Aging, Author Interviews, Frailty / 17.01.2015

MedicalResearch.com Interview with: Alexander Voukelatos BSc, BA, MA(psych), PhD Healthy Populations Program Manager Health Promotion Sydney Local Health District and Conjoint Lecturer School of Public Health and Community Medicine University of NSW Medical Research: What is the background for this study? Response:Falls in older people has been a significant public health issue in high income countries for several decades now. We know that if current trends continue, given that more people will be living for longer, falls will be an even bigger issue in the not too distant. Falls are not an inevitable part of ageing, and in fact many falls can be prevented relatively simply by increasing physical activity. For over 15 years we've known that physical activity is one of the most effective ways of reducing the risk of falls in older people living in the community; since the publication of the first Cochrane review on Interventions for preventing falls in the elderly by Gillespie and colleagues. [1]  I know that Health Departments here, in Australia, and in New Zealand - as I suspect has been the case in many high income countries - have invested a lot of resources over the past few decades into reducing falls-related hospital admissions in older people. Much of this going into promoting and funding physical activity programs for older people. However, this investment has had very little if any impact on falls-related hospital admissions in older people. There may be several reasons we haven't seen any difference in these rates. In New South Wales - Australia's most populous state -  we know that physical activity rates amongst older people have actually risen by about 15% between 1998 and 2005,[2] the most popular activity by far being walking,[3] yet we haven't see any corresponding change in falls-related hospitalization rates. Perhaps there has not been enough time for these programs to have made an impact on hospitalization rates, or perhaps the change in physical activity levels is insufficient to make an impact on these rates. Another possibility could be that while we've seen an increase in physical activity in older people perhaps its not the kind of physical activity that results in a reduction in falls. Sherrington and colleagues [4] reviewed effective physical activity interventions for preventing falls in older people and found they had several elements in common: a) the physical activity included balance challenging exercise i.e. exercises taking participants to the limits of their stability, b) at least 50 hours of accumulated activity was needed, and c) no walking was included in the exercises. So we know not all types of physical activity will be equally effective in reducing the risk of falling. There is some disagreement in the literature about walking. There are several studies that included walking as part of the intervention and showed a reduction in falls in older people. Other studies supported the conclusions made by Sherrington that walking is not associated with a reduction in falls. All of these studies included walking as a component of an intervention which makes it difficult to figure out what effect walking specifically has on falls rates. This is were our study comes in. We wanted to investigate the effectiveness of a walking program on falls in older people, specifically sedentary older people, who we presumed would get the most benefit from becoming more physically active. We developed a walking program specifically for sedentary older people, that they could do themselves in their own time, at their preferred locale. The aim of the program was to get participants walking for at least 150 minutes per week at a brisk pace. The program comprised of four parts: the first part focused on increasing the frequency of walks, the second part focused on getting participants to walk for at least 150 minutes per week, followed by walking for 150 minutes at a brisk pace, while the final part focused on supporting participants in maintaining their walking levels and incorporating walking as part of their daily activities. (more…)
AHA Journals, Author Interviews, Heart Disease, Stroke / 17.01.2015

Jonathan Thigpen, PharmD Assistant Professor Clinical and Administrative Sciences Notre Dame of Maryland University School of PharmacyMedicalResearch.com Interview with: Jonathan Thigpen, PharmD Assistant Professor Clinical and Administrative Sciences Notre Dame of Maryland University School of Pharmacy Medical Research: What is the background for this study? What are the main findings? Dr. Thigpen: This effort assessed the accuracy of International Classification of Disease 9th Edition (ICD-9) stroke codes in identifying valid stroke events in a cohort of atrial fibrillation (AF) patients. The initial electronic search yielded 1,812 events across three stroke centers (Boston Medical Center, Geisinger Health System, and University of Alabama). All ICD-9 identified stroke events were vetted through manual chart review with final adjudication by a stroke neurologist. Atrial fibrillation was verified by evidence via electrocardiogram at stroke admission, 6 months prior to, or 90 days after stroke admission. In addition to assessing the accuracy of the stroke codes alone, we also assessed the accuracy of stroke and Atrial fibrillation codes combined as well as the accuracy of stroke codes when seeking for stroke associated with Atrial fibrillation. These additional steps give readers insight as to the accuracy and reliability of using ICD-9 codes alone to create a stroke plus AF cohort. We feel that this effort is extremely important given the increasing reliance on ICD-9 codes as a means of identifying stroke events and covariates in research, especially research using administrative data. The positive predictive value (PPV) of stroke codes alone was 94.2%. PPVs did not differ across clinical site or by type of event (ischemic vs. intracranial hemorrhage). PPV of stroke codes did differ by event coding position (primary vs. other; 97.2% vs. 83.7%) and by ischemic stroke code (433 vs. 434; 85.2% vs. 94.4%). When combined with validation of Atrial fibrillation codes, the PPV of stroke codes decreased to 82.2%. After excluding ischemic stroke due to a different mechanism (eg, vascular procedure, tumor, sepsis) the PPV dropped further to 72.8%. As a separate exercise, manual review confirmed 33 (7.2%) ischemic strokes in 458 events coded as "without infarction". (more…)
Author Interviews, Endocrinology, Weight Research / 16.01.2015

Caroline M. Apovian, MD Chair of the Endocrine Society task force that developed “Pharmacological Management of Obesity: An Endocrine Society Clinical Practice Guideline” Boston University School of Medicine Boston Medical CenterMedicalResearch.com interview with: Caroline M. Apovian, MD Chair of the Endocrine Society task force that developed “Pharmacological Management of Obesity: An Endocrine Society Clinical Practice Guideline” Boston University School of Medicine Boston Medical Center MedicalResearch: What is the background for this report? Dr. Apovian: The Food and Drug Administration has approved four new anti-obesity drugs – lorcaserin, phentermine/topiramate, naltrexone/bupropion and liraglutide – in the past two years. To help clinicians navigate this changing landscape, the Endocrine Society developed its Clinical Practice Guideline to provide strategies for prescribing drugs to manage obesity and promote weight loss. MedicalResearch: What are the main findings? Dr. Apovian: In the Clinical Practice Guideline, the Endocrine Society recommends that diet, exercise and behavioral modifications be part of all obesity management approaches. Other tools such as weight loss medications and bariatric surgery can be combined with behavioral changes to reduce food intake and increase physical activity, in appropriate patients. Patients who have been unable to successfully lose weight and maintain a goal weight may be candidates for prescription medication if they meet the criteria on the drug’s label as well as BMI criteria (BMI greater than or equal to 30 or greater than or equal to 27 with at least one comorbidity). Other recommendations from the CPG include:
  • If a patient responds well to a weight loss medication and loses 5 percent or more of their body weight after three months, the medication can be continued. If the medication is ineffective or the patient experiences side effects, the prescription should be stopped and an alternative medication or approach considered.
  • Since some diabetes medications are associated with weight gain, people with diabetes who are obese or overweight should be given medications that promote weight loss or have no effect on weight as first- and second-line treatments. Doctors should discuss medications’ potential effects on weight with patients.
  • Certain types of medication – angiotensin converting enzyme inhibitors, angiotensin receptor blockers and calcium channel blockers – should be used as a first-line treatment for high blood pressure in obese people. These are effective blood pressure treatments that are less likely to contribute to weight gain than an alternative medication, beta-adrenergic blockers.
  • When patients need medications that can have an impact on weight such as antidepressants, antipsychotic drugs and medications for treating epilepsy, they should be fully informed and provided with estimates of each option’s anticipated effect on weight. Doctors and patients should engage in a shared-decision making process to evaluate the options.
  • In patients with uncontrolled high blood pressure or a history of heart disease, the medications phentermine and diethylpropion should not be used.
(more…)
Author Interviews, Technology / 16.01.2015

Moe Alsumidaie MBA MSF President & Chief Scientific Officer Annex ClinicalMedicalResearch.com Interview with: Moe Alsumidaie MBA MSF President & Chief Scientific Officer Annex Clinical   MedicalResearch: What is the background for this study? Response: SUMMARY: A real-world case study measuring the impact of Short Messaging System (SMS) or “Text Messaging” on clinical trial patient recruitment using an interactive two-way patient engagement platform by Mosio, Inc., which provides clinical research services designed to increase patient recruitment, engagement and retention, found that use of text messaging alone can be an effective means of patient engagement that results in clinical trial patient enrollment. Patient recruitment, retention and medication adherence continue to be challenges in conducting effective clinical trials. While clinical trials often rely on email recruitment, recent studies suggest that only 22% of emails are read.1 Alternatively, 98% of text messages are read1 and 90% of text messages are read within the first three minutes of receipt.2 Recent research has evaluated the impact of Short Messaging System (SMS) or “Text Messaging” in healthcare settings, such as appointment reminders and medication adherence. Results have demonstrated that SMS intervention significantly improved patient behavioral outcomes: patients who received SMS reminders were more likely to show up to appointments on time,3 and patients who received SMS reminders were more adherent to medications.4 However, only limited research is available on the effect of SMS on clinical trial subject enrollment. Johnson County Clin-Trials (JCCT), a clinical research facility that specializes in executing 10-15 vaccine clinical trials per year, was facing issues with enrolling patients rapidly in a tight time frame using email. To access a more effective strategy to better engage patients, JCCT employed two-way SMS/text messaging solutions, and this study assessed the impact of SMS/text messaging on patient recruitment and enrollment. (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA, Medicare, Mental Health Research, Pharmacology / 16.01.2015

Dr. Jeanne Madden PhD Instructor, Department of Population Medicine Harvard Medical SchoolMedicalResearch.com Interview with: Dr. Jeanne Madden PhD Instructor, Department of Population Medicine Harvard Medical School   Medical Research: What is the background for this study? What are the main findings? Dr. Madden: When Medicare Prescription Drug Coverage started in 2006, many experts voiced concerns about disabled patients with serious mental illness making the transition from state Medicaid coverage to Medicare.  Our study is one of the first to examine the impact of the transition in mentally ill populations.  People living with schizophrenia and bipolar disorder are at high risk of relapse and hospitalization and are especially vulnerable to disruptions in access to their treatments. We found that the effects of transitioning from Medicaid to Medicare Part D depended on where patients lived.  Transition to Part D in states that put limits on Medicaid drug coverage resulted in fewer patients going without treatment. By contrast, in states with more generous drug coverage, we saw reductions in use, of antipsychotics in particular, after patients shifted to Medicare Part D.  This may have been due to new cost controls used within many private Medicare drug plans.  Given that most states in the US are in this latter category, with the relatively generous Medicaid drug coverage, we also found reductions in antipsychotic use nation-wide. Although a very large group of people made that transition from Medicaid to Medicare in 2006, thousands more still transition every year because when disabled people qualify for Medicare, they must wait 2 years for their benefits kick in.  Also, many other disabled patients are on Medicaid only and don’t qualify for Medicare.  They are of course affected by restrictions on Medicaid coverage, which vary from state to state. (more…)
Author Interviews, Dengue, Infections, PLoS / 16.01.2015

MedicalResearch.com Interview with: Jose R. Loaiza Smithsonian Tropical Research Institute, Panama City, Panama, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología,  Universidad de Panamá, Ciudad de Panamá, Panamá   Medical Research: What is the background for this study? Response: The mosquito Aedes albopictus is a worldwide vector of both Dengue and Chikungunya viruses. This species invaded Panama in 2002, and it expanded across much of the country since that time. Our main goal was to determine the factors (e.g., ecological and non-ecological) associated with its expansion, and to comment on the implications for vector and disease control programs elsewhere in the American tropics. Medical Research: What are the main findings? Response: We found that road networks alone best predicted the distribution of Ae. albopictus in Panama over other variables such as population density and climate. Our data explain the invasion mode of this mosquito species on a local level and demonstrate a remarkable population expansion velocity across the country. Ae. albopictus is likely moving across the landscape as immature stages (i.e., larvae and pupae) in open water, such as used tires. (more…)
Author Interviews, Breast Cancer, Inflammation / 16.01.2015

Dr. Jorge Morales-Montor Departamento de Inmunología Instituto de Investigaciones Biomédicas Universidad Nacional Autónoma de México México City MéxicoMedicalResearch.com Interview with: Dr. Jorge Morales-Montor Departamento de Inmunología Instituto de Investigaciones Biomédicas Universidad Nacional Autónoma de México México City México MedicalResearch: What is the background for this study? Dr. Morales-Montor: Cytokines are highly inducible, secretory proteins that mediate intercellular communication in the immune system. They are grouped in several protein families referred as tumour necrosis factors, interleukins, interferons and colony stimulating factors. In recent years, it has become clear that some of these proteins as well as their receptors are produced in the organisms under physiological and pathological conditions. The exact initiation process of breast cancer is unknown, although several hypotheses have emerged. Inflammation has been proposed as an important player in tumor initiation, promotion, angiogenesis and metastasis, all phenomena in which cytokines are prominent players. The data we have hitherto let us suggest that cytokines play an important role in the regulation of both induction and protection in breast cancer. This knowledge could be fundamental for the proposal of new therapeutic approaches to particularly breast cancer and other cancer related disorders. (more…)
Author Interviews, CDC, Infections, JAMA, Pediatrics / 16.01.2015

MedicalResearch.com Interview with: Dr. Stefan Goldberg MD Medical Officer in CDC’s Division of Tuberculosis Elimination Clinical Research Branch Medical Research: What is the background for this study? What are the main findings? Dr. Goldberg: A shorter, simpler treatment regimen for children with latent TB infection can help prevent TB disease and reduce future transmission. The results from our study, a multinational, clinical trial, found that a once-weekly regimen of the anti-TB drugs rifapentine and isoniazid taken as directly observed therapy over a period of three months was safe and as effective for children (age 2-17) in preventing TB disease as the standard self-administered nine-month daily regimen of isoniazid alone. The study also showed that children are more likely to complete the shorter course of treatment, which is important given that treatment completion can be difficult. Specifically, we found that 88 percent of the trial participants on the combination regimen completed therapy while 81 percent completed the standard regimen. The CDC’s Tuberculosis Trials Consortium (TBTC), which conducted this study, works to include children in research when their inclusion is scientifically supportable and when children also might benefit from important new tools, such as alternative treatment regimens. This study is an extension of a large, international trial among persons age 12 and older, published by TBTC in 2011, which showed the shorter, simpler regimen to be as safe and effective as standard treatment. (more…)
Author Interviews, Ebola, PLoS / 16.01.2015

John M. Drake, Ph.D. Associate Professor, Odum School of Ecology, University of Georgia Director, Population Biology of Infectious Diseases REU SiteMedicalResearch.com Interview with: John M. Drake, Ph.D. Associate Professor, Odum School of Ecology University of Georgia Director, Population Biology of Infectious Diseases REU Site Medical Research: What is the background for this study? What are the main findings? Dr. Drake: Ebola virus disease is a deadly illness caused by infection with the zoonotic Ebola virus. The world's largest epidemic of Ebola virus disease is currently ongoing in West Africa, concentrated in the countries of Liberia, Sierra Leone, and Guinea. Ebola emerges in a human population after contact with an infected animal host and persists through human-to-human transmission. Persons with late stage illness are especially infectious. Ebola outbreaks are typically contained by outbreak investigation and patient isolation. But, as the current epidemic shows, containment may be very difficult to achieve in areas of high population density or where there is little health infrastructure. During the second half of 2014, the West African nation of Liberia suffered the greatest rates of Ebola transmission. Slowing the spread of Ebola was found to be especially difficult after the virus reached the urban areas around Monrovia, particularly the township of West Point. The United States, other nations, and non-governmental organizations promised aid and developed a plan to improve Liberia's health infrastructure, but many aspects of urban Ebola transmission were then unknown, including the relative importance of hospital- and community-acquired infection, how much hospital capacity must be increased to provide care for the anticipated patient burden, and what level patient of isolation would be required to contain the outbreak. To address these issues, we developed a model for Ebola transmission that accounted for the separate sites at which infection could occur, for instance in the home, in public places (particularly at funerals), or in health facilities. Based on information available by mid-October, it was not clear whether enough was being done to contain the epidemic in Liberia. But, through public vigilance and community participation, particularly the willingness of infected persons to be treated in health facilities and to allow safe handling of the bodies of the deceased, transmission dropped dramatically in the last quarter of the year. An updated version of our model developed in early December suggests that if these gains can be maintained then the epidemic may be over by the middle of 2015. (more…)
Author Interviews, Prostate, Prostate Cancer, Urology / 16.01.2015

MedicalResearch.com Interview with: Mufaddal Mamawala, MBBS, MPH, CPH Biostatistician Johns Hopkins School of Medicine Brady Urological Institute Medical Research: What is the background for this study? What are the main findings? Dr. Mamawala: Twenty years after prostate-specific antigen (PSA) was FDA approved for the diagnosis of prostate cancer, its use remains highly controversial. There has been an ‘over- diagnosis’ and ‘over-treatment’ of low-risk prostate cancers that would have never progressed to a more lethal form of the disease during one’s life. Active surveillance (AS) is an alternative to immediate treatment, which allows for monitoring of favorable risk patients with selective delayed intervention among those with disease progression. However  ‘misclassification’ is a cause of concern for patients in the initial years of been in AS. The initial biopsy may have missed an area of prostate with an aggressive cancer, due to under-sampling of cores or due to randomness, such that this patient could get misclassified as having a low-risk disease and by the time the follow-up biopsy shows an aggressive cancer the window of curability is lost. However with more sampling of the prostate there is more likelihood to find an aggressive cancer. As such if the patient is compliant with their biopsies, and more prostate is sampled under the microscope, better are the chances of finding a higher risk cancer. Conversely if the patient has more biopsies that show no high-risk cancer then they are less likely to have a high-risk cancer on future biopsies. Thus we wanted to evaluate the risk of reclassification, from a low-risk disease to a high-risk disease (higher Gleason score, or increase in extent of the disease), over a period of time in compliant active surveillance patients.  The length of time under Active surveillance without reclassification has not been evaluated as a predictor of future reclassification. Biopsies are invasive procedures, and the fact that patient has to undergo this invasive procedure regularly is a deterrent from been in Active surveillance. This study would help to make informed decisions about the need for doing frequent biopsies in light with other clinical factors especially in older patients who had many non-reclassifying biopsies before. We found that the risk of reclassification was not equally distributed across time. As a result of ‘under sampling’ of prostate at diagnostic biopsy we had highest rates of reclassification in the first two years of been in Active surveillance with more than 50% of total reclassifications happening during those two years. The ‘low-risk’ and the ‘very-low-risk’ groups, determined by the Epstein criteria, had similar rates of reclassification in the first two years. After first two years the ‘low-risk’ group were 2.4 times as likely to have a higher risk of reclassification than the ‘very-low-risk’ group. In both the groups the risk of reclassification declined over time significantly by at least 30% with each biopsy that did not show reclassification. (more…)
AHA Journals, Author Interviews, Heart Disease, Hospital Readmissions, NYU / 16.01.2015

Leora Horwitz, MD, MHS Director, Center for Healthcare Innovation and Delivery Science New York University Langone Medical Center Director, Division of Healthcare Delivery Science Department of Population Health, NYU School of Medicine New York, NY 10016MedicalResearch.com Interview with: Leora Horwitz, MD, MHS Director, Center for Healthcare Innovation and Delivery Science New York University Langone Medical Center Director, Division of Healthcare Delivery Science Department of Population Health, NYU School of Medicine New York, NY 10016 Medical Research: What is the background for this study? What are the main findings? Dr. Horwitz: We reviewed over 1500 discharge summaries from 46 hospitals around the nation that had been collected as part of a large randomized controlled trial (Telemonitoring to Improve Heart Failure Outcomes). All summaries were of patients who were admitted with heart failure and survived to discharge. We found that not one of them met all three criteria of being timely, transmitted to the right physician and fully comprehensive in content. We also found that hospitals varied very widely in their average quality. For instance, in some hospitals, 98% of summaries were completed on the day of discharge; in others, none were. In the accompanying Data Report, we show that summaries transmitted to outside clinicians and including more key content elements are associated with lower risk of rehospitalization within 30 days of discharge. This is the first study to demonstrate an association of discharge summary quality with readmission. (more…)
Author Interviews, CDC, OBGYNE, Supplements / 15.01.2015

Jennifer Williams MSN, MPH, FNP-BC National Center on Birth Defects and Developmental Disabilities CDC, Atlanta, Georgia MedicalResearch.com Interview with: Jennifer Williams MSN, MPH, FNP-BC National Center on Birth Defects and Developmental Disabilities CDC, Atlanta, Georgia Medical Research: What is the background for this study? What are the main findings? Response: Neural tube defects are serious birth defects of the brain and spine that can cause significant disability and death. Studies have shown that taking 400 mcg of folic acid daily before and during pregnancy can reduce the prevalence of neural tube defects. Therefore, in 1992, the US Public Health Service (USPHS) recommended that all women of childbearing age in the United States who are capable of becoming pregnant consume 400mcg of folic acid per day to reduce the risk of neural tube defects. To help women meet this requirement, in 1998 the US Food and Drug Administration (FDA) mandated that folic acid be added to enriched grain products for the prevention of neural tube defects. This study looks at how many neural tube defects have been prevented annually since folic acid fortification. Using data from birth defects tracking systems, researchers found that since folic acid fortification, the birth prevalence of neural tube defects has decreased by 35% in the United States, which translates to about 1,300 babies that are born each year without a neural tube defect who might otherwise have been affected.  This study also reports that the number of babies born with a neural tube defect annually differs by the mother’s race/ethnicity. Hispanic mothers continue to be at the highest risk for having a baby with a neural tube defect. (more…)
AHA Journals, Author Interviews, Genetic Research, Heart Disease, Lipids / 15.01.2015

Jean-Claude Tardif MD Professor of Medicine Director of the Research Centre Montreal Heart Institute Montreal, Quebec CanadaMedicalResearch.com Interview with: Jean-Claude Tardif MD Professor of Medicine Director of the Research Centre Montreal Heart Institute Montreal, Quebec Canada MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Tardif: Epidemiological and mechanistic studies have suggested that high-density lipoproteins (HDL) could have beneficial cardiovascular properties. However, several medications targeting HDL have failed in recent clinical trials, including the CETP inhibitor dalcetrapib in the dal-Outcomes trial. We hypothesized that dalcetrapib would be beneficial in the subset of patients with the appropriate genetic profile. We conducted the pharmacogenomic analysis of approximately 6000 patients from the dal-Outcomes study which showed that patients with the AA genotype at a specific genetic location (rs1967309) of the adenylate cyclase (ADCY9) gene benefited from a 39% reduction in cardiovascular events including cardiovascular death, myocardial infarction, stroke, unstable angina and the need for coronary revascularization when treated with dalcetrapib compared to placebo. In contrast, patients with the GG genotype had a 27% increase in cardiovascular events. We then obtained confirmatory evidence from the dal-Plaque-2 imaging study which revealed that patients with the protective genotype (AA) had a reduction in their carotid artery wall thickness and that those with the genotype associated with clinical harm (GG) had an increase in their wall thickness. (more…)
Author Interviews, Heart Disease / 15.01.2015

MedicalResearch.com Interview with: Lauren Petrick Ph.D. The Lipid Research Laboratory Rappaport Faculty of Medicine and Research Institute The Technion Center of Excellence in Exposure Science and Environmental Health (TCEEH), Technion, Haifa, Israel MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Petrick: Nanoparticles are becoming ubiquitous in our environment, leading to higher chances of exposure. This exposure may be especially chronic for those employed in research laboratories and in high tech industry where workers handle, manufacture, use and dispose of nanoparticles. Furthermore, nanoparticle exposure to the general population occurs in the form of ultrafine particles (UFP) primarily from transportation exhaust. While nanoparticle toxicity has been investigated in general terms, its atherogenic effects and mechanisms of nanoparticle atherogenicity are not yet clear. Therefore, we decided to expose engineered silica nanoparticles to macrophages in order to investigate cell atherogenicity and cytotoxicity. What we found is that the nanoparticles were cytotoxic and increased oxidative stress and triglyceride (TG) accumulation in the cells.  Triglyceride accumulation in macrophages was not due to a decrease in triglyceride cell secretion or to an increased triglyceride biosynthesis rate, but was the result of attenuated triglyceride hydrolysis secondary to decreased lipase activity and both adipose triglyceride lipase (ATGL) and hormone-sensitive lipase (HSL) protein expression. This supports a possible role for ultrafine particles in exacerbating atherosclerosis development, and shows increased cardiovascular risk associated with nanoparticle exposure. (more…)
Author Interviews, Genetic Research, PTSD, UCLA / 15.01.2015

Armen K. Goenjian, M.D., L.D.F.A.P.A., F.A.C.G.S. Research Professor of Psychiatry Department of Psychiatry and Biobehavioral Sciences David Geffen School of Medicine at UCLAMedicalResearch.com Interview with: Armen K. Goenjian, M.D., L.D.F.A.P.A., F.A.C.G.S. Research Professor of Psychiatry Department of Psychiatry and Biobehavioral Sciences David Geffen School of Medicine at UCLA Medical Research: What is the background for this study? Response: Post-traumatic stress disorder (PTSD) is a psychiatric disorder that develops after exposure to a traumatic event such as rape, war, natural disaster, and accident. Symptoms include recurrent intrusive traumatic memories, flashbacks, nightmares, hyper-vigilance, jumpiness, and anxiety. Dopaminergic and serotonergic systems have been implicated in PTSD. Catechol-O-methyltransferase (COMT) is an enzyme that degrades dopamine, an important brain neuro-hormone that regulates human behavior, thoughts and emotions.  Tryptophan hydroxylase is the rate limiting step in the synthesis of serotonin, another important neuro-hormone that regulates arousal, sleep, anxiety, and mood. This study evaluated the association of four COMT gene loci, and the joint effect of COMT and tryptophan hydroxylase 2 (TPH-2) genes on PTSD symptoms. (more…)
Annals Thoracic Surgery, Author Interviews, Biomarkers, Kidney Disease / 15.01.2015

MedicalResearch.com Interview with: Professeur Sidney Chocron Chef de Service Chirurgie Thoracique et Cardio-Vasculaire CHU de Besançon - Hôpital Jean Minjoz BESANCON Cedex Medical Research: What is the background for this study? What are the main findings? Prof. Chocron: Acute kidney injury (AKI) is one of the most frequent complications after cardiac surgery.There is a time delay between the onset of renal impairment and the resulting telltale increase in blood creatinine levels. Recent studies have underlined the promising properties of Neutrophil Gelatinase-Associated Lipocalin (NGAL). NGAL values early after surgery could predict the duration and severity of Acute Kidney Injury. In addition, NGAL can independently predict deteriorating renal function and could therefore be useful even in the context of pre-existing renal failure. We aimed to assess the predictive ability of plasma NGAL levels to identify deteriorations in renal function after cardiac surgery in patients with pre-existing renal failure. Medical Research: What are the main findings? Prof. Chocron: One hundred sixty six patients with pre-operative renal failure i.e pre-operative creatinine clearance ≤60 mL/min/1.73m2 according to the Cockcroft Gault formula, were included in the study. The threshold NGAL values at 6 hours after operation, as determined by ROC curve analysis was 155 ng/mL with a sensitivity of 79% and a specificity of 58%. By multivariate analysis at 6 hours, a history of hypertension (OR=3.2 [1.2 - 8.9]), occurrence of at least 1 post-operative complication (OR=4.5 [1.3 - 15]), and an NGAL value above 155 ng/mL (OR=7.1 [2.7 - 18]) were shown to be independent predictors of the occurrence of post-operative AKI. (more…)
Author Interviews, Melanoma / 14.01.2015

Keiran Smalley, PhD. Scientific Director, The Comprehensive Melanoma Research Center Associate Professor The Moffitt Cancer Center & Research Institute, Tampa, FLMedicalResearch.com Interview with: Keiran Smalley, PhD. Scientific Director, The Comprehensive Melanoma Research Center Associate Professor The Moffitt Cancer Center & Research Institute, Tampa, FL   Medical Research: What is the background for this study? What are the main findings? Dr. Smalley: Although many patients with BRAF mutant melanoma respond very well to BRAF inhibitors and the BRAF/MEK inhibitor combination, resistance is commonplace and the majority of those treated ultimately fail therapy. Most studies to date have focused upon the genetic changes that are associated with acquired BRAF and BRAF/MEK inhibitor resistance. We decided to take a different approach and to use proteomics to comprehensively map all of the signaling changes associated with resistance. Our study showed that melanoma cells with resistance to BRAF and BRAF/MEK inhibition were highly invasive and aggressive. This aggressive phenotype was driven through a cell surface receptor called EphA2, and this became upregulated in both melanoma cell cultures and in patient tumors following BRAF inhibitor treatment. As this suggested that the resistant cells would be more metastatic, we then performed animal experiments and analyzed tumors from melanoma patients receiving BRAF inhibitor. These studies showed an increase in EphA2 expression in the metastatic tumors that was lacking in the primary tumors. When we looked at cohorts of melanoma patients who received either a BRAF inhibitor or an older chemotherapy drug, we found that more of the BRAF inhibitor treated patients seemed to develop disease at new sites. Together this suggested that BRAF inhibition may switch the cancer cells to being more metastatic. (more…)
Author Interviews, Brigham & Women's - Harvard, Heart Disease / 14.01.2015

MedicalResearch.com Interview with: Paula Chu Doctoral candidate Harvard University's Health Policy Program Boston MA Medical Research: What is the background for this study? What are the main findings? Response: This study was borne out of a mutual interest in the effects of yoga and wellness in general between myself and my coauthors. ​We had heard and read about yoga's effects on certain conditions like anxiety and pain, and we wanted to see if there was scientific evidence on yoga's impact on measurable physiological cardiovascular ​outcomes. (more…)
Author Interviews, Duke / 14.01.2015

Nenad Bursac PhD Rooney Family Associate Professor of Biomedical Engineering Associate Professor of Medicine Duke UniversityMedicalResearch.com Interview with: Nenad Bursac PhD Rooney Family Associate Professor of Biomedical Engineering Associate Professor of Medicine Duke University     Medical Research: What is the background for this study? What are the main findings? Dr. Bursac: Researchers have tried for a long time to coax human muscle cells (obtained from needle biopsies) into contracting muscle fibers in a dish in order to be able to study human muscle physiology ex vivo. We are the first group that succeeded by carefully optimizing culture conditions including methods to expand and then culture cells in three-dimensional hydrogel matrices under passive tension. By doing so, we made first human muscle model that in response to electrical stimulation generates classical muscle contractile responses (twitch and tetanus). We have also shown that these engineered muscles (that we call "myobundles") contract in response to acetylcholine as it naturally happens when neurons in our body activate muscle. We demonstrated reproducibility and robustness of the approach by generating functional myobundles with similar properties from 10 independent donor muscle samples. We further went to show that myobundles have intact signaling characteristic of native muscle and respond to diverse set of drugs as human muscles do in clinics. (more…)
Author Interviews, Cognitive Issues, PNAS / 14.01.2015

Dr Christos Pliatsikas PhD Lecturer in Cognitive Psychology School of Psychology University of Kent Canterbury KentMedicalResearch.com Interview with: Dr Christos Pliatsikas PhD Lecturer in Cognitive Psychology School of Psychology University of Kent Canterbury Kent Medical Research: What is the background for this study? What are the main findings? Response: It has been proposed that lifelong bilingualism preserves the white matter structure of older bilinguals because of the increased cognitive demands that come with handling two languages for their entire life. We wanted to extend this by investigating whether active (or "immersive") bilingualism in younger late bilinguals would give similar results. We showed increased white matter integrity (or myelination) in several white matter tracts that have also been shown to be better preserved in older lifelong bilinguals, compared to monolinguals.  Based on our findings, we propose that any benefit of bilingualism to the brain structure is simply an effect of actively handling two languages without presupposing lifelong usage- our participants were only about 30 years old and had been active bilinguals for only about 7-8 years. In other words, immersive bilingualism, even in late bilinguals, leads to structural changes that can bring about benefits in older age, by assisting in the preservation of the white matter structure in the brain. (more…)
Alcohol, Author Interviews, BMJ, Occupational Health / 14.01.2015

Professor Marianna Virtanen PhD Unit of Expertise for Work and Organizations Finnish Institute of Occupational Health Helsinki, Finland.MedicalResearch.com Interview with: Professor Marianna Virtanen PhD Unit of Expertise for Work and Organizations Finnish Institute of Occupational Health Helsinki, Finland. Medical Research: What is the background for this study? What are the main findings? Professor Virtanen: Risky alcohol use is common among working populations but the contribution of work-related factors such as long working hours has rarely been studied. In the present study we performed the first systematic analysis on published studies regarding long working hours and risky alcohol use and added unpublished individual participant data to the analyses. Altogether 61 studies were included in the cross sectional analysis and 20 studies in the prospective analysis. The pooled cross sectional analysis showed 11% higher alcohol use associated with long working hours. In the prospective analysis we found that working 49-54 hours a week was associated with a 13% increase in the probability of new-onset risky alcohol use and working 55 hours or more with a 12% increased risk. (more…)
Author Interviews, Breast Cancer, JAMA / 14.01.2015

Javaid Iqbal, MD, MSC (Candidate) Institute of Medical Sciences, and Women’s College Research Institute/Women’s College Hospital University of Toronto, Toronto CanadaMedicalResearch.com Interview with: Javaid Iqbal, MD, MSC (Candidate) Institute of Medical Sciences, and Women’s College Research Institute/Women’s College Hospital University of Toronto, Toronto Canada What is the background for this study? What are the main findings? Dr. Iqbal: A woman’s racial/ethnic background predicts her participation in breast cancer control program (i.e., awareness and screening). The ultimate objective of breast cancer control program is to detect cancer at an optimal stage, which is stage I, because women with stage I breast cancer survive longer. Given the racial/ethnic diversity of North America, this poses questions such as “what predicts stage I breast cancer in the multiethnic North American population?”, “what predicts its survival?”, and “does a woman’s ethnic background plays a role in predicting an early stage, and survival?” We studied 373,563 women diagnosed with invasive breast cancer in the United States between 2004 and 2011. We followed these women for 7 years and recorded whether or not they died of breast cancer, or whether they are still alive. We then divided all women into different ethnic groups, in particular white, black, Chinese, Japanese, and Indian/Pakistani (South Asian). For each racial/ethnic group, we estimated proportions of women who were diagnosed with stage I breast cancer, and risk of death at 7 years. Our aim was to determine if the racial/ethnic differences in early stage breast cancer, and its survival were better explained by intrinsic biological differences in tumor characteristics, or by differences in early-detection of breast cancer. We found that a woman’s racial/ethnic background predicted the diagnosis of stage I breast cancer, as well as her risk of dying at 7 years after breast cancer. A black woman was less likely than a white woman to be diagnosed with stage I breast cancer. A black woman was also more likely than a white woman to die of stage I breast cancer 7 years after her diagnosis. The Japanese and Chinese women were more likely than white women to be diagnosed with stage I breast cancer. The risk of death at 7 years was lowest for Indian or Pakistani (South Asian) women. Furthermore, even for small sized (2.0) breast cancers the risk of death at 7 years was higher for black women (9%), compared to white women (5%). Compared to white women, small sized breast cancers in black women were more aggressive at diagnosis, and had spread to lymph nodes and other organs. (more…)
Author Interviews, Melanoma / 13.01.2015

MedicalResearch.com Interview with: Razieh Soltani-Arabshahi, MD, MSci Department of Dermatology, University of Utah, Salt Lake City, Utah MedicalResearch.com: What is the background for this study? Dr. Soltani-Arabshahi: The incidence of melanoma is rapidly rising. Dermatologists are the leading specialty group to diagnose melanoma. While ABCD cirteria for diagnosis of melanoma have been used by many dermatologists, there are few studies of it's predictive value. MedicalResearch.com: What are the main findings? Dr. Soltani-Arabshahi: We showed that at an academic dermatology center, nearly 16 clinically suspicious lesions need to be biopsied to find one case of melanoma. Biopsies of lesions larger than 6 mm in diameter on older male patients had the highest yield. (more…)
Author Interviews, Autism, Pediatrics, Pediatrics / 13.01.2015

Terisa P. Gabrielsen, PhD, NCSP Assistant Professor, School Psychology Dept. of Counseling Psychology and Special Education Brigham Young University, Provo, UT 84602MedicalResearch.com Interview with: Terisa P. Gabrielsen, PhD, NCSP Assistant Professor, School Psychology Dept. of Counseling Psychology and Special Education Brigham Young University, Provo, UT 84602 Medical Research: What is the background for this study? What are the main findings? Dr. Gabrielsen: One of the keys to improving outcomes for individuals with outcomes is to begin intervention as early as possible, which means we need to identify autism symptoms as early as possible, preferably during the early toddler years.  The current study grew out of a screening feasibility study to see what would happen if pediatricians followed the AAP guidelines for screening every child for autism at ages 18 and 24 months as part of their regular pediatric care appointments.  That study  was conducted in a large, independent community pediatrics practice.  We found that universal screening of 796 patients helped to identify 10 toddlers with autism who had not previously been referred for evaluations.  Physicians had previously identified 3 others with autism in the group, and toddlers with other delays, such as language delays, were also identified through the screening process.  We wondered what some possible causes were for the low rate of autism referrals and designed the current study to look for what information was available to a pediatrician during the timespan of a typical pediatric exam.  We found that even in toddlers with autism, a brief (10-minute) sample contains an overwhelming ratio of typical behaviors (averaging 89%) compared to infrequent atypical behaviors (11%)  that would indicate the presence of autism.  We had autism experts identifying the behaviors from videos of the evaluations of children in the previous study, so they had many luxuries that a clinician doesn't have during an exam (i.e., ability to focus on one aspect of development, ability to rewind and re-view behaviors).  After watching the 10-minute video observations, we asked our experts, "Would you refer this child for an autism evaluation?"  We found that even the experts missed referring a child for an autism evaluation 39% of the time when the only data available were the brief observations. (more…)
Author Interviews, Dengue, Infections, NEJM, Vaccine Studies / 13.01.2015

Gustavo Dayan, MD Director, Clinical Development Sanofi Pasteur Discovery Drive Swiftwater, PA 18370MedicalResearch.com Interview with: Gustavo Dayan, MD Director, Clinical Development Sanofi Pasteur  Discovery Drive Swiftwater, PA 18370 Medical Research: What is the background for this study? What are the main findings? Dr. Dayan: This is the first dengue vaccine efficacy trial conducted in Latin America. The trial met its primary objective showing an efficacy of 60.8% against symptomatic VCD (virologically confirmed dengue) after a 3-dose vaccination schedule. Serotype-specific efficacy was also demonstrated against all four serotypes. Furthermore, the dengue vaccine candidate effectively reduced hospitalization due to dengue by 80.3% and severe dengue disease by 95.5% over the 25-month study period. (more…)
Author Interviews, Hepatitis - Liver Disease, Lancet, NIH / 13.01.2015

MedicalResearch.com Interview with: Anita Kohli MD Critical Care Medicine Department NIH Clinical Center, National Institutes of Health, Bethesda, MD Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research,  National Laboratory for Cancer Research, Frederick, MD, Medical Research: What is the background for this study? What are the main findings? Dr. Kohli: While therapy using for 8-12 weeks of all oral directly acting antivirals (DAAs) has been shown to result in high SVR "cure" rates for hepatitis C, the optimal combination and minimum duration required for treatment of hepatitis C has not been defined. The development of the simplest, short duration regimen for hepatitis C possible with high cure rates is important given the ~180 million people infected globally. Medical Research: What should clinicians and patients take away from your report? Dr. Kohli: Combination therapy with  directly acting antivirals may allow for the further shortening of treatment duration for hepatitis C. Using the right combination of DAA's therapy for as short as six-weeks may results in high rates of SVR. (more…)
Author Interviews, Cancer Research, Dermatology / 13.01.2015

MedicalResearch.com Interview with : Cédric Blanpain, MD, PhD Professor of Stem Cell and Developmental Biology WELBIO, Interdisciplinary Research Institute (IRIBHM) Université Libre de Bruxelles Belgium MedicalResearch.com : What is the background for this study? What are the main findings? Dr. Blanpain: Squamous cell carcinoma (SCC) represents the second most frequent skin cancer with more than half million new patients affected every year in the world. Cancer stem cells (CSCs) are a population of cancer cells that have been described in many different cancers including skin SCCs and that feed tumor growth. These cells could be resistant to therapy thus being responsible for tumor relapse after therapy. However, still very little is known about the mechanisms that regulate Cancer stem cells functions. In a new study published and making the cover of Cell Stem Cell, researchers led by Pr. Cédric Blanpain, MD/PhD, professor and WELBIO investigator at the IRIBHM, Université libre de Bruxelles, Belgium, report the mechanisms regulating the different functions of Twist1 controlling skin tumour initiation, cancer stem cell function and tumor progression. Benjamin Beck and colleagues used state of the art genetic mouse models to dissect, the functional role and molecular mechanisms by which Twist1 controls tumor initiation, cancer stem cell function and tumor progression. In collaboration with Dr Sandrine Rorive and Pr Isabelle Salmon from the department of Pathology at the Erasme Hospital, ULB and the group of Jean-Christophe Marine (VIB, KUL Leuven), they demonstrated that while Twist1 is not expressed in the normal skin, Twist1 deletion prevents skin cancer formation demonstrating the essential role of Twist1 during tumorigenesis. The authors demonstrate that different levels of Twist1 are necessary for tumor initiation and progression. Low level of Twist1 is required for the initiation of benign tumors, while higher level of Twist1 is necessary for tumor progression. They also demonstrate that Twist1 is essential for tumor maintenance and the regulation of cancer stem cell function. The researchers also uncovered that the different functions of Twist1 are regulated by different molecular mechanisms, and identified a p53 independent role of Twist1 in regulating cancer stem cell functions. (more…)
Author Interviews, Hospital Acquired, JAMA / 13.01.2015

Teresa Waters PhD Professor and Chair, Preventive Medicine University of Tennessee Health Science Center Memphis TNMedicalResearch.com Interview with: Teresa Waters PhD Professor and Chair, Preventive Medicine University of Tennessee Health Science Center Memphis TN Medical Research: What is the background for this study? What are the main findings? Dr. Waters: On October 1, 2008, Medicare implemented the Hospital-Acquired Conditions (HACs) Initiative, a policy penalizing hospitals for eight complications of hospital care, also known as never events. Under the HACs Initiative, hospitals could no longer justify a higher level Medicare MS-DRG when caring for a patient who developed 1 of the 8 never events. This Initiative was one in a series of CMS payment reforms intended to increase emphasis on value-based purchasing. We found that Medicare's nonpayment policy was associated with significant improvements in the time trends for central line associated blood stream infections (CLABSIs) and catheter associated urinary tract infections(CAUTIs). For these outcomes, our data from the National Database of Nursing Quality Indicators showed that introduction of the Medicare policy was associated with an 11% reduction in the rate of change in central line associated blood stream infections and a 10% reduction in the rate of change in CAUTIs. We did not find any relationship between introduction of the policy and significant changes in injurious falls or hospital acquired pressure ulcers (two other important never events covered by the policy). We hypothesized that the Hospital-Acquired Conditions Initiative may have a great effect for conditions where there is strong evidence that better hospital processes yield better outcomes or where processes are more conducive to standardization. (more…)
Author Interviews, Baylor College of Medicine Houston, Radiology / 13.01.2015

MedicalResearch.com Interview with: Aymer Al-Mutairi, MD Primary Care Research fellow Dept. Family and Community Medicine Baylor College of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Al-Mutairi: Previous studies indicate that 8% of abnormal imaging results did not receive follow-up actions by referring providers within 4 weeks. In addition, abnormal imaging results often state recommendations for further testing and radiology reports occasionally contain language that conveys doubt regarding the results. We hypothesized that recommendations for further imaging, and expressions of doubt or uncertainty in the radiology report, are more likely to be associated with lack of timely follow-up. We found that patients with abnormal imaging results where radiologists recommended further imaging were less likely to be followed-up by a treating clinician within 4 weeks compared with patients without such recommendations. Expression of “doubt” in the radiology reports did not affect follow-up actions. (more…)