California's tobacco control efforts losing steam, finds report

 

October 23, 2014

University of California, San Francisco (UCSF)

California’s position as a leader in tobacco control is under threat, according to a new report. Once a highly successful program and international model, the state's anti-tobacco efforts now appear to be waning due to the decreased spending power of the California Tobacco Control Program, a resurgence of the tobacco industry in state politics, and the emergence of new unregulated tobacco products.

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California's position as a leader in tobacco control is under threat, according to a new report from the UC San Francisco Center for Tobacco Control Research and Education. Once a highly successful program and international model, the state's anti-tobacco efforts now appear to be waning due to the decreased spending power of the California Tobacco Control Program, a resurgence of the tobacco industry in state politics, and the emergence of new unregulated tobacco products.

"The combination of weak leadership at the state level, willingness of political leaders to accept tobacco industry money, and inflation eroding the spending power of the California Tobacco Control Program are compromising its effectiveness, which will lead, even in the short term, to more smoking," said Stanton Glantz, PhD, UCSF professor of medicine and director of the UCSF Center for Tobacco Control Research and Education.

The report will be published on Oct. 23 in eScholarship, which provides open-access scholarly publishing services to the University of California.

The report covers tobacco policymaking and tobacco industry political influence in California from 2007 to 2014 and is the latest in a series of reports on the state dating to 1976. It is part of a longstanding research project that tracks the effect of tobacco programs in protecting public health. To date, 29 states have been studied.

The California report draws from a comprehensive collection of sources including legislative records, campaign contribution data, lobbying reports, media reports, interviews, and peer reviewed journals.

In 1989, the California Tobacco Control Program was established after voters enacted Proposition 99 -- the Tobacco Tax and Health Protection Act. It has since achieved great success in reducing tobacco use by Californians. From 1989 to 2012, the percentage of adult smokers in California dropped from 22.7 percent to 12.6 percent, and while nearly 2.5 billion packs of cigarettes were sold in California in 1988, only 951 million packs were sold by 2012. Between 1989 and 2008, the California Tobacco Control Program cost $2.4 billion to run but led to a cumulative healthcare savings of $134 billion.

Despite these triumphs, the program is now much smaller and less aggressive than in its early years. By 2014, inflation had reduced the program's spending power to 53 percent of what it was when it began.

Furthermore, the rate of decline in tobacco consumption in California has slowed compared to the national rate. From 2004 to 2013, consumption per capita in California dropped 28.2 percent, while national consumption decreased 34.8 percent. In the previous ten-year period, however, the reverse was true, with California consumption dropping 40.8 percent, compared to a national decline of 20.5 percent.

The decrease in youth smoking in California was lower than that nationally between 2000 and 2011, especially among middle school students, who saw a 28.4 percent decline in California compared to a 60.9 percent decline nationally.

"It's unquestionably concerning to see that where we once were a leader we are now starting to fall behind," said lead author Elizabeth Cox, an assistant research specialist at the UCSF Center for Tobacco Control Research and Education. "The resources just aren't there anymore, and state leaders are no longer prioritizing tobacco control."

The report details how the tobacco industry has utilized its massive spending power in recent years to influence tobacco policymaking in California through campaign contributions and powerful lobbyists. Between 2007 and 2013, the industry spent nearly $64.5 million on California political activity. This period also saw an increase in the Democratic leadership's willingness to accept tobacco industry money, including the first California governor to take tobacco money in years, Governor Edmund G. Brown Jr.

Despite the need for new tobacco control funding sources, California leaders have fallen short in making this a priority, explains the report. California has the 33rd lowest cigarette tax in the nation, and yet none of the seven bills introduced to increase the cigarette excise tax from 2007 to 2014 moved past the legislature.

"Public health advocates need to increase pressure on politicians to again refuse tobacco industry money and to prioritize public health," Glantz said. "Only concerned action by health organizations to hold the politicians accountable will change this situation."

The new report also documents the influence of the rising electronic cigarette industry. According to the authors, as e-cigarettes become increasingly popular, they pose an unregulated threat to undermine tobacco control efforts. Despite the strong connection between cigarette smoking and e-cigarette use, the California Department of Public Health has not integrated e-cigarettes into its media campaign or other aspects of the California Tobacco Control Program. Furthermore, only one state bill has been passed to prohibit the sale of e-cigarettes to minors, but it lacks any enforcement measures.

With state leaders failing to take action, local policymaking has remained the most effective form of tobacco control. California led the nation on efforts to protect residents of multiunit housing from secondhand smoke. By 2014, 37 localities had passed ordinances restricting smoking in multiunit housing. In addition, 14 strong local tobacco retail licensing ordinances passed, and 40 percent of California residents were protected from e-cigarette smoke in public places by local ordinances from Eureka to Los Angeles.

"The bright spot in California is clearly at the local level, where political leaders have been putting the public interest above the tobacco companies by enacting strong legislation," Glantz said. "It is my sincere hope that state policymakers will take note of these successes and begin to follow suit, beginning by announcing that they are refusing and returning campaign cash from tobacco companies."

The full report will be available online at http://www.escholarship.org/uc/item/4jj1v7tv. Reports on other states are available at http://tobacco.ucsf.edu/states and for other countries at http://escholarship.org/uc/search?entity=ctcre_tcpmi.

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Story Source:

The above story is based on materials provided by University of California, San Francisco (UCSF). The original article was written by Elizabeth Fernandez. Note: Materials may be edited for content and length.

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Cancer exosome 'micro factories' aid in cancer progression

 

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Exosomes, tiny, virus-sized particles released by cancer cells, can bioengineer micro-RNA (miRNA) molecules resulting in tumor growth. They do so with the help of proteins, such as one named Dicer. New research from The University of Texas MD Anderson Cancer Center suggests Dicer may also serve as a biomarker for breast cancer and possibly open up new avenues for diagnosis and treatment. Results from the investigation were published in Cancer Cell.

"Exosomes derived from cells and blood serum of patients with breast cancer, have been shown to initiate tumor growth in non-tumor-forming cells when Dicer and other proteins associated with the development of miRNAs are present," said Raghu Kalluri, M.D., Ph.D., chair of the department of cancer biology at MD Anderson. "These findings offer opportunities for the development of exosomes-based biomarkers and shed insight into the mechanisms of how cancer spreads."

Exosomes are small vesicles consisting of DNA, RNA and proteins enclosed in a membranes made up of two lipid layers. They perform specialized functions such as coagulation, intercellular signaling and cell "waste management." They are shed into bodily fluids forming a source of disease-specific nucleic acids and proteins. Increasingly, exosomes are studied for their potential as both indicators of disease, and as a prospective new treatment approach.

All exosomes contain a cellular stew of smaller components including proteins, messenger RNA (mRNA) and miRNAs. Kalluri's team reported that breast cancer associated exosomes contain specific miRNAs associated with a multi-protein complex known as RNA-induced silencing complex (RISC).

In addition to RISC, the breast cancer exosomes also house Dicer and two other proteins, AGO2 and TRBP, all of which together provoke tumor growth.

"The role of miRNAs associated with exosomes in cancer progression is largely unknown. Many studies have suggested the presence of miRNAs in exosomes and speculated on their function," said Kalluri. "We demonstrated that inhibiting the action of Dicer in cancer exosomes significantly impairs tumor growth, raising the possibility that miRNAs in exosomes contributes to cancer progression."

Kalluri's study indicated that the interplay between Dicer and its "host" exosome may allow cancer cells to develop an "oncogenic field effect" by manipulating surrounding cells via exosomes. Think of a child blowing a dying dandelion's spores into the wind where they float over a newly mowed lawn and one can envision how this molecular mixer easily spreads the disease to surrounding tissue.

"These studies reflect the need to evaluate the functional contribution of miRNA machinery in exosomes and their role in tumor progression and metastasis," said Kalluri.

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Story Source:

The above story is based on materials provided by University of Texas M. D. Anderson Cancer Center. Note: Materials may be edited for content and length.

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Journal Reference:

1. Raghu Kalluri, M.D., Ph.D. et al. Cancer Exosomes Perform Cell-Independent MicroRNA Biogenesis and Promote Tumorigenesis. Cancer Cell, October 2014 DOI: 10.1016/j.ccell.2014.09.005

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Sweat-analyzing skin patch could replace blood sampling

 

Prof. Jason Heikenfeld with the prototype patch (left) and the upcoming Bluetooth version (Photo: University of Cincinnati)

Nobody likes having blood samples drawn. What's more, such samples typically have to be analyzed in a lab before they're able to tell us anything. But now scientists at the University of Cincinnati and the US Air Force Research Laboratory are developing a system in which a Band-Aid-like skin patch is able to gather and transmit medical data in almost real time, by analyzing the patient's sweat ... and you just need a smartphone to read it, no poking or prodding required.

Developed by a team led by U Cincinnati's Prof. Jason Heikenfeld, the flexible adhesive patch contains an electronic circuit, communications antenna, controller chip, and a microfluidic paper-based sweat-sampling system. That paper wicks minute amounts of sweat from the skin in a tree root-shaped pattern, in order to maximize the sampling area.

In order to keep the sweat flowing through the paper for a sustained period of time (instead of just initially saturating it), a superabsorbent hydrogel is also incorporated into the patch, to draw in and store the sampled perspiration – even after several hours of collecting sweat, that gel reportedly only swells by 2 to 3 millimeters.

The patch has no power source of its own, but instead draws power from an adjacent smartphone's signal – just like a passive RFID tag. Once a phone is close enough to it, the patch sets to work measuring ion concentrations of given biomarkers present in the sweat. The current prototype patch has been designed to measure sodium and chloride concentrations, although future versions could also measure things like electrolytes, metabolites, proteins, small molecules, and amino acids.

That data is wirelessly transmitted to an app on the phone. By analyzing the biomarker ion concentrations, it's possible to ascertain the patient's physical state. This means that the technology could one day be used for applications such as keeping athletes from cramping up by monitoring their electrolyte levels, non-invasively keeping tabs on premature infants' vital signs, allowing diabetics to watch their glucose levels, or for fine-tuning medication dosages by measuring drug metabolites in the patient's sweat.

Human trials of the system are expected to begin later this year. Additionally, a second-generation patch is almost complete, which communicates with the phone via Bluetooth.

Heikenfeld recently described his project in an article he wrote for IEEE Spectrum magazine. Similar research is being conducted at the University of California, San Diego. There, a team led by Prof. Joseph Wang has been using sweat-analyzing temporary tattoos to measure athletes' lactate levels, and to detect metabolic problems.

Sources: University of Cincinnati, IEEE Spectrum

 

YEATS protein potential therapeutic target for cancer

 

October 23, 2014

University of Texas M. D. Anderson Cancer Center

Federal Express and UPS are no match for the human body when it comes to distribution. There exists in cancer biology an impressive packaging and delivery system that influences whether your body will develop cancer or not, scientists say. Researchers have announced findings indicating a possible new way of manipulating chromatin and its histones through a protein reader known as the YEATS domain protein, providing new hope for cancer treatment.

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Federal Express® and UPS® are no match for the human body when it comes to distribution. There exists in cancer biology an impressive packaging and delivery system that influences whether your body will develop cancer or not.

One area of interest focuses on histones, the chief component of chromatin, a cluster of large molecules. Aberrations in chromatin are thought to lead to DNA damage such as with cancer. Researchers at The University of Texas MD Anderson Cancer Center announced findings indicating a possible new way of manipulating chromatin and its histones through a protein reader known as the YEATS domain protein. Protein readers attach to histone "tails" and play an important role in gene activation.

"Our findings indicate the importance of the YEATS domains as potential therapeutic targets for the treatment of cancer," said Xiaobing Shi, Ph.D., assistant professor of epigenetics and molecular carcinogenesis at MD Anderson. "We have identified YEATS as a novel 'reader' for histone acetylation.

Shi's findings are published in this month's issue of Cell.

When DNA wraps around histones much like baling twine on a spool, they form a larger collection of DNA-wrapped histones called nucleosomes. Nucleosomes are further packaged into chromatin containing DNA, protein and RNA. Chromatin's role is to shrink DNA to fit into a cell thus preventing DNA damage and allowing healthy cell division through controlled gene expression. Certain histone modifications such as acetylation and methylation are critical to chromatin's performance.

"These histone modifications serve as docking sites for reader proteins which recognize specific modifications and influence downstream biological outcomes," said Shi. "Compared with a great variety of readers that have previously been identified for histone methylation, few reader proteins that recognize histone acetylation are known."

In other words, if the scanner doesn't recognize the barcode on your package, things can go terribly wrong. In the case of something as crucial as DNA packaging and delivery, it could mean cancer. A family of histone acetylation readers called bromodomain was discovered about a decade ago and was thought to be the sole "reader" for histone acetylation, until now.

"Earlier identification of potent inhibitors target bromodomain proteins has proved histone acetylation readers to be attractive therapeutic targets," said Shi. "Our findings add to this understanding by identifying the YEATS domains as yet another histone acetylation reader that we believe is connected to both healthy and potentially cancer-causing processes."

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Story Source:

The above story is based on materials provided by University of Texas M. D. Anderson Cancer Center. Note: Materials may be edited for content and length.

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Journal Reference:

1. Yuanyuan Li, Hong Wen, Yuanxin Xi, Kaori Tanaka, Haibo Wang, Danni Peng, Yongfeng Ren, Qihuang Jin, Sharon Y.R. Dent, Wei Li, Haitao Li, Xiaobing Shi. AF9 YEATS Domain Links Histone Acetylation to DOT1L-Mediated H3K79 Methylation. Cell, 2014; 159 (3): 558 DOI: 10.1016/j.cell.2014.09.049

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Sleep difficulties common among toddlers with psychiatric disorders

 

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John Boekamp, Ph.D., clinical director of the Pediatric Partial Hospital Program (PPHP) at Bradley Hospital recently led a study that found sleep difficulties -- particularly problems with falling asleep -- were very common among toddlers and preschool-aged children who were receiving clinical treatment for a wide range of psychiatric disorders. The study, titled "Sleep Onset and Night Waking Insomnias in Preschoolers with Psychiatric Disorders," is now published online in the journal Child Psychiatry & Human Development.

"The most common sleep difficulties reported nationally for toddlers and preschoolers are problems of going to bed, falling asleep and frequent night awakenings -- collectively, these problems are referred to as behavioral insomnias of childhood," said Boekamp. "Sleep problems in young children frequently co-occur with other behavioral problems, with evidence that inadequate sleep is associated with daytime sleepiness, less optimal preschool adjustment, and problems of irritability, hyperactivity and attention."

Boekamp's team was interested in learning more about sleep and sleep problems in young children with behavior problems, as early sleep problems may be both a cause and consequence of children's difficulties with behavioral and emotional self-regulation. "Essentially, these young children might be caught in a cycle, with sleep disruption affecting their psychiatric symptoms and psychiatric symptoms affecting their sleep-wake organization," said Boekamp.

The partial program that Boekamp leads at Bradley Hospital is a family-centered, intensive day treatment program for very young children aged from newborn to six who have serious emotional, behavioral or relationship disturbances. This study examined the nature and prevalence of diagnostically defined sleep disorders, including Sleep Onset Insomnia (SOI) and Night Waking Insomnia (NWI), in a group of 183 young children admitted to the program. Diagnosable sleep disorders, particularly SOI, were quite common in the group, exceeding previous estimates obtained in community settings. Overall, 41 percent of children in the study also met diagnostic criteria for a sleep disorder. Sleep problems were especially common in children with disruptive behavior, attention, anxiety and mood problems.

"It is important for families to be aware of how important sleep is to the behavioral adjustment and wellbeing of young children," said Boekamp. "Sleep disorders may be unrecognized and under-diagnosed in young children, particularly when other behavioral or emotional problems are present."

Difficulties with sleep may be particularly important to address when children are also struggling with challenging daytime behaviors, such as problems with compliance, aggression, attention and mood. Sleepiness and fatigue may exacerbate these problem behaviors.

"This study is a great reminder that it's critical for mental health providers working with young children and their families to ask about children's sleep," said Boekamp. "Simple questions about children's sleep patterns, including how long it takes a child to fall asleep at night and how frequently a child awakens after falling asleep, may yield important information that is relevant to clinical care, even when sleep problems are not the primary focus of treatment."

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Story Source:

The above story is based on materials provided by Lifespan. Note: Materials may be edited for content and length.

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Journal Reference:

1. John R. Boekamp, Lauren R. Williamson, Sarah E. Martin, Heather L. Hunter, Thomas F. Anders. Sleep Onset and Night Waking Insomnias in Preschoolers with Psychiatric Disorders. Child Psychiatry & Human Development, 2014; DOI: 10.1007/s10578-014-0505-z

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Designer 'barrel' proteins created

 

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The orthogonal views of 5-, 6- and 7-helix barrel proteins created by Drew Thomson, Dek Woolfson and colleagues at the University of Bristol, UK, and described this week in Science. The images show the central channels in these structures to which the team aim to add functions in future.

Proteins are long linear molecules that fold up to form well-defined 3D shapes. These 3D molecular architectures are essential for biological functions such as the elasticity of skin, the digestion of food, and the transport of oxygen in blood.

Despite the wide variety of tasks that natural proteins perform, they appear to use only a limited number of structural types, perhaps just a few thousand or so. These are used over and over again, being altered and embellished through evolution to generate many different functions. This raises the question: are more protein structures possible than those used and presented to us by nature?

A team from Bristol's School of Chemistry and School of Biochemistry, headed by Professor Dek Woolfson, have addressed this by designing humanmade protein molecules from scratch.

Although the design principles used are learned from natural proteins, from which the team develops rules for assembling their proteins, some of the designed protein shapes are completely new and have not been observed in nature yet.

Specifically, the scientists have made proteins with central cavities, or channels, running through them. The team believes that these will be useful in designing new protein functions, such as catalysts for breaking down fats, or molecules that span cell membranes to allow new communications between cells.

Professor Woolfson said: "This is a really exciting time to be exploring what can be done with biological principles and building blocks to make new and useful molecules, but completely outside the context of biology itself. It is one aspect of the emerging field of synthetic biology, in which Bristol is taking a lead both nationally and internationally."

This work has been highly collaborative combining computational modelling, peptide chemistry, biophysics and protein X-ray crystallography across the Schools of Chemistry (Drew Thomson, Antony Burton, Gail Bartlett and Dek Woolfson) and Biochemistry (Richard Sessions and Leo Brady), and an South West Doctoral Training Partnership student (Chris Wood) working between the two Schools.

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Story Source:

The above story is based on materials provided by University of Bristol. Note: Materials may be edited for content and length.

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Journal Reference:

1. Andrew R. Thomson, Christopher W. Wood, Antony J. Burton, Gail J. Bartlett, Richard B. Sessions, R. Leo Brady, and Derek N. Woolfson. Computational design of water-soluble α-helical barrels. Science, October 2014 DOI: 10.1126/science.1257452

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Anaplastic lymphoma kinase immunohistochemistry testing comparable to fluorescence [in situ] hybridization testing

 

October 23, 2014

International Association for the Study of Lung Cancer

Sixteen institutions across Europe collaborated together to show for the first time that a semi-quantitative anaplastic lymphoma kinase protein expression test, immunohistochemistry, is reliable amongst several laboratories and reviewers when test methodology and result interpretation are strictly standardized and the scoring pathologists are appropriately trained on the test.

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Sixteen institutions across Europe collaborated together to show for the first time that a semi-quantitative anaplastic lymphoma kinase (ALK) protein expression test, immunohistochemistry (IHC), is reliable amongst several laboratories and reviewers when test methodology and result interpretation are strictly standardized and the scoring pathologists are appropriately trained on the test.

ALK tyrosine kinase inhibitors (TKIs) shrink tumors and increase progression-free survival in late-stage non-small cell lung cancer (NSCLC) patients positive for ALK as determined by the fluorescence in situ hybridization (FISH) test, a test for DNA rearrangement within the gene. Testing positive for ALK is required in order to be prescribed the therapeutic inhibitors. However, the FISH test is expensive, time-consuming, and requires specialized equipment and expertise. Many other studies have shown comparable results between IHC and FISH but none have compared a highly standardized test and scoring methodology performed at multiple institutions in numerous countries.

Fifteen well-characterized NSCLC specimens were tested and scored for IHC at 16 institutes of pathology in Belgium, Denmark, France, Germany, Scotland, Spain, Sweden and Switzerland. The specimens were pre-tested 3 times by FISH at 2 separate institutions in Germany. Prior to the IHC testing all the equipment was standardized between all the institutions and the scoring pathologists all attended an internet-based training session with teaching cases.

The results published in the November issue of the Journal of Thoracic Oncology, the official journal for the International Association for the Study of Lung Cancer (IASLC), show that all 16 institutions agreed with 100% concordance on the 7 FISH/IHC negative and on 4 FISH/IHC positive specimens. There was also 100% concordance from all institutions on 2 obvious IHC positive cases that were uncertain by FISH ("borderline"). These 2 cases were confirmed ALK positive by a third test, reverse transcription-polymerase chain reaction (RT-PCR). The last 2 cases were ALK-FISH positive and were scored IHC positive by 15/16 and 12/16 institutions, respectively. However, those not scoring these 2 cases as unequivocal ALK IHC positive, called them IHC equivocal and would have demanded an additional ALK test (FISH, PCR) under diagnostic conditions.

The authors conclude "after harmonization of the staining instruments and training of the observers, the ALK IHC assay can be regarded as a reliable multicenter technique for the detection of ALK protein expression." For the future the authors note "there is need to compare validated ALK IHC assays and ALK-FISH in clinical trials as therapy response data of patients with differing ALK IHC and FISH results will help to implement ALK-IHC not only as a prescreening tool, but also as a potential stand-alone test (at least in cases displaying a clear staining pattern). Until then ALK diagnosis should be based on the rational application of both methods adapted to the given case as FISH has some disadvantages and even validated IHC may produce equivocal staining patterns."

Lead author Dr. Maximilian von Laffert, senior author Dr. Manfred Dietel, and co-authors Drs. Arne Warth, Keith M. Kerr, Fernando Lopez-Rios, Patrick Pauwels, Lukas Bubendorf, and Alex Soltermann are members of IASLC.

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Story Source:

The above story is based on materials provided by International Association for the Study of Lung Cancer. The original article was written by Murry W. Wynes. Note: Materials may be edited for content and length.

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Journal Reference:

1. Maximilian von Laffert, Arne Warth, Roland Penzel, Peter Schirmacher, Keith M. Kerr, Göran Elmberger, Hans-Ulrich Schildhaus, Reinhard Büttner, Fernando Lopez-Rios, Simone Reu, Thomas Kirchner, Patrick Pauwels, Katja Specht, Enken Drecoll, Heinz Höfler, Daniela Aust, Gustavo Baretton, Lukas Bubendorf, Sonja Stallmann, Annette Fisseler-Eckhoff, Alex Soltermann, Verena Tischler, Holger Moch, Frederique Penault-Llorca, Hendrik Hager, Frank Schäper, Dido Lenze, Michael Hummel, Manfred Dietel. Multicenter Immunohistochemical ALK-Testing of Non–Small-Cell Lung Cancer Shows High Concordance after Harmonization of Techniques and Interpretation Criteria. Journal of Thoracic Oncology, 2014; 9 (11): 1685 DOI: 10.1097/JTO.0000000000000332

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Tokyo

 

Tokyo ("Eastern Capital")  officially Tokyo Metropolis  is one of the 47 prefectures of Japan. Tokyo is the capital of Japan, the center of the Greater Tokyo Area, and the most populous metropolitan area in the world. It is the seat of the Japanese government and the Imperial Palace, and the home of the Japanese Imperial Family. Tokyo is in the Kantō region on the southeastern side of the main island Honshu and includes the Izu Islands and Ogasawara Islands. Tokyo Metropolis was formed in 1943 from the merger of the former Tokyo Prefecture and the city of Tokyo.

Tokyo is often referred to and thought of as a city, but is officially known and governed as a "metropolitan prefecture", which differs from and combines elements of both a city and a prefecture; a characteristic unique to Tokyo. The Tokyo metropolitan government administers the 23 Special Wards of Tokyo (each governed as an individual city), which cover the area that was formerly the City of Tokyo before it merged and became the subsequent metropolitan prefecture in 1943. The metropolitan government also administers 39 municipalities in the western part of the prefecture and the two outlying island chains. The population of the special wards is over 9 million people, with the total population of the prefecture exceeding 13 million. The prefecture is part of the world's most populous metropolitan area with upwards of 37.8 million people and the world's largest urban agglomeration economy. The city hosts 51 of the Fortune Global 500 companies, the highest number of any city. The city is also home of various television networks like Fuji TV and the Tokyo Broadcasting System.

The city is considered an alpha+ world city—as listed by the GaWC's 2008 inventory—and in 2014, Tokyo was ranked first in the "Best overall experience" category of TripAdvisor's World City Survey (the city also ranked first in the following categories: "Helpfulness of locals", "Nightlife", "Shopping", "Local public transportation" and "Cleanliness of streets"). In 2013, Tokyo was named the third most expensive city for expatriates, according to the Mercer consulting firm, and the world's most expensive city, according to the Economist Intelligence Unit's cost-of-living survey. In 2009 Tokyo was named the third Most Liveable City by the magazine Monocle. The Michelin Guide has awarded Tokyo by far the most Michelin stars of any city in the world.

Tokyo Dome

Okuma Lecture Hall – Waseda University

Fuji TV Headquarters and Acqua City – Odaiba

Bank of Japan

Skyscrapers of Shinjuku

Without swift influx of substantial aid, Ebola epidemic in Africa poised to explode

 

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Artist's conception (stock illustration).

The Ebola virus disease epidemic already devastating swaths of West Africa will likely get far worse in the coming weeks and months unless international commitments are significantly and immediately increased, new research led by Yale researchers predicts.

The findings are published in the Oct. 24 issue of The Lancet Infectious Diseases.

A team of seven scientists from Yale's Schools of Public Health and Medicine and the Ministry of Health and Social Welfare in Liberia developed a mathematical transmission model of the viral disease and applied it to Liberia's most populous county, Montserrado, an area already hard hit. The researchers determined that tens of thousands of new Ebola cases -- and deaths -- are likely by Dec. 15 if the epidemic continues on its present course.

"Our predictions highlight the rapidly closing window of opportunity for controlling the outbreak and averting a catastrophic toll of new Ebola cases and deaths in the coming months," said Alison Galvani, professor of epidemiology at the School of Public Health and the paper's senior author. "Although we might still be within the midst of what will ultimately be viewed as the early phase of the current outbreak, the possibility of averting calamitous repercussions from an initially delayed and insufficient response is quickly eroding."

The model developed by Galvani and colleagues projects as many as 170,996 total reported and unreported cases of the disease, representing 12% of the overall population of some 1.38 million people, and 90,122 deaths in Montserrado alone by Dec. 15. Of these, the authors estimate 42,669 cases and 27,175 deaths will have been reported by that time.

Much of this suffering -- some 97,940 cases of the disease -- could be averted if the international community steps up control measures immediately, starting Oct. 31, the model predicts. This would require additional Ebola treatment center beds, a fivefold increase in the speed with which cases are detected, and allocation of protective kits to households of patients awaiting treatment center admission. The study predicts that, at best, just over half as many cases (53,957) can be averted if the interventions are delayed to Nov. 15. Had all of these measures been in place by Oct. 15, the model calculates that 137,432 cases in Montserrado could have been avoided.

There have been approximately 9,000 reported cases and 4,500 deaths from the disease in Liberia, Sierra Leone, and Guinea since the latest outbreak began with a case in a toddler in rural Guinea in December 2013. For the first time cases have been confirmed among health-care workers treating patients in the United States and parts of Europe.

"The current global health strategy is woefully inadequate to stop the current volatile Ebola epidemic," co-author Dr. Frederick Altice, professor of internal medicine and public health added. "At a minimum, capable logisticians are needed to construct a sufficient number of Ebola treatment units in order to avoid the unnecessary deaths of tens, if not hundreds, of thousands of people."

Other authors include lead author Joseph Lewnard, Martial L. Ndeffo Mbah, Jorge A. Alfaro-Murillo, Luke Bawo, and Tolbert G. Nyenswah.

The National Institutes of Health funded the study.

Novel software application can stratify early-stage non-small cell lung cancer patients

 

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Computer-Aided Nodule Assessment and Risk Yield, is a novel software tool developed at Mayo Clinic that can automatically quantitate adenocarcinoma pulmonary nodule characteristics from non-invasive high resolution computed tomography (HRCT) images and stratify non-small cell lung cancer (NSCLC) patients into risk groups that have significantly different disease-free survival outcomes.

The majority of NSCLC patients are diagnosed with advanced-stage disease which is concomitant with an exceptionally poor prognosis, 5-year survival rate of 4%. In contrast, tumors detected at an early stage have 5-year survival rates of 54%. The National Lung Cancer Screening Trial (NLST) demonstrated a 20% reduction in lung-cancer specific mortality by screening with HRCT, but many detected nodules are non-cancerous and slow-growing, which can lead to costly and risky overdiagnosis and overtreatment. Thus, better risk classification based on the nodules characteristics is desirable.

HRCT images from 264 clinical stage I pulmonary nodules of the lung adenocarcinoma spectrum were analyzed with the CANARY system and the software used an unsupervised clustering algorithm to classify the patients into categories of similar nodule characteristics.

The results published in the November issue of the Journal of Thoracic Oncology, the official journal for the International Association for the Study of Lung Cancer (IASLC), show that the adenocarcinomas naturally segregated into 3 groups based on HRCT characteristics. The three identified groups corresponded to good, intermediate, and poor postoperative outcomes with 5-year disease-free survival rates of 100%, 73% and 51%, respectively.

"Our preliminary assessment suggests CANARY represents a robust risk stratification tool that can be utilized with a wide variety of HRCT techniques and equipment for retrospective or prospective evaluation of lung nodules in a real-world setting," conclude the authors. Dr. Raghunath, lead author of the study, suggests "HRCT-based CANARY classification could ultimately guide the individualized treatment of HRCT-detected lesions with nodules noninvasively categorized as "good" managed with less aggressive surgical approaches, noninvasive or minimally invasive therapy or watchful waiting, whereas nodules that have characteristics corresponding to the "poor" group would be managed with current standard of care, such as lobectomy, and perhaps additional adjuvant therapy."

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Story Source:

The above story is based on materials provided by International Association for the Study of Lung Cancer. The original article was written by Murry W. Wynes. Note: Materials may be edited for content and length.

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Journal Reference:

1. Sushravya Raghunath, Fabien Maldonado, Srinivasan Rajagopalan, Ronald A. Karwoski, Zackary S. DePew, Brian J. Bartholmai, Tobias Peikert, Richard A. Robb. Noninvasive Risk Stratification of Lung Adenocarcinoma using Quantitative Computed Tomography. Journal of Thoracic Oncology, 2014; 9 (11): 1698 DOI: 10.1097/JTO.0000000000000319

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