Protect Your Child from Rotavirus Disease

 

Rotavirus spreads easily among infants and young children, and can cause severe diarrhea. They can get very dehydrated and need to be hospitalized. Protect your child with rotavirus vaccine. Rotavirus disease is common among infants and young children. Rotavirus can cause severe watery diarrhea, vomiting, fever, and abdominal pain. Some children with rotavirus disease can lose a lot of fluids and become very dehydrated. As a result, they may need to be hospitalized and can even die. Rotavirus spreads easily among children. The virus passes into the environment through a sick person's stool (poop) and spreads when a child puts something with rotavirus on it, such as their hand or a toy, in their mouth. Children can also get infected by consuming food and liquids that have rotavirus in them. In the United States, children are more likely to get rotavirus from December to June. Rotavirus Can Cause Dehydration Symptoms of Dehydration Decrease in urination Dry mouth and throat Feeling dizzy when standing up A dehydrated child may cry with few or no tears and be unusually sleepy or fussy. Prevent Dehydration You can help prevent your child from getting dehydrated by having them drink plenty of liquids. Oral rehydration solutions (ORS) are helpful to prevent and treat dehydration. These are commonly available in food and drug stores. If you are unsure about how to use ORS, call your doctor. Children are most likely to get rotavirus disease in the winter and spring (December through June). Protect your child with rotavirus vaccine Rotavirus vaccine is the best way to protect your child from rotavirus. Almost all children who get rotavirus vaccine (85 to 98 percent) will be protected from severe rotavirus disease. Most vaccinated children will not get rotavirus disease at all. There are two different rotavirus vaccines. Both are given by putting vaccine drops in an infant's mouth. Rotateq® - Infants should receive three doses of this vaccine—at 2 months, 4 months, and 6 months of age. Rotarix® - Infants should receive two doses of this vaccine—at 2 months and 4 months of age. This first dose of either vaccine is most effective if given before a child is 15 weeks old. Children should receive all doses of rotavirus vaccine before they turn 8 months old. Millions of infants have been vaccinated Millions of infants in the United States have gotten rotavirus vaccine safely. However, some studies have shown a small increase in cases of intussusception from rotavirus vaccination. Intussusception is a bowel blockage that is treated in a hospital and may require surgery. It is estimated that risk of intussusception is 1 in every 20,000 infants to 1 in every 100,000 infants after vaccination. Intussusception is most likely to happen within the first week after the first or second dose of rotavirus vaccine.​ CDC continues to recommend that infants receive rotavirus vaccine. The benefits of the vaccine far outweigh the small risk of intussusception. Thanks to the rotavirus vaccine, there has been a dramatic decrease in hospitalizations and emergency room visits for rotavirus illness. Paying for Rotavirus Vaccines Most health insurance plans cover the cost of vaccines. However, you may want to check with your insurance provider before going to the doctor. If you don't have health insurance or if your insurance does not cover vaccines for your child, the Vaccines for Children (VFC) Program may be able to help. This program helps families of eligible children who might not otherwise have access to vaccines. To find out if your child is eligible, visit the VFC website or ask your child's doctor. You can also contact your state VFC coordinator.

Haptic technology: The next frontier in video games, wearables, virtual reality, and mobile electronics

 

The next frontier in human-computer interaction will be all about making you feel the virtual, digital world as though it were real and tangible (Photo: David Brohede) Image Gallery (15 images) Tactile feedback is nothing new. It's been used in telecommunications and in entertainment for decades, and it became a standard feature in the late 1990s in mobile phones and video games – where vibrations alert you to new messages or help you "feel" the forces exerted on your avatar. Haptic technology has been very much a bit player in the fields that it's infiltrated, though, and only now are we seeing it begin to take its place alongside visual and audio tech as a key element in human-computer interaction. Smartwatches such as the upcoming Apple Watch are embracing haptics to give you turn-by-turn directions. Researchers, meanwhile, are experimenting with haptic cues built into the steering wheel of cars for enhanced safety, and with tactile feedback built into touchscreens and public maps for more natural-feeling interactions. Haptics enable deafblind people to browse the web (thanks to Morse Code) or even to play video games. In the gaming space, haptics is a fast-growing field thanks to the rise of virtual reality and the desire of players to feel just as viscerally as they see and hear their virtual environments. Haptic technology is also helping to train the next generation of surgeons, and improving simulations in the industrial sector for pilots and large machine operators. The basics Before we get into any of that, let's step back a moment and look at what haptic technology is. In most cases it uses a kind of motor called an actuator to convert electrical, hydraulic or pneumatic energy into vibrations, which can be managed and controlled by software that determines the duration, frequency, and amplitude. The Nintendo 64 rumble pack introduced a mass gaming audience to the idea of vibrations in a controller enhancing play (Photo: Evan-Amos) Smartphones typically use haptic technology for alerts and notifications, as well as for subtle feedback as you type messages or dial numbers on their touchscreens. Video game controllers use haptics now in the same way that they did almost two decades ago with the Nintendo 64 rumble pack and PlayStation DualShock gamepad – to lend a tangibility, felt through your hands gripping the controller, to an explosion or crash or a rough surface that you're driving over. But there's a lot more that haptics can do, both at the lower resolutions of feedback offered by an Xbox or PlayStation controller (which amounts to little more than an on/off switch with dimmer controls for each of their two actuators) and at the higher resolutions that the latest haptic technology can provide (which allows for feedback localized to specific coordinates and even, at the cutting-edge level, according to how hard you press on the surface). Haptics look set to be the next big thing in our interactions with the digital world. We can cram surround-sound effects into headphones and record audio at high fidelity with our smartphones, and we can touch and pinch and zoom near everything that appears on a screen. But it all feels flat and lifeless because we've put so little effort into making it anything but that. The human body has a highly-sophisticated capacity for recognizing and responding to textures and vibrations and pokes and all manner of other external forces that engage the receptors in our somatosensory system. Improving tactile feedback in consumer technology will be crucial as we further our attempts to bridge the divide between all that is physical and tangible and all that is digital and virtual. Among those attempting to explore the possibility space is Mathias Nordvall, a cognitive scientist and game designer at Linköping University in Sweden. Sightlence and haptic Pong "A lot of culture today is either vision based or audio based," notes Nordvall. "You go to a concert or you listen to the radio or go to the movies." And if you lack one of those senses, you compensate with the other. Predominately visual interfaces like browsing the web are presented to visually-impaired people through screen readers that speak the text on a page, while TV shows and movies can be watched with closed captions for the hearing impaired. One day Nordvall wondered: "What happens if you don't have access to either one of them?". How can deafblind people (people with little or no vision and little or no hearing) interact with the modern world? Many of those at the farther end of the deafblind spectrum have never been able to enjoy television, the internet or video games. So Nordvall set out to see if a video game could be made that's "completely and only" based on haptic technology – a game that makes no use of graphics or audio whatsoever. He sought to do it on the cheap, using only low-cost, off-the-shelf consumer technology, and quickly settled on Xbox 360 controllers, which have two motors in them (and, Nordvall notes, inner workings that are nearly identical to the Nintendo 64 rumble pack released a decade earlier, except for the addition of a second actuator). And after some thought he decided to attempt to translate an existing game, Pong, because that would ensure that any difficulties to play are due to faults in the user interface and not in the game's ruleset. The result does not feel at all like Pong, or at least not at first. Players hold one Xbox 360 controller in their hands, with the paddle's movement mapped to one of the joysticks, and they place a second in their lap or somewhere else on their body. Vibrations in each of the controllers indicate where the ball is according to the following rules: The gamepad in your hands will have a steady weak vibration if the ball is above your paddle, a strong vibration if the ball is below, and no vibration if they are at the same height The gamepad in your lap will progressively vibrate faster as the ball moves toward your paddle and slower as it moves away One or the other gamepad will pulse on impact with the walls or paddles, depending on what the ball bounces off It took my girlfriend and I around half an hour to get the hang of the game, as we started first with the visual and sound aides turned on and then gradually eased our way into haptic-only play. That, Nordvall says, is about standard. "Whenever we test people on it, it's very hard in the beginning," he tells Gizmag. "But after like 20-25 minutes something clicks in your head and you start to realize that 'Oh wait, this signal is actually not at all the same as this other signal that I'm also feeling.' So you can start to tease those out." In its pure state, haptic Pong features no visual or auditory aides, and a screen that's completely blank but for the score (Image: Mathias Nordvall) Nordvall likens the pulses to a language. "Those pulses that you feel have very little correspondence to a ball bouncing off a paddle or a ball actually coming towards you," he says. "In that sense, it's more about a semantic language; here's an arbitrary signal that means that ball is coming towards you, just like it's arbitrary that we spell 'cat' c-a-t in the English language. But If you write it down on a piece of paper and show it to someone they can understand you." Video game controllers come associated with a language of play and interaction that gamers have been developing for over 30 years, and people who have played games at any point during that period can learn the language relatively easily. But haptic interfaces don't yet have any kind of standard interface(s), and there hasn't been much experimentation with the idea of creating one. Enter Sightlence. A screenshot from the beta version of Sightlence, a straightforward haptic editor meant for easy creation of haptic signals to be used in apps and games for any device (Image: Mathias Nordvall) As an extension of the haptic Pong game, Nordvall and his colleagues have built Sightlence, a haptic editor, which will be available soon and is meant to make it easier for anyone to design haptic output signals for games and other software. Nordvall likens it to a digital audio workstation that's not for creating music but rather for haptics. You have boxes for individual signals, and "samples" that you can create or import and then mix and match, and then you choose where the signal goes – an Xbox gamepad or an Android or iOS device, or perhaps a custom device that you built yourself. The editor is plugin-based, so even if there's no out-of-the-box support for a device, you can write a new plugin driver and jump into the tools. The idea is that Sightlence will provide the tools for developers to establish a kind of scaffolding for haptic interfaces. "We're not used to using haptic interfaces at all," explains Nordvall. "Especially not for information that's only conveyed through haptics and nothing else." Haptic growth Nordvall's haptic editor could help kickstart development of new haptic experiences – of haptic "languages" – where there's currently a big spike in interest on three separate fronts: virtual reality, wearable computing, and touchscreen technology. The Oculus Rift is helping to drive research and development in haptics as part of a gold rush for total VR immersion Sightlence may not help much with virtual reality, which leans more toward simulation in one way or another and thus could benefit from direct translation of recorded real-world forces into haptic signals. But wearables and touchscreens will need to be more abstract in their use of the technology, and that appears well-suited to a haptic editor that lets you tap or draw out signals and tweak them to your heart's content. Apple touts its upcoming Watch as coming with a Taptic Engine that provides tactile sensations on your wrist that are "recognizably different for each kind of interaction." It will, the documentation suggests, allow users to send each other their heartbeats as measured by the heart rate sensor, and perhaps other customized haptic cues. The watch will also guide you in the right direction with a gentle buzz when you're navigating. Other smartwatches and their arrays of apps are trying similar things, and as new kinds of wearables emerge, we're likely to see haptics play a key role in how we interact with the technology we carry around with us. Especially now that screens, too, are gaining improved haptic technology. Clever techniques such as one involving pushing liquid into prearranged tactile pixels can provide the sensation of pressing physical buttons. Fujitsu last year showed off prototypes for haptic-enhanced tablets that go even farther, offering users a feeling of texture beneath their fingers through ultrasonic vibrations of varying frequencies and amplitudes. In the virtual reality space, haptic technology could be the missing puzzle piece that propels the likes of Oculus Rift and Sony's Project Morpheus into the mainstream. The trouble is that virtual reality now looks and sounds so lifelike that you instinctively feel like you're physically in the virtual space, and that means that you want to touch things and to feel things touching you. But without haptics (or a whole lot of props and careful planning), neither of these are possible. That's why there's an arms race in the field. Control VR and PrioVR, among others, track your hands and fingers or entire body in real time, with haptic feedback being gradually explored in most of them. Others don't worry about motion tracking, and focus only on the haptics. KOR-FX makes you feel every virtual impact – big or small – in your chest, as explosions seem to blow right through you, engines rumble deep beneath your skin, and you feel something akin to the real g-force of your car or spaceship turning. Others still offer motion-tracked props with built-in haptic feedback, such as with the Striker Virtual Recoil rifle or Tactical Haptics Reactive Grip device. Immerz's KOR-FX haptic vest lends games and movies a much greater punch, especially when coupled with a virtual reality headset And this is without even getting into the high-cost custom-designed haptic tools used in industrial, medical, and military simulations. Surgeons train or perform remote surgery with 3D glasses and haptic instruments, soldiers get a taste of battle using fake guns with realistic recoil and vests not unlike KOR-FX, while pilots and mining machine technicians also get tactile feedback from their training programs. A vibrant future In all of these applications of haptic technology, Nordvall suggests the key is that tactile feedback be used to either augment an experience (to make it feel more real or satisfying, like subtle vibrations on a virtual keyboard or pulses when your virtual car crashes into a wall) or to replace elements of the interface entirely such that the information haptics provide is not available through the soundscape or visually on the screen. In a video game, for instance, "you could have some vibration telling you which way is north, so that you don't have to look at a mini-map all the time," says Nordvall. Neither method has been explored fully, and the latter especially is ripe for attention. You could have experiences that are only possible with haptics, Nordvall suggests, or reinvent existing ones, like the game of Pong or perhaps navigating through a maze. With recent research producing both new forms of haptic feedback (just last month Gizmag reported on holographic objects that can be seen and felt) as well as more sophisticated tactile displays and 3D maps, the future of haptics seems limited only by our imaginations. The technology is maturing rapidly, and it's making its way into the mass market on a scale worthy of developer attention. Now the interfaces that apply it need to catch up.

Environment, not genes, dictates human immune variation, study finds

 

Mark Davis and his colleagues have discovered that our environment, not our genes, play a greater factor in shaping the human immune system. A study of twins conducted by Stanford University School of Medicine investigators shows that our environment, more than our heredity, plays the starring role in determining the state of our immune system, the body's primary defense against disease. This is especially true as we age, the study indicates. Much has been made of the role genes play in human health. Stunning advances in gene-sequencing technologies, in concert with their plummeting costs, have turned many scientists' attention to minute variations in the genome -- the entire toolbox of genes carried in virtually every cell in the body -- in the hope of predicting people's future health. Such studies have revealed a genetic contribution to health outcomes. But, with some notable exceptions, very few individual genetic variants contribute much to particular health conditions. "The idea in some circles has been that if you sequence someone's genome, you can tell what diseases they're going have 50 years later," said Mark Davis, PhD, professor of microbiology and immunology and director of Stanford's Institute for Immunity, Transplantation and Infection. But while genomic variation clearly plays a key role in some diseases, he said, the immune system has to be tremendously adaptable in order to cope with unpredictable episodes of infection, injury and tumor formation. "The immune system has to think on its feet," said Davis, senior author of the new study, which will be published Jan. 15 in Cell. Lead authorship is shared by former Stanford postdoctoral scholars Petter Brodin, MD, PhD, and Vladimir Jojic, PhD. Nature versus nurture "Unlike inbred lab mice, people have broadly divergent genetic heritages," said Davis, who is also the Burt and Marion Avery Family Professor. "And when you examine people's immune systems, you often find tremendous differences between them. So we wondered whether this reflects underlying genetic differences or something else. But what we found was that in most cases, including the reaction to a standard influenza vaccine and other types of immune responsiveness, there is little or no genetic influence at work, and most likely the environment and your exposure to innumerable microbes is the major driver." To determine nature's and nurture's relative contributions, Davis and his colleagues turned to a century-old method of teasing apart environmental and hereditary influences: They compared pairs of monozygotic twins -- best known to most of us as "identical" -- and of dizygotic, or fraternal, twins. Monozygotic twins inherit the same genome. Despite inevitable copying errors when cells divide, which cause tiny genetic divergences to accumulate between monozygotic twins over time, they remain almost 100 percent genetically identical. Dizygotic twins are no more alike genetically than regular siblings, on average sharing 50 percent of their genes. Because both types of twins share the same environment in utero and usually share the same environment in childhood, they make excellent subjects for contrasting hereditary versus environmental influence. About two decades ago, study co-author Gary Swan, PhD, who was then at SRI Inc. and is now a consulting professor of medicine at Stanford, began curating a registry of twins for research purposes. The registry now includes about 2,000 twin pairs. For the new study, the researchers recruited 78 monozygotic-twin pairs and 27 pairs of dizygotic twins from the registry. They drew blood from both members of each twin pair on three separate visits. The Stanford team then applied sophisticated laboratory methods to the blood samples to measure more than 200 distinct immune-system components and activities. All samples were sent immediately to Stanford's Human Immune Monitoring Core, which houses the latest immune-sleuthing technology under a single roof. The power of environment Examining differences in the levels and activity states of these components within pairs of monozygotic and dizygotic twins, the Stanford scientists found that in three-quarters of the measurements, nonheritable influences -- such as previous microbial or toxic exposures, vaccinations, diet and dental hygiene -- trumped heritable ones when it came to accounting for differences within a pair of twins. This environmental dominance was more pronounced in older identical twins (age 60 and up) than in younger twins (under age 20). Davis and his associates also observed considerable environmental influence over the quantities of antibodies produced in members of twin pairs who had been vaccinated for influenza in a separate Stanford investigation directed by study co-author Cornelia Dekker, MD, professor of pediatric infectious disease and medical director of the Stanford-Lucile Packard Children's Hospital Vaccine Program. While many previous studies have suggested a powerful genetic component in vaccine responsiveness, Davis noted that those studies typically were performed in very young children who had not yet undergone the decades of environmental exposure that appears to reshape the immune system over time. In a striking example of the immune system's plasticity, the Stanford scientists found that the presence or absence of a single chronic viral infection could have a massive effect on the system's composition and responsiveness. Three out of five people in the USA and as many as nine out of 10 people in the developing world are chronic carriers of cytomegalovirus, which is dangerous in immune-compromised people but otherwise generally benign. In 16 of the 27 monozygotic twin pairs participating in the study, one member of the pair had been exposed to cytomegalovirus but the other had not. For nearly 60 percent of all the features Davis' group measured, cytomegalovirus' presence in one twin and absence in another made a big difference. "Nonheritable influences, particularly microbes, seem to play a huge role in driving immune variation," said Davis. "At least for the first 20 or so years of your life, when your immune system is maturing, this amazing system appears able to adapt to wildly different environmental conditions. A healthy human immune system continually adapts to its encounters with hostile pathogens, friendly gut microbes, nutritional components and more, overshadowing the influences of most heritable factors."

Eczema woes not just skin deep

 

Eczema wreaks havoc on its sufferers' lives with health problems that are more than skin deep. Adults who have eczema -- a chronic itchy skin disease that often starts in childhood -- have higher rates of smoking, drinking alcoholic beverages and obesity and are less likely to exercise than adults who don't have the disease, reports a new Northwestern Medicine® study. These behaviors give them a higher risk of cardiovascular disease, including high blood pressure and high cholesterol as well as diabetes. They also have higher rates of insomnia. "This disease takes a huge emotional toll on its sufferers, like chronic pain," said lead study author Dr. Jonathan Silverberg. "Because eczema often starts in early childhood, people are affected all through their developmental years and adolescence. It hurts their self-esteem and identity. That's part of why we see all these negative behaviors." Silverberg is an assistant professor of dermatology at Northwestern University Feinberg School of Medicine and a dermatologist at Northwestern Memorial Hospital. He also is director of the Northwestern Medicine Multidisciplinary Eczema Center. Adding to eczema patients' health woes is difficulty exercising, because sweat and heat aggravate the itching. "They will avoid anything that triggers the itch," Silverberg said. "Patients report their eczema flares during a workout." The study was published Jan. 8 in the Journal of Allergy and Clinical Immunology. "This opens our eyes in the world of dermatology that we're not just treating chronic inflammation of the skin but the behavioral, lifestyle side of things," Silverberg said. Dermatologists need to ask patients about their lifestyle habits such as smoking and physical activity so they can offer interventions. The study analyzed data for 27,157 and 34,525 adults aged 18 to 85 years from the 2010 and 2012 National Health Interview Survey. The Northwestern study reported patients with eczema had 54 percent higher odds of being morbidly obese, 48 percent higher odds of hypertension, up to 93 percent higher odds of having pre-diabetes and up to 42 percent higher odds of having diabetes. They also had 36 percent higher odds of high cholesterol. Silverberg said patients should be offered interventions for alcohol and smoking by their dermatologists. In addition, he is collaborating with colleagues in Northwestern's department of physical therapy and human movement sciences to figure out how patients with eczema can exercise to improve their health without worsening their skin flare-ups. Story Source: The above story is based on materials provided by Northwestern University. The original article was written by Marla Paul. Note: Materials may be edited for content and length. Journal Reference: Jonathan I. Silverberg, Philip Greenland. Eczema and cardiovascular risk factors in 2 US adult population studies. Journal of Allergy and Clinical Immunology, 2015; DOI: 10.1016/j.jaci.2014.11.023

Inventors choose to reveal their secret sauce before patent approval

 

January 15, 2015 Georgia Institute of Technology Common wisdom and prior economic research suggest that an inventor filing a patent would want to keep the technical know-how secret as long as possible. But a new study of nearly 2 million patents shows that inventors are not as concerned with secrecy as previously thought. Researchers found that since 2000, most inventors when given the choice opted to disclose information about their patents before patent approval -- even small inventors -- and this disclosure correlates with more valuable patents. Common wisdom and prior economic research suggest that an inventor filing a patent would want to keep the technical know-how secret as long as possible. But a new study of nearly 2 million patents shows that inventors are not as concerned with secrecy as previously thought. Researchers found that since 2000, most inventors when given the choice opted to disclose information about their patents before patent approval -- even small inventors -- and this disclosure correlates with more valuable patents. "Do inventors really value the secrecy that economists assumed they did based on the prior literature? Our findings are that overwhelmingly, and in every category that we can test, inventors don't," said Stuart Graham, study co-author and assistant professor at the Georgia Institute of Technology's Scheller College of Business. Graham was the first-ever chief economist appointed at the U.S. Patent and Trademark Office (USPTO), serving in the U.S. Department of Commerce while on leave from Georgia Tech from 2010 to 2013. The study, co-authored with Deepak Hegde (New York University), will be published January 16 in the journal Science, and was sponsored in part by the Ewing Marion Kauffman Foundation. During the congressional debate over the AIPA, prominent inventors raised concerns that reduced secrecy would harm not only small inventors, but undermine the inventive spirit throughout the world. So a loophole was included in the AIPA, allowing inventors to maintain secrecy of their patent applications if they were not also filing for parallel foreign patent protection on the same invention. The change in the law created an opportunity for Graham and his colleague Deepak Hegde, an assistant professor of management and organizations at NYU's Stern School of Business, to examine which inventors were choosing to opt into the secrecy loophole, and whether their patents differed in important ways. They examined 1.8 million granted patents filed at the USPTO from 1995 to 2005 and analyzed the disclosure preferences of the inventors. Their analysis found that, among those not seeking foreign protection, about 85 percent of inventors filing a patent since 2000 chose to disclose information about their patents prior to their approval. "Overwhelmingly, those inventors patenting only in the U.S. are choosing 18 month disclosure," co-author Hegde said. The patents examined in the study are called utility patents, which are available on new and useful processes, machines, manufactured articles, or compositions, and protect technologies like software, laptops, medical devices, and drugs. These are the commonest type of patent with more than 570,000 filed at the USPTO in 2013, each containing technical information. When the AIPA was passed, one of the biggest complaints was that the publication requirement would hurt U.S. small inventors, but the researchers found that individuals and small companies still opted for disclosure during the study period. "Small U.S. inventors are not choosing the secrecy route," Graham said. "When they patent only in the U.S., they are choosing secrecy in only about 15 percent of the cases, not statistically different than the rate among all other types of inventors." Another major complaint of the AIPA was that disclosing patent secrets would stop the engine of innovation in the United States and that society would get less meaningful inventions. Contrary to these arguments, the researchers found that patents born out of secrecy were overall less valuable than those that opted for disclosure. "When we examine indicators of patent value, we find consistent evidence that the least-valuable and least-impactful patents are those that opted for pre-grant secrecy," Hegde said. The authors point out that more patent information, provided to society earlier, could be socially beneficial. Publishing patent information earlier may provide a head start for other innovators, and may help society avoid unnecessary duplicative research spending, the researchers said. "We have limited resources in our society that we can invest in innovation and invention," Graham said. "To the extent that we can more efficiently choose projects and avoid wasteful, redundant efforts, then that's good for us as a society." Future work will involve pinpointing why inventors are choosing not to keep their patent information secret until grant. Some possible answers are that disclosure acts as an early signal to competitors to not innovate in that technology space, or announces to potential licensees that a technology is coming to the marketplace and may be available as an input for someone else's manufacturing or engineering process. "This study is a first window into what inventors are really doing. The next question is why are they doing it?" Graham said. "It remains for us to figure out why inventors seeking to maximize the value of their inventions are not particularly interested in pre-patent secrecy." Story Source: The above story is based on materials provided by Georgia Institute of Technology. Note: Materials may be edited for content and length. Journal Reference: S. Graham, D. Hegde. Disclosing patents' secrets. Science, 2015; 347 (6219): 236 DOI: 10.1126/science.1262080

When used effectively, discharge summaries reduce hospital readmissions

 

New Yale research shows how effectively using discharge summaries can prevent hospital readmissions for heart failure patients. For heart failure patients making the transition from hospital to home, a discharge summary that gets to their primary doctors quickly and contains detailed and useful information can mean the difference between recovering quickly or returning to the hospital, according to two studies from Yale School of Medicine researchers. The findings are published by the Yale research team in the current issue of Circulation: Cardiovascular Quality and Outcomes. In theory, a discharge summary is meant to help outside physicians understand what happened to patients while they were hospitalized, but in practice, it has served as an aid for medical billing, according to lead author Leora Horwitz, M.D., adjunct associate professor of internal medicine at Yale School of Medicine and director of the Center for Healthcare Innovation and Delivery Science at New York University Langone Medical Center. "The medical community hasn't really made full use of discharge summaries as a tool for transitions," she said. Horwitz and her team analyzed data from Telemonitoring to Improve Heart Failure Outcomes (Tele-HF), a large multicenter study of patients hospitalized with heart failure. This data contained more than 1,500 discharge summaries from 46 hospitals across the country. Horwitz said in order for a discharge summary to do the job of making the transition from hospital to home safer, it needs three key factors: It has to be timely, it has to be sent to the outside physician, and it has to include useful information. "It's like a three-legged stool," she said. "All three need to be present in order for it to do its job." In the first study, Horwitz and her team expected the summaries to be similar at all the hospitals they analyzed, but they found that hospitals varied widely in their performance. And even at the highest-performing hospitals, the quality of discharge summaries was insufficient in terms of timeliness, transmission, and content. No hospital consistently produced high-quality summaries in all domains. In the second study using the same data from Tele-HF, the team looked at whether improving hospital practices regarding discharge summaries made a difference in hospital readmissions. They found that discharge summary quality was indeed associated with readmission risk; patients whose summaries included useful content or were sent to outside clinicians had lower readmission rates. "This study tells us for the first time that it is actually worth spending the time and effort to improve discharge communication, and patients do seem to benefit," said Horwitz. Story Source: The above story is based on materials provided by Yale University. The original article was written by Karen N. Peart. Note: Materials may be edited for content and length. Journal References: M. S. Al-Damluji, K. Dzara, B. Hodshon, N. Punnanithinont, H. M. Krumholz, S. I. Chaudhry, L. I. Horwitz. Hospital Variation in Quality of Discharge Summaries for Patients Hospitalized With Heart Failure Exacerbation. Circulation: Cardiovascular Quality and Outcomes, 2015; DOI: 10.1161/CIRCOUTCOMES.114.001227 M. S. Al-Damluji, K. Dzara, B. Hodshon, N. Punnanithinont, H. M. Krumholz, S. I. Chaudhry, L. I. Horwitz. Association of Discharge Summary Quality With Readmission Risk for Patients Hospitalized With Heart Failure Exacerbation. Circulation: Cardiovascular Quality and Outcomes, 2015; DOI: 10.1161/CIRCOUTCOMES.114.001476

Study reveals lack of data on opioid drugs for chronic pain

 

A National Institutes of Health white paper that was released today finds little to no evidence for the effectiveness of opioid drugs in the treatment of long-term chronic pain, despite the explosive recent growth in the use of the drugs. The paper, which constitutes the final report of a seven-member panel convened by the NIH last September, finds that many of the studies used to justify the prescription of these drugs were either poorly conducted or of an insufficient duration. An NIH white paper finds little to no evidence for the effectiveness of opioid drugs in the treatment of long-term chronic pain. That makes prolific use of these drugs surprising, says Dr. David Steffens, chair of the psychiatry department at UConn Health and one of the authors of the study. When it comes to long-term pain, he says, "there's no research-based evidence that these medicines are helpful." Yet despite this, prescriptions for opioid drugs (also known as opiate drugs; the two terms are technically distinct, but most physicians use them interchangeably) have more than tripled in the past 20 years, with more than 219 million prescriptions written in 2011, according to the study. At the same time, the abuse of these drugs has also skyrocketed, leading some to refer to prescription drug abuse as an epidemic. More than 16,000 people died from prescription opioid overdoses in 2012, according to the Centers for Disease Control, and drug overdose now causes more deaths than motor vehicle accidents for people ages 25-64. This level of opioid use and abuse is unprecedented in the world: the United States, with just 4.6 percent of the world's population, consumes 80 percent of the world's opioid drugs. That, says Steffens, makes this "a peculiarly American problem." Steffens, like the other members of the panel, was surprised by many of these findings, since he is not an expert in opioid drugs, in drug abuse, or in pain management. The members of the panel were experienced clinicians with expertise in other areas; Steffens' specialty is geriatric psychiatry. "The NIH intentionally invited people from other fields of medicine," he says, "in order to avoid potential conflicts of interest, and to get a fresh perspective on the issue." Over two days, the panel listened to evidence presented by an outside agency, which had conducted an exhaustive search of all the available studies about the use of opioid drugs. The panel's draft report was made available for public comment late last fall. The final report is published in the Annals of Internal Medicine. Steffens notes that one of the great challenges in grappling with this issue is the fact that opioid drugs clearly are an effective treatment for some people dealing with pain, but it is hard to predict where trouble will crop up. Part of the problem, he points out, is the need for better communication about best practices to physicians who are prescribing these drugs. "There are certain syndromes, like fibromyalgia, where opioids are less likely to be effective and patients are more likely get into trouble with abuse," says Steffens. Another issue both for patients and for society at large is that pills from the pharmacy don't always end up in the hands they were prescribed for. The process of medicine being sold or given away (known as diversion) has long been identified as a key driver in the rise of prescription drug abuse. Says Steffens, "I wish that doctors treating people for sports or workplace injuries would be cautious with the amount of pills they dispense." Story Source: The above story is based on materials provided by University of Connecticut. The original article was written by Tim Miller. Note: Materials may be edited for content and length. Journal Reference: David B. Reuben, Anika A. H. Alvanzo, Takamaru Ashikaga, G. Anne Bogat, Christopher M. Callahan, Victoria Ruffing, David C. Steffens. National Institutes of Health Pathways to Prevention Workshop: The Role of Opioids in the Treatment of Chronic Pain. Annals of Internal Medicine, 2015; DOI: 10.7326/M14-2775

Liquids and glasses relax, too -- but not like you thought

 

At the picosecond scale, liquids move not so much in a gang rush as a follow-the-leader process akin to the space moving around in a 15 puzzle, according to a group of NIST researchers. The physical model they propose has implications for the design of protein-based drugs that must be stored for long periods at room temperature. A new insight into the fundamental mechanics of the movement of molecules recently published by researchers at the National Institute of Standards and Technology (NIST) offers a surprising view of what happens when you pour a liquid out of a cup. More important, it provides a theoretical foundation for a molecular-level process that must be controlled to ensure the stability of important protein-based drugs at room temperature. Proteins depend critically on their three-dimensional structure, the shape the long and complex molecules tend to fold into. Modern protein-based drugs -- for example, vaccines or antibodies created to fight cancers -- generally are not stable at room temperature or in the liquid formulations most convenient for clinical use. To preserve them for use in parts of the world without reliable refrigeration, manufacturers freeze-dry the proteins and coat the complex molecules with glassy sugars to keep their structure intact. "It's like a lollypop," observes NIST biochemist Marcus Cicerone, "but these lollypops are only 10 microns or smaller." The challenge is to design the sugar coating to get the maximum shelf life for a given pharmaceutical protein, which ideally would be measured in years. The issue revolves around what chemists refer to as "relaxation" -- broadly, any molecular motion that leads to transport of the molecule. About 10 years ago, NIST researchers discovered a testing shortcut. Using neutron radiation, they discovered that measuring tiny molecular movements in the proteins at very short timescales -- picoseconds* -- could reliably predict the long-term stability of a formulation. The sugars that worked the best were the ones that suppressed the tiny, rapid motions. Exactly why this was so was not particularly clear, but it worked. This new paper finally explains the underlying principles. The neutron experiments, says Cicerone, measure mean square displacement. "Imagine a jarful of molecules. It's how far the average molecule jiggles around for a given timescale," he says. "In condensed matter like a liquid or glass, we usually think that all the molecules are identical, and on the average they all have the same environment with a little bit of space for them to jiggle, but not very much." "What we found is that picture is not really right." In reality, Cicerone says, there are two different environments the molecules can be in. "There is one environment like that -- molecules are very well packed and on a picosecond timescale they move maybe one percent of their radius. They're hardly moving at all. But there's another environment where some molecules can move maybe 30 percent of their radius in the same time.They're really making big jumps, and in glasses, those big jumps are essentially the only way that molecules can move around. Everybody else is completely stuck. "It's kind of like a 15 puzzle. You can only move one at a time." What happens is a molecule next to a region that's more loosely packed can move there, and does. Then one that was next to it suddenly has room to move, and does, and so on. On a picosecond and nanometer scale of time and space, when you pour a liquid out of a cup, it doesn't really all come out all at once. It's more follow-the-leader. On a practical level, says Cicerone, the results explain why the short timescale mean displacement measurements can predict the results of molecular degradation measurements that would normally take months. "It gives a really good solid understanding of why these picosecond and nanosecond timescale measurements correlate with degradation processes in glass for the proteins," he says, "so it gives us confidence that the techniques we build that are based on this idea will be robust and people will be able to use them." As a bonus, he says, the model also explains a somewhat arcane degradation process in glasses called Johari-Goldstein relaxation. "It's the timescale for the switching between the tightly packed and loosely packed regions. It's the vacancy in the game of 15 moving around," says Cicerone. *0.000 000 000 001 second Story Source: The above story is based on materials provided by National Institute of Standards and Technology (NIST). Note: Materials may be edited for content and length. Journal Reference: Marcus T. Cicerone, Qin Zhong, Madhusudan Tyagi. Picosecond Dynamic Heterogeneity, Hopping, and Johari-Goldstein Relaxation in Glass-Forming Liquids. Physical Review Letters, 2014; 113 (11) DOI: 10.1103/PhysRevLett.113.117801

"Affordable" Chevrolet Bolt electric vehicle concept has a range of 200 miles

 

The Chevrolet Bolt EV concept has a range of 200 miles (322 km) and should cost around $30,000 (Photo: Loz Blain/Gizmag) Image Gallery (13 images) Two of the biggest obstacles to the widespread adoption of electric vehicles (EVs) have been their prohibitively high prices and limited ranges. Chevrolet's new Bolt EV concept seeks to tackle both of these factors. It is designed to go 200 miles (322 km) per charge and cost from around US$30,000. Chevrolet says it has used the knowledge gained from its Volt and Spark EVs to produce the Bolt. "We have made tremendous strides in technologies that make it easier and more affordable for Chevrolet customers to integrate an all-electric vehicle in their daily lives," said General Motors CEO Mary Barra. Amongst the technologies present in the car is the ability to change driving mode depending on the environment in which it is being used. Available modes are tailored towards daily commuting and "spirited weekend cruising," as well as other situations. Selecting different modes changes aspects of the car's setup, such as accelerator pedal mapping, vehicle ride height and suspension tuning. The Bolt is also said to support DC fast charging and has LED headlights and taillights. The Bolt's weight has been kept to a minimum by using lightweight materials, including aluminum, magnesium, carbon fiber and woven mesh. This helps to increase the vehicle's range. Chevrolet says the car has been designed in such a way as to minimize any overhang at both the front and the rear, maximizing interior space. A large glass roof and large expanses of glass right around the vehicle, meanwhile, allows plenty of light in and increases visibility. A variety of technologies are used inside the Bolt aimed at improving the driving experience. A 10-in touchscreen on the dashboard provides vehicle information, whilst the Bolt EV Connect app allows a user's smartphone to be used as a key fob and for ride-sharing management. The app also allows users to exit the vehicle and instruct it to park itself, before summoning it back to their location at a later time. The Chevrolet Bolt EV concept is currently on display at the North American International Auto Show in Detroit. There is no word on commercial availability. Source: Chevrolet Share About the Author Stu is a tech writer based in Liverpool, UK. He has previously worked on global digital estate management at Amaze and headed up digital strategy for FACT (Foundation for Art and Creative Technology). He likes cups of tea, bacon sandwiches and RSS feeds.   All articles by Stu Robarts

Skin care: 5 tips for healthy skin

 

Good skin care — including sun protection and gentle cleansing — can keep your skin healthy and glowing for years to come. By Mayo Clinic Staff Don't have time for intensive skin care? You can still pamper yourself by acing the basics. Good skin care and healthy lifestyle choices can help delay the natural aging process and prevent various skin problems. Get started with these five no-nonsense tips. 1. Protect yourself from the sun One of the most important ways to take care of your skin is to protect it from the sun. A lifetime of sun exposure can cause wrinkles, age spots and other skin problems — as well as increase the risk of skin cancer. For the most complete sun protection: Use sunscreen. Use a broad-spectrum sunscreen with an SPF of at least 15. Apply sunscreen generously, and reapply every two hours — or more often if you're swimming or perspiring. Seek shade. Avoid the sun between 10 a.m. and 2 p.m., when the sun's rays are strongest. Wear protective clothing. Cover your skin with tightly woven long-sleeved shirts, long pants and wide-brimmed hats. Also consider laundry additives, which give clothing an additional layer of ultraviolet protection for a certain number of washings, or special sun-protective clothing — which is specifically designed to block ultraviolet rays. 2. Don't smoke Smoking makes your skin look older and contributes to wrinkles. Smoking narrows the tiny blood vessels in the outermost layers of skin, which decreases blood flow. This depletes the skin of oxygen and nutrients that are important to skin health. Smoking also damages collagen and elastin — the fibers that give your skin strength and elasticity. In addition, the repetitive facial expressions you make when smoking — such as pursing your lips when inhaling and squinting your eyes to keep out smoke — can contribute to wrinkles. If you smoke, the best way to protect your skin is to quit. Ask your doctor for tips or treatments to help you stop smoking. Next Dec. 16, 2014 References See more In-depth