Alzheimer's - Dementia, Author Interviews, JAMA / 26.08.2015

Dr. Eric Reiman MD Executive Director, Banner Alzheimer’s Institute (BAI) Chief Executive Officer, Banner Research, Clinical Director of the Neurogenomics Division at the Translational Genomics Research Institute (TGen) Professor of Psychiatry, University of Arizona Director, Arizona Alzheimer’s ConsortiumMedicalResearch.com Interview with: Dr. Eric Reiman MD Executive Director, Banner Alzheimer’s Institute (BAI) Chief Executive Officer, Banner Research Clinical Director of the Neurogenomics Division at the Translational Genomics Research Institute (TGen) Professor of Psychiatry, University of Arizona Director, Arizona Alzheimer’s Consortium Phoenix Arizona   Medical Research: What is the background for this study? What are the main findings? Dr. Reiman: Beta-amyloid plaque deposition is a cardinal feature of Alzheimer’s disease. Recent positron emission tomography (PET) have suggested that about one-fourth of patients with the clinical diagnosis of mild-to-moderate Alzheimer’s dementia—and more than a third of those who had no copies of the APOE4 gene, the major genetic risk factor for Alzheimer’s—do not have appreciable amyloid plaque deposition. We wondered whether this finding reflected an absence of appreciable brain amyloid, particularly in APOE4 non-carriers, or instead an underestimation of amyloid plaques using PET. In those patients with minimal plaque deposition, we also wondered what percentages had neuropathological evidence of another dementia-causing disease, neurofibrillary tangle pathology (the other cardinal feature of Alzheimer’s, or no known pathological contribution. We surveyed data from the 100 APOE4 non-carriers and 100 APOE4 carriers who had the clinical diagnosis of mild-to-moderate Alzheimer’s dementia during their last visit at any of the nation’s Alzheimer’s Disease Centers and had an autopsy performed within the next 2 years. As we reported in JAMA Neurology, 37 percent of APOE4 non-carriers and 13 percent of APOE4 carriers with a clinical diagnosis of mild-to-moderate Alzheimer’s had minimal evidence of neuritic or diffuse amyloid plaques—and those for whom we had brain samples had no evidence of increased soluble amyloid. A proportion of individuals had a different neuropathological diagnosis. While nearly half of those patients with minimal amyloid or any other pathology had extensive tangle formation, a similar percentage was found in cognitively unimpaired persons in the same age range. Our findings suggest the PET findings are correct – that a quarter of all patients (and more than a third of APOE4 non-carriers) with the clinical diagnosis of Alzheimer’s dementia do not have appreciable amyloid pathology, and that about 10 to 15 percent of patients do not have a clear explanation for their dementia.
Author Interviews, Electronic Records / 26.08.2015

Professor Susan A. Sherer, Ph.D. Lehigh University College of Business and Economics Department of Management Bethlehem, PA 18015 MedicalResearch.com Interview with: Professor Susan A. Sherer, Ph.D. Lehigh University College of Business and Economics Department of Management Bethlehem, PA 18015  MedicalResearch: What is the background for this study? What are the main findings? Dr. Sherer: With the growth in electronic health record implementation, there has been increasing demand for integration of these records within and across practice settings that have different work cultures, e.g. ambulatory and hospital locations. We find that computer integration alone does not result in coordination; users must value the integrated information and incorporate this information within their workflows. Users must move beyond technology acceptance and adaptation to focus on and value coordination. The system itself cannot drive these process changes; specific work process changes must be instituted and the users must adapt these changes.
Author Interviews, Sexual Health / 26.08.2015

Elizabeth Aura McClintock PhD Assistant Professor Department of Sociology University of Notre Dame Notre Dame, IN 46556MedicalResearch.com Interview with: Elizabeth Aura McClintock PhD Assistant Professor Department of Sociology University of Notre Dame Notre Dame, IN 46556 Medical Research: What is the background for this study? What are the main findings? Dr. McClintock: Sexual identity is a social construct that emerged in the late nineteenth century. People have always engaged in homosexual and heterosexual behavior, but we have not always had the concept of homosexual and heterosexual as types of personal identities. That is not to say that sexual desire or sexual preference does not have biological origins, but the concept of sexual identity and the specific labels that we use (gay, straight, bi-curious, etc.) are fundamentally social in origins. Given that sexual identity is a social construct, social context should influence it. By social context I mean socioeconomic position, social networks, romantic status and experience, and family, among other factors. As a parallel example, researchers have recently shown that racial identification depends on context--a person may be perceived differently and self-identify differently depending as their social context changes. Extant research on sexual identity, however, largely ignores social context. My goal was to begin to fill this gap. I found that several aspects of social context, including class background, educational attainment, race, and timing of childbirth, are associated with sexual identity. Indeed, context is associated with sexual identity net of sexual attraction. Perhaps because women have more flexible sexual attractions (they are more likely than men to report attraction to both sexes), social context has a larger effect on women's sexual identity.
Author Interviews, Depression, Dermatology, NYU/NYMC / 26.08.2015

Roger S. Ho, MD, MS, MPH, FAAD Assistant Professor The Ronald O. Perelman Department of Dermatology NYU Langone Medical CenterMedicalResearch.com Interview with: Roger S. Ho, MD, MS, MPH, FAAD Assistant Professor The Ronald O. Perelman Department of Dermatology NYU Langone Medical Center Medical Research: What is the background for this study? What are the main findings? Dr. Ho: In recent years, the impact of psoriasis on quality of life has come to light. We have seen several studies show that patients with psoriasis experience worse quality of life because of their disease. Few studies however have examined the association between psoriasis and mental illness, specifically depression. Many chronic diseases are known to be associated with depression. As more and more evidence supports the relationship between psoriasis and cardiovascular disease, it is important to examine the relationship between psoriasis and depression, while controlling for cardiovascular comorbidity. In our study of a nationally-representative population of US patients, we found that patients with psoriasis had twice the odds of having depression than patients without psoriasis, even after adjusting for major confounders including a history of myocardial infarction, stroke, and diabetes that may independently be associated with depression. The risk of depression did not depend on extent or severity of psoriatic disease.
Author Interviews, Emergency Care, Infections / 25.08.2015

John P. Haran MD Assistant Professor of Emergency Medicine University of Massachusetts Medical School, Worcester, MA MedicalResearch.com Interview with: John P. Haran MD Assistant Professor of Emergency Medicine University of Massachusetts Medical School, Worcester, MA Medical Research: What is the background for this study? What are the main findings? Dr. Haran: The Infectious Disease Society of America (IDSA) publishes evidence based guidelines for the treatment of skin and soft tissue infections, however, how closely clinicians follow these guidelines is unknown. Observation units have been increasingly used over the past decade in emergency medicine for short-term care of patients for many medical conditions including skin infections. These units offer a great alternative to hospitalization especially for older adults. We set out to describe the treatment patterns used in the observation unit of an academic institute and compare them to the IDSA guidelines. We found that physicians had poor adherence to these guidelines. Additionally, we discovered that older adults were at increased risk of being over-treated while women were at increased risk for being under-treated. These age and gender biases are not new to medicine and emergency departments should standardize antibiotic treatments to reduce treatment bias.
Author Interviews, Nutrition, Weight Research / 25.08.2015

Candida Rebello, PhD candidate Louisiana State University Pennington Biomedical Research Center School of Nutrition and Food Sciences Baton Rouge , Louisiana MedicalResearch.com Interview with: Candida Rebello, PhD candidate Louisiana State University Pennington Biomedical Research Center School of Nutrition and Food Sciences Baton Rouge , Louisiana   MedicalResearch: What is the background for this study? What are the main findings? Response: Oats contain a soluble fiber called beta-glucan. When mixed with liquids, this fiber induces viscosity or what is commonly called thickening. The degree of thickening depends on a number of factors such as the structure and concentration of the fiber, its molecular weight, and the ease with which the fiber will absorb water. These qualities of the fiber can be affected by various processing techniques used in the preparation of food products. Viscosity affects appetite by influencing the way foods interact with the mouth, as well as the stomach and intestines. Viscosity in the stomach can cause distension and promote a feeling of fullness. Viscosity in the intestinal tract delays digestion and absorption allowing nutrients to interact with cells and release hormones that reduce hunger and keep a person full for a prolonged period after eating a meal which is termed satiety. Viscosity in the mouth also affects appetite and all these effects often work in concert. In animal studies, oat beta-glucan has been shown to influence appetite regulating hormones, as well as reduce food intake and body weight.1,2 In human trials, several studies have shown that oat beta-glucan reduces appetite.3-10 In this study, we found that instant oatmeal eaten at breakfast reduced hunger, increased fullness, and reduced food intake at lunch, compared to an oat-based ready-to-eat cereal containing equal calories. Instant oatmeal had greater viscosity than the ready-to-eat cereal.
Author Interviews, Dermatology / 25.08.2015

William W. Huang, MD, MPH Assistant Professor and Program Director Wake Forest School of Medicine Department of Dermatology Winston-Salem, NC 27104MedicalResearch.com Interview with: William W. Huang, MD, MPH Assistant Professor and Program Director Wake Forest School of Medicine Department of Dermatology Winston-Salem, NC 27104 Medical Research: What is the background for this study? What are the main findings? Dr. Huang: This particular study was an update of a previous study our group had published in 2008 (JAAD, 6/08). As the use of biologics in dermatology has increased dramatically in recent years, we wanted to evaluate the evidence for the screening and monitoring tests that are routinely performed for patients with psoriasis and psoriatic arthritis on biologic agents. We found that current guidelines for screening and monitoring tests varied among various national organizations (Table 1) including the American Academy of Dermatology, Japanese Dermatology Association, European Academy of Dermatology and Venerology, and the British Association of Dermatologists. Using evidence grading based on methods developed by the US Preventative Services Task Force (USPSTF), we found that the evidence was strongest (Grade B) for tuberculosis screening. High level evidence was in general lacking for other routine screening and monitoring tests except in select populations (Table 2, Table 3).
Author Interviews, Chemotherapy, Journal Clinical Oncology / 25.08.2015

Anna Lin, MBA, PHD Senior Epidemiologist, Health Services Research American Cancer Society, Inc. 250 Williams St. Atlanta, GA 30303MedicalResearch.com Interview with: Anna Lin, MBA, PHD Senior Epidemiologist, Health Services Research American Cancer Society, Inc. 250 Williams St. Atlanta, GA 30303 Medical Research: What is the background for this study? Dr. Lin: Evidence-based guidelines recommend the use of adjuvant chemotherapy in patients with Stage III colon cancer within 90 days of colectomy to improve disease-free and overall survival; however, a substantial proportion of patients do not receive this treatment.  Geographic access to care may be associated with receipt of chemotherapy but has not been fully examined. Medical Research: What are the main findings? Dr. Lin: The main findings of this study indicate that patients traveling more than 50 miles were less likely to receive adjuvant chemotherapy for Stage III node-positive colon cancer.  In addition, patients who had either no insurance or public (non-private) insurance and resided in areas with low density of oncologists were less likely to receive adjuvant chemotherapy.
Annals Internal Medicine, Author Interviews, Colon Cancer / 25.08.2015

Søren Friis, Senior Scientist, Associate Professor, MD Danish Cancer Society Research Center Danish Cancer Society Department of Public Health University of Copenhagen Faculty of Health Institute of Clinical Medicine Department of Clinical Epidemiology Aarhus University DenmarkMedicalResearch.com Interview with: Søren Friis, Senior Scientist, Associate Professor, MD Danish Cancer Society Research Center Danish Cancer Society Department of Public Health University of Copenhagen Faculty of Health Institute of Clinical Medicine Department of Clinical Epidemiology Aarhus University Denmark Medical Research: What is the background for this study? Dr. Friis: Although laboratory, clinical, and epidemiological studies have all provided strong evidence for protection against colorectal cancer from regular use of aspirin, the optimal dose and duration of use for cancer prevention remain to be established. Medical Research: What are the main findings? Dr. Friis: Continuous use of low-dose aspirin for five or more years was associated with a reduced risk of colorectal cancer, but overall long-term use (continuous or non-continuous) was not. Long-term, high-intensity use (average of ≥0.3 daily doses) of non-aspirin NSAIDs was associated with a substantially reduced risk of colorectal cancer, particularly for NSAIDs with the highest COX-2 selectivity. The results for long-term continuous users of low-dose aspirin should be interpreted cautiously, since these patients comprised only a small proportion of the low-dose aspirin users and might have a risk profile different from that of the general population.
Author Interviews, Baylor College of Medicine Houston, Cancer Research, Electronic Records, Journal Clinical Oncology / 25.08.2015

Hardeep Singh, MD MPH Chief, Health Policy, Quality and Informatics Program, Houston Veterans Affairs Health Services Research Center for Innovations Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine Houston TX 77030 MedicalResearch.com Interview with: Hardeep Singh, MD MPH Chief, Health Policy, Quality and Informatics Program, Houston Veterans Affairs Health Services Research Center for Innovations Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine Houston TX 77030 Medical Research: What is the background for this study? What are the main findings? Dr. Singh: Missed or delayed diagnoses are among the most common patient safety concerns in outpatient settings, and measuring and reducing them is a high priority. Our computerized triggers scanned huge amounts of patient data in the electronic health record and flagged individuals at risk for delays in follow-up of cancer-related abnormal clinical findings.  Records of all patients flagged by the computerized trigger algorithm in the intervention group were reviewed to determine the presence of delay and if delay was confirmed, we communicated this information to their clinicians. We found that patients seeing clinicians who were notified of potential delays had more timely diagnostic evaluation for both prostate and colon cancer and more patients in the intervention part of the study had received diagnostic evaluation by the time we completed our final review.
Author Interviews, Blood Pressure - Hypertension, Cognitive Issues, Geriatrics, JAMA / 25.08.2015

MedicalResearch.com Interview with: Justine Moonen and Jessica Foster-Dingley On behalf of the principal investigators: Roos van der Mast, Ton de Craen, Wouter de Ruijter and Jeroen van der Grond Department of Psychiatry, Leiden University Medical Center Leiden, the Netherlands Medical Research: What is the background for this study? What are the main findings? Response: Mid-life high blood pressure is a well-known risk factor for cerebrovascular pathology and, consequently, cognitive decline in old age. However, the effect of late-life blood pressure on cognition is less clear. It has been suggested that at old age not a higher, but a lower blood pressure increases the risk of cognitive decline as well as neuropsychiatric symptoms. Older persons are at risk for impaired regulation of their cerebral blood flow, and stringently lowering their blood pressure may compromise cerebral blood flow, and thereby cognitive function. Therefore, we hypothesized that increasing blood pressure by discontinuation of antihypertensive treatment would improve cognitive and psychological functioning. We performed a community-based randomized controlled trial in a total of 385 participants aged ≥75 years with mild cognitive deficits and without serious cardiovascular disease, and who were all receiving antihypertensive treatment. Persons were randomized to continuation or discontinuation of antihypertensive treatment. Contradictory to our expectation, we found that discontinuation of antihypertensive treatment in older persons did not improve cognitive functioning at 16-week follow-up.
Author Interviews, Nature, NYU/NYMC / 25.08.2015

Robert C. Froemke, PhD, Assistant professor NYU Langone and Skirball Institute of Biomolecular Medicine New York MedicalResearch.com Interview with: Robert C. Froemke, PhD, Assistant professor NYU Langone and Skirball Institute of Biomolecular Medicine New York Medical Research: What is the background for this study? What are the main findings? Dr. Froemke: We studied how a brain area called the ‘locus coeruleus’ is involved in hearing. The locus coeruleus is the brain’s alarm clock, it’s a small region deep in the brainstem that is responsible for arousal and wakefulness, activated by surprising or potentially dangerous events. The locus coeruleus releases the neurochemical noradrenalin (similar to adrenalin) throughout the brain to greatly increase brain activity, and so might convey the significance of sounds related to past events that were very important or startling in some way (like the sound of an alarm, a baby crying, or other sounds that require immediate attention). We found that sounds related to surprising events can come to directly activate the locus coeruleus, meaning that this brain area can learn from past experience. This learning happens quickly (within seconds to minutes) and can be incredibly long-lasting, up to weeks as measured in our study, and we suspect indefinitely or all life-long. We studied this by training lab rats to respond to sounds, poking their nose in a hole to get a food reward whenever they heard a certain sound. We activated the locus coeruleus briefly in some of these animals, and observed that they were much more sensitive to this sound and learned much faster than other unstimulated animals. We made recordings of electrical activity in the locus coeruleus and the auditory cortex, one of the major ‘hearing’ parts of the brain. In stimulated animals, sounds activated the locus coeruleus within tens of milliseconds, releasing noradrenalin into the auditory cortex to greatly boost the audio processing there- making almost every neuron respond very vigorously to that special sound.
Author Interviews, Geriatrics, JAMA, Statins / 24.08.2015

Michael Johansen MD MS Assistant Professor - Clinical Dept of Family Medicine The Ohio State UniversityMedicalResearch.com Interview with: Michael Johansen MD MS Assistant Professor - Clinical Dept of Family Medicine The Ohio State University Medical Research: What is the background for this study? What are the main findings? Dr. Johansen: -Over the last 15 years there has been increasing emphasis placed on the use of statins to decrease people's risk of heart attacks and strokes. Individuals with known heart disease are recommended to be on statins. However, there is no convincing evidence that elderly individuals (>79 years of age) without heart disease benefit from statins. Therefore, we investigated how use patterns of statins has changed over the last ~14 years. We identified a dramatic increase in statin use in the very elderly during the time of the study. As of 2012, around 1/3 of very elderly individuals without heart disease took a statin during that year.
Author Interviews, JAMA, Pediatrics, University Texas / 24.08.2015

Jeffrey R. Kaiser, MD, MA Professor of Pediatrics and Obstetrics and Gynecology Section of Neonatology Baylor College of Medicine Texas Children's Hospital Houston, TX 77030MedicalResearch.com Interview with: Jeffrey R. Kaiser, MD, MA Professor of Pediatrics and Obstetrics and Gynecology Section of Neonatology Baylor College of Medicine Texas Children's Hospital Houston, TX 77030 Medical Research: What is the background for this study? What are the main findings? Dr. Kaiser:  The continuous utero-placental-umbilical infusion of glucose ends at birth, and levels decrease during the first 1–2 hours stimulating counterregulatory hormones and promoting successful glucose homeostasis in healthy newborns. This is important because the newborn brain principally uses glucose for energy, and prolonged and severe hypoglycemia has been linked with poor long-term neurodevelopment. Most previous newborn hypoglycemia-outcome studies, however, are problematic because they did not control for maternal educational level and socioeconomic status, factors that are highly associated with childhood neurodevelopment and academic success. Further, little is known about whether newborn transient hypoglycemia (1 low value followed by a second normal value), frequently considered to be a normal physiological phenomena with no serious sequelae, is associated with poor academic achievement. To address this knowledge gap, we compared initial newborn glucose values from the universal glucose-screening database, available only at the University of Arkansas for Medical Sciences (UAMS), to their matched student achievement-test scores in 4th grade (10 years later). After controlling for gestational-age group, race, gender, multifetal gestation, insurance, maternal education, and gravidity, we observed transient hypoglycemia in a heterogeneous cohort of newborns born at a university hospital was associated with lower fourth-grade achievement-test scores—real-world assessments that predict high school graduation, college attendance, and long-term adult economic success.
Author Interviews, Blood Pressure - Hypertension / 24.08.2015

Stephanie Tjen-A-Looi, MS, PhD Project Scientist Susan Samueli Center for Integrative Medicine Department of Medicine University of Medicine, IrvineMedicalResearch.com Interview with: Stephanie Tjen-A-Looi, MS, PhD Project Scientist Susan Samueli Center for Integrative Medicine Department of Medicine University of Medicine, Irvine Medical Research: What is the background for this study? Response: Mild to moderate hypertensive patient engaged in a stressful condition can lead to adverse cardiovascular responses such as a heart attack or stroke.  Complementary to conventional medical antihypertensive drug treatments that pose side effects, acupuncture therapy with minimal side effects appears to reduce the high blood pressure. Medical Research: What are the main findings? Response: The main findings indicate a reduction in blood pressure in patients with hypertension.  The data show that about 70% of the acupuncture treated patients benefit from this therapy.  Moreover, plasma hormones indexing high sympathetic activity such as nor-epinephrine as well as renin, angiotensin and aldosterone are reduced with acupuncture.
Author Interviews, Colon Cancer, Nutrition / 23.08.2015

MedicalResearch.com Interview with: Dr Andrew Kunzmann & Dr Helen Coleman Joint first authorsCentre for Public Health Queen’s University Belfast Northern Ireland Medical Research: What is the background for this study? Response: There is now a large amount of evidence to suggest that individuals who consume diets high in fiber tend to be at a lower risk of bowel (colorectal) cancer. However, it is not known whether this association begins at the early stages of bowel cancer development or at later stages, in individuals with polyps (adenomas) that can lead to bowel cancer if left untreated. The best source of dietary fiber (cereals, fruit or vegetables) for bowel adenoma and cancer prevention is also debatable. We analysed data from individuals taking part in a large U.S trial assessing bowel screening, who completed a dietary questionnaire and received sigmoidoscopy screening at the start of the trial and received further screening 3 to 5 years later. This allowed us to investigate whether individuals with higher fiber diets had a lower risk of developing their first left-sided adenoma, but also for having adenomas recur at a later time, or indeed risk of bowel cancer, than individuals with diets low in fiber. By analysing only the screened participants, everyone had an equal opportunity to have their recurrent adenomas diagnosed – something that previous studies of dietary fiber have been unable to address.
Author Interviews, Dermatology, Emory, JAMA, Sexual Health / 23.08.2015

MedicalResearch.com Interview with: Howa Yeung, MD PGY3, Emory Dermatology Emory University Medical Research: What is the background for this study? What are the main findings? Dr. Yeung: Indoor tanning is a well-established and preventable cause for melanomas and non-melanoma skin cancers. Public health efforts in curbing indoor tanning have focused on known high-risk populations, such as young, college-aged, White women. However, other demographic risk factors for indoor tanning remain unknown. As our nation increasingly focuses on addressing and improving the health of lesbian, gay, bisexual, and transgender (LGBT) individuals, more and more evidence demonstrates that various LGBT subpopulations face higher rates of cancer-related behavior risk factors, such as smoking, alcohol use, obesity, etc. We wanted to find out whether risk factors for skin cancer, such as indoor tanning, disproportionately affected LGBT populations. Our study showed higher rates of indoor tanning among gay and bisexual men, with 1.8-fold and 3.6-fold higher odds of tanning bed use within the past year, compared to straight men, after adjusting for sociodemographic factors. Disparities in frequent tanning, defined as using tanning bed 10 or more times within the past year, are even more prominent among gay and bisexual men. In contrast, no significant sexual orientation disparities were noted among women after adjusting for sociodemographic factors.
Author Interviews, Cognitive Issues, UCSF / 22.08.2015

Jin-Tai Yu MD, PhD Memory and Aging Center, Department of Neurology University of California San Francisco San Francisco, CA 94158 MedicalResearch.com Interview with: Jin-Tai Yu MD, PhD Memory and Aging Center, Department of Neurology University of California San Francisco San Francisco, CA 94158 Medical Research: What is the background for this study? What are the main findings? Response: The number of dementia cases in the whole world was estimated to be 35.6 million in 2010 and this number was expected to almost double every 20 years, to 65.7 million in 2030 and 115.4 million in 2050. The global prevalence of dementia was 5-7% and Alzheimer’s disease accounts for roughly 60%. This data means that we are facing an increasing number of global populations of this specific neurodegenerative disease and also the heavy burden brought by it. Data from the website of global clinical trials (http://clinicalTrials.gov) showed that a total of 1,732 clinical trials for Alzheimer’s disease were under way. However, the previous results are not so optimistic, possibly due to the complex etiological mechanisms. In one word, we had currently no effective drugs for this disease. Figuring out how to effectively prevent its occurrence is increasingly attracting people’s attentions.Therefore, we have done the most extensive and comprehensive systematic review and meta-analysis to date, which employs a full-scale search of observational studies to calculate effect sizes and grade the evidence strength of various modifiable risk factors for this disease. We hope these results will be informative and instructive.
Author Interviews, Dermatology / 22.08.2015

MedicalResearch.com Interview with: Erika Hagstrom, M.D., M.A. Preliminary Internal Medicine PGY-1 Loyola University Medical Center  Medical Research: What is the background for this study? What are the main findings? Dr. Hagstrom: Allocation of funding dollars to research is a critical and daunting task. While many factors may impact research-funding decisions, establishing a transparent priority-setting exercise is paramount. This is particularly important for the National Institutes of Health, which invests over $30 billion for medical research each year. Diseases that have the greatest impact on our population warrant increased research dollars to reduce disease burden. The Global Burden of Disease Study (GBD) is an epidemiological effort to quantify the global burden of disease in a universal metric called disability-adjusted life years (DALYs). Focusing on our particular interest of dermatology, we investigated the 2012-2013 NIH funding for 15 skin diseases and matched this to the corresponding DALY metrics.
Author Interviews, Infections / 22.08.2015

Nichola Kinsinger, Ph.D Postdoctoral Researcher, Chemical & Environmental Engineering University of California, Riverside USDA National Institute for Food and Agricultural Postdoctoral Fellow DoD Office of Naval Research National Defense Science and Engineering Graduate Research Fellow EIT (Chemical Engineering)MedicalResearch.com Interview with: Nichola Kinsinger, Ph.D Postdoctoral Researcher, Chemical & Environmental Engineering University of California, Riverside USDA National Institute for Food and Agricultural Postdoctoral Fellow DoD Office of Naval Research National Defense Science and Engineering Graduate Research Fellow, EIT (Chemical Engineering) Medical Research: What is the background for this study? What are the main findings? Dr. Kinsinger: Outbreaks observed in produce are becoming increasing common possibly due to contaminated irrigation waters or contaminated waters used during processing.  In 2006 California had spinach-borne E. coli outbreak that impacted 26 states and 200 confirmed sickened.  Leafy greens account for 20% of the outbreaks alone and are of increased concern since they are frequently consumed raw. These outbreaks drew our attention over the past few years and we started applying methods originally developed for studying bacterial adhesion on engineered surfaces to the issue of food safety.  Although food safety is a new area of study for our lab, the project is based upon the concept of pathogen adhesion transport which has been the focus of my advisor’s lab for many years previously.  Rather than the previous scenario looking at pathogen interaction with engineered or mineral surfaces, we are looking at a spinach leaf instead. salad-cdc-image We are using a parallel plate flow chamber system developed by Professor Sharon Walker to evaluate the real time attachment and detachment of the pathogens to the spinach epicuticle layer (surface layer of the leaf) in realistic water chemistries and flow conditions.  Subsequently we can evaluate the efficacy of the rinsing process to kill the bacteria that may remain on the leaf.  Initially we were finding that at low concentrations of bleach, bacteria will detach from the leaf surface allowing for potential cross-contamination later in the process.   However above 500ppb we observed 100% of the attached bacterial cells are killed. So how in commercial rinsing operations that use bleach concentration ranging from 50-200ppm result in outbreaks?  Through this study we analyzed the topography of the leaf and modeled the concentration gradient across the surface of a leaf based on commercial rinsing practices.  We found that even at high bleach concentrations within rinse water result in low bleach concentrations at the leaf surface on the order of 5-1000 ppb bleach, which in our study has shown to that the bacteria can survive when attached to the leaf and/or detach causing concern for cross-contamination.   In this case the very disinfection processes intended to clean, remove, and prevent contamination was found to be a potential pathway to amplifying foodborne outbreaks.
Aging, Author Interviews, Cognitive Issues, Exercise - Fitness / 22.08.2015

Rikke Hodal Meincke PhD student Center for Healthy Aging and the Department of Public Health University of CopenhagenMedicalResearch.com Interview with: Rikke Hodal Meincke PhD student Center for Healthy Aging and the Department of Public Health University of Copenhagen Medical Research: What is the background for this study? Response: A sufficient level of physical capability is a precondition for maintaining independence and quality of life. Physical capability can be assessed objectively by tests of physical performance, for instance handgrip strength, chair-rising and postural balance. Physical performance is associated with mortality and disability in late life, so gaining insights into the variance in physical performance is important to promote sustained physical capability and prevent disability. Research has previously found physical activity, health status and socioeconomic position to be associated with physical performance. In addition, early life factors, such as childhood SEP, have been found to be associated with measures of physical performance later in life. The objective of our study was to examine the association between intelligence in early adulthood and midlife physical performance in Danish men. If an association between intelligence in early life and midlife physical performance exists it may indicate that cognitive abilities and physical performance share some of the same neurodevelopmental processes, but may also indicate that intelligence has an independent effect on later physical performance through various pathways. Medical Research: What are the main findings? Response: In our study of more than 2800 Danish men, we found positive associations between intelligence in early adulthood and five objective measures of physical performance in midlife independent of other early life factors. A one standard deviation increase in intelligence score resulted in 1.1 more chair-rises in 30 seconds, a 1 cm higher jump, a 3.7% smaller balance area, a 0.7 kg increase in handgrip-strength, and a 0.5 kg increase in lower back force.
Author Interviews, Biomarkers, Gastrointestinal Disease, Hepatitis - Liver Disease / 22.08.2015

Stuart Gordon, M.D. Director of Hepatology at Henry Ford HospitalMedicalResearch.com Interview with: Stuart Gordon, M.D. Director of Hepatology at Henry Ford Hospital Detroit, Michigan Medical Research: What is the background for this study? What are the main findings? Dr. Gordon: The U.S. Centers for Disease Control and Prevention’s Division of Viral Hepatitis estimates 2.7 to 3.9 million people in the United States currently suffer from chronic hepatitis C. But, unfortunately, many of these patients may be unaware of the severity of their liver damage. We looked at evidence of cirrhosis among hepatitis C patients by examining four different parameters: ICD9 codes; liver biopsy reports; evidence of liver failure; and the FIB-4 test, an easily calculated biomarker. By using all four indicators of cirrhosis, we found a far higher prevalence of cirrhosis than would be indicated by any one method.
Author Interviews, Heart Disease, Kidney Disease / 22.08.2015

Tae-Hyun Yoo MD PhD Department of Internal Medicine, College of Medicine Severance Biomedical Science Institute, Brain Korea 21 PLUS Yonsei University, Seoul, KoreaMedicalResearch.com Interview with: Tae-Hyun Yoo MD PhD Department of Internal Medicine, College of Medicine Severance Biomedical Science Institute, Brain Korea 21 PLUS Yonsei University, Seoul, Korea Medical Research: What is the background for this study? What are the main findings? Dr. Tae-Hyun Yoo: Sarcopenia, reduction in muscle mass, is frequently observed in PEW and is prevalent in chronic kidney disease (CKD) patients. In ESRD patients, sarcopenia is significantly associated with greater mortality. Skeletal muscles produce and release myokines, which  suggested to mediate their protective effects. Irisin, a novel myokine, has been introduced to drive brown-fat-like conversion of white adipose tissue and has beneficial effects of skeletal muscle on energy homeostasis and glucose metabolisms. Therefore, we hypothesized that irisin had significant association with sarcopenia and cardiovascular disease in dialysis patients. In peritoneal dialysis patients, serum irisin was positively correlated with mid-arm muscle circumference and thigh circumference. In addition, serum irisin was a significant independent predictor for carotid atherosclerosis even after adjustment for high-sensitivity C-reactive protein in these patients. This study demonstrated that serum irisin was significantly associated with sarcopenia and carotid atherosclerosis in peritoneal dialysis patients.
Author Interviews, JAMA, Orthopedics, Surgical Research / 22.08.2015

MedicalResearch.com Interview with: Sandrine Colas, MSc, MPH Department of Epidemiology of Health Products French National Agency for Medicines and Health Products Safety (ANSM) Saint-Denis, France Medical Research: What is the background for this study? What are the main findings? Response: Total hip replacement (THR) is to replace a damaged coxofemoral joint with a prosthetic implant. Primary or secondary degenerative osteoarthritis of the hip joint is the main indication for THR (other indications are essentially trauma, which is more common in the elderly and mostly affects women over 80 years of age). The number of THR has increased in all industrialized countries, particularly on account of the ageng population.Total hip replacement is one of the most common and successful surgical procedures in modern practice. Although results are generally good, revision (consisting in changing one or all components of the implant) is sometimes necessary (about 1% per year). Prosthetic revision is a longer and more complex operation than primary implantation and it has a higher incidence of post-surgical complications. Several prosthetic revision risk factors have been highlighted recently in published studies, but results relating to prosthetic and/or patient characteristics and total hip replacement survivorship tend to vary. The existence of an association between the fixation technique and/or bearing surface and prosthetic survivorship has yet to be established. The main aim of our work was therefore to compare total hip replacement short-term survivorship according to cement type and bearing surface, in a large population of subjects who have undergone total hip replacement for reasons other than trauma (25%) and bone tumor (<0.1%), taking prosthetic revision risk factors (age, gender, comorbidities, concomitant medication, implanting center, etc.) into account. Total hip replacement characteristics are related to early implant survivorship. After 33 months of follow-up, antibiotic-impregnated cemented THRs have a better prognosis. MoM total hip replacemenst have a slightly worse prognosis.
Author Interviews, Heart Disease, Radiology / 22.08.2015

MedicalResearch.com Interview with: Bjarne Linde Norgaard, MD PhD Department of Cardiology, Aarhus University Hospital Skejby Aarhus, Denmark   Medical Research: What is the background for this study? What are the main findings? Dr. Norgaard: Noninvasive fractional flow reserve derived from standard acquired coronary CT angiography (CTA) (FFRct) in patients with suspected coronary artery disease exhibits high and superior diagnostic performance when compared to coronary CTA alone in identifying lesion-specific ischemia (which is the established metric for decision-making on coronary revascularization). As the presence of coronary calcification may compromise the diagnostic accuracy and specificity of coronary CTA, this study was performed in order to investigate the influence of calcification on the diagnostic performance of FFRct in patients (214) and vessels (333) with suspected coronary artery disease. The main finding in this study was that FFRct provides high and superior diagnostic performance and discrimination of ischemia compared with coronary CTA interpretation alone in patients and vessels with high levels of calcification.
Author Interviews, Infections, University of Pennsylvania, Vaccine Studies / 22.08.2015

David B. Weiner, Ph.D. Professor, Department of Pathology and Laboratory Medicine Chair, Gene Therapy and Vaccine Program, CAMB Co-Leader Tumor Virology Program, Abramson Cancer Program University of Pennsylvania, Perelman School of MedicineMedicalResearch.com Interview with: David B. Weiner, Ph.D. Professor, Department of Pathology and Laboratory Medicine Chair, Gene Therapy and Vaccine Program, CAMB Co-Leader Tumor Virology Program, Abramson Cancer Program University of Pennsylvania, Perelman School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Weiner: MERS, like the Severe Acute Respiratory Syndrome (SARS), is characterized by high fever and severe cough from pneumonia. MERS is caused by an emerging human coronavirus, which is distinct from the SARS coronavirus. Since its identification in 2012, MERS has been linked to over 1,300 infections and close to 400 deaths. It has occurred in the Arabian Peninsula, Europe, and in the US and in Asia. It can be spread in a hospital setting. Scientists now report that a novel synthetic DNA vaccine can, for the first time, induce protective immunity against the Middle EastRespiratory Syndrome (MERS) coronavirus in animal species.   Researchers from the Perelman School of Medicine at the University of Pennsylvania. The NIH, the Public Health agency of Canada, and from a leading company in the development of synthetic DNA vaccine technology, Inovio described the results in a paper  published their work in Science Translational Medicine (STM) this week.  The experimental, preventive vaccine, given six weeks before exposure to the MERS virus, fully protects rhesus macaques from disease. The vaccine also generated potentially protective antibodies in blood drawn from camels, the purported source of MERS transmission in the Middle East.
Author Interviews, Pediatrics, Vaccine Studies / 21.08.2015

Gary S. Marshall, M.D. Professor of Pediatrics Chief, Division of Pediatric Infectious Diseases Director, Pediatric Clinical Trials Unit University of Louisville School of Medicine MedicalResearch.com Interview with: Gary S. Marshall, M.D. Professor of Pediatrics Chief, Division of Pediatric Infectious Diseases Director, Pediatric Clinical Trials Unit University of Louisville School of Medicine     Medical Research: What is the background for this study? What are the main findings? Dr. Marshall: The infant immunization schedule has become crowded. That’s great news, in a sense, because it means that our children have become better protected against more diseases. At the same time, this has led to well child visits during which many shots are recommended, and some parents want to limit the number of injections their children receive at one time. This leads to deferrals, poor timeliness and decreased coverage rates, all of which could impair protection. This study shows that a hexavalent vaccine—one that combines diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b, and hepatitis B vaccines in one syringe—is safe and just as immunogenic as the currently used component vaccines. 
Author Interviews, Genetic Research / 21.08.2015

Hendrik Marks Ph.D Group leader Epigenetics of Stem Cells Radboud University, Department of Molecular Biology, RIMLS, Nijmegen, The Netherlands MedicalResearch.com Interview with: Hendrik Marks Ph.D Group leader Epigenetics of Stem Cells Radboud University, Department of Molecular Biology, RIMLS Nijmegen, The Netherlands   Medical Research: What is the background for this study? What are the main findings? Dr. Marks: In mammals, sex is determined by two so-called "sex" chromosome: males have a single X chromosome as well as a Y chromosome, whereas females have two copies of the X chromosome. However, if both X chromosomes were to be active in female cells, these cells would have a double dosis of X-chromosomal gene products as compared to male cells. As this is lethal for almost all cells, female cells shut off one X chromosome in every cell in a process called X inactivation. This process occurs during early embryonic development. A lot is known about how this process is turned on, but is was unclear how such a silencing process spreads along a full chromosome. In order to further study this, we used female mouse embryonic stem cells (mESCs) as a model system and initiated X inactivation by means of differentiation. With the latest technologies, we were able to keep the two X chromosomes apart and measure one of them – with its 166 million base pairs (Mbs) – in detail. Every day we checked which parts of the chromosome had been switched off. The whole process took about eight days, and the inactivation spreads out from the centre of the X chromosome towards the ends. That doesn’t happen gradually but moves jumpwise from domain to domain. Domains are long pieces of DNA (of around 1Mb) that cluster together in knots. As it seems that X inactivation jumps from domain to domain, we now know that these domains are co-regulated. Also, we collected strong evidence that the same process is occurring in human.
Author Interviews, JAMA, Opiods, Pharmacology / 21.08.2015

Lainie Rutkow, JD, PhD, MPH Associate Professor Department of Health Policy and Management Johns Hopkins Bloomberg School of Public HealMedicalResearch.com Interview with: Lainie Rutkow, JD, PhD, MPH Associate Professor Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health  Medical Research: What is the background for this study? What are the main findings? Dr. Rutkow: Rates of prescription drug diversion and misuse, as well as overdose deaths, have increased throughout the United States. CDC estimates that each day, 44 people die from a prescription drug overdose. In the mid-2000s, Florida was viewed as the epicenter of this epidemic, with prescription drug overdose deaths increasing more than 80% from 2003 to 2009. In response, Florida enacted several laws to mitigate prescription drug abuse and diversion. Its pill mill law required pain management clinics to register with the state and prohibited physician dispensing of certain drugs. Florida’s Prescription Drug Monitoring Program (PDMP) collects data about dispensing of prescription drugs and can be accessed by physicians and pharmacists. Little is known about how these laws have affected prescribing of opioids. We applied comparative interrupted time series analyses to pharmacy claims data to examine four outcomes related to opioid prescribing in Florida, with Georgia as a comparison state. We found that in the first year of implementation, Florida’s Prescription Drug Monitoring Program and pill mill law were associated with modest reductions in prescription opioid volume, prescriptions written, and the dose per prescription. These declines were statistically significant among the highest volume prescribers and patients at baseline.