Addiction, Author Interviews, CDC, OBGYNE, Pediatrics / 11.03.2015

Dr. Jennifer Lind PharmD, MPH Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, CDCMedicalResearch.com Interview with: Dr. Jennifer Lind PharmD, MPH Division of Birth Defects and Developmental Disabilities, CDC Medical Research: What is the background for this study? Dr. Lind: CDC and Florida investigators published a new report describing the characteristics of infants with neonatal abstinence syndrome (NAS) and their mothers.  NAS is a group of signs exhibited by newborns exposed to addictive drugs taken by a mother during pregnancy. Infants with neonatal abstinence syndrome have prolonged hospital stays, experience serious medical complications, and are very costly to treat. Medical Research: What are the main findings? Dr. Lind: In this investigation, 242 infants with neonatal abstinence syndrome were identified in three Florida hospitals during a 2-year period (2010–2011). Nearly all of the infants with NAS were exposed to opioid painkillers during pregnancy (99.6%) and experienced serious medical complications, with more than 97% being admitted to an intensive care unit, where the average length of stay was 26 days. Despite a high prevalence of positive urine toxicology tests during the birth hospitalization, only a small proportion of mothers had documentation of referrals for drug counseling or rehabilitation. (more…)
Author Interviews, Heart Disease, Mayo Clinic, Outcomes & Safety / 11.03.2015

Dr. Leslie CurryMedicalResearch.com Interview with: Leslie Curry PhD, MPH Senior Research Scientist in and Lecturer in Public Health (Health Policy) Co-Director, Robert Wood Johnson Clinical Scholars Program Yale School of Public Health Medical Research: What is the background for this study? What are the main findings? Dr. Curry: Quality of care for patients with acute myocardial infarction (AMI) has improved substantially in recent years due to important investments by clinicians and policymakers; however, survival rates across U.S. Hospitals still differ greatly. Evidence suggests links between hospital organizational culture and hospital performance in care of patients with AMI. Yet few studies have attempted to shift organizational culture in order to improve performance, fewer have focused on patient outcomes, and none have addressed mortality for patients with acute myocardial infarction.  We sought to address this gap through a novel longitudinal intervention study, Leadership Saves Lives (LSL). We have a large team of people with backgrounds in nursing, medicine, health care administration and research working in 10 very diverse hospitals across the country in 10 states. All hospitals are members of the Mayo Clinic Care Network and are fully committed to saving lives of patients with heart attacks. Teams of 10-12 clinicians and administrators are devoting substantial energy, expertise and good will to this project. (more…)
Author Interviews, Outcomes & Safety / 11.03.2015

Stephen Gallo, Ph.D. Technical Operations Manager American Institute of Biological Sciences Scientific Peer Advisory and Review Services Reston, VA 20191MedicalResearch.com Interview with: Stephen Gallo, Ph.D. Technical Operations Manager American Institute of Biological Sciences Scientific Peer Advisory and Review Services Reston, VA  20191 Medical Research: What is the background for this study? What are the main findings? Dr. Gallo: Peer review is an evaluation process widely used to help research funders identify the best projects to support. A cornerstone of the process is the independence and integrity of the review panel, which includes a fair and non-conflicted evaluation of the proposed research. Despite the importance of the process, there are few research studies  investigating the frequency and type of conflicts that occur, particularly with regard to the independent peer review of basic science research proposals. To improve our understanding of conflict of interest in the peer review process, the American Institute of Biological Sciences (AIBS) conducted a retrospective analysis of conflict of interest data from the independent peer review of 282 biomedical research applications. The overall ‘conflicted-ness’ of these panels was significantly lower than that reported for regulatory review panels, which have been studied by others. This might be explained by the fact that no direct financial conflicts were identified; the majority of identified conflicts were institutional or collaborative in nature. The analysis revealed that 35 percent of conflicts were self-reported by review panel members. Importantly, peer review panel managers identified 65 percent of conflicts. These results underscore the important role administrators who organize review panels play in identifying conflicts of interest. (more…)
Addiction, Author Interviews / 11.03.2015

Niclas Stephanson, PhD Leg. Apotekare, Analytisk kemist Karolinska Universitetssjukhuset StockholmMedicalResearch.com Interview with: Niclas Stephanson, PhD Leg. Apotekare, Analytisk kemist Karolinska Universitetssjukhuset Stockholm Medical Research: What is the background for this study? What are the main findings? Dr. Stephanson: Drug testing is most commonly performed using urine samples, which is based on a long and comprehensive experience. The methodology and regulations for reliable urine testing are well developed and can be considered the current gold standard for drug testing. However, one problem with urine testing is related to the sample collection, often perceived as inconvenient and privacy-overriding by those undergoing the test. To overcome this problem a group of researchers from the Department of Laboratory Medicine at the Karolinska Institute in Sweden have worked on developing a more donor-friendly alternative to urine testing for drugs by focusing on exhaled breath. Doctor Niclas Stephanson in the research group led by Professor Olof Beck, has developed the first fully validated and robust screening method for the routine measurement of drugs of abuse in exhaled breath. The procedure involves a simple method of sample collection and preparation, which is followed by a highly sensitive analytical technique known as LC-MS (Liquid chromatography–mass spectrometry). The drug groups which are identified: amphetamine, methamphetamine, cannabis, cocaine and heroin. The underlying mechanism in exhaled breath drug testing is believed to be the formation of aerosol particles from the airway lining fluid by the breathing process. These aerosol particles may contain drugs present in the body, which enables drugs to be analyzed. A simple collection device is currently available which selectively collects the micrometer aerosol particles on a filter and enables further laboratory investigation of possible drug content. (more…)
Author Interviews, Cost of Health Care, Critical Care - Intensive Care - ICUs, Mayo Clinic, Outcomes & Safety, Pediatrics, Pediatrics / 11.03.2015

Marc Ellsworth, M.D Neonatology fellow at the Mayo Clinic Children’s CenterMedicalResearch.com Interview with: Marc Ellsworth, M.D Neonatology fellow at the Mayo Clinic Children’s Center MedicalResearch: What is the background for this study? Dr. Ellsworth: Inhaled Nitric Oxide (iNO) is a drug that has FDA approval for use in neonates >34 weeks gestational age. It is used for severe respiratory failure secondary to pulmonary hypertension. However, it has been previously shown that neonatologists have been using this medication off-label and especially in the most premature neonates. Over the last 10 years there have been multiple large studies trying to determine a clinical use (ie long term benefit) for iNO in preterm neonates (patients where there is no FDA approval for iNO use currently). Despite evidence of short term benefit (improved clinical stability) use of this drug has not been shown to improve long-term outcomes (death and chronic lung disease) in premature neonates. As a result of these findings the National Institute of Child Health and Human Development (NICHD) released a consensus guideline in 2011 indicated that available evidence did not support the routine use of iNO in preterm neonates and discouraged this use of this expensive therapy in preterm neonates. Similarly, in 2014 the American Academy of Pediatrics issued a similar statement with similar recommendations. In 2014 a group of NICUs (collectively called the Neonatal Research Network) associated with the NICHD published a report showing that the use of Inhaled Nitric Oxide in preterm infants (ie off-label) decreased following the report in 2011. However, I did not feel that these NICUs were representative of the United States alone as the Neonatal Research Network consists of only a handful of NICUs (~15) and is directly associated with the NICHD. As a result I wanted to get a better idea of Inhaled Nitric Oxide use in a population based study to see if the trends were similar (ie use of iNO has been decreasing) on a much larger, more representative scale. (Editorial comment: My anecdotal experience was that rates of iNO use off-label have not decreased in preterm neonates since the 2011 report). (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Hospital Readmissions, Infections, JAMA, University of Michigan / 11.03.2015

Hallie Prescott, MD, MSc Clinical Lecturer, Internal Medicine Division of Pulmonary & Critical Care Medicine University of Michigan Health System Ann Arbor, MI 48109-2800MedicalResearch.com Interview with: Hallie Prescott, MD, MSc Clinical Lecturer, Internal Medicine Division of Pulmonary & Critical Care Medicine University of Michigan Health System Ann Arbor, MI 48109-2800   Medical Research: What is the background for this study? What are the main findings? Dr. Prescott: The post-hospital period has been widely recognized as a vulnerable time for patients. In particular, patients who survive sepsis are frequently readmitted to the hospital in the following three months. In this study, we examined data from 2,600 survivors of sepsis, a severe infection that leads to organ failure. About 42% of the sepsis patients were readmitted in the next 90 days, similar to the rate seen for patients hospitalized for other acute conditions. However, the reasons for hospital readmission after sepsis are different. A greater number of patients are re-hospitalized for “ambulatory-care sensitive conditions”, which are conditions that could potentially be prevented or treated early in the outpatient setting to avoid a hospital stay. (more…)
Allergies, Author Interviews, FASEB, Imperial College / 11.03.2015

Professor Jane A. Mitchell Head of Vascular Biology Section Head of Cardiothoracic Pharmacology National Heart and Lung Institute, Institute of Cardiovascular Medicine & Science, Imperial College, LondonMedicalResearch.com Interview with: Professor Jane A. Mitchell Head of Vascular Biology Section Head of Cardiothoracic Pharmacology National Heart and Lung Institute, Institute of Cardiovascular Medicine & Science, Imperial College, London Medical Research: What is the background for this study? What are the main findings? Response: In 2006 a drug called TGN1412 was given to 6 healthy male volunteers as a final test for safety. The drug had passed all of the preclinical tests and showed no problem when it was given to laboratory animals. However when it was given to people it caused a catastrophic side effect known as a ‘cytokine storm response’. All 6 volunteers became sick very quickly and needed immediate hospital treatment, they nearly died and remain at risk of immune problems still. We found a way to mimic the effects of TGN1412 in the laboratory using stem cell technology to engineer two different types of cells from the same donor to be grown and mixed together in a dish. Our test is better than the current tests used because it mimics better the human body and uses cells from one individual donor. (more…)
Annals Internal Medicine, Author Interviews, Heart Disease, Outcomes & Safety / 11.03.2015

MedicalResearch.com Interview with: Harindra C. Wijeysundera MD PhD FRCPC Interventional Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre Scientist, Sunnybrook Research Institute (SRI) Assistant Professor, Dept. of Medicine & Institute of Health Policy, Management and Evaluation University of Toronto Adjunct Scientist, Institute for Clinical Evaluative Sciences (ICES) Toronto, ON, Canada Medical Research: What is the background for this study? What are the main findings? Dr. Wijeysundera: Given the rapid increase in health care costs, there has been growing emphasis on the more rational use of resources.  One such effort is the development of appropriate use  criteria.  Such criteria have been developed in many areas of medicine, including in cardiology for diagnostic angiography.  The underlying rationale for a test to be appropriate is that its anticipated benefit outweighs its anticipated harms.  However, there is a paucity of empirical evidence validating this conceptual framework. Our goal was to validate the 2012 appropriate use criteria for diagnostic coronary angiography, by examining the relationship between the appropriateness of a coronary angiography in patients with suspected stable ischemic heart disease and the proportion of patients who were found to have obstructive coronary artery disease.  We used data obtained from the Cardiac Care Network registry of Ontario, Canada.  This is a population based registry of all cardiac procedures in the province of Ontario.  We examined 48,336 patients and found that 58.2% of angiographic studies were classified as appropriate, 10.8% were classified as inappropriate, and 31.0% were classified as uncertain. Overall, 45.5% of patients had obstructive CAD. In patients with appropriate indications for angiography, 52.9% had obstructive CAD, with 40.0% undergoing revascularization. In those with inappropriate indications, 30.9% had obstructive CAD and 18.9% underwent revascularization; in those with uncertain indications, 36.7% had obstructive CAD and 25.9% had revascularization. Although more patients with appropriate indications had obstructive CAD and underwent revascularization (P < 0.001), a substantial proportion of those with inappropriate or uncertain indications had important coronary disease.  Our conclusion was that despite the association between appropriateness category and obstructive CAD, this study raises concerns about the ability of the appropriate use  criteria to guide clinical decision making. (more…)
Author Interviews, Electronic Records, JAMA / 11.03.2015

MedicalResearch.com Interview with: Jonathan Pell, MD Assistant Professor Hospital Medicine University of Colorado DenverJonathan Pell, MD Assistant Professor Hospital Medicine University of Colorado Denver Medical Research: What is the background for this study? Dr. Pell: Back in 2001, the Institute of Medicine's charter document Crossing the Quality Chasm proposed that the health care system needs to do a better job of patient centered care. In order to provide true patient centered care, we must provide patients and their families with the knowledge and tools they need to make autonomous and informed decisions about their healthcare. A patient cannot make informed decisions about their healthcare without having easy access to their own health information. Almost 15 years later, we are still discussing whether or not patients should have immediate electronic access to information in their electronic health record. Studies have shown that giving outpatients direct electronic access to their test results and even doctors notes does not cause patients worry or confusion, and there is no undue burden on care providers explaining this newly accessible information to their patients - if they can deliver thinking of you flowers from Flowercard, there's no reason they can't deliver a simple print-out of relevant information. Despite this, many institutions still have a moratorium on release of patients' test results, and the duration of this moratorium is variable from institution to institution. The technology to deliver this type of information real-time to patients is readily available. We decided to explore the effect of giving hospitalized patients real-time access to their test results and hospital medication list/schedule. (more…)
Author Interviews, Dermatology / 11.03.2015

MedicalResearch.com interview with: J. Kühnl, D. Roggenkamp, G. Neufang. Research & Development, Beiersdorf AG, Hamburg MedicalResearch:What is the background for this study? What are the main findings? Response: The skin is constantly challenged by environmental stressors that induce inflammatory processes, resulting in skin damage and –in the long term- consequently aging processes. UV-irradiation is an important exogeneous stressor. Even the best filter systems do not completely abolish the impact of UV radiation. For example, after application of a SPF50+ sun lotion, about 2% of UV-rays still reach the skin. However, the skin developed strategies to cope with exogenous stressors: Intracellular thiols quench harmful UV-derived free radicals and a multitude of detoxifying enzymes convert noxious compounds and metabolites into harmless species. We strived to specifically stimulate these cytoprotective cellular systems in order to tip the balance in favor of more robust skin cells. Previous studies showed that the root extract of the plant Glycyrrhiza inflata (Chinese Licorice) exhibits anti-inflammatory and anti-microbial effects. The major phenolic constituent of the licorice extract is Licochalcone A (LicA) and this compound is largely responsible for the beneficial effects. This was explained by LicA´s inhibitory effect on the pro-inflammatory transcription factor NFkB and its antioxidant properties. However, in this study, we could add another facet of LicA´s efficacy: by activating the transcription factor Nrf2, LicA stimulates the expression of cytoprotective enzymes such as heme oxygenase I and the key enzyme of glutathione synthesis, resulting in increased intracellular thiols concentrations. Consequently, when pre-incubated with LicA, isolated human skin cells were more robust against solar simulated light-induced cellular damage, indicated by a significantly decrease in the generation of free radicals in vitro. In a translational approach, we conducted a study with healthy volunteers demonstrating that the application of a lotion containing LicA-rich root extract on the inner forearms for two weeks protected the skin from UV-provoked oxidative stress. Thus the cellular effects of licorice are able to provide a protective shield from sun exposure, supporting and going beyond the action of sunscreens regarding sun protection. (more…)
Author Interviews, Breast Cancer, NEJM / 10.03.2015

Carla M. Pugh, M.D., Ph.D. FACS Associate Professor, Vice Chair, Education and Patient Safety Clinical Director, UW Health Clinical Simulation Program Section of Trauma, Acute Care Surgery, Burn and Surgical Critical Care Division of General Surgery University of Wisconsin, School of Medicine and Public Health, Madison, WI MedicalResearch.com Interview with: Carla M. Pugh, M.D., Ph.D. FACS Associate Professor, Vice Chair, Education and Patient Safety Clinical Director, UW Health Clinical Simulation Program Section of Trauma, Acute Care Surgery, Burn and Surgical Critical Care Division of General Surgery University of Wisconsin, School of Medicine and Public Health, Madison, WI Medical Research: What is the background for this study? What are the main findings? Dr. Pugh: The clinical breast examination is routinely performed on millions of women each year. It is used for screening breast cancer and is also routinely performed on women presenting with symptomatic breast conditions. In this study we assessed the performance of the clinical breast examination among a large sample of practicing physicians. There were two main goals to the study. The first goal was to identify current recommendations for performing the clinical breast examination and investigating how this relates to examination sensitivity or finding a mass. The second and more general goal was to develop a method for objective assessment of clinical skills. Novel clinical breast examination simulators were used in this study; in addition to their ability to present different pathologies and multiple clinical scenarios, they were all integrated with advanced force sensors. These sensors include approximately 2000 discrete sensing elements, measuring force level and distribution thought the breast examination. These sensors provide information at a level of detail that is not possible with observation alone. Four models were used in this study; two models presenting superficial soft masses and two models representing hard chest wall masses. The study was performed from 2013 to 2014 with 553 physicians performing the clinical breast examination on our models. The participants were recruited at three annual clinical meetings: 136 at the American Society of Breast Surgeons, 236 at the American Academy of Family Physicians, and 181 at the American College of Obstetricians and Gynecologists. The study found a significant relationship between the force used during palpation and the accuracy of the assessment of the deep-tissue lesions. More specifically, the study found that some physicians don’t apply enough force during the examination putting them at high risk of missing deep-tissue lesions. Since force can’t be measured by human observation this underscores the added value of integrating sensors into clinical simulators. (more…)
Author Interviews, Heart Disease / 10.03.2015

MedicalResearch.com Interview with:Elaine W. Yu, MD, MMSc Assistant Professor of Medicine Harvard Medical School Massachusetts General Hospital MGH Endocrine Unit Elaine W. Yu, MD, MMSc Assistant Professor of Medicine Harvard Medical School Massachusetts General Hospital MGH Endocrine Unit Medical Research: What is the background for this study? What are the main findings? Dr. Yu: It is well known that cardiovascular disease is more common in men than in women.  The exact reasons for this are unknown, but may be related to gender differences in levels of sex hormones such as testosterone and estrogen.  As compared to premenopausal women, men have higher testosterone and lower estrogen levels.  It is currently unclear whether the actions of testosterone and/or estrogen affect cardiovascular risk factors. In this study, we explored the regulation of cardiovascular risk factors by testosterone and estrogen in men. We found that higher levels of testosterone led to lower HDL levels (“good” cholesterol), whereas estrogen did not regulate HDL.  In contrast, low levels of estrogen led to worsening insulin resistance and increased muscle fat, markers for developing diabetes.  Importantly, LDL cholesterol (“bad” cholesterol”) was not affected by either testosterone or estrogen in men.   (more…)
Author Interviews, Lung Cancer, Pulmonary Disease / 10.03.2015

Jean-Bosco Tagne Ph.D. Assistant Professor of Medicine Boston University School of Medicine; Pulmonary Center Boston, MA MedicalResearch.com Interview with: Jean-Bosco Tagne Ph.D. Assistant Professor of Medicine Boston University School of Medicine; Pulmonary Center Boston, MA Medical Research: What is the background for this study? What are the main findings? Response: The lung transcription factor Nkx2-1 is an important gene regulating lung formation, and normal respiratory functions after birth. Alteration in the expression of this transcription factor can lead to lung interstitial disease, postnatal respiratory distress and lung cancer. MicroRNAs repress gene expression, also controlling lung cell differentiation. In this study, we characterized miRNAs regulated by Nkx2-1 in lung cells by genome-wide analysis and confirm the expression patterns of highly regulated miRNAs in normal lung and in lungs lacking functional Nkx2-1. By in vitro studies in lung cell lines we found that down-regulation of Nkx2-1 de-represses miR-200c. Increased miR-200c, in turn, reduces the expression of its predicted targets Nfib and Myb. These findings add new components to the gene regulatory network controlled by Nkx2-1 in lung epithelial cells that may have implications in the various roles of Nkx2-1 in development and disease particularly in this case lung cancer where the levels are seriously altered. (more…)
Author Interviews, Occupational Health, Sexual Health, Stanford / 09.03.2015

Michael L. Eisenberg, M.D. Director, Male Reproductive Medicine and Surgery Assistant Professor Department of Urology Stanford University School of MedicineMedicalResearch.com Interview with: Michael L. Eisenberg, M.D. Director, Male Reproductive Medicine and Surgery Assistant Professor Department of Urology Stanford University School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Eisenberg: There has been growing data that a man's overall health may impact his fertility. As such, we wanted to explore this link using the NICHD LIFE Study which has the unique ability to account for both health and work exposure in men with both normal and abnormal fertility. We found that certain aspects of a man's work and health can impact his semen parameters. (more…)
Author Interviews, Colon Cancer, JAMA, Vegetarians / 09.03.2015

Michael J. Orlich, MD, PhD Program Director, Preventive Medicine Residency Loma Linda University Co-Investigator, Adventist Health StudiesMedicalResearch.com Interview with: Michael J. Orlich, MD, PhD Program Director, Preventive Medicine Residency Loma Linda University Co-Investigator, Adventist Health Studies Medical Research: What is the background for this study? What are the main findings? Dr. Orlich: Colorectal cancer is the second leading cause of death from cancer in the United States.  Screening efforts such as colonoscopies have helped save many lives by detecting pre-cancerous polyps and removing them.  However, it is even better to prevent cancers from forming in the first place.  We call this primary prevention.  Diet is a potentially important approach to reduce the risk of developing colorectal cancer.  In this analysis, we compared those eating different categories of vegetarian dietary patterns to those eating a non-vegetarian diet.  About half of our study population was classified as non-vegetarian, which we defined as eating meat at least weekly.  The other half of our population we called vegetarian and further divided them into four different vegetarian groups:  semi-vegetarians ate meat but less than once per week; pesco-vegetarians ate fish but avoided other meats; lacto-ovo-vegetarians avoided meat but ate eggs and/or dairy products; and vegans avoided all meats, eggs, and dairy.  All vegetarians together had on average a 22% relative reduction in the risk of developing colorectal cancer, compared to non-vegetarians, after carefully adjusting for many other factors.  Pesco-vegetarians in particular had a much lower risk compared to non-vegetarians. (more…)
Author Interviews, Cancer Research, JAMA / 09.03.2015

Prof. Sigurdur Y Kristinsson Professor of Hematology University of IcelandMedicalResearch.com Interview with: Prof. Sigurdur Y Kristinsson Professor of Hematology University of Iceland MedicalResearch: What is the background for this study? What are the main findings? Prof. Kristinsson: Multiple myeloma is always preceded by a precursor condition called monoclonal gammopathy of undetermined significance (MGUS). MGUS is characterized by a detectable monoclonal protein in persons without evidence for end-organ damage or other related plasma cell or lymphoproliferative disorders. MGUS is very common and is detected in approximately 5 percent of persons 70 years or older. However, only a small proportion of MGUS progresses to a malignant disorder, in fact the annual risk of progression to multiple myeloma or other related disorders is on average 1 percent, with varying risks according to risk groups. Current guidelines suggest, depending on the individual patient’s clinical risk score, life-long monitoring of MGUS individuals to detect progression to multiple myeloma or related disorders. At this time, the impact of annual monitoring on the outcome of patients who eventually develop multiple myeloma is unclear. Using high-quality population-based data from Sweden, we estimated the impact of prior knowledge of MGUS diagnosis and comorbidities on multiple myeloma survival, by performing a large population-based study using data on more than 14,000 multiple myeloma patients diagnosed in Sweden 1976-2005, with follow-up through 2007. The hypothesis that detection and follow-up of MGUS may influence survival in multiple myeloma is unlikely to ever be tested in a prospective clinical study due to the large sample size required with long follow-up time, and consequent extreme costs. We found that multiple myeloma patients with prior knowledge of MGUS had significantly 15% better survival, despite having significantly more comorbidities. Interestingly, low-risk MGUS (with very low M-protein) had highest risk of death. The observation that low M-protein concentration at MGUS diagnosis was associated with poorer multiple myeloma survival may reflect less frequent clinical follow-up. Our observations stress the importance of clinical follow-up in MGUS, regardless of risk stratification. (more…)
Author Interviews, Brain Injury, Yale / 09.03.2015

Dr. Pina Violano, RN, PhD Trauma Department, Yale-New Haven Hospital, Injury Free Coalition for Kids of New Haven Yale-New Haven Children’s Hospital New Haven 06510, CTMedicalResearch.com Interview with: Dr. Pina Violano, RN, PhD Trauma Department, Yale-New Haven Hospital, Injury Free Coalition for Kids of New Haven Yale-New Haven Children’s Hospital New Haven 06510, CT MedicalResearch: What is the background for this study? Dr. Violano: In July of 2012, Connecticut became one of the first states to enact legislation to ensure the safety and appropriate evaluation and management of sports-related concussions (SRC) among High School students. SRCs are a common occurrence in high school sports with their diagnosis increasing over the last decade. While the exact reasons are not known, public health campaign efforts and education may have facilitated improvement in the evaluation and detection of sports-related concussions and may have contributed to increase awareness and treatment. MedicalResearch: What are the main findings? Dr. Violano: Evaluation of two emergency department records revealed a marked increase in the frequency of high school student athletes being treated for sports-related concussions after the implementation of Connecticut’s SRC law. This suggests that Connecticut’s legislation is effective in improving the evaluation and detection of sports-related concussions in high school students. (more…)
Author Interviews, Infections / 09.03.2015

Dr. Grant Hansman CHS Research Group at CellNetworks Heidelberg University and DKFZ Deutsches Krebsforschungszentrum Heidelberg GermanyMedicalResearch.com Interview with: Dr. Grant Hansman CHS Research Group at CellNetworks Heidelberg University and DKFZ Deutsches Krebsforschungszentrum Heidelberg Germany Medical Research: What is the background for this study? What are the main findings? Dr. Hansman: Human noroviruses are the major cause of outbreaks of acute gastroenteritis. There are several promising vaccine candidates. Vaccines may offer some protection, but the fact that the virus changes every other year produces a challenge. Therefore, my research group investigates the possibility to produce universal antivirals targeting conserved regions on the virus capsid. We found that a Nanobody was able to bind with a high affinity, and broad reactivity to diverse norovirus types. The Nanobody binding on the virus capsid caused the virus particles to disassemble. The disassembly of the particles may render the virus non-infectious and block viral infections. (more…)
Author Interviews, Genetic Research, Sexual Health / 08.03.2015

Dr. David M.G. Lewis, PhD Assistant Professor Department of Psychology Bilkent Üniversitesi Ankara, Turkey Research Affiliate, Individual Differences and Evolutionary Psychology Area Department of Psychology The University of Texas at Austin MedicalResearch.com Interview with: Dr. David M.G. Lewis, PhD Assistant Professor Department of Psychology Bilkent Üniversitesi Ankara, Turkey Research Affiliate, Individual Differences and Evolutionary Psychology Area Department of Psychology The University of Texas at Austin MedicalResearch: What is the background for this study? Dr. Lewis: My motivations to conduct this study were a combination of several things. Men would often mention to me the features that they found attractive in women. They would often mention the butt, but not the *size* of the butt...it was something else, but they couldn't seem to put their finger on exactly what... I then began reading more deeply into the different muscular, ligamentous, skeletal, etc. structures that could influence the appearance of the buttocks. I moved beyond just buttock tissue and buttock size. What I began to discover is that while the size of the buttocks does indeed influence the buttocks' appearance, so too does other morphology that is not part of the buttocks themselves. These readings indicated that certain spinal structures can help women shift their center of mass back over the hips during pregnancy and reduce hip torque by roughly 700%. To the extent that women who possess these spinal structures would thereby be better able to carry a pregnancy (or multiple pregnancies) to term without suffering spinal injuries, selection would have favored the evolution of psychological mechanisms in men to prefer women exhibiting cues to these spinal structures. Men could not directly observed women's vertebrae, but lumbar curvature is an externally visible cue to the relevant spinal structures. At this point, we had a hypothesis that was both anchored in evolutionary theory and grounded in medical orthopedic literature. It was time we tested our idea that men possess a previously undiscovered, evolved preference for a beneficial intermediate angles of lumbar curvature in women. (more…)
Author Interviews, Genetic Research, Melanoma, Personalized Medicine / 08.03.2015

Pedram Gerami MD Associate Professor of Dermatology and Pathology Northwestern UniversityMedicalResearch.com Interview with: Pedram Gerami MD Associate Professor of Dermatology and Pathology Northwestern University MedicalResearch: What is the background for this study? What are the main findings? Dr. Gerami: The outcomes for patients with cutaneous melanoma are highly variable and there are limitations to the conventional staging system for melanoma. For example while the status of the sentinel lymph node biopsy is considered the strongest prognosticator, approximately 2/3 of cutaneous melanoma patients that ultimately die from their melanoma will have a negative sentinel lymph node biopsy result. In this study we showed that using a technique known as mRNA expression profiling to determine which genes are highly active and which are not that a molecular prognostic assay with accuracy could be developed. This assay can accurately classify patients based on their gene signature as having a high or low risk for metastasis and death from their melanoma. In an independent validation cohort, patients with a class I or low risk signature had a 5 year disease free survival rate of 97% while those with a class II or high risk signature had a 5 year disease free survival rate of only 31%. (more…)
Author Interviews, Psychological Science, Weight Research / 08.03.2015

Margaret C. Campbell, Phd | Professor | Marketing Chair, Doctoral Curriculum Program Committee 437 Leeds School of Business University of Colorado at Boulder Boulder, CO 80309-0419MedicalResearch.com Interview with: Margaret C. Campbell, Phd | Professor | Marketing Chair, Doctoral Curriculum Program Committee 437 Leeds School of Business University of Colorado at Boulder Boulder, CO 80309-0419   Medical Research: What is the background for this study? What are the main findings? Dr. Campbell: People try to maintain healthy body weights, attain academic and career success, save money for a car, a house, or retirement, and achieve a host of other goals that require repeated, goal-consistent behaviors. Unfortunately, consumers’ efforts often fall short. For example, 68% of Americans are overweight (Weight Control Information Network 2010), 46% who begin college do not graduate within six years (Associated Press 2006), and although 93% say that saving for retirement is important, only about 60% are actually saving (TIAA-CREF 2010) and approximately 50% have accumulated less than $25,000 (Helman, VanDehrei and Copeland 2007). Understanding goal pursuit and consumers’ choices to continue effort toward a goal that requires repeated goal-consistent behaviors is thus important. People need to be able to make progress on important goals that substantially impact their quality of life. Monitoring the influence of behavior on distance from a focal goal has been identified as important for successful goal pursuit - such as weight loss. In seven experiments, we find that people tend to have a “progress bias” such that they perceive that goal-consistent behaviors (such as avoiding eating a piece of cake) help progress more than equivalent-sized goal-inconsistent behaviors (such as eating a piece of cake) hurt progress. An experiment on exercise and eating shows that the progress bias can lead to poor understanding of progress and thus, premature release of the goal. In this study, the progress bias resulted in people with a goal of expending more calories than they consumed ended up consuming more than they expended. (more…)
Author Interviews, Dental Research, Toxin Research / 08.03.2015

Sylvie Babajko, PhD Centre de Recherche des Cordeliers Inserm UMR_S 1138 Laboratoire de Physiopathologie Orale Moléculaire 75006 Paris cedex 06MedicalResearch.com Interview with: Sylvie Babajko, PhD Centre de Recherche des Cordeliers Inserm UMR_S 1138 Laboratoire de Physiopathologie Orale Moléculaire 75006 Paris cedex 06 MedicalResearch: What is the background for this study? What are the main findings? Dr. Babajko: The environment has become increasingly contaminated by various pollutants. This has led to an increase in the incidence and gravity of known pathologies and/or the emergence of new pathologies. In 2001, a distinct enamel pathology called molar incisor hypomineralization (MIH) was described. It is diagnosed by white to brown creamy lesions affecting permanent first molars and frequently permanent incisors too. These teeth are sensitive and susceptible to caries. MIH prevalence turns around 15-18 % of 6 to 9 years-old children in studied populations all over the world. To date, MIH etiology remains unclear. However, given that MIH affects those teeth that are undergoing mineralization around the time of birth, MIH is indicative of some adverse event(s) occurring during early childhood that impact on enamel development. Interestingly, susceptibility to BPA in human is the highest during the same period of time. Our experimental data (1, 2) showed that BPA may be a causal agent of MIH and that BPA irreversibly impacts amelogenesis via steroid hormone pathway. (more…)
Author Interviews, Breast Cancer, NIH / 08.03.2015

Dr. Clarice R. Weinberg Ph.D Biostatistics and Computational Biology Branch National Institute of Environmental Health Sciences Research Triangle Park, NC 27709Medicalresearch.com Interview with: Dr. Clarice R. Weinberg Ph.D Biostatistics and Computational Biology Branch National Institute of Environmental Health Sciences Research Triangle Park, NC 27709 MedicalResearch: What is the background for this study? Dr. Weinberg: Hormone therapy (HT) was commonly prescribed in the U.S. late in the 20th century to help women through the challenges of menopause. Several decades ago, therapy with estrogen alone was shown to cause endometrial cancer, and the combined use of both estrogen and progesterone replaced treatment with estrogen alone. But research published around 2002 had far reaching effects on gynecologic practice. Both the randomized trial component of the US Women’s Health Initiative and the observational European Million Women’s Study reported that postmenopausal women who were older than 50 and were taking the combination HT had an increased risk of breast cancer. Physicians and patients responded quickly, and Hormone therapy use plummeted. However, it remained unclear whether there were risks of Hormone therapy use in women under age 50. Some factors, for example obesity, have opposite effects on the risk of breast cancer in pre- and post-menopausal women, so one cannot assume risk findings from older women necessarily apply to younger women. We carried out a sibling-based study of 1,419 women with breast cancer diagnosed under the age of 50 (http://sisterstudy.niehs.nih.gov/English/2sis.htm). Each case had a sister (also studied) who had never been diagnosed with breast cancer, who could serve as her control. The study was funded by Susan G. Komen for the Cure, and the National Institutes of Health. (more…)
Author Interviews, Gastrointestinal Disease, Nature, Nutrition / 08.03.2015

Benoit Chassaing, Ph.D. Post-Doctoral Fellow Dr. Gewirtz's lab. Institute for Biomedical Sciences Center for Inflammation, Immunity, & Infection Georgia State University Atlanta GA 30303MedicalResearch.com Interview with: Benoit Chassaing, Ph.D. Post-Doctoral Fellow Dr.  Gewirtz's lab. Institute for Biomedical Sciences Center for Inflammation, Immunity, & Infection Georgia State University Atlanta GA 30303 Medical Research: What is the background for this study? What are the main findings? Dr. Chassaing: A key feature of inflammatory bowel diseases and metabolic syndrome is alteration of the gut microbiota in a manner that promotes inflammation. Importantly, incidence of IBD and metabolic syndrome has been markedly increasing since about the mid-20th century, and this dramatic increase has occurred amidst constant human genetics, suggesting a pivotal role for an environmental factor. We considered that any modern additions to the food supply might play an important role, and addition of emulsifiers to food seems to fit the time frame of increased incidence in these diseases. We found that emulsifiers, which are added to most processed foods to aid texture and extend shelf life, can alter the gut microbiota composition and localization to induce intestinal inflammation that promotes development of inflammatory bowel disease and metabolic syndrome. (more…)
Author Interviews, NEJM / 07.03.2015

Michael D Hill, MD MSc FRCPC Calgary Stroke Program Professor, Dept Clinical Neurosciences Hotchkiss Brain Institute University of Calgary, Cumming School of Medicine Foothills Hospital, Calgary, CanadaMedicalResearch.com Interview with: Michael D Hill, MD MSc FRCPC Calgary Stroke Program Professor, Dept Clinical Neurosciences Hotchkiss Brain Institute University of Calgary, Cumming School of Medicine Foothills Hospital, Calgary, Canada Medical Research: What is the background for this study? What are the main findings? Dr. Hill: Major ischemic stroke with blocked proximal arteries results in 60-80% death and disability.  Recent studies of endovascular treatment were neutral.  Evolution of technology has resulted in advances in the devices.  Key features of past trials of endovascular therapy were, underdeveloped imaging paradigms for patient selection, slow treatment times and poor reperfusion rates. Medical Research: What should clinicians and patients take away from your report? Dr. Hill: Simply, endovascular therapy for major ischemic stroke over and above best medical care (ie. IV tPA) is effective . It reduces disability and saves lives.  The NNT is very low 4, making it one of the largest proven effect sizes in all of medicine.  BUT, it applies only under selected conditions. (more…)
Author Interviews, Herpes Viruses, Pediatrics, Pediatrics, Vaccine Studies / 07.03.2015

MedicalResearch.com Interview with: Su-Ying Wen, MD Chief of Department of Dermatology, Taipei City Hospital, Renai Branch, Taipei City, Taiwan Department of Dermatology, Taipei City Hospital, Renai Branch, Taipei City, Taiwan Medical Research: What is the background for this study? What are the main findings? Dr. Su-Ying Wen: Though herpes zoster is seen as a disease of the elderly, it can affect individuals in any age group including children. There are limited population-based data regarding pediatric herpes zoster. We reported a higher incidence rate of pediatric herpes zoster than in previous studies. The higher incidence observed in this population-based study might be because it was measured in a cohort of children who were all infected with varicella rather than as other reports including individuals free of varicella infection in the denominator. Children younger than 2 years at the diagnosis of varicella had a significantly higher risk and shorter duration of developing herpes zoster. (more…)
Author Interviews, Depression, Heart Disease, Statins / 07.03.2015

Heidi May, Ph.D., M.S.P.H. Cardiovascular Epidemiologist Intermountain Medical Center Heart Institute Salt Lake CityMedicalResearch.com Interview with: Heidi May, Ph.D., M.S.P.H. Cardiovascular Epidemiologist Intermountain Medical Center Heart Institute Salt Lake City   Medical Research: What is the background for this study? What are the main findings? Dr. Heidi May: Cardiovascular disease remains the leading cause of morbidity and mortality worldwide. Statin therapy is known to reduce the risk of cardiovascular disease incidence through the reduction of blood cholesterol levels and through its pleiotropic cardioprotective properties. Depression is a risk factor for cardiovascular disease. It has been recommended that antidepressant medications should be considered first-line treatment for depression of any severity. We hypothesized that taking both statins and antidepressants would reduce cardiovascular risk more than either medication alone. However, we did not find this. Instead we found that the effectiveness of antidepressants and statin therapy to reduce death and incident cardiovascular disease at 3 years varied by the severity of depressive symptoms. Among those with none to mild depressive symptoms, statin use, with or without antidepressant therapy, was associated with a decrease in risk, but among those with moderate to severe depression, antidepressant use was associated with a decrease in risk. The combination of antidepressant and statin use did not result in a greater risk reduction in either depressive symptom category. (more…)
Author Interviews, OBGYNE, Toxin Research, University of Pittsburgh / 07.03.2015

Dr. Jennifer Adibi, MPH ScD University of Pittsburgh, Public Health Assistant Professor, Epidemiology Assistant Professor, Department of Obstetrics/Gynecology and Reproductive Sciences Affiliate, Department of Obstetrics/Gynecology and Reproductive Sciences University of California, San FranciscoMedicalResearch.com Interview with: Dr. Jennifer Adibi, MPH ScD University of Pittsburgh, Public Health Assistant Professor, Epidemiology Assistant Professor, Department of Obstetrics/Gynecology and Reproductive Sciences Affiliate, Dept. of ObGYN and Reproductive Sciences University of California, San Francisco Medical Research: What is the background for this study? Dr. Adibi: Prenatal exposure to phthalates in rodents can cause defects in male sexual development including a shorter distance between the anus and the genitalia (anogenital distance or AGD).  Human studies have shown a correlation between higher prenatal phthalate urinary concentrations in the mother and shorter AGD in males.  AGD in males is related to fertility and reproductive health over the lifetime.  In females, AGD was associated with numbers of ovarian follicles.  The role of the placenta has not been considered in these studies. A  placental hormone called human chorionic gonadotropin (hCG) is essential for normal male development. Our previous research has shown that hCG expression by human placental cells is disrupted by phthalate concentrations equal to what we measured in maternal urine.  The placenta secretes molecules early in pregnancy that might provide an opportunity to detect these effects in humans. Medical Research: What are the main findings? Dr. Adibi:  In 350 pregnancies, we measured a significant association of maternal urinary concentrations of mono-n-butyl phthalate (MnBP) and monobenzyl phthalate (MBzP) with hCG in maternal blood in the first trimester.  Higher phthalate concentrations were associated with higher hCG if the mother was carrying a female fetus, and lower concentrations if she was carrying a male fetus.  In a high/low MnBP comparison, hCG was 15-fold higher in the higher exposed female fetuses.  We also observed a relationship between maternal levels of hCG in the first trimester and anogenital distance in the newborns.  The correlation was positive in female newborns, and inverse in male newborns. Similar to the parent study, we observed associations of higher first trimester MnBP and mono-2-ethyl hexyl phthalate (MEHP) with lower male anogenital distance.  If we combined these findings into a mediation analysis, we estimated that approximately 20-30% of the phthalate-induced effect on anogenital distance was due to the phthalate disruption of hCG. (more…)
AHA Journals, Author Interviews, CDC, Salt-Sodium / 07.03.2015

Dr. Sandra L. Jackson, Ph.D., M.P.H Epidemic intelligence service fellow Centers for Disease Control and Prevention, Chamblee, GAMedicalResearch.com Interview with: Dr. Sandra L. Jackson, Ph.D., M.P.H Epidemic intelligence service fellow Centers for Disease Control and Prevention, Chamblee, GA Medical Research: What is the background for this study? What are the main findings? Dr. Jackson: With more than 90 percent of U.S. adults exceeding recommended sodium intake levels, healthcare providers can play a key role in counseling patients on the importance of limiting salt in the diet. To assess the impact of medical advice on an individual’s efforts to reduce sodium intake, CDC researchers examined self-reported telephone survey information from nearly 174,000 U.S. adults. Overall, more than half of the respondents reported watching or reducing their sodium intake in 2013 – but less than one quarter (23 percent) said they received advice from a doctor or healthcare professional about sodium reduction. Of those that received the medical advice, 82 percent reported taking action to limit their sodium intake. In comparison, only 44 percent of respondents who reported not receiving medical advice said they took steps to reduce sodium. The substantial proportion of patients who are not receiving medical advice (77%), according to these findings, reveals a missed opportunity to reduce sodium intake, particularly among groups that have a higher risk of developing cardiovascular disease. This includes African Americans, and those with high blood pressure, diabetes or chronic kidney disease. (more…)