From relic to revolutionary: streetcars revitalize city transit.

Now, the Pearl District has two private gyms and just about every type of ethnic cuisine. And in possibly the ultimate sign of neighborhood prosperity, a dog park is in the works. “It totally transformed far beyond anything we could have imagined,” said Rick Gustafson, executive director and chief operating officer of Portland Streetcar. “The streetcar was part of a whole effort to make this kind of development occur.”

By the 1950s, streetcars were in trouble. In their heyday, these electrified passenger rails chugged along the streets of just about every American community with more than 5,000 residents.

But after World War II, when streetcars were flagging from auto industry competition, municipalities and transportation authorities were convinced to make the switch to buses. Contracts were signed. Rails were paved over or torn out and sold for scrap. And streetcars dropped off their last passengers, traveled to the end of the line and were burned. “The [auto] companies did not want the competition of the streetcars with their buses,” said Patrick Condon, a professor at the University of British Columbia and author of Seven Rules for Sustainable Communities.

There were some exceptions. Remnants of original streetcar systems are still running in parts of Philadelphia and Boston. And, despite a close call with the city’s new mayor, Toronto maintains the region’s largest original streetcar system. But more than a half-century after most streetcars were abandoned and burned, at least a dozen U.S. cities are working to revive these systems from the ashes. In addition to Portland, Atlanta is building a downtown streetcar line that, when service begins next year, will feature a Siemens S70 vehicle powered by a single overhead trolley wire. And in Los Angeles, a city defined by its car culture, residents are beginning to imagine what Broadway would look like with streetcar tracks.

Since streetcars were mostly overrun by subsidies for automobiles and airplanes, it’s taken decades of car culture consequences — congestion, oil dependence, environmental costs — to bring them back into fashion. “We created an enormous dependence upon airlines and cars,” Gustafson said. “Now we understand that transit is a very fundamental component of our city’s vitality. It’s almost like a utility. You need it.”

But while other advanced countries largely maintained and updated their rail systems, the United States was left on the hook for billions of dollars in rebuilds. “We’ve destroyed all the infrastructure we’d built,” Gustafson said. “We have nothing. Almost nothing.”

A clean alternative to cars

As American cities started shelling out big bucks to revitalize their urban corridors, streetcars — also known as trams or trolleys — became an obvious transit option for connecting those populated downtown locales. Unlike light rails, which often transport passengers between suburbs and cities, streetcars are more like intercity circulators specializing in shorter trips.

Some transit experts argued that more bus routes would be a better, lower-cost alternative to the streetcar. But buses are hardly the catalyst that major property owners and developers want when it comes to investing to revitalize a community, Gustafson said. “They wanted a demonstration of commitment by the city to the area. They wanted the permanence of rails,” he said. “Creating a streetcar was part of an emphasis on making mixed-use work.”

In several cities, the streetcar has been living up to its end of the bargain, Condon said. “It changes the quality of a neighborhood so dramatically in a beneficial way,” he said, “that the intangible benefits of the introduction of these systems is quite enormous.” The construction of a streetcar line, with the permanence of its rails, Condon said, has spurred growth in housing and mixed-use buildings and shifted some city dwellers’ dependence on cars to transit, biking and walking.

What’s more, streetcars can protect the environment. “If you have clean electrical energy sources and feed them into the tram system,” Condon said, “it is greenhouse gas zero.” That combination of smart urban development and eco-friendly transit, he said, means more sustainable cities by 2050. “The real benefit of thinking about trams is not the vehicle itself,” Condon said, “but rather how the whole city works and how you move from place to place in a way that’s elegant, comfortable and greenhouse gas zero.”

Building the future

Portland has proven a positive test case, Condon said, on how a streetcar system can improve and protect an urban area. Since 2001, Gustafson said, more than $4 billion in investment has come to the area, including 10,000 new housing units. “We turned it around and made it the hottest growth area in the region, rather than vacant land,” he said, adding that developers wouldn’t have made such an investment without the streetcar. In renewing an industrial wasteland into a liveable urban community, Gustafson said, planning by developers and the city focused on amenities including parks, underground parking and affordable housing.

City travelers reduce road congestion and avoid the hassle of finding parking, Gustafson said, when they choose the streetcar over the car for a short midday trip. In Portland, peak streetcar ridership is between 11 a.m. and 6 p.m., he said, with passengers popping out of the office for lunch or heading to happy hour with colleagues.

In Los Angeles, where a four-mile streetcar system is in development, officials expect commuters and tourists alike to ride the rails. The downtown route would overlap with subway and light rail stops and connect the city’s financial and commercial districts, including such sites as the Staples Center and Walt Disney Concert Hall. “It’s for everybody,” said Shiraz Tangri, general counsel for the non-profit group Los Angeles Streetcar.

United Streetcar, a subsidiary of Oregon Iron Works, was the first U.S. company to manufacture a modern streetcar. Unlike their 20th-century predecessors, modern streetcars are faster, more spacious, cheaper to maintain, Americans with Disabilities Act compliant and outfitted with regenerative brakes and LED lights. Using a model developed by the company Skoda in the Czech Republic, United Streetcar designed an “Americanized” version with roof fixtures and hinge plate headlights, said president Chandra Brown.

“The Czechs have old-world craftsmanship and a lot more people working on it,” Brown said. “We’re more about automation … we had to change the design substantially to make it a better, easier, more cost-effective and higher-quality way of building.” Since United Streetcar’s 2005 launch, the company has been contracted to supply streetcars for Portland, Tucson and Washington, D.C.

It can take more than a year to build a city’s first streetcar, Brown said, because of the long lead-time on certain items. “Because our market is so much smaller [in the U.S.], it’s harder to find a good supply chain,” she said. “We’re committed to using as much local products and services as we can, but there are items that aren’t even made in the United States.”

Still, more than 200 U.S. companies are supplying United Streetcar, many of them small businesses. “We’re excited about the ripple effect on U.S. manufacturing,” Brown said. Internationally, other companies designing streetcars include Vossloh in Germany and Alstom in France.

Just as finding the parts for a U.S. streetcar can be difficult, it’s not always easy for cities to turn the streetcar concept into reality. Though a streetcar system costs only about 10 percent of the price of a subway line, raising the funds is difficult. Government grants, such as TIGER funds awarded for streetcars in cities including Dallas, New Orleans and Tucson, are competitive. The city of Portland self-financed its initial streetcar line, priced at about $25 million per mile, with the help of property owners and bonds backed by parking revenue from city garages, Gustafson said. In contrast, the streetcar’s expansion, opening Sept. 22, received half of its funding from federal sources.

Los Angeles continues to grapple with financing. Residents living within three pedestrian-friendly blocks of the proposed streetcar line will vote this fall on whether to approve a tax that would pay for about half of the construction costs. A taxpayer’s individual burden would depend on his proximity to the streetcar line, Tangri said, with the majority of area condominium owners set to pay less than $100 a year.

A former downtown Los Angeles resident, Tangri argued the costs are reasonable considering the potential return on investment: new jobs, new businesses and more tourists. If the measure passes, he said, the private sector commitment would be used to leverage federal funding for other project costs. The public sector would handle streetcar operations. “It’s a collective investment,” Tangri said, “something much bigger than any individual developer could do.”

Source: Smart Planet

Study Halves Inappropriate Antibiotic Prescribing in Pediatric Practices.

Providing pediatricians with regular reports on their prescribing habits, including how they measure up to national guidelines, can cut inappropriate antibiotic prescribing in half, according to a press release on a study presented at IDWeek in San Diego. (IDWeek is a joint meeting of four U.S. infectious disease societies.)

Eighteen pediatric practices in the northeast U.S. were randomized to an intervention or control group. Intervention practices received a brief refresher on the latest infectious disease prescribing guidelines, and subsequently, clinicians received quarterly reports describing their prescribing habits, how they compared with the guidelines, and how they compared with their colleagues. The control group received no intervention.

At baseline, 28% of all children inappropriately received prescriptions for broad-spectrum antibiotics for sinusitis, group A strep, or pneumonia. After 1 year, the rate fell to 14% in intervention practices (vs. 23% among controls).

“The intervention isn’t complicated or high-tech, so it should be ‘scalable’ to large populations,” a meeting chairperson said in the IDWeek press release.

Source: IDWeek press release


Norovirus Outbreaks in Nursing Homes Lead to Increases in Hospitalizations, Mortality.

All-cause hospitalizations and deaths increase among nursing home residents during norovirus outbreaks, according to a JAMA study.

CDC researchers examined more than 300 Medicare-certified nursing homes that reported some 400 norovirus outbreaks over a 2-year period. All-cause hospitalizations were reported in about a third of the outbreaks, and deaths in 7%.

Hospitalizations were more common during outbreak versus non-outbreak periods (124 vs. 110 hospitalizations per nursing home–year), as was mortality (54 vs. 42 deaths per nursing home–year). Residents aged 90 and older were particularly affected, with roughly a 25% increase in hospitalization or death during outbreaks.

The researchers estimate that there would be one excess hospitalization for every four outbreaks and one excess death for every nine outbreaks. They call for more research, but for now, recommend “general treatment for dehydration and infection control to prevent and control outbreaks.”

Source: JAMA


Adolescent inmates released from prison present major treatment challenges.

Within 2 weeks after penal release, adult prisoners are 12 times more likely than matched controls to die (within 2 years, 3.5 times more likely), usually from drug overdose (JW Gen Med Jan 23 2007). To study mental health in teenagers after release, investigators conducted structured in-person interviews with 1829 teenagers upon detention (1172 males and 657 females; mean age, 14.5 years) and reinterviewed 85% of them approximately 3 and 5 years after incarceration. Second informants (e.g., parents) were not interviewed.

Nearly 30% of participants were incarcerated at follow-up. Analyses controlled for age, ethnicity, and sex. At baseline, 62% of males and 65% of females had a DSM-IV diagnosis with impairment. Over time, prevalence of all diagnoses (except mania in girls) decreased, but remained higher than population estimates. At the second follow-up, 46% of males and 29% of females had a DSM-IV diagnosis with impairment (e.g., males: substance use, 28%; any disruptive disorder, 22%; schizophrenia/mania, 0.1%). As in general-population samples, mood disorders were more prevalent in females and disruptive disorders more prevalent in males.

Comment: Similar to adults, young inmates after release have significantly higher rates of disorders than population estimates. Prevalence of psychotic disorders was lower than found previously in adult prisoners (5.2%; Am J Psychiatry 2005; 162:774), perhaps because some young prisoners have yet to develop a psychosis or because jail has replaced mental institutions for many older psychotic individuals (Adm Policy Ment Health 2001; 29:21). Because suicidal behaviors and drug overdose rates were not reported, these cannot be compared to rates in adult inmates. Across the age span, people released from prison present major treatment challenges, augmented by poor social supports. These data cogently argue for developing preventive strategies in children with antisocial behaviors, such as those for callous-unemotional traits (JW Psychiatry Oct 16 2006 and Nov 17 2008).

Source: Journal Watch Psychiatry

Israeli Vaccine: Stops Cancer from Coming Back..

An Israeli company is developing a new cancer drug which aims to stop cancer from coming back.

Every year millions of people are diagnosed with cancer worldwide. Although modern medicine has made huge progress in treating this disease, what often happens is that the cancer is treated and the patient goes into remission or is even “cured” – but then it becomes a waiting game to see if the cancer comes back.

Imagine if there was a new treatment option that would stop cancer from returning!

An Israeli medical team is attempting to do just that, to offer a new treatment with the potential for long-term maintenance – to stop the cancer from coming back.

Vaxil is a clinical stage biotechnology company based in Israel which develops therapeutic vaccines to treat cancer and infectious diseases. Therapeutic vaccines seek to harness the patient’s immune system to attack and destroy cancer cells.

The therapeutic vaccine educates the immune system to seek out and destroy those cells which display cancer “markers” and to leave the healthy cells untouched. This means that the treatment has very few side effects, unlike other conventional treatments. This safety profile also means that it is suitable for long-term maintenance therapy.

Vaxil’s lead product, ImMucin, aims to teach the immune system of the cancer patient to attack those cancer cells which display the protein “MUC1″. Since MUC1 appears on 90% of all cancer cellss, ImMucin has a potentially broad application to many different strands of cancer such as lung, breast, kidney, prostate, ovarian, pancreatic and colon cancer – and even to hematological cancers such as leukemia, lymphomas and myeloma.

ImMucin is currently being evaluated in a Phase I/II clinical trial in patients with Multiple Myeloma (a blood cancer). All patients enrolled are in a stage process whereby the disease is coming back after a period of remission.

The clinical trial is being conducted at Hadassah University Hospital in Jerusalem and at the Rambam Medical Center in Haifa.

The trial is expected to be completed by the end of the year, and will involve 15 patients. Future trials are planned in Israel and abroad and will have larger number of participants.

Interim results on half of the trial subjects enrolled (7 out of 15 patients) were released last April and were very encouraging. There were no serious side effects and all ImMucin-treated patients induced a strong immune response.

Moreover, out of the seven patients analyzed, three re-attained a stage of complete response, meaning that the disease progression was stopped and there was no longer any detectable cancer.  Final results from this trial are expected at the beginning of next year. The team is also conducting a follow up study of patients who have completed their treatment with ImMucin and do not require further treatments.

Vaxil’s founder and CEO is Lior Carmon, PhD., MBA.  Dr. Carmon is an expert in the fields of immunology and cancer. After earning his PhD from the Weizmann Institute, Dr. Carmon founded and managed several Israeli biotech companies.  He was joined by Julian Levy M.A., who acts as Vaxil’s President and CFO. Mr. Levy is a Cambridge educated lawyer, who immigrated to Israel England and is a seasoned biotechnology entrepreneur with extensive experience in early stage biotech companies.

Dr. Carmon notes that  “A key advantage of Vaxil’s vaccines is that they can induce a comprehensive and divest immune response without need for an adaptation to the individual’s type of immune systems. Every patient has a unique immune system.  Thus, many therapeutic vaccines are suitable only for a proportion of the potential patient population. Results obtain so far has shown that ImMucin can initiate strong and diversified immune response in all patients, irrespective of their immune system. This is not trivial.” Moreover, unlike many other products “our vaccines are design to try and deal with the tumor’s tendency to evade the immune response. We believe that this is a critical factor for success.”

Although Vaxil’s main interest is therapeutic vaccines, its research team has shown that the scope of the company’s VaxHit technology is very broad and may include new areas such as diagnostics. Earlier this year the company published an article describing the discovery of naturally generated antibodies in cancer patients with myeloma.  By detecting and following the levels of these antibodies, it may be possible to determine the likelihood of patients developing cancer in the future.