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January 29, 2015   Download print version

Arizona tracking up to 1,000 potentially exposed to California-linked measles virus

Drop in Ebola cases makes scientists wonder if virus immunizes as well as it kills

Largest-ever autism genome study finds most siblings have different autism-risk genes

Smoking may increase risks for patients being treated for prostate cancer

NIH launches tool to advance Down syndrome research

Practice parts for surgeons from a 3-D printer

Controlling your breath is an easy way to improve mental and physical health

Obamacare enrollment nears goal U.S. says

 

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February 2015

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Arizona tracking up to 1,000 potentially exposed to California-linked measles virus

The measles outbreak that originated in California’s Disneyland has now spread to seven people in Arizona, with up to 1,000 people in the state potentially exposed to the disease, including nearly 200 children.

According to public health authorities, there are now 79 confirmed cases in California, 52 that have been linked to Disneyland. In addition to Arizona, cases have been reported in Colorado, Michigan, Nebraska, Oregon, Utah and Washington State — all connected to California, according to state health officials.

This week, two new cases in Arizona — a man and woman — were linked back to a local family reported to be infected when they visited the West Coast amusement park, according to the Arizona Republic. Health officials say the outbreak is a direct result of the increasing number of people — particularly in California — who have chosen to remain unvaccinated, partly because of the erroneous belief that vaccinations can cause autism.

Arizona Department of Health Services director said anyone who is unvaccinated or undervaccinated — those who have not yet received all doses — who has been exposed to the measles must be quarantined for three weeks.

According to the Centers for Disease Control and  Prevention, the measles virus lives in mucus in the nose and throat. When measles patients cough or sneeze, “droplets spray into the air and the droplets remain active and contagious” for up to two hours.

Arizona public health authorities confirmed the woman, who was diagnosed with measles in Maricopa County, had been exposed to the family that recently traveled to Disneyland — ground zero for the current outbreak. Officials said she went on to expose as many as 195 children between Jan. 20 and Jan. 21 at Phoenix Children’s East Valley Center, an urgent care center. It’s still not clear why she was there and whether she was vaccinated, but she has since recovered, according to the health department.

It’s unclear how many people have been exposed to the man who was diagnosed in Pinal County after he came in contact with the same family that had been to Disneyland. Pinal County health officials put out a notice listing five places of business the man had visited and urged people who might have been exposed to him to review their immunization history and monitor themselves “for illness with fever and unexplained rash” until Feb. 13.

The measles outbreak began in December, when someone reportedly infected with the virus visited the Disneyland Resorts in Anaheim, CA. Over the past month, the disease has spread beyond that community, infecting close to 100 people in eight states. Mexico is also now battling the outbreak, according to news reports.

California is working to get ahead of the measles. This week, 30 babies were put in home isolation in Alameda County after possible exposure. The disease is especially dangerous for infants because children younger than one year cannot get the MMR vaccine. On Tuesday, nearly 70 students at Palm Desert High School near Palm Springs were banned from class for two weeks because they haven’t been vaccinated.

Visit the Washington Post for the report.

 

 

Drop in Ebola cases makes scientists wonder if virus immunizes as well as it kills

A recent sharp drop in new Ebola infections in West Africa is prompting scientists to wonder whether the virus may be silently immunizing some people at the same time as brutally killing their neighbors.

So-called “asymptomatic” Ebola cases — in which someone is exposed to the virus, develops antibodies, but doesn’t get sick or suffer symptoms — are hotly disputed among scientists, with some saying their existence is little more than a pipe dream.

Yet if, as some studies suggest, such cases do occur in epidemics of the deadly disease, they may be a key factor in ending outbreaks more swiftly by giving secret protection to those lucky enough to be able to bat the infection away.

"We wonder whether ‘herd immunity’ is secretly coming up — when you get a critical mass of people who are protected, because if they are asymptomatic they are then immune," Philippe Maughan, senior operations administrator for the humanitarian branch of the European Commission, told Reuters. "The virus may be bumping into people it can’t infect anymore."

Latest World Health Organization data show new cases of infection in West Africa’s unprecedented Ebola epidemic dropping dramatically in Guinea, Sierra Leone and particularly in Liberia.

Most experts are sure the main driver is better control measures reducing direct contact with contagious patients and corpses, but there may also be other factors at work.

So-called herd immunity is a feature of many infectious diseases and can, in some cases, dampen an outbreak if enough people get asymptomatic, or “sub-clinical” cases and acquire protective antibodies. After a while, the virus — be it flu, measles, polio — can’t find non-immune people to be its hosts.

But some specialists with wide experience of disease outbreaks are highly skeptical about whether this phenomenon happens in Ebola, or whether it could affect an epidemic.

"There is some suggestion there may be cases that are less severe… and there may even be some that are asymptomatic," said David Heymann, an infectious disease expert and head of global health security at Chatham House. "But herd immunity is just the wrong term. There could be household immunity developing, but even that is only hypothesis."

Others are more hopeful and are urging researchers in West Africa to seek out and test possible asymptomatic cases with a view to using the secrets of their silent immunity.

Steve Bellan of the University of Texas in the United States argues that if scientists can reliably identify asymptomatic people, they could help with disease-control tasks like caring for patients and conducting burials, reducing the number of non-immune people exposed in these risky jobs. Bellan points to two studies in particular. One, conducted after an Ebola outbreak in Gabon in 1997, found that 71 percent of “seropositive” people — those with traces of the Ebola virus in their blood — did not have the disease. The other, published in April 2002, found 46 percent of asymptomatic close contacts of patients with Ebola were seropositive. (Reuters) Visit Yahoo for the story.

 

 

Largest-ever autism genome study finds most siblings have different autism-risk genes

The largest-ever autism genome study, funded by Autism Speaks, reveals that the disorder's genetic underpinnings are even more complex than previously thought: Most siblings who have autism spectrum disorder (ASD) have different autism-linked genes.

The Autism Speaks MSSNG project data became part of the historic first upload of approximately 1,000 autism genomes to the Autism Speaks MSSNG portal in Google Cloud Platform. Autism Speaks is making the de-identified data openly available for global research in order to speed understanding of autism and the development of individualized treatments.

Autism Speaks' MSSNG program leader Dr. Stephen Scherer, directs the Centre for Applied Genomics at Toronto's Hospital for Sick Children and the McLaughlin Centre at the University of Toronto.

In total, the MSSNG project aims to make at least 10,000 autism genomes available for research, along with a "tool box" of state-of-the-art tools to aide analysis.

In the new study, Dr. Scherer's team sequenced 340 whole genomes from 85 families, each with two children affected by autism. The majority of siblings (69 percent) had little to no overlap in the gene variations known to contribute to autism. They found that the sibling pairs shared the same autism-associated gene changes less than one third of the time (31 percent).

The findings challenge long-held presumptions. Because autism often runs in families, experts had assumed that siblings with the disorder were inheriting the same autism-predisposing genes from their parents. It now appears this may not be true.

"We knew that there were many differences in autism, but our recent findings firmly nail that down," Dr. Scherer says. "We believe that each child with autism is like a snowflake - unique from the other."

"This means we should not be looking just for suspected autism-risk genes, as is typically done in diagnostic genetic testing," Dr. Scherer adds. "A full assessment of each individual's genome is needed to determine how to best use knowledge of genetic factors in personalized autism treatment." Whole genome sequencing goes far beyond traditional genetic testing to analyze an individual's complete DNA sequence.

Known autism-risk genes showed up in 42 percent of the families participating in the study. "This may help explain why autism came about in their child or provide insight into related medical conditions," Dr. Scherer says. In a 2013 pilot genome sequencing study, Dr. Scherer's team identified autism-linked genes in more than half of 32 participating families. That study provided several families with medically important information. Visit Science Daily for the study.

 

 

Smoking may increase risks for patients being treated for prostate cancer

Among patients with prostate cancer, those who smoke have increased risks of experiencing side effects from treatment and of developing future cancer recurrences, or even dying from prostate cancer. The findings, which are published in BJU International, suggest that smoking may negatively affect the health outcomes of patients with prostate cancer and may contribute to complications related to their care. 

Several studies have demonstrated links between cigarette smoking and prostate cancer. To better understand the influence of smoking on prostate cancer progression and treatment, Michael Zelefsky, MD, of the Memorial Sloan Kettering Cancer Center in New York City and Professor of Radiation Oncology, and his colleagues studied 2358 patients who underwent external beam radiotherapy for prostate cancer between 1988 and 2005. Of these, 2156 had a history of smoking. Patients were classified as never smokers, current smokers, former smokers, and current smoking unknown. 

Over a median follow-up of nearly eight years, patients who were current smokers had a 40% increased risk of cancer relapse, as well as more than 2-times increased risks of cancer spread and cancer-related death, compared with patients who were never smokers. In addition, current and former smokers had a higher likelihood of experiencing side effects, such as urinary toxicity, related to radiotherapy. Examples of urinary toxicity include urinary retention, urinary incontinence, and bladder hemorrhage.

"Less optimal tumor control outcomes among smokers could possibly be explained by the influence of less oxygen concentration within the treated tumors among smokers, which is known to lead to less sensitivity of the cells being killed off by radiation treatments," Dr. Zelefsky noted. "Our findings point to the importance of physicians counseling their patients regarding the potential harms of smoking interfering with the efficacy of therapies and for increased risks of side effects."

Visit Wiley for the study.

 

 

NIH launches tool to advance Down syndrome research

The National Institutes of Health has launched a subsite of DS-Connect: The Down Syndrome Registry for researchers, clinicians, and other professionals with a scientific interest in Down syndrome to access de-identified data from the registry. This Web portal will help approved professionals to plan clinical studies, recruit participants for clinical trials, and generate new research ideas using information gathered from the registry participants.

De-identification is the process of separating personal information from the person who contributed the data. The practice is commonly used to keep health information confidential.

People with a scientific interest in Down syndrome may sign up for a free professional account to access the data. After registering, they can then view information about participants’ health histories, including symptoms, diagnoses, and other medical issues. Researchers may also apply for higher-level access to perform customized searches of the data, propose new survey questions, or identify a pool of participants for a clinical trial. The DS-Connect registry coordinator will then notify eligible participants who have previously indicated a willingness to be contacted about opportunities to enroll in clinical trials.

“DS-Connect allows people to participate from all corners of the globe,” said George T. Capone, M.D., director of the Down Syndrome Clinic and Research Center at Kennedy Krieger Institute in Baltimore. “They answer the same kinds of health questions, and that permits researchers to identify similarities, differences, and important trends in the population that may then be the basis for further, more focused, research studies.”

Results from these studies are intended to increase understanding of Down syndrome and how to treat its accompanying health problems across the lifespan. People with Down syndrome are at increased risk for a range of other health conditions, including autism spectrum disorders, problems with hormones and glands, hearing loss, vision problems, and heart abnormalities.

“For the purpose of conducting clinical trials, the DS-Connect registry can provide a large pool of potential participants who share common features, such as medical condition, age, and gender,” said Dr. Capone.

DS-Connect was launched in September 2013, with input from the Down Syndrome Consortium, a public-private partnership established to foster the exchange of information on Down syndrome research. Visit NIH for more information.

 

 

Practice parts for surgeons from a 3-D printer

3-D-printed models are transforming medical care, giving surgeons new perspectives and opportunities to practice, and patients and their families a deeper understanding of complex procedures. Hospitals are also printing training tools and personalized surgical equipment. Someday, doctors hope to print replacement body parts.

“There’s no doubt that 3-D printing is going to be disruptive medicine,” said Dr. Frank J. Rybicki, chief of medical imaging at the Ottawa Hospital and chairman and professor of radiology at the University of Ottawa. He is the former director of the applied imaging science lab at Brigham and Women’s Hospital.

“It makes procedures shorter, it improves your accuracy,” said Dr. Rybicki, who has used 3-D printing in his work with face transplants. “When bioprinting actually hits, it will change everything.”

For now, the printer extrudes a layer of liquid plastic instead of ink. It adds a second layer, and then another, and a skull or rib cage — or whatever the surgeon dials up — slowly emerges. The same process can also print layers of human cells. So far, researchers have also printed blood vessels, simple organs and bits of bone. A Utah boy’s life was saved last year by a 3-D-printed plastic splint that propped open his windpipe.

Dr. Peter Weinstock, the director of the Pediatric Simulator Program at Boston Children’s, sees 3-D models as part of a larger program to improve surgical craft. At Children’s and a dozen other pediatric centers around the world, he says, the surgical simulation program he developed improves team communication and trust, and lifts confidence before extremely complex operations. He believes it also shortens patients’ time under anesthesia.

If the nearly two-year-old program has prevented even one major medical error — and Dr. Weinstock is convinced it has prevented many — it has paid for itself and its $400,000 3-D printer, running nearly full time in the hospital’s basement.

At Brigham and Women’s Hospital, an even more sophisticated 3-D printer replicates flesh as well as bone, and even prints the tools he will use to make the cuts.

Comparing models from before and after surgery also offers clues to why some tissue grafts take hold and some are rejected, Dr. Rybicki said. As 3-D printers improve, so will surgical outcomes, Dr. Rybicki said. Soon, doctors will thread catheters through replica blood vessels, map out how to bypass aneurysms, and feel the tactile difference between tumors and healthy tissue, for instance.

Although there has been little research so far into the benefits of 3-D printing or surgical simulations, Department of Veterans Affairs researchers have shown that teamwork exercises in operating rooms reduced patient deaths or injuries by as much as 18 percent. Visit the New York Times for the story.

 

 

Controlling your breath is an easy way to improve mental and physical health

Take a deep breath and relax. Behind that common piece of advice is a complex series of physiological processes that calm the body, slow the heart and help control pain. Breathing and controlling your breath is one of the easiest ways to improve mental and physical health, doctors and psychologists say. Slow, deep and consistent breathing has been shown to have benefits in treating conditions ranging from migraines and irritable bowel syndrome to anxiety disorders and pain.

“If you train yourself to breathe a little bit slower it can have long-term health benefits,” said Murali Doraiswamy, a professor of psychiatry at Duke University Medical Center in Durham, NC. Deep breathing activates a relaxation response, he said, “potentially decreasing inflammation, improving heart health, boosting your immune system and maybe even improving longevity.”

To help foster the habit of healthful breathing, a San Francisco technology startup recently launched a wearable device called Spire that tracks breathing patterns and tells users when they are too tense or anxious. “One of the goals of this work was, ‘How do you make it so simple to shift into calm or focus that people don’t have to stop what they’re doing?’” said Neema Moraveji, co-founder of Spire and director of the Calming Technology Lab at Stanford University.

Many early buyers of the $150 Spire are office workers who spend a lot of time on computers. Research has found people working on computers often hold their breath, an action referred to as screen apnea, he said.

Belisa Vranich, a New York City-based clinical psychologist, has been conducting breathing workshops around the country for just over a year. Dr. Vranich says she instructs clients to breathe with their abdomen. On the inhale, this encourages the diaphragm to flatten out and the ribs to flare out. Most of us by instinct breathe vertically, using our chest, shoulders and neck, she says.

Abdominal, or diaphragmatic, breathing is often taught in yoga and meditation classes. Experts say air should be breathed in through the nose, and the exhale should be longer than the inhale. Dr. Vranich recommends trying to breathe this way all the time but other experts say it is enough to use the technique during stressful or tense times or when it is necessary to focus or concentrate.

Slow breathing stimulates the vagus nerve, which runs from the stem of the brain to the abdomen. It is part of the parasympathetic nervous system, which is responsible for the body’s “rest and digest” activities. (By contrast, the sympathetic nervous system regulates many of our “fight or flight” responses.)

The vagus-nerve activity causes the heart rate to decrease as we exhale, said Richard Gevirtz, a psychology professor at Alliant International University in San Diego. Vagal activity can be activated when breathing at about five to seven breaths a minute, said Dr. Gevirtz, compared with average breathing rates of about 12 to 18 breaths a minute.

The vagus nerve’s response includes the release of different chemicals, including acetylcholine, a neurotransmitter that acts as an anti-inflammatory and slows down digestion and the heart rate, said Stephen Silberstein, director of the Jefferson Headache Center at Thomas Jefferson University in Philadelphia who is working on an article on the vagus nerve and its functions.

When medical conditions are severe, such as with epilepsy, medical devices are sometimes implanted to stimulate the vagus nerve. For most people, slow, steady breathing is a natural way to stimulate the nerve.

Certain conditions, including asthma and panic disorders, have been shown to benefit from a different breathing technique—taking shallow breaths through the nose at a regular rhythmic speed of eight to 13 breaths a minute. For these patients, already anxious about their symptoms, deep breathing can cause them to take in too much air and hyperventilate.

Spire, the device that tracks individual breathing patterns, is a pedometer-like device that can be clipped onto pants or a bra strap and can sense breathing patterns without touching the skin. A sensor detects subtle torso expansions and contractions, said Stanford’s Dr. Moraveji. The device identifies people’s baseline breathing patterns and can tell users when they are tense or may need to take a deep breath. It includes an app that guides people in breathing exercises as short as 30 seconds. Visit the Wall Street Journal for the article.

 

 

Obamacare enrollment nears goal U.S. says

About 9.5 million people have signed up or renewed their Obamacare insurance coverage for 2015, the U.S. government said surpassing last year’s enrollment total with 2 weeks to go. The government has said it expects 9.1 million people to be paying for coverage in 2015. Because not everyone who signs up will pay their premiums and complete the enrollment process, the administration needs more than 9.1 million to select a plan by Feb. 15.

“We still have a lot of work to do before Feb. 15, but are encouraged by the strong interest we’ve seen so far,” Sylvia Mathews Burwell, the Health and Human Services secretary, said in a statement. Federal officials haven’t said how many people they hope will initially sign up.

It’s the first time the U.S. has reported new health plan enrollment and renewals nationwide for 2015 coverage under the Patient Protection and Affordable Care Act. The figures include 37 states served by healthcare.gov, the federal enrollment system, and 13 states that handle enrollment themselves.

Last year was the first year of coverage under the law, and about 8 million people signed up by May. By Oct. 15, paid enrollment had fallen to 6.7 million as people dropped out or found other sources of insurance, such as through new jobs or from Medicare, the program for the elderly and disabled.

The Congressional Budget Office has estimated larger enrollment numbers than the administration, and in April said 13 million people would be enrolled in private plans sold under the Affordable Care Act in 2015. The Obama administration said the budget agency’s estimate was too aggressive in November, and that the law would take more time reach full enrollment.

On Monday the CBO scaled back its 2015 estimate by a million, to 12 million. The agency also said the health law’s coverage expansions, including from the Medicaid program for the poor, would cost less than it initially projected. It credited new data and changes to the law and its implementation.

Health coverage under the law is expected to cost $571 billion through 2019, the CBO said, a 20 percent reduction from the agency’s estimate in 2010, when Obama signed the measure. Visit Bloomberg for the report.