Recommendations prioritize strategies to prevent ventilator-associated pneumonia .


Thousands of critically ill patients on life support develop ventilator-associated pneumonia (VAP) each year. A new document released today by a consortium of professional organizations helps prioritize strategies to prevent this potentially fatal infection.

This guidance, featured in the update of the Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals, is published in the August issue of Infection Control and Hospital Epidemiology and was produced in a collaborative effort led by the Society for Healthcare Epidemiology of America, the Infectious Diseases Society of America, the American Hospital Association, the Association for Professionals in Infection Control and Epidemiology, and The Joint Commission. Included in the guidance are specific recommendations for implementation in acute care facilities for adults, pediatric and neonatal patient populations.

“Because the Compendium consists of guidance documents rather than guidelines, we have flexibility to include recommendations where the formal grading of the quality of evidence is relatively low but where experts agree that the potential benefits outweigh potential risks and costs,” said Michael Klompas, MD, MPH, a co-lead author with Sean Berenholtz, MD, MHS. “This is especially important for younger patient populations where evidence is sparse.”

The guidance includes basic prevention strategies, as well as special approaches that can be considered for hospitals with VAP rates that are not improving despite high performance rates on basic practices. Also included are common attributes of successfully implemented care improvement programs since accountability is necessary to consistent and effective execution of prevention strategies.

Prevention strategies highlighted by the authors include:

 

  • For adult patients:
    • Avoid intubation if possible.
    • Minimize sedation.
    • Assess readiness to extubate daily.
    • Encourage exercise and mobilization.
    • Use endotracheal tubes with subglottic secretion drainage for high risk patients.
    • Elevate the head of the bed.
  • For pediatric and neonatal patients:
    • Avoid intubation if possible.
    • Minimize the duration of mechanical ventilation.
    • Provide regular oral care (toothbrushing, gauze or sterile water only depending on age).
    • Elevate the head of the bed (pediatric patients only).

    The new practice recommendations are a part of Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals: 2014 Updates, a series of articles sharing evidence-based strategies to help healthcare professionals effectively control and prevent the spread of healthcare-associated infections (HAIs). The 2014 release revises the initial 2008 Compendium publication.

 

New Schizophrenia Gene Links Uncovered


A new genetic analysis of people with schizophrenia — and the largest study investigating the genetic basis of any psychiatric disorder to date — provides hints that the disease may sometimes be connected with infections as some researchers have long suggested.

These findings could one day lead to new therapies for people with schizophrenia, scientists said. There have been few innovative drug treatments for schizophrenia over the last 60 years.

“In the past, people thought schizophrenia must happen because of some really bad mutations in a person not seen in people around them,” said study co-author Steve McCarroll, director of genetics at the Stanley Center for Psychiatric Research at the Broad Institute of MIT and Harvard in Cambridge, Massachusetts. “This study shows a substantial part of the risk of schizophrenia comes from many tiny nudges to the genome that all humans share.”

Schizophrenia affects about one out of every 100 people worldwide, and tends to emerge during the teens and early 20s. People with the disorder may have hallucinations, delusions, reduced emotional responses and a breakdown of thought processes.

The medications currently on the market for schizophrenia treat only one class of its symptoms — hallucinations and delusions — and do not address the debilitating effects the disorder can have on patients’ emotional responses or thought processes. And no medications with fundamentally new ways of treating schizophrenia have been developed since the 1950s.

Part of the reason the treatment options are so limited is that the biological mechanisms underlying schizophrenia remain poorly understood. All existing approved drugs for schizophrenia attack the same molecules in the brain — proteins linked with the brain chemical dopamine — and researchers only discovered this strategy for treatment by accident. However, previous studies have hinted that schizophrenia is caused by the combined effects of many different genes. [5 Controversial Mental Health Treatments]

The genetics of schizophrenia

To see which locations in the human genome may be linked to any given specific trait, such as a disease, researchers often carry out what are called genome-wide association studies. These involve scanning people’s entire genomes to look for mutations that are more common in people with a disease than in those without it. The locations in the genome where the differences reside can provide valuable clues about the causes of the disease.

Prior studies had identified only about 30 locations in the human genome associated with the risk of developing schizophrenia. Now, the new research brings the total to more than 100.

“Thirty years ago, genetics played an important role in opening up the problem of cancer, and I think genetics could play a similar role in schizophrenia now,” McCarroll said. Cancer patients now have far better treatment options than they did 30 years ago, he said. “We may be at the beginning of similar discoveries with schizophrenia.”

In this new genome-wide association study, researchers investigated nearly 37,000 schizophrenia patients and more than 113,000 people without schizophrenia. The study is the result of several years of work by the Schizophrenia Working Group of the Psychiatric Genomics Consortium, an international collaboration that conducts broad-scale analyses of genetic data for psychiatric disease.

The scientists found 108 locations in the human genome associated with risk for schizophrenia, including 83 loci, as scientists refer to the sites in the genome, which had not previously been linked to the disorder.

What these genes do

“Many of the genetic variations we found are common — every human being has dozens of genetic variations that appear to contribute to risk of schizophrenia,” McCarroll said. “Schizophrenia patients, on average, have more of these variants than unaffected individuals, but that’s only true on average.”

The researchers can now group these genetic changes based on the pathways they are involved in, or the functions they perform, said lead study author Stephan Ripke, also of the Broad Institute. “This is helping us to understand the biology of schizophrenia.”

For example, many of these loci are genes involved in how signals get transmitted between cells in the brain, and a number are active within immune cells. This may support the so-called germ theory of schizophrenia, which suggests that some fraction of schizophrenia cases may be due to problems with infections. Another possibility is that immune cells might malfunction in some schizophrenia patients and attack their brains, causing the disorder.

However, McCarroll cautioned that although these genes are active in immune cells, the genes might play a completely different role in the brain. “We have to be humble and careful with our interpretation of these results,” he said.

The researchers also found a link between schizophrenia and the gene that produces the dopamine-linked molecule that is targeted by all existing approved medications for schizophrenia. This suggests that other loci uncovered by this new study may point to more potential targets for therapies.

 

‘Optical fibre’ made out of thin air .


Scientists say they have turned thin air into an ‘optical fibre’ that can transmit and amplify light signals without the need for any cables.

In a proof-of-principle experiment they created an “air waveguide” that could one day be used as an instantaneous optical fibre to any point on earth, or even into space.

The findings, reported in the journal Optica, have applications in long range laser communications, high-resolution topographic mapping, air pollution and climate change research, and could also be used by the military to make laser weapons.

“People have been thinking about making air waveguides for a while, but this is the first time it’s been realised,” says Professor Howard Milchberg of the University of Maryland, who led the research, which was funded by the US military and National Science Foundation.

Lasers lose intensity and focus with increasing distance as photons naturally spread apart and interact with atoms and molecules in the air.

Fibre optics solves this problem by beaming the light through glass cores with a high refractive index, which is good for transmitting light.

The core is surrounded by material with a lower refractive index that reflects light back in to the core, preventing the beam from losing focus or intensity.

Fibre optics, however, are limited in the amount of power they can carry and the need for a physical structure to support them.

Light and air

Milchberg and colleagues’ made the equivalent of an optical fibre out of thin air by generating a laser with its light split into a ring of multiple beams forming a pipe.

They used very short and powerful pulses from the laser to heat the air molecules along the beam extremely quickly.

Such rapid heating produced sound waves that took about a microsecond to converge to the centre of the pipe, creating a high-density area surrounded by a low-density area left behind in the wake of the laser beams.

“A microsecond is a long time compared to how far light propagates, so the light is gone and a microsecond later those sound waves collide in the centre, enhancing the air density there,” says Milchberg.

The lower density region of air surrounding the centre of the air waveguide had a lower refractive index, keeping the light focused.

“Any structure [even air] which has a higher density will have a higher index of refraction and thereby act like an optical fibre,” says Milchberg.

Amplified signal

Once Milchberg and colleagues created their air waveguide, they used a second laser to spark the air at one end of the waveguide turning it into plasma.

An optical signal from the spark was transmitted along the air waveguide, over a distance of a metre to a detector at the other end.

The signal collected by the detector was strong enough to allow Milchberg and colleagues to analyse the chemical composition of the air that produced the spark.

The researchers found the signal was 50 per cent stronger than a signal obtained without an air waveguide.

The findings show the air waveguide can be used as a “remote collection optic,” says Milchberg.

“This is an optical fibre cable that you can reel out at the speed of light and place next to [something] that you want to measure remotely, and have the signal come all the way back to where you are.”

Australian expert Professor Ben Eggleton of the University of Sydney says this is potentially an important advance for the field of optics.

“It’s sort of like you have an optical fibre that you can shine into the sky, connecting your laser to the top of the atmosphere,” says Eggleton.

“You don’t need big lenses and optics, it’s already guided along this channel in the atmosphere.”

 

Researchers create vaccine for dust-mite allergies


If you’re allergic to dust mites (and chances are you are), help may be on the way.

Researchers at the University of Iowa have developed a that can combat dust-mite allergies by naturally switching the body’s . In animal tests, the nano-sized vaccine package lowered lung inflammation by 83 percent despite repeated exposure to the allergens, according to the paper, published in the AAPS (American Association of Pharmaceutical Scientists) Journal. One big reason why it works, the researchers contend, is because the vaccine package contains a booster that alters the body’s inflammatory response to dust-mite allergens.

“What is new about this is we have developed a vaccine against dust-mite allergens that hasn’t been used before,” says Aliasger Salem, professor in pharmaceutical sciences at the UI and a corresponding author on the paper.

Dust mites are ubiquitous, microscopic buggers who burrow in mattresses, sofas, and other homey spots. They are found in 84 percent of households in the United States, according to a published, national survey. Preying on skin cells on the body, the mites trigger allergies and breathing difficulties among 45 percent of those who suffer from asthma, according to some studies. Prolonged exposure can cause lung damage.

Treatment is limited to getting temporary relief from inhalers or undergoing regular exposure to build up tolerance, which is long term and holds no guarantee of success.

“Our research explores a novel approach to treating mite allergy in which specially-encapsulated miniscule particles are administered with sequences of bacterial DNA that direct the immune system to suppress allergic immune responses,” says Peter Thorne, professor at the UI and a contributing author on the paper. “This work suggests a way forward to alleviate mite-induced asthma in allergy sufferers.”

The UI-developed vaccine takes advantage of the body’s natural inclination to defend itself against foreign bodies. A key to the formula lies in the use of an adjuvant—which boosts the potency of the vaccine—called CpG. The booster has been used successfully in cancer vaccines but never had been tested as a vaccine for dust-mite allergies. Put broadly, CpG sets off a fire alarm within the body, springing into action. Those immune cells absorb the CpG and dispose of it.

This is important, because as the immune cells absorb CpG, they’re also taking in the vaccine, which has been added to the package, much like your mother may have wrapped a bitter pill around something tasty to get you to swallow it. In another twist, combining the antigen (the vaccine) and CpG causes the body to change its immune response, producing antibodies that dampen the damaging health effects dust-mite allergens generally cause.

In lab tests, the CpG-antigen package, at 300 nanometers in size, was absorbed 90 percent of the time by immune cells, the UI-led team reports. The researchers followed up those experiments by giving the package to mice and exposing the animals to dust-mite allergens every other day for nine days total. In analyses conducted at the UI College of Public Health, packages with CpG yielded greater production of the desirable antibodies, while was lower than particles that did not contain CpG, the researchers report.

“This is exactly what we were hoping for,” says Salem, whose primary appointment is in the College of Pharmacy.

The researchers will continue to test the vaccine in the hope that it can eventually be used to treat patients.

How Exercise Can Help Neuropathy .


For many patients treated with chemotherapy, peripheral neuropathy can be an uncomfortable and sometimes dangerous side effect. The condition, which includes tingling or loss of sensation in the arms or legs, can increase risk for falls and fall-related injuries.

To help prevent and ease these problems, Dana-Farber exercise physiologist Nancy Campbell, MS, recommends patients use low-impact exercise routines like finger taps, calf stretches, and ankle rolls. These exercises help increase blood flow to the peripheral nerves, restoring feeling in the extremities. The routines also build strength and improve balance, which can lead to fewer falls.

watch the PPP.

URL: http://www.slideshare.net/DanaFarber/how-exercise-can-help-neuropathy

How good you are in solving complex mathematics could be in your genes


Around half of the genes that influence how well a child can read also play a role in their mathematics ability, say scientists from University of Oxford and King’s College London who led a study into the genetic basis of cognitive traits.

While mathematics and reading ability are known to run in families, the complex system of genes affecting these traits is largely unknown.

Scientists looked at the Twins Early Development Study (TEDS) to analyze the influence of genetics on the reading and mathematics performance of 12-year-old children from nearly 2,800 British families.

Twins and unrelated children were tested for reading comprehension and fluency, and answered mathematics questions based on the UK national curriculum.

The information collected from these tests was combined with DNA data, showing a substantial overlap in the genetic variants that influence mathematics and reading.

Dr Oliver Davis from UCL Genetics said: “We looked at this question in two ways, by comparing the similarity of thousands of twins, and by measuring millions of tiny differences in their DNA. Both analyzes show that similar collections of subtle DNA differences are important for reading and Maths.”

Professor Robert Plomin from King’s College London who leads the TEDS study said,”This is the first time we estimate genetic influence on learning ability using DNA alone. The study does not point to specific genes linked to literacy or numeracy, but rather suggests that genetic influence on complex traits, like learning abilities, and common disorders, like learning disabilities, is caused by many genes of very small effect size.”

The study also confirms findings from previous twin studies that genetic differences among children account for most of the differences between children in how easily they learn to read and to do Maths.

Scientists said that children differ genetically in how easy or difficult they find learning and we need to recognize and respect these individual differences. Finding such strong genetic influence does not mean that there is nothing we can do if a child finds learning difficult – heritability does not imply that anything is set in stone – it just means it may take more effort from parents, schools and teachers to bring the child up to speed.

Dr Chris Spencer from Oxford University said,”We’re moving into a world where analysing millions of DNA changes, in thousands of individuals, is a routine tool in helping scientists to understand aspects of human biology. This study used the technique to help investigate the overlap in the genetic component of reading and Maths ability in children. Interestingly, the same method can be applied to pretty much any human trait, for example to identify new links between diseases and disorders, or the way in which people respond to treatments.”

HIV slowly adapting to humans.


Scientists studying the evolution of HIV in North America have found evidence that the virus is slowly adapting over time to its human hosts.

However, this change is so gradual that it is unlikely to have an impact on vaccine design, researchers said.

“Much research has focused on how HIV adapts to antiviral drugs — we wanted to investigate how HIV adapts to us, its human hosts, over time,” said lead author Zabrina Brumme, an assistant professor in the Faculty of Health Sciences at Simon Fraser University.

“HIV adapts to the immune response in reproducible ways. In theory, this could be bad news for host immunity — and vaccines — if such mutations were to spread in the population,” said Brumme.

“Just like transmitted drug resistance can compromise treatment success, transmitted immune escape mutations could erode our ability to naturally fight HIV,” said Brumme.

Researchers characterised the human immunodeficiency virus (HIV) sequences from patients dating from 1979, the beginning of the North American HIV epidemic, to the modern day.

The team reconstructed the epidemic’s ancestral HIV sequence and from there, assessed the spread of immune escape mutations in the population.

“Overall, our results show that the virus is adapting very slowly in North America. In parts of the world harder hit by HIV though, rates of adaptation could be higher,” said Brumme.

“We already have the tools to curb HIV in the form of treatment — and we continue to advance towards a vaccine and a cure. Together, we can stop HIV/AIDS before the virus subverts host immunity through population-level adaptation,” Brumme added.

World’s biggest organ scanning project starts in UK


In what is the world’s biggest scanning project, 100,000 Britons are now undergoing detailed imaging of their brain, heart and vital organs to help researchers study a wide range of common, chronic and life-threatening conditions like diabetes, cancer and heart disease.

Scientists say that the UK Bio-bank imaging study is one of the most ambitious and exciting health research opportunities in recent years.

It will provide an unprecedented level of information to help scientists and doctors working on a wide range of illnesses, including dementia, heart disease, cancer, arthritis, depression and eye and lung disorders over very many years.

DNA has been collected from all the volunteers who will be compared and cross-referenced with the scans.

Prof Sir Rory Collins Chief Exec, UK Biobank said, “The aim is to try to improve the diagnosis and treatment of a huge range of diseases. We are trying to understand why one person gets a disease and another does not.” The Bio bank said, “The project will collect pictures of participants’ brains, hearts and bones.

Many thousands of UK Bio bank participants will be invited to take part over the coming year. We are grateful to all participants who have given up so much of their time to help medical research so far. Their contribution is already helping innovative research studies.”

“We hope many will join this scanning project and provide more information for research which will benefit future generations,” said Professor Collins.

The project will include Magnetic resonance imaging ( MRI) scans of the brain, heart and body to determine the structure of internal organs and the distribution of body fat. Ultrasound – scan of the carotid (neck) arteries will be carried out to study the build-up of fat in the vessels. Dual-Energy X-ray Absorptiometry (DXA) scan using low-energy X-rays will then measure bone density and risk of osteoporosis and arthritis.

Scientists have already begun to analyze the DNA of all 500,000 participants.

These will be identifying 850,000 biomarkers, many of which are associated with diseases.

30% of world is now fat, no country immune.


Almost a third of the world is now fat, and no country has been able to curb obesity rates in the last three decades, according to a new global analysis.

Researchers found more than 2 billion people worldwide are now overweight or obese. The highest rates were in the Middle East and North Africa, where nearly 60 percent of men and 65 percent of women are heavy. The U.S. has about 13 percent of the world’s fat population, a greater percentage than any other country. China and India combined have about 15 percent.

“It’s pretty grim,” said Christopher Murray of the Institute for Health Metrics and Evaluation at the University of Washington, who led the study. He and colleagues reviewed more than 1,700 studies covering 188 countries from 1980 to 2013. “When we realized that not a single country has had a significant decline in obesity, that tells you how hard a challenge this is.”

Murray said there was a strong link between income and obesity; as people get richer, their waistlines also tend to start bulging. He said scientists have noticed accompanying spikes in diabetes and that rates of cancers linked to weight, like pancreatic cancer, are also rising.

The new report was paid for by the Bill & Melinda Gates Foundation and published online Thursday in the journal, Lancet.

Last week, the World Health Organization established a high-level commission tasked with ending childhood obesity.

“Our children are getting fatter,” Dr. Margaret Chan, WHO’s director-general, said bluntly during a speech at the agency’s annual meeting in Geneva. “Parts of the world are quite literally eating themselves to death.” Earlier this year, WHO said that no more than 5 percent of your daily calories should come from sugar.

“Modernization has not been good for health,” said Syed Shah, an obesity expert at United Arab Emirates University, who found obesity rates have jumped five times in the last 20 years even in a handful of remote Himalayan villages in Pakistan. His research was presented this week at a conference in Bulgaria. “Years ago, people had to walk for hours if they wanted to make a phone call,” he said. “Now everyone has a cellphone.”

Shah also said the villagers no longer have to rely on their own farms for food.
“There are roads for (companies) to bring in their processed foods and the people don’t have to slaughter their own animals for meat and oil,” he said. “No one knew about Coke and Pepsi 20 years ago. Now it’s everywhere.”

In Britain, the independent health watchdog issued new advice on Wednesday recommending heavy people be sent to free weight-loss classes to drop about 3 percent of their weight, reasoning that losing just a few pounds improves health and is more realistic. About two in three adults in the U.K. are overweight, making it the fattest country in Western Europe.

“This is not something where you can just wake up one morning and say, `I am going to lose 10 pounds,'” said Mike Kelly, the agency’s public health director, in a statement. “It takes resolve and it takes encouragement.”

Nasa builds world’s first flying observatory


Nasa has fitted a 17-tonne telescope with an effective diameter of eight feet on a modified Boeing 747 jetliner that the US space agency is using as a flying observatory to study stars.

The infrared telescope called “Stratospheric Observatory for Infrared Astronomy” (SOFIA) is mounted behind a sliding door that reveals it to the skies.

The jet can stay airborne for over 12 hours and its range is up to 6,625 nautical miles (7,624 miles).

According to Nasa, “The data provided by SOFIA cannot be obtained by any other astronomical facility on the ground or in space.”

SOFIA is mobile, so it can better spot transient space events like supernovae and comets.

The telescope, built with the help from German Aerospace Centre (DLR), can easily be repaired or reprogrammed when necessary.

Nasa plans SOFIA — now in Germany for its last extensive maintenance and refitting leg — to launch in 2015 which will keep flying for another 20 years, wired.com reported.