. In the United States, an Emergency Use Authorization (EUA) is a legal means for the FDA to authorize new medical devices or drugs during a declared public health emergency. "This new diagnostic test has the potential to significantly reduce the impact of 2009 H1N1 influenza by allowing for testing under appropriate laboratory conditions achievable even in a local hospital setting," says Phillip H. Grimm, President and Chief Executive Officer of DxNA LLC. The small and lightweight kit works as a module in the GeneSTAT system, a portable tabletop instrument about the size of a coffee machine. More from DxNA (which is a terrific name for a company that makes DNA diagnosis equipment)... Demo video of the DxNA's GeneSTAT system:... Nicholas
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Micromachine Sensor Distinguishes Type of Coronary Plaque

University of Southern California researchers are using a MEMS (microelectromechanical systems) device to distinguish between stable and unstable atherosclerotic plaques in coronary arteries. If this technology survives clinical trials, we might see in the future a new generation of angio catheters, preloaded with MEMS devices, that will help us to distinguish between stable patients and those that are prone to develop coronary thrombosis and myocardial infarction. The same system could also be used for diagnosis and treatment of peripheral vascular atherosclerotic disease. The MEMS system uses minute heat perturbations as a proxy for blood flow and detects changes in bulk resistance for plaque characteristics. The lab has demonstrated that this sensor can make the distinction between stable and unstable plaque in laboratory examinations of specimens of plaque clogged arteries extracted from rabbits fed a special plaque-producing diet. Another configuration of the same sensors can measure the forces on the artery walls produced by blood flows, identifying spots where back currents may be promoting plaque formation. The next step will be to embed the MEMS sensors into angiogram catheters, and show that they can accurately make the same distinctions, first in animals, then in human subjects. USC press release: Stable Plaque or Heart Attack Plaque? BME Researcher Builds New Sensor to Tell Which is Which...... Michael
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Not a Joke: Exciting New Medical Device Planned

Recently the satirical news source, The Onion, ran a piece entitled "New Device Desirable, Old Device Undesirable" which poked fun at modern press releases and analyst assessments, and never bothered to name or describe the device. Today we came across a real life press release that, if we didn't know better, could have been ripped from the pages of The Onion. The Solutions Group has joined forces with CrowleyJones to study the feasibility of an exciting new medical device. What product is planned? How does it work? Who will benefit? What other products have been made by these folks? Absolutely none of these questions are addressed: Terry Jones, Managing Director of CrowleyJones, stated, "Solutions Group has presented an innovative solution to a medical problem with a significant market for us. We look forward to working with them on this proof the concept stage, and to moving on to the engineering and manufacturing of the product." Sean O'Neil, Solutions Group CEO, stated, "It is exciting to work with this experienced team on this new medical device." We'd excerpt the whole release, but while there's more text, there's precious little additional substance. One hint is below: Due to the complexity of the technology, SGI will be working closely with Dr. Steven Robert Biegalski {PRIVATE}, P.E., Director; Nuclear Engineering Teaching Laboratory at The University of Texas at Austin, to ensure the success of the project. Hmm... whatever this mysterious project involves, it requires a nuclear scientist for success! Perhaps there's a reason for all this vagueness and secrecy (but, of course, not enough of a reason to scuttle the press release altogether...) Image: Whatknot... Nicholas
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Experimental System Aims to Help Astronauts Return to Solid Footing

Researchers from NASA Johnson Space Center Neurosciences Laboratory and National Space Biomedical Research Institute are testing a new system that may make astronauts' return to Earth a bit easier. If you've ever seen space travelers land back on terra firma after months in orbit, you must have noticed that they are usually carried by others or use wheelchairs. This happens because over time our sensory system forgets how to coordinate using gravity as one of the inputs. The new system may end up being used on spacecraft to keep astronauts from forgetting how to walk when gravity comes back to them. Called an Adaptability Training System, the treadmill has a projection screen in front of it that shows an image of a room or hallway that moves as the user walks. Disturbances are simulated by tilting the treadmill in one direction as the image is tilted in another. “At first, people find it difficult to walk on the treadmill since its movement and images are out of sync. But over time, they learn to walk on it efficiently. We call this concept ‘learning to learn,’” said Bloomberg, who is the associate team leader of NSBRI’s Sensorimotor Adaptation Team and a senior research scientist at NASA. In addition to maximizing training efficiency, Bloomberg is looking at how long the benefit of the adaptability training lasts. Once subjects master the treadmill, they come back periodically for testing to see how well they perform. He is investigating if subjects can retain the training for up to six months, which would allow the training to take place before a long space mission. Another goal of the researchers is to integrate a version of the system into the treadmill on a spacecraft, allowing astronauts to perform adaptability training on long missions. Integration would save space and power, both precious commodities on a spacecraft. Full story from the National Space Biomedical Research Institute: Astronaut balancing act: Training to help explorers adapt to a return to gravity...... Michael
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