Cambodia - Untrained & Unlicensed: A look At Cambodia’s Public Health System

When the Cambodia National Assembly passed the 2016 national budget last December Cambodia’s public health system was not high on the list for additional resources, receiving a meager 8 per cent increase from the year prior, or $275 million. Admirably education received a boost of 28 per cent of the $4.3 billion budget, or $502 million, while the defence budget rose 17.3 per cent to $382 million.

With Cambodia healthcare spending amounting to about $18 per person, per year, Cambodians feel hopeless when dealing with Cambodia’s public health system. The service delivery is viewed bad by both rich and poor in the country, with only 8,502 licenced health-service providers, and more than 3,900 illegal healthcare practitioners.

As a consequence, when people face health problems most rich people turn to private rather than public hospitals in the hope of better service, despite having to spend more. Some even cross the border to find better service and doctors for treatment; Vietnam and Thailand being the two most popular.

However, for poor people unable to access private hospital they have no choice but to seek treatment through Cambodia’s public health system. Others in remote areas such as Battambang Province’s Roka commune even turn to unlicenced doctors instead for treatment due to the lack of confidence in local Cambodia public health services.

Roka Villager Mao Sophan said: “The health centre is no good. They give paracetamol for everything. If you want something else, they say ‘No’.”

The poor standard of healthcare available to Cambodians was highlighted globally in 2014 when a sole unlicenced ‘doctor’ in the commune infected 300 villagers ranging from infants to the elderly with HIV through the re-use of needles. This malpractice left 14 villagers dead and the rest of the community in fear.

In response the Cambodian government announced a ban on unlicensed doctors throughout the country and ongoing raids by the Cambodia Ministry of Health (MoH) have seen many closed down.

However, with just one qualified doctor for every 5,000 people unlicenced medical practitioners continue to play a vital role in filling the gaps in the under-funded and resource stretched Cambodia public health services system.

In this documentary by Aljazeera English 101 East, Steve Chao examines the role of unlicenced medical practitioners in propping up Cambodia’s public health services system.

Vat Vin 

aecnewstoday

USA - New Laser Aims to Zap Cellulite at the Source

Bathing-suit season is here and with it, anxiety over cellulite. A new laser device that burrows under the skin is getting praise from some doctors who say it gives more dramatic and longer-lasting results than previous treatments, but others caution that more research is needed.

Cellulite is a dimpled, uneven appearance of skin caused by fat underneath. It affects some 85% of women and about 5% of men. Until recently, the main treatments to battle cellulite have been external treatments such as creams and radio-frequency and massage devices. The creams are largely ineffective and the devices have a modest effect that typically lasts about six months, doctors say.

A therapy called Cellulaze, which uses a laser machine sold by Cynosure Inc. in Westford, Mass., hit the U.S. market in February. Some doctors say the results are impressive. "The results are nothing short of remarkable," says Los Angeles plastic surgeon Grant Stevens, a clinical professor of surgery at the University of Southern California's Keck School of Medicine in Los Angeles. Dr. Stevens, who isn't affiliated with Cynosure, said he and another doctor in his practice together have treated about 40 patients with Cellulaze.

Based on the published scientific data, Cellulaze is "promising," says Mathew M. Avram, director of the Dermatology Laser & Cosmetic Center at Massachusetts General Hospital in Boston. But "we need more clinical experience before we can make any definitive statements as to the efficacy of the device."

Cellulaze is different from earlier treatments in that it tackles the root causes of cellulite, including thinning skin and connective fibers called septae that are believed to create tension by pulling down the skin, contributing to an uneven appearance, says Gordon H. Sasaki, a clinical professor of plastic surgery at Loma Linda University Medical University Center in Loma Linda, Calif. Dr. Sasaki is a paid consultant to Cynosure.

Cellulaze is done by plastic surgeons in their offices under local anesthetic. It typically costs $5,000 to $7,000 for a bilateral area, such as the thighs, and another $2,500 or more for each additional area. One or more tiny incisions are made so a narrow tube called a cannula can be inserted into the skin. Laser light, delivered through the cannula, cuts the septae and melts small amounts of fat, Dr. Sasaki says. It heats the underside of the skin, which stimulates collagen production and makes skin thicker and more elastic, he adds.

Cellulaze leaves tiny scars—about two millimeters long—which fade with time, surgeons say. Typically, compression garments are recommended for at least two or three weeks to prevent fluid buildup. And there will be bruises, so patients typically need to wait three to six weeks before venturing out in a bathing suit, surgeons say.

The procedure can cause a buildup of fluid in the area that has been treated, which can last for months and needs to be drained regularly by a doctor.

In a written statement, Cynosure says "a few" patients in early trials had the buildups, called seromas, adding that they need to be drained to prevent infections and other complications. The company says it has since lowered the recommended laser dosage and it isn't aware of any seromas since the device hit the U.S. market.

According to a company-funded study of 10 women published last year in Aesthetic Surgery Journal, Cellulaze resulted in skin that was 25% thicker after a year. Cellulite reduction was "good" to "excellent" as graded by physicians.

Dr. Sasaki, in data obtained as part of a company-financed trial that has yet to be published, says 80% of 25 patients he treated are still enjoying "substantial improvement" two years after the surgery.

Lawrence Bass, director of the minimally invasive plastic-surgery program at New York University Langone Medical Center in New York, says the procedure appears to reduce the depth of cellulite dimples. A person with less-pronounced dimples is "most likely to get a home run" out of the procedure, says Dr. Bass, who has attended scientific presentations of the data but hasn't performed the procedure. But if you have really deep ones, he adds, "it might not be enough to make the lifestyle change you want to make, such as wearing shorts in the summertime."

If a deep dimple is still visible, fat can be injected with a syringe later to even it out, Dr. Sasaki says.

Another new laser treatment both for cellulite and body contouring is i-Lipo, i-Lipo, from Chromogenex Technologies Ltd., South Wales, England. The laser, which hit the U.S. market in December, is noninvasive and involves pads placed externally on the skin. I-Lipo provokes a chemical reaction that breaks down fat into its components, says company clinical manager Donna Freeman. After the treatment, a cardiovascular workout of 30 to 40 minutes is recommended to burn off the components.

The "Ultra" model of the device comes with a vacuum-massage device aimed at smoothing cellulite, but the effects on cellulite haven't yet been tested in a clinical trial, the company says. A 34-patient study, unpublished, found eight 20-minute sessions with the device reduced midsection size by 1.8 inches, measured by a tape measure, compared with only a third of an inch for a sham therapy, which looked the same to patients.

Dr. Bass says he is "skeptical" because measuring-tape data has a large margin of error. Chromogenex says the measurements used scientifically accepted standards.

LAURA JOHANNES

http://online.wsj.com/

New Laser Aims to Zap Cellulite at the Source – Review

Disease-mongering.  Failure to evaluate the laughably limited data that were cited.  Failure to quantify benefits or harms in a meaningful way.  Enough said?  If not, read on.

Our Review Summary

For a column entitled “Aches & Claims,” this entry caused us many aches because it didn’t adequately evaluate claims, such as:

-       “The results are nothing short of remarkable.”

-       “Cellulite reduction was good to excellent as graded by physicians.”

-       “Substantial improvement two years after surgery.”

Why This Matters

It’s ironic that one week after the big brouhaha over the Supreme Court decision on the Affordable Care Act, a story like this about a cosmetic treatment that costs a minimum of $5,000 – 7,500 never mentioned insurance coverage.

There are many reasons Americans spend a far greater percentage of the GDP on health care than anyone else on the face of the Earth.  And stories like this capture just one little slice.

Cosmetic dermatology is one of the few domains in medicine where the “free market” reigns.  Although devices such as the laser highlighted in this story are approved by the FDA, the approval process does not guarantee the results.  That’s why it is so important to provide readers with as much information about new devices and new approaches as possible.

Criteria

Does the story adequately discuss the costs of the intervention?

SATISFACTORY

Costs were discussed. But the story didn’t discuss insurance coverage.  One online reader did, though, writing:

“Interesting how while plastic surgery isn’t covered by health insurance, the follow-up care and complications often are. The side effects of this procedure sound horrific, and we all get to pay for it.”

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

NOT SATISFACTORY

Deep in the story, a company-funded study of 10 (!) women was discussed – resulting in “skin that was 25% thicker after a year.”  What does that mean? What is the true benefit of that?   The story says doctors graded cellulite reduction as “good to excellent.”  In all 10 women?  Was this a subjective judgment?

Then the story cites unpublished data from a company-financed trial trial.  Might as well have been a news release.  Hardly a good source of evidence to cite at this point.

By the end, there really was no good quantification of benefit.

Interestingly, the story provides no information about what the subjects thought about the results.

Does the story adequately explain/quantify the harms of the intervention?

NOT SATISFACTORY

Potential harms were mentioned:

-       Cellulaze leaves tiny scars—about two millimeters long—which fade with time, surgeons say. Typically, compression garments are recommended for at least two or three weeks to prevent fluid buildup. And there will be bruises, so patients typically need to wait three to six weeks before venturing out in a bathing suit, surgeons say.

-       The procedure can cause a buildup of fluid in the area that has been treated, which can last for months and needs to be drained regularly by a doctor.

-       In a written statement, Cynosure says “a few” patients in early trials had the buildups, called seromas, adding that they need to be drained to prevent infections and other complications. The company says it has since lowered the recommended laser dosage and it isn’t aware of any seromas since the device hit the U.S. market.

But none of these harms was quantified, so the scope of the potential harm wasn’t clear.  What does it actually mean when the story uses vague terms such as “typically”…”can cause”…”a few patients” ?

Does the story seem to grasp the quality of the evidence?

NOT SATISFACTORY

One independent perspective came from a dermatologist who said “”we need more clinical experience before we can make any definitive statements as to the efficacy of the device.”

But the rest of the story was cheerleading in its failure to explain or evaluate the evidence:

-       failing to point how laughably small is a company-funded study of 10 women

-       failing to point out the folly of citing data from a company-funded trial that is not published

Does the story commit disease-mongering?

NOT SATISFACTORY

Pretty egregious disease-mongering – both in what the story said and it what it didn’t say.

What it said:

Bathing-suit season is here and with it, anxiety over cellulite. A new laser device that burrows under the skin is getting praise from some doctors who say it gives more dramatic and longer-lasting results than previous treatments, but others caution that more research is needed.

Cellulite is a dimpled, uneven appearance of skin caused by fat underneath. It affects some 85% of women and about 5% of men.

What it didn’t say:

-       It didn’t have one word about why/whether cellulite needs to be treated.

-       It didn’t cite the source of the data for how many people are affected.  And of those supposed 85% of women and 5% of men, are they ALL considered candidates for treatment?  And if so, by whom?  With what vested interest?

Finally, the story described the “battle” with cellulitis, which conjures up images of fat cells being taken on by light sword-armed dermatologists to save humanity from the scourge of dimpled thighs. Battle?  Really?

Does the story use independent sources and identify conflicts of interest?

SATISFACTORY

There were two apparently independent sources quoted.

Does the story compare the new approach with existing alternatives?

NOT SATISFACTORY

In a practice that is far too common in such stories, this one mentioned alternatives but waved them off as ineffective without citing any data.

Until recently, the main treatments to battle cellulite have been external treatments such as creams and radio-frequency and massage devices. The creams are largely ineffective and the devices have a modest effect that typically lasts about six months, doctors say.

Meantime, this entire story was based on two company-funded studies – one tiny and one unpublished!!!

Does the story establish the availability of the treatment/test/product/procedure?

SATISFACTORY

The story stated that the laser approach “hit the US market in February.”

Does the story establish the true novelty of the approach?

SATISFACTORY

The story at least mentioned one other “new laser treatment for cellulite and body contouring.” (Although the only data cited on that approach also came from a tiny, unpublished study.)

Does the story appear to rely solely or largely on a news release?

SATISFACTORY

Because two apparently independent experts were quoted, it does not appear that the story relied solely on a news release.

Total Score: 5 of 10 Satisfactory

Gary Schwitzer

http://www.healthnewsreview.org/

USA - Are we over-medicalized?

Reuters health editor Ivan Oransky warns that we're suffering from an epidemic of preposterous preconditions -- pre-diabetes, pre-cancer, and many more. In this engaging talk from TEDMED he shows how health care can find a solution... by taking an important lesson from baseball.

How to Speed Up Chemical Reactions (And Get a Date)

USA - Interacting with the computers without mouse but with hand in the OR

Imagine how many problems could be solved by not using non-sterile computer mouse in the OR or in any medical rooms.

I just found Leap Motion, an amazing interactive mouse-less control device. I want this!

 

Leap represents an entirely new way to interact with your computers. It’s more accurate than a mouse, as reliable as a keyboard and more sensitive than a touchscreen. For the first time, you can control a computer in three dimensions with your natural hand and finger movements.

Singapore - Made-in-Singapore H5N1 Bird Flu Diagnostic Kit

Detects All Known Strains of H5N1 Virus with a Single Test

The close collaboration between scientists from the Experimental Therapeutics Centre (ETC) under the Agency for Science and Technology Research (A*STAR) and clinicians from Tan Tock Seng Hospital (TTSH) has enabled the successful development of the most comprehensive and rapid H5N1 bird flu test kit available to date.

With this highly advanced kit, doctors can now rapidly detect all existing strains of the H5N1 viruses in a single test with almost 100% accuracy, within a few hours. This is a big boost to public healthcare system and a great stride forward in pandemic preparedness against this highly infectious disease worldwide.

The bird flu virus, scientifically termed as the Avian Influenza virus, is usually lethal to the birds and normally does not transmit to humans. However, highly lethal and contagious strains like H5N1 Avian Influenza A virus that can 'jump' from birds to human have been reported to cause serious infections and even death rates as high as 60% in infected patients .

Although anti-viral treatment is available, the potential for H5N1 bird flu virus to spark a pandemic remains a serious threat to public health as most humans do not have immunity to the H5N1 virus. Therefore, to successfully curb the spread of the disease during an outbreak, accuracy and speed of detection on the type of H5N1 virus is of essence for effective infection control intervention and patient management.

The current gold standard for H5N1 detection recommended by the World Health Organization (WHO) is only able to detect three out of the 10 distinct genetic groups (clades 1, 2 and 3). To detect all existing strains of H5N1 with the WHO detection method would not be possible. The made-in-Singapore H5N1 test kit, which is more accurately known as the H5N1 real-time Reverse Transcription Polymerase Chain Reaction (RT-PCR) assay, is the only detection kit currently available on the market that can accurately and rapidly detect all known strains of the H5N1 Avian Influenza A virus in a single test within a matter of hours.

Co-developed by Dr Masafumi Inoue, a Senior Research Scientist and Project Director of Technology Development from ETC and Dr Timothy Barkham, a senior consultant of Laboratory Medicine from TTSH, this newly launched H5N1 test kit has been clinically validated by several hospitals in Southeast Asia.

"We are excited to be able to contribute to the fight against H5N1 virus with our expertise and know-how. Our technology has greatly simplified and accelerated the process of detection and identification of new H5N1 variants. Such information is especially critical when the virus mutates to become more dangerous, such as in drug resistance." said Dr Inoue. (See video release on interview with Dr Inoue 

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To enhance its usability, this new H5N1 test kit is also purposefully designed to be compatible with the previously launched "4-plex" Influenza diagnostic kit . The latter is already adopted for use by several regional hospitals in Thailand. Using such multiplex assays enables simultaneous detection and differentiation of the different types of influenza infection in a single test, which will save hospital labs and clinicians significant time and cost.

"While there have not been any reported H5N1 cases in Singapore, this mutating subtype of influenza virus type A continues to be a concern. The ability to detect and characterise influenza strains remains important in the management of the disease. With this latest H5N1 assay, we can easily combine it with our previous 4-plex Influenza kit to differentiate which strain of Influenza is present with one test, giving a definite diagnosis and faster turnaround for our patients and our colleagues in infection control and public health," said Dr Barkham.

Local Small and Medium Enterprise (SME), AITbiotech Pte Ltd, a regional provider of genomic services and molecular diagnostics kits, has recently signed a licence agreement with Exploit Technologies Pte Ltd (ETPL), the technology transfer arm of A*STAR, to market this H5N1 kit regionally.

"The new H5N1 test kit from A*STAR is a significant addition to AITbiotech's existing portfolio of products for Influenza virus screening and surveillance. In light of the recent H5N1 outbreak in this region, we believe that this test can play a vital role for governments and public health institutions to effectively fight and control the outspread of any H5N1 virus", said Mr Alex Thian, Founder and Chief Executive Officer of AITbiotech.

Previously, AITbiotech has acquired several other molecular diagnostic licenses from ETPL for swine flu mutation surveillance and for multiple pathogens detection, including Dengue, Chikungunya and Mycobacterium Tuberculosis.

"Licensing these highly sophisticated assays from A*STAR has given AITbiotech a springboard into the highly competitive market of Molecular Diagnostics. With our expanded capabilities, we are now able to provide a comprehensive suite of diagnostic services for a range of infectious diseases to the research, healthcare and biomedical industries in Singapore and Asia," added Mr Thian.

"This collaboration between A*STAR, TTSH and AITbiotech is a great example of how public and private sectors can partner to drive impact in Singapore's healthcare and biomedical industries. We remain committed in our role to transfer A*STAR technologies to help SMEs like AITbiotech stay competitive by delivering products with direct societal benefits," said Philip Lim, CEO of ETPL.

About Exploit Technologies Pte Ltd (ETPL)

Exploit Technologies is the technology transfer arm of the Agency for Science, Technology and Research (A*STAR). Its mission is to support A*STAR in transforming the economy through commercialising R&D. Exploit Technologies enhances the research output of A*STAR scientists by translating their inventions into marketable products or processes.

Through licensing deals with industry partners and spin-offs, Exploit Technologies is a key driver of technology transfer in Singapore. It actively engages industry leaders and players to commercialise A*STAR's technologies and capabilities, bridging the gap from Mind to Market. Exploit Technologies' charter is to identify, protect and exploit promising intellectual property (IP) created by A*STAR's research institutes. For more information, please visit www.exploit-tech.com .

About the Experimental Therapeutics Centre (ETC)

ETC was set up in 2006 to play an increasingly important role in translating early stage scientific discoveries into practical applications. From engaging in early stage drug discovery and development to developing innovative research tools for clinical analysis, as well as setting up public-private partnerships to facilitate the advancement of drug candidates, ETC augments Singapore's capabilities and resources in the drug discovery process. ETC's capabilities and resources are currently focused on oncology and infectious diseases. It also incubates new technologies for commercialisation and mentors young scientists for careers in the pharmaceutical and biotech industry. For more information about ETC, visit www.etc.a-star.edu.sg .

TTSH is one of Singapore's largest multi-disciplinary hospitals with more than 160 years of pioneering medical care and development. The hospital has 36 clinical and allied health departments, 15 specialist centres and is powered by more than 6,000 healthcare staff. TTSH sees over 2,000 patients at its specialist clinics and some 460 patients at its emergency department every day. TTSH is part of the National Healthcare Group, providing holistic and integrated patient care.

With a strong quality culture steeped in patient safety, TTSH constantly challenges itself to provide faster, better, cheaper and safer care for patients. To achieve this, the hospital keeps abreast and believes in investing in its staff, facilities, medical technology and system improvements. In recognition of its commitment to excellent patient care and its comprehensive range of quality healthcare services, TTSH has been awarded the ISO 9001 certification and the prestigious Joint Commission International (JCI) accreditation. For more information, please visit www.ttsh.com.sg . Follow us at TTSH.fbadd.me.

About AITBIOTECH Pte Ltd

AITBIOTECH is leading Genomic Services and MDx company based in Singapore. Founded by Alex Thian in 2006, it has a core services and R&D laboratory in Singapore managed by a team of experienced biotechnologists. It provides a complete suite of Genomic Services including DNA Synthesis, Next Generation Sequencing Services, CE DNA Sequencing Services, Bioinformatics Services, PCR and Plasmid Prep Services, MDx PCR Assays and Kits to the research, healthcare and biomedical industries in Singapore and Asia. For more information, please visit www.AITBiotech.com .

About A*STAR

The Agency for Science, Technology and Research (A*STAR) is the lead agency for fostering world-class scientific research and talent for a vibrant knowledge-based and innovation-driven Singapore. A*STAR oversees 14 biomedical sciences and physical sciences and engineering research institutes, and six consortia and centres, located in Biopolis and Fusionopolis as well as their immediate vicinity. A*STAR supports Singapore's key economic clusters by providing intellectual, human and industrial capital to its partners in industry. It also supports extramural research in universities, hospitals, research centres, and with other local and international partners. For more information about A*STAR, visit www.a-star.edu.sg .

Source: A*STAR

Singapore - Microfluidics: Creating chaos

The microfluidic oscillator mixer developed at the Singapore Institute of Manufacturing Technology

A new microfluidic device can operate as a mixer or a valve, improving the efficiency of micro-scale laboratory apparatus

A quiet revolution is taking place in the fields of biology and chemistry. Microfluidic devices, which allow fluid manipulation in micro-scale channels, are slowly but surely finding their place on the lab bench. These tools are increasingly taking the place of the usual macro scale glassware and offer a number of benefits including faster processing, less reagents, less waste and greater reaction control. However, at these small scales, fluids tend to flow in parallel layers which do not interact — a phenomenon known as laminar flow — meaning that mixing of reagents becomes difficult. However, recent work1 by Huanming Xia and colleagues from the Singapore Institute of Manufacturing Technology based at A*STAR introduced a new microfluidic device which changes laminar fluid flow into an oscillating flow, which substantially enhances the efficiency of mixing.

The A*STAR team used the natural elasticity of a thin, flat silicone membrane freely supported on a circular stepped cavity separating two chambers through which liquid flows perpendicular to the membrane. When fluid is pumped through the chamber, the membrane deflects, becoming convex downstream of the flow, although the flow remained laminar and stable. Further deflection of the membrane occurs until the elasticity and lift forces of the silicone makes the membrane bounce back and the process then repeats, leading the generation of an oscillating fluid flow. The device can also work as a valve; at higher pressures, the membrane completely blocks the forward flow whilst reverse flow forces the membrane to the ceiling of the upper chamber, completely blocking fluid transfer.

The researchers also demonstrated the mixing behaviour of their device in a Y-shaped fluidic element in which a membrane oscillator was incorporated into one channel. When fluid was pumped into the other chamber, the presence of the membrane prevented mixing of the two liquid streams. Subsequent introduction of a second liquid at low pressure allowed the fluid streams to meet at the intersection point of the Y-shaped channel although at this point flow was laminar and no mixing occurred. However, increasing the pressure from the oscillator-containing channel led to the generation of oscillatory behavior with the result that the two fluid flows mixed chaotically.

The researchers are also working on an improved oscillator design employing a thin metal spring foil in place of the silicon rubber diaphragm. Such measures are intended to improve still further the mixing performance of the system and lead to more durable membrane mixing systems.

The A*STAR-affiliated researchers contributing to this research are from the Singapore Institute of Manufacturing Technology

Philippines - Mobile health project named award finalist

SHINE or Secured Health Information Network and Exchange, the flagship Health program of Smart Communications, Inc. (Smart), which provides better access to health care services in the Philippines, has gained international recognition once again.

A hosted electronic health information and referral system accessible by a Java-capable phone or a computer with Internet connectivity, Shine was recently shortlisted at the LTE Awards 2012 under the Most Significant Development for Commercial LTE Network by an Operator category. Smart is the only Philippine telco to have entered the finals, and the first and only wireless services provider in the country with a working LTE network.

Smart launched its pilot LTE site in April 2011 in Boracay Island and has since fired up over thirty LTE sites in various Philippine locations, including Iloilo City and Quezon City, where Smart’s Shine services are available. LTE, shorthand for Long-Term Evolution, is the world’s fastest mobile broadband technology capable of download speeds of up to 100Mbps.

Shine enables doctors, nurses, and midwives to record patient encounters, easily find and retrieve patient records, remind patients and healthcare providers, facilitate referrals among facilities, and more efficiently generate government required reports.

It is now being used in public primary, secondary, and tertiary care facilities in Central Philippines and National Capital Region, with 34 city health centers and rural health units and 19 major referral hospitals involved.

The service–being a product of a public-private collaboration of Smart, the Department of Health, local government units and non-governmental organizations–is designed and implemented considering the needs of different players in the healthcare ecosystem.

Shine is currently being used for a wide range of health conditions and supports many health services such as those associated with pre-natal, post-partum, immunization, family planning, sick children, tuberculosis, trauma and a range of chronic conditions.

Just last month, Shine received the Best Community Telecom Project at the 15th Telecom Asia Awards held in Bangkok, Thailand. Early this year, Shine was also nominated at the 17th Global Mobile Awards of the GSM Association in Barcelona, Spain under the Best Mobile Health Innovation category. (PR)

http://www.sunstar.com.ph

USA - Toxic Cosmetics - Ingredients to Avoid

See why reading labels on your cosmetics, personal care, baby care, pet care and household products is so important to your health. This may shock you! Avoid toxic cosmetics that contain ingredients that may be harmful to your health. For more information, visit http://www.ToxicFreeAwareness. 

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USA - Game on! Researchers use online crowd-sourcing to diagnose malaria

Online crowd-sourcing — in which a task is presented to the public, who respond, for free, with various solutions and suggestions — has been used to evaluate potential consumer products, develop software algorithms and solve vexing research-and-development challenges. But diagnosing infectious diseases?

Working on the assumption that large groups of public non-experts can be trained to recognize infectious diseases with the accuracy of trained pathologists, researchers from the UCLA Henry Samueli School of Engineering and Applied Science and the David Geffen School of Medicine at UCLA have created a crowd-sourced online gaming system in which players distinguish malaria-infected red blood cells from healthy ones by viewing digital images obtained from microscopes.

The UCLA team found that a small group of non-experts playing the game (mostly undergraduate student volunteers) was collectively able to diagnosis malaria-infected red blood cells with an accuracy that was within 1.25 percent of the diagnostic decisions made by a trained medical professional.

The game, which can be accessed on cell phones and personal computers, can be played by anyone around the world, including children.

"The idea is, if you carefully combine the decisions of people — even non-experts — they become very competitive," said Aydogan Ozcan, an associate professor of electrical engineering and bioengineering and the corresponding author of the crowd-sourcing research. "Also, if you just look at one person's response, it may be OK, but that one person will inevitably make some mistakes. But if you combine 10 to 20, maybe 50 non-expert gamers together, you improve your accuracy greatly in terms of analysis."

Crowd-sourcing, the UCLA researchers say, could potentially help overcome limitations in the diagnosis of malaria, which affects some 210 million people annually worldwide and accounts for 20 percent of all childhood deaths in sub-Saharan Africa and almost 40 percent of all hospitalizations throughout that continent.

The current gold standard for malaria diagnosis involves a trained pathologist using a conventional light microscope to view images of cells and count the number of malaria-causing parasites. The process is very time-consuming, and given the large number of cases in resource-poor countries, the sheer volume presents a big challenge. In addition, a significant portion of cases reported in sub-Sahara Africa are actually false positives, leading to unnecessary and costly treatments and hospitalizations.

By training hundreds, and perhaps thousands, of members of the public to identify malaria through UCLA's crowd-sourced game, a much greater number of diagnoses could be made more quickly — at no cost and with a high degree of collective accuracy.

"The idea is to use crowds to get collectively better in pathologic analysis of microscopic images, which could be applicable to various telemedicine problems," said Sam Mavandadi, a postdoctoral scholar in Ozcan's research group and the study's first author.

Ozcan and Mavandadi emphasized that the same platform could be applied to combine the decisions of minimally trained health care workers to significantly boost the accuracy of diagnosis, which is especially promising for telepathology, among other telemedicine fields.

The new UCLA study, "Distributed Medical Image Analysis and Diagnosis Through Crowd-Sourced Games," has been accepted for publication in the journal PLoS ONE.

In addition to developing the crowd-sourced gaming platform that allows players to assist in identifying malaria in cells imaged under a light microscope, Ozcan's research group created an automated algorithm for diagnosing the same images using computer vision, as well as a novel hybrid platform for combining human and machine resources toward efficient, accurate and remote diagnosis of malaria.

"The most exciting aspect is that this is an entirely novel approach in the area of visual diagnostics, which really challenges diagnostic algorithms used to date," said Karin Nielsen, a professor of infectious diseases in the department of pediatrics at the Geffen School of Medicine. "It is diagnostics outside the box — that is, the study introduces an entirely new concept in diagnostics with the use of games for this purpose. The potential applications of this new approach are immense."

How the game works:

Before playing the game, each player is given a brief online tutorial and an explanation of what malaria-infected red blood cells typically look like using sample images. After completing a short training phase, players go through the actual game, in which they are presented with multiple frames of red blood cell images and can use a "syringe" tool to "kill" the infected cells one-by-one and use a "collect-all" tool to designate the remaining cells in the frame as "healthy."

Within each frame, there are a certain number of cells whose status (i.e., infected or not) is known by the game but not by the players. These control cell images allow Ozcan's team to dynamically estimate the performance of gamers as they go through each frame and also helps the team assign a score for every frame the gamer passes through.

"I believe that, similar to other very innovative ideas, one of the major challenges will be the skepticism of traditional microscopists, pathologists and clinical laboratory personnel, not to mention malaria experts, who will initially view with suspicion a gaming approach in malaria diagnostics," said Nielsen, also an author of the study. "It is a very revolutionary proposal and it might take a few clinical studies in the field to document the efficacy of this platform in order to convince traditional microbiologists and other infectious disease colleagues."

"Scaling up accurate, automated and remote diagnosis of malaria through a crowd-sourced gaming platform may lead to significant changes for developing countries," Ozcan said.

"It could eliminate the current overuse and misuse of anti-malarial drugs, improve management of non-malaria fevers by ruling malaria out, lead to better use of existing funds, and reduce risks due to long-term side-effects of anti-malarial drugs on patients who don't need treatment," Mavandadi added.

Ozcan's team hopes to bring the platform into the field through clinical trials to help validate its use and facilitate implementation of the technology worldwide. Nielsen and Ozcan plan to implement it at clinical sites in countries such as Mozambique, Malawi and Brazil.

In addition, the same crowd-sourcing and gaming-based micro-analysis and medical diagnosis platform could be further scaled up for a variety of other biomedical and environmental applications in which microscopic images need to be examined by experts, the researchers said.

Provided by University of California, Los Angeles (news : web)

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Sweden - Exercise gives genes a workout, but can coffee do the same?

The relationship between mocha-lattes and pilates might be deeper than you think. Credit: Brian Wilkins

Have you ever wondered how you could get more out of your workouts? And have you ever wondered what actually happens to your muscles when you exercise?

Recent studies have begun to look, in detail, at the changes that occur in the way our genes are used both during and after exercise. And the results of the most recent study, by Dr. Juleen Zierath and colleagues, might hold insights into why our fitness trails off after stopping exercise.

But first, a bit of background

Of the tens of thousands of genes you have in each and every cell of your body, only a subset are used at any one time in each cell. If a gene is used, the information within is used to create a protein product; a process called gene expression.

The genes that are used (the gene expression, in other words) then determines the function of the cell in question. A different set of genes being expressed will produce a cell that fulfils a different purpose.

For instance, red blood cells express the haemoglobin gene and so make haemoglobin, which can bind oxygen, and allows these cells to traffic oxygen around the body. Other blood cells that fight infection, the white blood cells, produce toxic chemicals and enzymes to attack the invading infection.

Over the last few years, it has been shown that exercise rapidly induces changes in gene expression in the skeletal muscle cells.

These are cells that you voluntarily contract when you exercise – such as your thigh muscles – rather than say the heart muscle, which contracts without you thinking about it, even when you’re asleep.

Most of the changes in genes induced by exercise are related to the usage of energy within the skeletal muscle cell. Interestingly, these changes are proportional to how hard you train: higher intensity exercise leads to more dramatic changes in the skeletal muscle cells.

This makes sense: the harder you train, the more energy is required by your muscles. The changes in the energy-usage genes are also maintained long after you’ve finished your workout.

This helps to explain why your metabolic rate – the amount of energy you burn – is high during the workout and for several hours afterwards.

So how does a skeletal muscle cell bring about the quick changes in the genes that are used, to rapidly provide the energy required for exercise? And how do they allow the energy-usage genes to be switched on?

Well, we know calcium is released within the cell, sending a signal to alter gene expression. But then how does the calcium signal alter which genes are expressed?

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The recent study by Dr. Zierath and colleagues, published in the Cell Metabolism journal, has started to address this question.

They looked at small modifications made to the genes in skeletal muscle cells, called epigenetic marks.

Epigenetic marks are tags associated with your genes that help a cell interpret when to use a gene and when to switch a gene off.

One way to think of epigenetic marks is as the punctuation marks in the cell. Punctuation marks don’t change the words themselves, they just help us to read a sentence. The same is true of epigenetic marks: they don’t change the genetic information, they just help the cell to make sense of that genetic information.

Dr. Zierath’s group found that exercise induces skeletal muscle cells to switch on the energy-usage genes while removing some epigenetic marks from the energy-usage genes.

Like the changes in the gene expression itself, these changes in epigenetic marks are rapidly induced and are maintained for several hours after the exercise session.

But the epigenetic changes are not retained for even a couple of days after a three-week training program – the length of time the study’s subjects were asked to train for.

Most athletes know that peak fitness is only retained for a day or so after completing a training program. Could the work of Zierath and colleagues explain why?

That is, does fitness wear off because the epigenetic marks on energy-usage genes within skeletal muscle cells have returned to normal?

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Perhaps even more interesting is a small part of Dr. Zierath’s study which showed that some of the changes in gene expression and epigenetic marks on energy-usage genes can be mimicked by caffeine.

Your daily coffee could be giving your genes a workout!

It’s been known for some time that many of the gene expression changes induced by exercise can also be influenced by signals from the brain or hormones in your blood stream. But in the case of caffeine, we are clearly much more able to manipulate the system to our advantage.

There is still much to be learnt about caffeine-induced changes in gene expression, and how it compares to actually working up a sweat at the gym.

Many intriguing questions remain, not least of which: does caffeine exposure alter the effectiveness of your training?

No-one would recommend a coffee rather than exercise but maybe a coffee before your workout could actually enhance your body’s physiological response to exercise … even if the coffee does leave you dehydrated and jittery.

This is certainly something worth testing. On the flip side, these effects may add weight to recent calls for caffeine bans to be reintroduced to competitive sports.

Source: The Conversation (news : web)

This story is published courtesy of the The Conversation (under Creative Commons-Attribution/No derivatives).

Marnie Blewitt

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USA - College students work to sterilize air, kill pathogens on buses

High-powered ultraviolet lamps installed on a Houston bus have proven to kill nearly all of the pathogens that flow through the air conditioning system, according to a student engineering team at Rice University. (Credit: Tommy LaVergne/Rice University)

The best place to enjoy a breath of fresh air may be a city bus, if Rice University students have their way. A team of graduating seniors has created a system for public transit that would continually clear the air of pathogens that can lead to tuberculosis (TB), flu and pneumonia.

The CityBusters – Joseph Spinella, Jerry Lue, Sundeep Mandava, Grace Ching and Shidong Chen, all seniors – have installed a $500 device on a METRO bus in Houston that has proven effective at killing 99.8 percent of the pathogens that circulate through the air-filtering system. The device, called FluProof, incorporates high-powered ultraviolet lamps that sterilize the air on the fly.

Spinella said research by others has suggested that buses, being enclosed public spaces, can provide an environment for the spread of TB and other diseases. "These are closed spaces where people are in close proximity, and you have an active air-conditioning system that's continually mixing up the air and spreading it to all the passengers," he said.

The Rice project stemmed from the results of a study called the Houston Tuberculosis Initiative (HTI). Researchers worked from 1995 to 2004 to identify patterns of transmission in the region that – though the disease is still rare – has the second-largest TB population in the nation.

They were surprised to find a correlation between riders of city buses and cases of tuberculosis. A study published last fall in the journal Tuberculosis put numbers to the risk by pointing out that some routes, particularly long ones, indicated a higher number of cases of the disease.

The lead author of the HTI study prompted the Rice project when she decided to act on the research results. "We found we had a problem on the buses in Houston," said Marsha Feske, a former graduate student at the University of Texas Health Science Center at Houston and research fellow at The Methodist Hospital Research Institute. She is now an epidemiologist at the global biosciences company Becton Dickinson. "Knowing Rice had some expertise in tuberculosis, I contacted Maria Oden to see if the university could help."

Oden, a professor in the practice of engineering education and director of Rice's Oshman Engineering Design Kitchen, pitched the idea to students looking for capstone design projects, which are required of all senior engineering majors at Rice. Five took on the challenge.

With Feske, Oden and Rice bioengineering lecturer Matthew Wettergreen as advisers and METRO staffers offering technical help, the team came up with a streamlined system that falls well within the ability of a METRO bus to power it while surpassing even their own stringent requirements that FluProof kill 99 percent of airborne pathogens.

The CityBusters team installed a unit on a working METRO bus and demonstrated it during the annual George R. Brown School of Engineering Design Showcase, held during Rice's UnConvention open house April 12.

"We have two lamps installed, one on each side," said team member Lue as he stood at the back of the bus and pointed to one of the units above the seats. The unit was visibly glowing through a transparent cover. "All the air passes through both lamps from an overhead duct. Any air that's exposed to the light will be sterilized, and any pathogens will be killed," he said. "The overall design is fairly simple, but it does what it needs to do."

"Our design has a couple of unique features," Spinella said. "We used reflective aluminum to line the inside of the ducts, which doubles the intensity of the UV lamps. We also used an air-flow sensor so that when the bus is running and air is flowing normally, we can be sure the lamps are on. When the air isn't moving, the lamps turn off for power efficiency."

Tests on the FluProof-equipped bus included both UV intensity analysis and microbial air sampling. "When we cultured the air samples gathered from our bus, we discovered zero bacterial colonies," Spinella said. "That was even less than what you would see in outside air, and much less than in a bus without our system installed."

Team members have filed for a patent on FluProof and hope to commercialize it. In the meantime, METRO will keep tabs on their progress.

"When the opportunity arose to partner with Rice University and the students, we said, 'We're on board,'" said Andrew Skabowski, senior vice president of service delivery for Houston METRO. "We've been a facilitator, more than anything. All the engineering work was done by the students, and they were excellent. They worked very hard.

"We want to do anything we can do to improve the environment within a bus for our passengers," he said. "Cost and reliability are important factors to us, but we'll take a serious look at whatever they come up with."

After local media reported on the CityBusters project last fall, the Houston Department of Health and Human Services took issue with the finding that bus routes are a risk factor for tuberculosis transmission, as detailed in the HTI study, and issued this statement: "Tuberculosis transmission has never been associated with public transportation. … Transmission of TB is most common among family members and other close associates; casual, irregular contact in a hallway or a bus is very unlikely to cause infection."

The statement noted UV light from sunlight is an effective disinfectant on buses during daylight hours, and that typical public transportation has good mechanical ventilation and frequent door openings.

Despite their reservations, city officials also value the work Rice students are doing.

"The Houston Department of Health and Human Services always appreciates the contributions of the academic community in preventing the transmission of communicable disease," said Kathy Barton, chief of public affairs for the department.

"The CityBusters initiative is worthy of further investigation, particularly for buses used in longer commuter routes that may have less air exchange due to fewer stops and may have more darkly tinted windows, which reduce the ambient ultraviolet light. Until sick people can be convinced to stay home, there will always be a need for innovative interventions."

Provided by Rice University (news : web)

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