Pentagon’s DARPA works on reading brains in real time.


The Defense Advanced Research Projects Agency (DARPA) is investing $70 million to develop a new implant that can track, and respond to, brain signals in real time.

The goal of the new project, dubbed “Systems-Based Neurotechnology for Emerging Therapies” (SUBNETS), is to gather new information via more advanced brain implants in order to reach the next level of effective neuropsychological treatment. DARPA is hoping to have the new implant developed within five years.

AFP Photo/Miguel Medina

Already, roughly 100,000 people worldwide live with a Deep Brain Stimulation implant, a device that helps patients cope with Parkinsons disease. While scientists are currently studying the possibility of using these devices to combat other diseases, the problem is current technology can only treat symptoms, not record the brain’s signals or analyze the effectiveness of any administered treatment.

“There is no technology that can acquire signals that can tell [scientists] precisely what is going on with the brain,” Justin Sanchez, DARPA’s program manager, told the New York Times.

The SUBNETS  program intends to change the current landscape significantly. Not only does DARPA want to map out exactly how diseases establish themselves in an individuals brain, the agency also wants its implant to be able to record the signs of illness in real time, deliver treatments, and monitor the treatment’s effectiveness.

Considering the toll that mental illnesses are taking on military veterans, there’s a new level of urgency surrounding the ambitious initiative. Ten percent of servicemembers receiving treatment from the Veteran’s Health Administration are being treated for mental health conditions or substance abuse, and mental disorders are now the primary reason for hospital bed stays.

“If SUBNETS is successful, it will advance neuropsychiatry beyond the realm of dialogue-driven observations and resultant trial and error into the real of therapy driven by quantifiable characteristic of neural state,” Sanchez said on DARPA’s website. “SUBNETS is a push toward innovative, informed and precise neurotechnological therapy to produce major improvements in quality of life for servicemembers and veterans who have very few options with existing therapies.”

The new project is part of President Obama’s BRAIN initiative, which sets aside $100 million in its first year to develop new innovations in neuroscience. DARPA is collaborating with the National Institutes of Health and the National Science Foundation on SUBNETS, and it is currently soliciting proposals from various research teams.

Whether the agency can actually achieve its goal in five years is a question mark – one neuroscientist told the New York Times that, like nearly all DARPA projects, it’s “overambitious” – but new discoveries concerning how the brain functions are expected regardless. Whether the implant itself becomes a reality or not, Sanchez said that new medical devices will be developed as a result.

“We’re talking about a whole systems approach to the brain, not a disease-by-disease examination of a single process or a subset of processes,” Sanchez said. “SUBNETS is going to be a cross-disciplinary, expansive team effort and the program will integrate and build upon historical DARPA research investments.”

Influence of Body Mass Index on Survival in Veterans With Multiple Myeloma.


Abstract

Purpose. We investigated the association between body mass index (BMI) at the time of multiple myeloma (MM) diagnosis and overall survival in a cohort of patients within the Veterans Health Administration system. We also evaluated the association between weight loss in the year prior to diagnosis and survival.

Patients and Methods. Prospective analysis was performed on a retrospectively assembled cohort of 2,968 U.S. veterans diagnosed and treated for MM between September 1, 1999, and September 30, 2009, with follow-up information through October 22, 2011. Cox modeling controlling for patient- and disease-related prognostic variables was used to analyze the data.

Results. Underweight patients (BMI <18.5 kg/m2) had increased mortality, whereas patients who were overweight (BMI 25–29.9 kg/m2) and obese (BMI ≥30 kg/m2) had lower mortality compared with healthy-weight patients (BMI 18.5–24.9 kg/m2). Weight loss ≥10% of baseline in the year before diagnosis was also associated with increased mortality and made the association between increased BMI and survival nonsignificant.

Conclusion. Disease-related weight loss may be an important and heretofore unknown indicator of poor prognosis in MM. Assessment of weight loss prior to MM diagnosis should become a standard component of the clinical history in patients with newly diagnosed MM. Further research may identify relationships between disease-related weight loss and currently used prognostic factors in MM, further defining the role of this clinical factor in prognostic stratification.

 

Source: The Oncologist.

Quality improvement initiatives required to reduce repeat lipid testing.


One-third of patients with coronary heart disease who reached target LDL levels underwent repeat lipid panels, suggesting that quality improvement efforts are needed to decrease unnecessary testing.

Salim S. Virani, MD, PhD, of the Michael E. DeBakey VA Medical Center and a researcher at the Health Services Research and Development Center of Excellence in Houston, and colleagues evaluated the number of patients with LDL levels lower than the Adult Treatment Panel III (ATP III) guideline-recommended LDL treatment target of 100 mg/dL who underwent repeat lipid testing within 11 months without medication intensification. They used data from patients with CHD in a VA network of seven medical centers with associated community-based outpatient clinics.

 “In these patients, repeat lipid testing may represent health resource overuse and possibly waste of health care resources,” the researchers wrote.

Potential waste of resources

Virani and colleagues identified 27,947 patients with CHDand LDL levels less than 100 mg/dL — 9,200 (32.9%) of whom underwent repeat lipid testing without intensification of treatment during the next 11 months. This translated to 12,686 repeat panels, with a mean of 1.38 additional tests per patient, according to study results.

“With a mean lipid panel cost of $16.08 based on Veterans Health Administration laboratory cost data, this is equivalent to $203,990 in annual costs for one VA network,” the researchers wrote.

“These results represent health care resource overuse and possibly their waste,” Virani told Cardiology Today. “Apart from the costs associated with these lipid panels, this also carries with it the cost for the patient’s time to undergo a repeat blood test and cost for the health care provider’s time to follow-up on these results after redundant testing and to inform the patient about these results.”

After adjustment for facility level clustering, data showed that those with a history of diabetes (OR=1.16; 95% CI, 1.10-1.22), hypertension (OR=1.21; 95% CI, 1.13-1.30), higher burden of illness (OR=1.39; 95% CI, 1.23-1.57) and more frequent primary care visits (OR=1.32; 95% CI, 1.25-1.39) had higher odds of undergoing repeat testing. In contrast, patients treated at a teaching facility (OR=0.74; 95% CI, 0.69-0.80) or from a physician provider (OR=0.93; 95% CI, 0.88-0.98) and patients with a medication possession ratio of 0.8 or higher (OR=0.75; 95% CI, 0.71-0.80) were less likely to have a repeat lipid panel.

The researchers also assessed 13,114 patients with CHD who met the ATP III optional treatment target of less than 70 mg/dL. In this population, 8,177 (62.4%) with LDL levels less than 70 mg/dL underwent repeat lipid testing during 11-month follow-up.

“This represents an area of redundant testing in patients and represents an opportunity to improve health care efficiency and reduce health care waste,” Virani said.

Interpretations

In an invited commentary, Joseph P. Drozda Jr., MD, of the Center for Innovative Care, Mercy, in Chesterfield, Mo., lauded the researchers’ study, noting that, with the implementation of electronic health records, future reports will likely identify other areas that require improvement and where waste can be reduced.

“This well-conceived study on a large clinical database, which has the advantage of containing pharmacy data for use in tracking medication adherence, delivers an important message regarding a type of waste that is likely widespread in health care and that goes under the radar because it involves a low-cost test. However, it is precisely these low-cost, high-volume tests and procedures that need to be addressed if significant saves from reduction of waste are to be realized,” he wrote.

For more information:

Drozda JP. JAMA Intern Med. 2013;doi:10.1001/jamainternmed.2013.6808.

Virani SS. JAMA Intern Med. 2013;doi:10.1001/jamainternmed/2013.8198.

Source: Endocrine Today

 

 

Sulfonylurea Drugs Associated with Increased Cardiovascular Risk vs. Metformin .


An observational study of patients beginning diabetes treatment finds that sulfonylureas carry a roughly 20% greater risk for major cardiovascular events than metformin. The work appears in the Annals of Internal Medicine.

Researchers used federal data from the Veterans Health Administration to ascertain outcomes in 250,000 veterans (almost all of whom were men) starting monotherapy for diabetes with a sulfonylurea (either glyburide or glipizide) or metformin. The primary outcome — a composite of hospitalization for acute MI or for stroke, or death — was more common among sulfonylurea users by 2.2 events per 1000 person-years of observation after adjustment for multiple factors, such as blood pressure and BMI.

An editorialist considers the findings “credible and important,” but ultimately “hypothesis-generating” in the absence of a randomized trial.

Source: Annals of Internal Medicine