Newswise — People with epilepsy experience uncontrolled seizures that can impair quality of life and cause stigma that leads to social isolation. The neurological condition can limit some activities most people take for granted, such as sustaining work or operating a vehicle. Researchers at the University of Pennsylvania and funded by the National Institute of Biomedical Imaging and Bioengineering (NIBIB) have developed a non-invasive brain imaging technique for a class of patients whose epilepsy symptoms do not respond to drug treatment and who would otherwise be poor candidates for seizure-relieving surgeries. Epilepsy affects approximately 65 million people worldwide. Seizure-controlling medications are ineffective in approximately one third of these patients. Alternatively, doctors can perform surgery to remove the source of the seizures, which often is a lesion, or scarring, within the brain. Conventional imaging procedures, such as magnetic resonance imaging (MRI) and positron emission tomography (PET) help surgeons identify and remove brain lesions. Approximately one third of those with drug-resistant epilepsy, however, do not have lesions that conventional brain imaging can detect. Now, researchers report a new specialized imaging technique that can trace the location of seizures that are not detected with conventional MRI or PET. The imaging technique, known as glutamate chemical exchange saturation transfer (GluCEST), was developed in the laboratory of senior author Ravinder Reddy, Ph.D., a professor of radiology and director of the University of Pennsylvania’s Center for Magnetic Resonance and Optical Imaging. The work is reported in the October issue of Science Translational Medicine. “This non-invasive MRI technique images distinct patterns and changes in glutamate levels in brain structures that could be indicative of neurological disorders” explains Richard Conroy, Ph.D., director of the NIBIB Division of Applied Science and Technology. “The research team is pursuing the tracking of glutamate because it is a key amino acid involved in transmitting signals between neurons, making it a potential marker for identifying the region of the brain where abnormal firing of neurons could cause epileptic seizures.” Normally, glutamate acts as an excitatory signal that relays messages through the brain and then quickly dissipates. In previous studies, researchers showed that glutamate does not dissipate in animals and humans with epilepsy, resulting in a build-up of glutamate that causes overstimulation and the onset of seizures. The specialized MRI technique relies on unique chemical properties of glutamate that permit water molecules surrounding the chemical to be visualized at a very high resolution. The increased signal from the surrounding water molecules indicates increased levels of glutamate. The researchers studied how GluCEST imaging detects glutamate in the hippocampus. The hippocampus is a bilateral area of the brain involved in spatial navigation and the conversion of short-term thoughts into long-term memories. Seizures often originate in the temporal lobes of the brain, which include the right and left halves of the hippocampus. In four patients with drug-resistant epilepsy, GluCEST imaging enabled the researchers to detect consistently higher levels of glutamate in the side of the hippocampus where the epileptic seizures originated. The researchers confirmed the results with electroencephalography, which identifies the side of the brain emitting irregular waves as a seizure is occurring. In 11 healthy individuals tested for comparison, the GluCEST signal for glutamate was the equivalent, or normal, in either side of the hippocampus. “The demonstration that GluCEST can localize hot spots of increased glutamate is a promising step towards improved treatment,” says Kathryn Davis, M.D., an assistant professor of neurology at the Perelman School of Medicine at the University of Pennsylvania and lead author of the study. “Finding the epileptic foci in a specific brain region gives clinicians critical information to guide targeted therapies that have the potential to control seizures in patients that currently do not have treatment options.” The researchers are optimistic that the GluCEST imaging technique offers patients the possibility for expanded epilepsy treatments, which could include surgery or laser ablation therapy. Neurostimulation—electrical stimulation similar to therapy for patients with Parkinson’s disease—may also be able to reduce abnormal excitation that produces erratic movements and seizures. The research was supported by the National Institutes of Health through a grant (EB015893) from NIBIB and a grant from the National Institute of Neurological Disorders and Stroke. Additional funding was provided by a McCabe Pilot Award and a University of Pennsylvania Center for Biomedical Image Computing and Analytics Seed Award.
Newswise — EUGENE, Ore. -- Nov. 11, 2015 -- University of Oregon scientists have found that strength in numbers doesn't hold true for microbes in the intestines. A minority population of the right type might hold the key to regulating good health. The discovery, based on research using zebrafish raised completely germ free, is reported in a paper published in the Nov. 11 issue of Cell Host & Microbe. The findings provide a path to study the function of each bacterial species in the gut and to eventually, perhaps, predict and prevent disease, says lead author Annah S. Rolig, a postdoctoral researcher in the UO's Institute of Molecular Biology. In the project, researchers watched for immune response as isolates of species of bacteria, normally associated with healthy zebrafish, were introduced one at a time and in combination into previously germ-free intestines of the fish. In a telling sequence, one bacterial species, Vibrio, drew numerous neutrophils, which indicated a rapid inflammatory response in one fish. Another species, Shewanella, inserted into a separate germ-free fish barely attracted an immune response. In a third germ-free fish, both species were introduced together and assembled with a ratio of 90- percent Vibrio to 10-percent Shewanella. The inflammatory response in the third fish was completely controlled by the low-abundance species. "Until now, we've only been able to capture proportional information, like you'd see displayed in a pie graph, of the makeup of various microbiota, in percentages of their abundance," Rolig said. "Biologists in this field have typically assumed an equal contribution based on that makeup." Low counts of a bacterial species generally have been discounted in importance, but slight shifts in the ratios of abundant microbe populations have been thought to have roles in obesity, diabetes and inflammatory bowel diseases such as Crohn's disease. That thinking is now changing, Rolig said. "The contribution of each bacterium is not equal. There is a per-capita effect that needs to be considered." The keystone - an important participant that functions to regulate a healthy microbiota - may reside in low-abundant bacterial species. The research team found through additional scrutiny that these species secreted molecules - for now unidentified - that allowed them to dampen the immune response to the whole community. "Now we've shown that these minor members can have a major impact. If we can identify these keystone species, and find that in a disease state one species may be missing, we might be able to go in with a specific probiotic to restore healthy functioning," said Rolig, who also is a scientist in the National Institutes of Health-funded Microbial Ecology and Theory of Animals Center for Systems Biology, known as the META Center, at the UO. To develop a model to capture per-capita contributions of microbes in a population, Rolig and her co-authors -- biology graduate student Adam R. Burns, microbiologist Brendan Bohannan of the Institute of Ecology and Evolution and biologist Karen Guillemin, director of the META Center -- turned to UO physicist Raghuveer Parthasarathy. His math-driven model, detailed in the paper, provides formulas that predict collective inflammatory responses of combinations of bacteria. "I'm really proud of this paper because it exemplifies an achievement of one of the major goals of the META Center for Systems Biology, namely to provide a predictive model of how host-microbe systems function," Guillemin said. "This experimental and modeling framework could be readily generalized to more complex systems such as humans, for example to predict disease severity in individuals with inflammatory bowel disease based on the pro-inflammatory capacity of their gut microbes as assayed in cell culture." ### The National Institutes of Health supported the research through grants P50GMO98911 to support the META Center, IF32DK098884 for a postdoctoral fellowship to Rolig and P01HD22486 that supports the UO's zebrafish facility. Sources: Annah S. Rolig, postdoctoral research associate, UO Institute of Molecular Biology, 541-346-5999, firstname.lastname@example.org, and Karen Guillemin, professor of biology and director of the META Center for Systems Biology, 541-346-5360, email@example.com Note: The UO is equipped with an on-campus television studio with a point-of-origin Vyvx connection, which provides broadcast-quality video to networks worldwide via fiber optic network. There also is video access to satellite uplink and audio access to an ISDN codec for broadcast-quality radio interviews.
Newswise — Women with apple-shaped bodies – those who store more of their fat in their trunk and abdominal regions – may be at particular risk for the development of eating episodes during which they experience a sense of “loss of control,” according to a new study from Drexel University. The study also found that women with greater fat stores in their midsections reported being less satisfied with their bodies, which may contribute to loss-of-control eating. This study marks the first investigation of the connections between fat distribution, body image disturbance and the development of disordered eating. “Eating disorders that are detected early are much more likely to be successfully treated. Although existing eating disorder risk models comprehensively address psychological factors, we know of very few biologically-based factors that help us predict who may be more likely to develop eating disorder behaviors,” said lead author Laura Berner, PhD, who completed the research while pursuing a doctoral degree at Drexel. “Our preliminary findings reveal that centralized fat distribution may be an important risk factor for the development of eating disturbance, specifically for loss-of-control eating,” said Berner. “This suggests that targeting individuals who store more of their fat in the midsection and adapting psychological interventions to focus specifically on body fat distribution could be beneficial for preventing eating disorders. The study, titled “Examination of Central Body Fat Deposition as a Risk Factor for Loss-of-Control Eating,” was published in the American Journal of Clinical Nutrition. Berner is now a postdoctoral research fellow at the Eating Disorders Center for Treatment and Research at UC San Diego Health. Michael R. Lowe, PhD, a professor in Drexel’s College of Arts and Sciences, was a co-author, along with Danielle Arigo, PhD, who was a postdoctoral research fellow at Drexel and is now an assistant professor of psychology at the University of Scranton; Laurel Mayer, MD, associate professor of clinical psychiatry at the Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute,; and David B. Sarwer, PhD, professor of psychology in Psychiatry and Surgery at the Perelman School of Medicine at the University of Pennsylvania as well as director of clinical services at the Center for Weight and Eating Disorders. Mounting evidence suggests that experiencing a sense of loss-of-control during eating – feeling driven or compelled to keep eating or that stopping once one has started is difficult – is the most significant element of binge-eating episodes regardless of how much food is consumed, according to the researchers. “This sense of loss of control is experienced across a range of eating disorder diagnoses: bulimia nervosa, binge eating disorder and the binge-eating/purging subtype of anorexia nervosa,” said Berner. “We wanted to see if a measurable biological characteristic could help predict who goes on to develop this feeling, as research shows that individuals who feel this sense of loss of control over eating but don’t yet have an eating disorder are more likely to develop one.” “This sense of loss of control is experienced across a range of eating disorder diagnoses: bulimia nervosa, binge eating disorder and the binge-eating/purging subtype of anorexia nervosa,” said Berner. “We wanted to see if a measurable biological characteristic could help predict who goes on to develop this feeling, as research shows that individuals who feel this sense of loss of control over eating but don’t yet have an eating disorder are more likely to develop one." Using a large dataset that followed female college freshman for two years, the researchers preliminarily investigated whether body fat distribution is linked to body dissatisfaction over time and increases risk for the development or worsening of loss-of-control eating. The nearly 300 young adult women completed assessments at baseline, six months and 24 months, that looked at height, weight and total body fat percentage and where it’s distributed. Participants, none of whom met the diagnostic criteria for eating disorders at the start of the study, were assessed for disordered eating behaviors through standardized clinical interviews in which experiences of sense of loss of control were self-reported. In this sample, the researchers found that women with greater central fat stores, independent of total body mass and depression levels, were more likely to develop loss-of-control eating and demonstrated steadier increases in loss-of-control eating episode frequency over time. Women with a larger percentage of their body fat stored in the trunk region were also less satisfied with their bodies, regardless of their total weight or depression level. The findings indicate that storage of body fat in trunk and abdominal regions, rather than elsewhere in the body, is more strongly predictive of loss-of-control eating development and worsening over time, and that larger percentages of fat stored in these central regions and body dissatisfaction may serve as maintenance or exacerbation for loss-of-control eating. “Our results suggest that centralized fat deposition increased disordered eating risk above and beyond other known risk factors,” said Berner. “The specificity of our findings to centralized fat deposition was also surprising. For example, a one-unit increase in the percentage of body fat stored in the abdominal region was associated with a 53 percent increase in the risk of developing loss-of-control eating over the next two years, whereas total percentage body fat did not predict loss-of-control eating development.” According to Berner, more research is needed to explain the mechanism behind these findings, though she speculates that there are a number of reasons why this might happen. “It’s possible that this kind of fat distribution is not only psychologically distressing, but biologically influential through, for example, alterations in hunger and satiety signaling,” she said. “Fat cells release signals to the brain that influence how hungry or satiated we feel. Our study didn’t include hormone assays, so we can’t know for sure, but in theory it’s possible that if a centralized distribution of fat alters the hunger and satiety messages it sends, it could make a person feel out of control while eating.” The findings may apply to other disordered eating behaviors beyond loss-of-control eating, but more research is needed. “Body fat distribution hasn’t been studied in disorders characterized by binge-eating behaviors as much as it has in anorexia nervosa,” said Berner. “The participants in our sample didn’t develop eating disorder diagnoses within the two year period that we studied them, but this study suggests that future research should investigate whether individuals with greater central fat stores are more likely to develop bulimia nervosa and binge eating disorder."
The Great American Smokeout is coming up on Thursday, Nov. 19, and Fred Hutchinson Cancer Research Center psychologist Dr. Jonathan Bricker is available to discuss the latest research-based smoking-cessation strategies. Even though, according to the Centers for Disease Control and Prevention, there are 5 million fewer adult cigarette smokers in the U.S. today than there were a decade ago, many still struggle with this lethal addiction, which claims 480,000 American lives annually. Bricker’s cutting-edge research could revolutionize smoking cessation for the millions of people who struggle to quit. He and his team at Fred Hutch are building smoking-cessation programs around an innovative approach – called acceptance and commitment therapy, or ACT – and delivering them through a variety of modalities, from group therapy to Web-based tools to a commercially available smartphone app called SmartQuit, which is free to residents of Washington state. Unlike traditional quit-smoking approaches, which focus on willpower and avoiding one’s urges to smoke, ACT focuses on increasing one’s willingness to accept the physical, mental and emotional challenges of quitting while also encouraging commitment to engage in values-based behavior change. For more about ACT, see his TEDxRainier talk, “The Secret to Self Control.” Preliminary research shows that Bricker’s programs are 50 to 300 percent more effective than traditional approaches to quitting smoking, and evidence suggests that the ACT model could help adults cope with many other addictions and harmful behaviors. In addition to ACT, Bricker can address all aspects of smoking cessation: motivation to quit, dealing with triggers or urges to smoke, developing a plan of action, relapse prevention, dealing with weight gain concerns, addressing anxiety and depression in the context of quitting smoking, the future of smoking cessation programs and who will need them most in the future. Bricker, an associate member of the Public Health Sciences Division at Fred Hutch, has served as principal investigator or co-investigator on a variety of National Institutes of Health-funded research projects and has received more than $14 million in federal research funding to study ACT. He has published 58 peer-reviewed scientific articles and serves as the senior editor of ADDICTION – the highest impact scientific journal on the topic of substance abuse. He received his Ph.D. in clinical psychology from the University of Washington, where he is an affiliate faculty member.
Newswise — RPB-supported researchers have made a significant discovery that might lead to the delay or prevention of the most common cause of blindness in the elderly: age-related macular degeneration (AMD). Patients who take the drug L-DOPA (for Parkinson Disease, Restless Legs or other movement disorders) are significantly less likely to develop AMD and, if they do, it is at a significantly later age. "There are only limited and highly invasive therapies for those with AMD and no known preventative treatment," said Brian S. McKay, PhD, Department of Ophthalmology and Vision Science, University of Arizona. "Our findings imply that L-DOPA may be repurposed to prevent or delay AMD." Here's how the multi-institution team of scientists made the discovery. The investigators had been conducting basic research into albinism, which causes profound vision loss and changes in the structure of the eye, especially the retina, and specifically the macula, the area of the retina that is associated with central vision lost in AMD. The retina pigment epithelium is a critical support layer of tissue in the retina that fosters macula development and keeps it healthy through L-DOPA signaling. L-DOPA is made in pigmented tissues, and it has been known for a long time that lower risk for AMD is associated with darker pigmentation; Blacks have a five-fold lower risk for AMD than Whites. The researchers postulated that signaling through the L-DOPA receptor may underlie racial disparities in AMD incidence. To test this, they examined the health records of 37,000 patients at the Marshfield Clinic for individuals with AMD, or those taking L-DOPA, or those with both AMD and taking L-DOPA. In patients who were given L-DOPA before being diagnosed with AMD, their AMD was diagnosed 8 years later than those not taking L-DOPA. These results were then confirmed in a much larger data set of 87 million patients, and the study was expanded to include prevention and delay of "wet" AMD, the most devastating form of the disease. "Developing a new drug costs more than $2 billion and takes 13.5 years from discovery to market. Drug repositioning does not require anywhere near those costs," said lead author Murray Brilliant, PhD, Director at the Center for Human Genetics at the Marshfield Clinic Research Foundation. "Our methods illustrate the power of precision medicine research -- using the electronic medical records of large numbers of patients -- to test unexpected drug interactions and find new uses for old drugs." "The results suggest a new path forward in our fight against AMD that may even include a strategy to prevent those at risk of the disease from ever developing it," McKay said. "In the end, L-DOPA may not be the drug that ends the disease, but the pathway identified here is likely to be a key observation as the search for a cure continues." This work was supported by Translational Sciences, The National Human Genome Research Institute, Research to Prevent Blindness, Bright Focus, The Edward N. & Della L. Thome Memorial Foundation, the Wisconsin Genomics Initiative, National Eye Institute, the Marshfield Clinic and the University of Arizona.
Newswise — Vampires may want your blood for the sake of their longevity, but have you ever wondered why your doctor is also interested in it? Well, unlike the vampire who draws blood for his own benefit, a doctor is interested in your blood for the good of your health. “Blood carries many secrets about your health,” says Karen Rizzo, MD, 2015 president of the Pennsylvania Medical Society and a practicing physician in Lancaster. “Through your blood, physicians can have a better understanding of your health as blood tests can help find potential problems early.” One such problem that worries physicians is heart disease. And, through blood tests, physicians can look inside your body to learn if you’re at risk or not. So, it’s not unusual for a physician to order a lipid panel to measure total cholesterol and triglycerides. It’s a common test given to determine the risk of heart disease. The total cholesterol is divided into two subclasses, which are called high-density lipoprotein (HDL) and low-density lipoprotein (LDL). Science has proven that the lower your LDL, triglycerides, and total cholesterol, the lower your risk of heart disease. People with heart disease tend to have elevated cholesterol, especially LDL and triglycerides. “Cholesterol is important piece of your health puzzle,” says Pennsylvania Academy of Family Physicians President Nicole Davis, MD, who practices in Wyncote. “Keeping it in check and under control can lead to longer, healthier lives, while abnormal numbers can be traced to serious issues like heart attack and stroke.” In Pennsylvania it’s no laughing matter. According to the Pennsylvania Department of Health, heart disease is the number one killer of Pennsylvanians. Stroke ranks up there too and is the third leading cause of death in women, and fifth for men. On an average day in 2010, there were 86 deaths due to heart disease and 18 deaths due to stroke. For that year, 31,274 Pennsylvanians died due to heart disease, representing 25.3 percent of all deaths. In that same year, 6,629 or 5.4 percent of deaths in Pennsylvania were the result of a stroke. Certain blood tests are also used to detect signs of cancer, although patients should not jump to conclusions if their physician orders a cancer blood test. Diagnosing a patient can be a process of elimination to find exactly what is wrong. But a complete blood count (CBC) is a common blood test that a doctor may recommend to help diagnose leukemia and lymphoma. It may also be used with current cancer patients to see if cancer has spread to bone marrow or to determine how a person is handling treatment. Most recently, Science Translational Medicine, a medical journal from the American Association for the Advancement of Science, published an article that reported a new blood test could help detect a relapse of breast cancer. This blood test uses a technique called mutation tracking and has been making national headlines. “It’s exciting to learn of these types of advancements, and as we’ve known for many other diseases, blood can tell us a lot about a patient,” says Margaret A. O’Grady, RN, MSN, OCN, who is currently president of the Pennsylvania Society of Oncology & Hematology. According to state statistics from the Pennsylvania Cancer Incidence and Mortality 2012 Executive Summary, there were 10,652 cases of female breast cancer in Pennsylvania. Another blood test is the prostate-specific antigen (PSA) blood test. This test is used to look for warning signs of prostate cancer; however, this detection test can’t fully tell a physician if a man has cancer. But, if the results are at a level that may be of a concern to the physician, this test could lead to a physician to order a biopsy. According to Cancer Facts and Figures, Pennsylvania 2014, prostate cancer was the third most common cancer in the Keystone State behind lung and breast. Fortunately, the age-adjusted rates of prostate cancer in Pennsylvania as well as the country showed a decreasing trend from 2001 to 2011 while the Pennsylvania rate was lower than the national rate. “It’s very clear that early detection plays an important role in beating any type of cancer,” says O’Grady. “Blood tests can and do play a role in early detection for many patients of certain types of cancer.” For those planning to have a baby, expect your physician to also be interested in your blood during pregnancy. For pregnant women, a blood test might be used to monitor potential problems such as anemia, or diagnosis of possible infections such as toxoplasmosis. Toxoplasmosis is harmless to the pregnant woman, but it may cross the placenta and cause harm to the baby. “It’s important for a mother-to-be to pay close attention to their health during pregnancy,” says Kurt T. Barnhart, MD, FACOG, who is currently the chair of the Pennsylvania Section of the American Congress of Obstetricians and Gynecologists. “Women should see their physician throughout pregnancy for the safety of both themselves and their baby,” says Dr. Barnhart, who practices in Philadelphia. “Blood tests can be expected periodically.” Finally, when it comes to blood, the Pennsylvania Medical Society says community members should consider becoming blood donors. According to the organization, there’s no substitute for human blood and one pint of donated blood could save as many as four lives. This news release is brought to you by the Pennsylvania Health News Service Project, consisting of 21 Pennsylvania-based medical and specialty associations and societies. Members of PHNS include Pennsylvania Allergy & Asthma Association, Pennsylvania Dental Association, Pennsylvania Academy of Dermatology & Dermatologic Surgery, Pennsylvania Academy of Ophthalmology, Pennsylvania Academy of Otolaryngology, Pennsylvania Academy of Family Physicians, Pennsylvania American Congress of Obstetricians and Gynecologists, Pennsylvania Chapter of the American College of Cardiology, Pennsylvania Chapter of the American College of Emergency Physicians, Pennsylvania Chapter of the American College of Physicians, Pennsylvania Chapter of the American Academy of Pediatrics, Pennsylvania Medical Society Alliance, Pennsylvania Medical Society, Pennsylvania Neurosurgical Society, Pennsylvania Orthopaedic Society, Pennsylvania Psychiatric Society, Pennsylvania Society of Anesthesiologists, Pennsylvania Society of Gastroenterology, Pennsylvania Society of Oncology & Hematology, Robert H. Ivy Society of Plastic Surgeons, and Urological Association of Pennsylvania. Inquiries about PHNS can be directed to Chuck Moran via the Pennsylvania Medical Society at (717) 558-7820, firstname.lastname@example.org, or via Twitter @ChuckMoran7.
Newswise — ANN ARBOR, Mich. — If you don’t have health insurance, or your insurance coverage still leaves you with big bills, hospitals are supposed to let you know if you qualify for free or reduced-price care, and to charge you fairly even if you don’t. That is, if they want to keep their tax-free nonprofit status under the Affordable Care Act’s new Section 501(r) rules. But a new study from the University of Michigan Institute for Healthcare Policy and Innovation finds many nonprofit hospitals have room to improve. Writing in the October 29 issue of the New England Journal of Medicine, the researchers report results from their review of Internal Revenue Service forms submitted by more than 1,800 nonprofit hospitals nationally. They looked at records for 2012, the first year hospitals had to comply with the ACA’s requirements and the most recent year for which data were available. A mixed bag of findings IHPI post-doctoral fellow Sayeh Nikpay, Ph.D., MPH and IHPI director John Z. Ayanian, M.D., MPP, call hospitals’ performance “far from perfect”. Their key findings: • Nearly all (94 percent) of the hospitals reported having a written charity care and emergency care policies, to guide them on deciding which patients could get free or reduced-price care. Though the ACA doesn’t tell hospitals which patients to offer discounts to, or how generous to be, it does say they must have such policies and make them known. • Only 29 percent of the hospitals reported they had begun charging uninsured and under-insured patients the same rate that they charged private insurers or Medicare. Such rates are often far lower than the “chargemaster” rates hospitals set as the starting point for negotiating with insurers about how much they will actually accept. • Only 42 percent of the hospitals reported they were notifying patients about their potential eligibility for charity care before attempting to collect unpaid medical bills. The ACA requires such notifications to give patients a chance to apply to get some or all of their costs written off. • One in five hospitals had not yet stopped using extraordinary debt-collection steps when patients failed to pay their medical bills. Such steps, such as reporting patients to credit agencies in ways that can damage their credit scores, placing liens on their property or garnishing their wages, are now banned. • Hospitals in states that have not expanded Medicaid reported having less generous charity care policies, and were less likely to have a policy about notifying patients of charity care options before they left the hospital. In general, patients have to be poorer to get free or discounted care in these states than in states that have expanded Medicaid. • Only 11 percent of hospitals reported having conducted a community health needs assessment in the past three years as of 2012. Such assessments, to identify pressing health issues in the population they serve, don’t necessarily affect charity care. Playing by the rules? Nonprofit hospitals are exempt from paying most taxes, which was valued at $24.6 billion in 2011. In return, they must justify their nonprofit status to the IRS each year by showing how much care they write off for those who cannot pay. When Congress wrote the ACA, they sought to use the tax tools available to them to reduce hospitals’ use of aggressive methods to pursue payment, and perhaps to prevent individual bankruptcies or credit score damage caused by medical bills. Though hospitals had to report for tax year 2012, the federal government did not issue final language about exactly how to comply and penalties for non-compliance until 2014. Nikpay and Ayanian will continue to study the issue as new IRS data become available. They are already working on 2013 data. “Hospitals are generally complying with the part of the rules that require they establish charity care policies and publicize them, but this may not impact the amount of charity care they provide,” says Nikpay, who is also a visiting scholar at the University of California, Berkeley. “So far, it appears many aren’t complying with the part of the rules that could increase their charity care.” Ayanian, a professor at the U-M Medical School with joint appointments in public policy and public health, says physicians and patients should familiarize themselves with policies at their hospitals. “Financial protection for patients is an under-recognized component of the ACA, and it’s important that hospitals are required to have policies, that they disclose these policies, and that they enable people to apply for help in a timely way,” he says. “This will be most important for patients living in states that have not expanded Medicaid to cover people with lower incomes. Hospitals in those states will likely experience additional demand for charity care because they now need to publicize their charity care policies and comply with other IRS provisions.” With these added requirements, hospitals may start to pull back on how generous they make their charity care policies – and Section 501(r) of the ACA does not set standards for that, Nikpay notes. As more Americans enroll in insurance plans that have high deductibles, they may find they need to ask for financial relief after a hospital stay. Even a single person earning $40,000 a year, or a family of four with an income of $80,000, might qualify for discounted care from many hospitals. Reference: New England Journal of Medicine, DOI: 10.1056/NEJMp1508605
Newswise — Women need to maintain good health years before they become pregnant. After all, healthy women are most likely to give birth to healthy babies. A web-based app, www.healthymomshra.com, can now help women gauge the level of their health and learn what changes they can make to enhance not only their own wellbeing, but also the health of any babies born to them in the future. “Our goal with the app is to encourage good health practices in women so they will be healthy for pregnancies, planned or unplanned,” said Adam T. Perzynski, PhD (Twitter: @ATPerzynski), director of the Patient Centered Medical Lab, and a sociologist with the Case Western Reserve University School of Medicine and MetroHealth Center for Health Care Research and Policy team, that developed the Healthy Moms Health Risk Assessment prototype at www.healthymomshra.com. Much infant mortality can be traced to low birth weight or early gestational birth age of newborns, which is often related to the poor health of the mother. The developers of the web-based app sought to help women reverse the major risk factors that negatively affect them in the categories of health habits, social support, driving safety, substance use, tobacco use, mental health, physical health, environmental risks, ethnicity, age and neighborhood of residence. The online Healthy Moms Health Risk Assessment features a user-friendly test where each question, regardless of a yes or no answer, is greeted with encouraging, helpful tips across the categories of health risks. All answers are based on Centers for Disease Control and Prevention (CDC) guidelines firmly grounded in scientific evidence. The test concludes with a report of the woman’s individual health risk in the categories. The report is color coded from green to red, so the more green the report, the better the test-taker’s health. “The main difference with this app is that it focuses on the preconception phase rather than exclusively on pregnant women,” Perzynski said. “Up to 50 percent of pregnancies are unplanned, so it’s important that a woman engage in healthy behaviors to prepare for the fact that she might become pregnant at some point.” Armed with latest wellness information from CDC for women, the Case Western Reserve team used flexible and scalable cloud-based computing environment to develop an app that would provide immediate, useful answers and offer a summary scorecard. The Healthy Moms Health Risk Assessment app was so impressive that it won an honorable mention at the recent Cleveland Medical Hackathon competition where the Case Western Reserve team vied with other teams to develop the best innovation to address an unmet health care need. “In many cases, mothers have health issues before they become pregnant, and those health issues can be challenging to resolve once they are pregnant,” Perzynski said. “We tailored our app to help women consider how health behaviors, activities and social circumstances might affect the health of a baby should a pregnancy happen, with the goal of empowering women to make healthy choices.”
Newswise — A new study in mice by researchers at Fred Hutchinson Cancer Research Center has found that a specialized type of immunotherapy — even when used without chemotherapy or radiation — can boost survival from pancreatic cancer, a nearly almost-lethal disease, by more than 75 percent. The findings are so promising, human clinical trials are planned within the next year. The study, led by Drs. Sunil Hingorani and Phil Greenberg, both members of the Clinical Research Division at Fred Hutch, tested the immunotherapy on mice genetically engineered to grow pancreatic tumors very similar to those of human pancreatic cancer. The mouse model, developed by Hingorani, already has led to a first-in-humans clinical trial that is showing early promise in some patients with advanced pancreatic cancer. Pancreatic cancer is notoriously difficult to treat, said Hingorani, because it recruits the body’s natural systems to construct both a tough physical barrier around tumors as well as an immune-cloaking device that keeps other, disease-fighting immune cells from recognizing the cancer. Unlike any other cancer, pancreatic tumors are able to survive with a significantly decreased blood supply. As a consequence, chemotherapy, commonly administered via the bloodstream, has a difficult time getting inside. The tumors not only commonly grow quite large before patients will ever notice something is wrong, but they are very prone to metastasize, or spread to other sites in the body. The investigators’ new study, published Thursday in Cancer Cell, breaches pancreatic cancer’s physical and immunological walls by using immunotherapy, a type of treatment that harnesses or refines the body’s own immune system, to recognize and destroy cancer cells. The researchers devised a therapy using T cells, disease-fighting immune cells, that they engineered in the lab to recognize and attack pancreatic cancer. T-cell therapy is showing promise as a treatment for several types of blood cancers, based on early results from Fred Hutch and other research centers, but aiming these cells at solid tumors like pancreatic cancer has historically proven more difficult, Hingorani said. Part of the challenge comes from the access to tumor cells — or lack thereof. T-cell therapy is administered through the bloodstream, like chemo. It’s easy enough to see why solid tumors may present more of a challenge to treat with this kind of immunotherapy than blood cancers such as leukemia and lymphoma. The researchers didn’t think the engineered T cells would stand a chance against pancreatic cancer on their own. But they needed somewhere to start, Greenberg said. But to their surprise, the T cells — engineered to recognize and kill cells bearing a protein called mesothelin, which is overproduced by virtually all pancreatic tumors — got into the mice’s tumors and started attacking them. In the mouse model of the disease — which is actually slightly more aggressive than the human version, Hingorani said — animals that received T cells engineered to recognize a non-cancerous protein survived on average 54 days after their cancer became detectable. Those that received the mesothelin-directed cells lived an average of 96 days, a 78 percent bump. Although the researchers weren’t expecting to take this first version of the T-cell therapy to clinic, that’s now their plan. Their team has already built the human version of the special T-cell protein that recognizes mesothelin. They’re planning to launch a phase 1 clinical trial to test the therapy’s safety in patients with advanced pancreatic cancer within the next year. “As best we can tell, this would be a better therapy than anything that exists for pancreatic cancer right now,” Greenberg said. “It’s hard to be this optimistic without ever having treated a pancreatic cancer patient with this [therapy], but the biology of what we’re doing looks so remarkably true and good.” The study was funded in part by the National Institutes of Health, the Giles W. and Elise G. Mead Foundation and Juno Therapeutics.
Newswise — Bethesda, Md. (October 20, 2015)—Resistance and endurance exercises affect the body very differently. These differences suggest that adapting to exercise involves many processes, but scientists have observed that one gene in particular, peroxisome proliferator-activated receptor-gamma coactivator PGC-1α, controls many of them. New research in Physiological Reports shows that although both resistance and endurance exercises activate the PGC-1α gene, the adaptation processes stimulated are not the same and depend on the type of exercise. Proteins run the body: They turn processes on or off or speed them up or slow them down. The body has many different proteins, and the instructions to make them are written on sections of DNA, referred to as genes. Different genes code for different proteins, but different proteins can also come from the same gene. Called isoforms, these proteins are produced when only part of the gene’s code is read. The PGC-1α protein turns on other genes. Several studies have shown that isoforms of PGC-1α exist and that the isoform produced depends on the exercise. In this new study, researchers at the University of Jyväskylä in Finland comprehensively examined the isoforms present shortly after exercising and the genes those isoforms turned on. Samples were taken from the thigh muscles of healthy men after they performed high-intensity resistance exercises or moderate-intensity endurance exercises. The researchers found that both endurance and resistance exercises produced isoforms PGC-1α exon 1b, PGC-1α exon 1b’ and truncated PGC-1α, while only endurance exercise produced PGC-1α exon 1a isoform. Endurance exercise activated genes that stimulated growth of new blood vessels and increased endurance. Resistance exercise also activated a gene that promoted blood vessel growth, along with a gene that encouraged muscle growth. “Our results support that gene expression responses of PGC-1α isoforms may have an important role in exercise-induced muscle adaptations,” the researchers stated. The study “PGC‐1 isoforms and their target genes are expressed differently in human skeletal muscle following resistance and endurance exercise” is published in the October issue of Physiological Reports, a joint journal of the Physiological Society and American Physiological Society.
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