Posts Tagged ‘education’

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Chronic focal brain cooling suppresses seizures during wakefulness

Chronic focal brain cooling suppresses seizures during wakefulness

Neuroscientists from Japan’s Yamaguchi University today reported during the 66th annual scientific meeting of the American Epilepsy Society (AES) that chronic focal brain cooling suppresses seizures during wakefulness and achieves the effect without significantly affecting brain function. Their research, and that of others in the field, provides critical evidence that this approach to seizure control has reached a stage where testing in humans will soon be possible.

Focal brain cooling is well established as an effective method for suppressing seizures. But the technology for creating a practical device with potential clinical application has only recently become available and tested in rodents. More evidence from large animals and humans is needed prior to testing in clinical trials for drug-resistant epilepsy.

The Yamaguchi researchers implanted two feline and two non-human primates with a titanium cooling plate, or heat exchanger. The brain cooling device was placed in contact with the brain surface over cortex areas responsible for movement and sensation. Seizures were then induced in the motor cortex. Brain wave recordings to assess seizure activity and temperature recordings were performed under wakefulness. (Abstract #3.056)

According to Masami Fujii, M.D.,Ph.D., and Takao Inoue, Ph.D., and Michiyasu Suzuki, M.D., Ph.D., who presented the report, seizure discharges were significantly suppressed at 15?C (59?F).

“The results of our study suggest that focal brain cooling has a strong effect to suppress the epileptiform seizures under the awake condition,” Dr. Fujii said. “Moreover, implantation of the device for at least five months did not result in detrimental changes in brain tissue subjected to cooling compared to tissue from a similar site in the opposing hemisphere.”

Source : http://www.news-medical.net/news/20121203/Chronic-focal-brain-cooling-suppresses-seizures-during-wakefulness.aspx

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New system can predict timing and severity of seasonal influenza outbreaks

New system can predict timing and severity of seasonal influenza outbreaks

Scientists have developed a system to predict the timing and severity of seasonal influenza outbreaks that could one day help health officials and the general public better prepare for them. The system adapts techniques used in modern weather prediction to turn real-time, Web-based estimates of influenza infection into local forecasts of seasonal flu.

Results appear online in the Proceedings of the National Academy of Sciences.

Year to year, and region to region, there is huge variability in the peak of flu season, which, in temperate areas of the Northern Hemisphere, can happen as early as October or as late as April. The forecast system can provide “a window into what can happen week to week as flu prevalence rises and falls,” says Jeffrey Shaman, PhD, an assistant professor of Environmental Health Sciences at Columbia University’s Mailman School of Public Health.

As a test case, Dr. Shaman and Alicia Karspeck, PhD, of the National Center for Atmospheric Research, used Web-based estimates of flu-related sickness from the 2003-2008 influenza seasons in New York City to retrospectively generate weekly flu forecasts and found that the technique could predict the peak timing of the outbreak more than seven weeks in advance of the actual peak.

In the future, such flu forecasts might conceivably be disseminated on the local television news along with the weather report, says Dr. Shaman. Like the weather, flu conditions vary from region to region; Atlanta might peak weeks ahead of Anchorage. “Because we are all familiar with weather broadcasts, when we hear that there is a 80% chance of rain, we all have an intuitive sense of whether or not we should carry an umbrella,” says Dr. Shaman. “I expect we will develop a similar comfort level and confidence in flu forecasts and develop an intuition of what we should do to protect ourselves in response to different forecast outcomes.”

As individuals, a flu forecast could prompt us to get a vaccine, exercise care around people sneezing and coughing, and better tune in to how we feel. For health officials, it could inform decisions on how many vaccines and antiviral drugs to stockpile, and in the case of a virulent outbreak, whether other measures, like closing schools, is necessary.

“Flu forecasting has the potential to significantly improve our ability to prepare for and manage the seasonal flu outbreaks that strike each year,” says Irene Eckstrand, PhD, of the National Institutes of Health’s National Institute of General Medical Sciences, which provided funding for the study.

Worldwide, influenza kills an estimated 250,000 to 500,000 people each year; in the U.S. about 35,000 die from the flu every year.

The seed of the new study was planted four years ago in a conversation between the two researchers, in which Dr. Shaman expressed an interest in using models to forecast influenza. Dr. Karspeck “recommended incorporating some of the data assimilation techniques used in weather forecasting to build a skillful prediction system” remembers Dr. Shaman.

In weather forecasting real-time observational data are used to “nudge the model to conform with reality and reduce error in the model simulations,” he explains. Applying this method to flu forecasting, the researchers used near-real-time data from Google Flu Trends, which estimates outbreaks based on the number of flu-related search queries in a given region.

Going forward, Dr. Shaman will test the model in other localities across the country using up-to-date data. This is necessary, he says, since “there is no guarantee that just because the method works in New York it will work in Miami.”

Source : http://www.news-medical.net/news/20121127/New-system-can-predict-timing-and-severity-of-seasonal-influenza-outbreaks.aspx

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Philips Healthcare, UH to showcase latest medical technology at Cleveland Medical Mart

Philips Healthcare, UH to showcase latest medical technology at Cleveland Medical Mart

University Hospitals (UH) and Philips Healthcare are among a group of global leaders in healthcare to showcase the latest medical technology at the new Cleveland Medical Mart & Convention Center. The two organizations will collaborate to highlight innovative imaging technology in use and in development by Philips and other Ohio biomedical companies.

Scheduled to open in July 2013, the $465 million Cleveland Medical Mart & Convention Center is a one million-square-foot campus located in the heart of downtown Cleveland. The space occupied by UH and Philips will anchor the building’s third floor, which is dedicated to “clinical spaces.”

The showcase at the Cleveland Medical Mart is an outgrowth of the Philips Healthcare Global Advanced Imaging Innovation Center, a collaboration between Philips and UH, along with Case Western Reserve University, which brings together scientists and physicians to test and evaluate new imaging technologies. Through the $38.5 million Center, established in 2010, the latest Philips Healthcare imaging equipment is brought to UH Case Medical Center for development, validation of clinical efficacy and product release.

“The Medical Mart showcase will further establish Cleveland as an international hub for imaging technology by highlighting the latest equipment that we have co-developed with Philips right here in Northeast Ohio,” said Thomas F. Zenty III, CEO of University Hospitals. “The synergy between our organizations has created a pipeline to move innovative technologies more quickly into patient care.

We look forward to showcasing the important work that has come out of the Philips Healthcare Global Advanced Imaging Innovation Center to the Cleveland Medical Mart’s visitors, while enhancing the rich heritage and distinctive capability of Northeast Ohio healthcare.”

The Department of Radiology at UH Case Medical Center and Case Western Reserve University, led by Pablo Ros, MD, Professor and Chairman, is home to a number of the nation’s leaders in radiology who partner with Philips, which has one of its North American largest manufacturing headquarters in Cleveland. The announcement comes in conjunction with the Radiological Society of North America annual meeting in Chicago, where Philips will display some of the equipment that will be in the Cleveland Medical Mart showcase.

“We are very excited to join the Cleveland Medical Mart with our partners at the nationally renowned University Hospitals Case Medical Center,” said Dominic Smith, Vice President, Global Computed Tomography at Philips. “Our company aspires to assist clinicians by providing breakthrough imaging technologies that today are not yet possible. The Philips Healthcare Global Advanced Imaging Innovation Center has helped us realize these objectives and in the process, help improve the healthcare of patients in Ohio and throughout the world.”

The four-story Cleveland Medical Mart will serve health and health care innovation, education, and commerce through state-of-the-art spaces, programs, and virtual offerings while building on and enhancing the rich heritage and distinctive capability of Northeast Ohio healthcare. Visitors will come to see state-of-the-art medical technologies in use, without having to go into the care or research setting itself.

“Congratulations to both University Hospitals Case Medical Center and Philips Healthcare for being the first Medical Mart collaborative partnership between a commercial enterprise and a leading healthcare provider,” said Cuyahoga County Executive Ed FitzGerald. “This is yet another positive and visible step forward for the Cleveland Medical Mart project.”

source : http://www.news-medical.net/news/20121127/Philips-Healthcare-UH-to-showcase-latest-medical-technology-at-Cleveland-Medical-Mart.aspx

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Addition of tomosynthesis to standard mammogram increases breast screening accuracy

Addition of tomosynthesis to standard mammogram increases breast screening accuracy

The addition of three-dimensional breast imaging-a technology called tomosynthesis-to standard digital mammography significantly increases radiologists’ diagnostic accuracy while reducing false positive recall rates, according to the results of a multi-center study published in Radiology.

“This is the first major advance in breast imaging and breast cancer screening since the development of breast MRI,” said lead researcher Elizabeth A. Rafferty, M.D., director of Breast Imaging at the Avon Comprehensive Breast Center at Massachusetts General Hospital in Boston. “The beauty of tomosynthesis is that it addresses two major concerns with screening mammography: missed cancers and false positive rates.”

According to the National Cancer Institute, there is convincing evidence that screening mammography reduces breast cancer mortality in women between the ages of 40 and 74. However, as many as 30 percent of breast cancers are not detected by mammography and an additional eight to 10 percent of women who undergo a screening mammogram are recalled for further testing when no cancer is present (called a false positive result).

Unlike a screening digital mammogram, which involves two X-ray images of each breast, breast tomosynthesis captures multiple, low-dose images from different angles around the breast. The images are then used to produce a three-dimensional reconstruction of the breast. Both digital mammography and breast tomosynthesis, which was approved by the United States Food and Drug Administration (FDA) in February of 2011, can be performed on the same mammography equipment in rapid succession.

Dr. Rafferty’s study involved 1,192 women recruited from five sites, of whom 997, including 780 screening cases and 217 women who needed pre-biopsy breast imaging, had complete data sets. Each of the women underwent a standard digital mammogram followed by breast tomosynthesis. The total radiation dose for the combined procedure was less than 3 milligray, which is the FDA limit for a single mammogram.

Drawing from the eligible cases, the researchers then conducted two reader studies involving 312 and 310 cases, respectively. Twelve radiologists participated in the first reader study; 15 radiologists in the second. A total of 48 cancers were included in the first reader study; 51 cancers in the second.

Compared to digital mammography alone, the use of both standard mammogram and tomosynthesis resulted in increased diagnostic accuracy for all 27 radiologists. Additionally, the diagnostic sensitivity of the combined exam – or the rate at which cancer present in the breast was correctly identified – increased by 10.7 percent for radiologists in Reader Study 1 and 16 percent for radiologists in Reader Study 2.

“Almost all of the gains in diagnostic sensitivity with the combined modality were attributable to the improved detection and characterization of invasive cancers, which are the cancers we are most concerned about because of their potential to metastasize,” Dr. Rafferty said.

With the addition of breast tomosynthesis to standard digital mammography, false positive recall rates also significantly decreased for all 27 of the radiologists. Absolute recall rate reductions of 38.6 percent and 17.1 percent were seen in Reader Studies 1 and 2, respectively.

“In the clinical setting, we would expect that type of reduction in recall rate to translate into a substantial number of unnecessary diagnostic tests being avoided,” Dr. Rafferty said.

Source : http://www.news-medical.net/news/20121120/Addition-of-tomosynthesis-to-standard-mammogram-increases-breast-screening-accuracy.aspx

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CAMH psychiatrist receives Polanyi Prize for university research in Ontario

CAMH psychiatrist receives Polanyi Prize for university research in Ontario

The Centre for Addiction and Mental Health (CAMH) is extremely proud to announce that psychiatrist Dr. Aristotle Voineskos, Koerner New Scientist and head of CAMH’s Kimel Family Translational Imaging-Genetics Research Laboratory in the Campbell Family Mental Health Research Institute, has been named one of five winners of the prestigious Polanyi Prize for university research in Ontario. The Polanyi Prizes are awarded by the Ontario government in the same categories as the Nobel Prizes (Physics, Chemistry, Literature, Economics, and Physiology/Medicine).

Marking its 25th anniversary this year, the prize was established to honour the achievement of John Charles Polanyi, a 1986 Nobel Prize Laureate in chemistry.

Dr. Voineskos, an Assistant Professor in the Department of Psychiatry, Faculty of Medicine at the University of Toronto, has won for his groundbreaking research in the category of Physiology/Medicine.

Using a lifespan-based approach, Dr. Voineskos’ work combines brain imaging and genetics to improve current diagnostic classification and treatment strategies for people suffering from severe mental illness using innovative combinations of MRI brain imaging techniques and genetics. Populations currently under study include people with schizophrenia, bipolar disorder, Alzheimer’s disease, as well as healthy individuals to study healthy aging.

“The goal of the research is to improve the life of people with severe mental illness either by improving their symptoms or delaying or preventing onset illness,” said Dr. Voineskos. “Stigma and discrimination continue to challenge these patients. We need to make the link between these scientific discoveries and improved public policy.”

“This award recognizes the exceptional calibre of Dr. Voineskos’ research, and the important contribution his work is making to our understanding of how the brain functions and how it becomes vulnerable to severe mental illness,” said Benoit H. Mulsant, Physician-in-Chief at CAMH today. “His work and its potential impact offers inspiration to researchers and real hope to patients. We at CAMH couldn’t be prouder.”

Source : http://www.news-medical.net/news/20121120/CAMH-psychiatrist-receives-Polanyi-Prize-for-university-research-in-Ontario.aspx

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How a Lawyer Approaches the Problems of Physicians, Scientists, and Engineers: Exclusive with Attorney Anthony Wicht

How a Lawyer Approaches the Problems of Physicians, Scientists, and Engineers: Exclusive with Attorney Anthony Wicht

How a Lawyer Approaches the Problems of Physicians, Scientists, and Engineers: Exclusive with Attorney Anthony Wicht

Medgadget editor Dan Buckland is in training to become a physician while trying to remain an engineer. Here he talks about how his training in different thinking styles leads to different problem solving strategies.

In my last post, I mentioned that I thought that a lot of the miscommunications between Surgeons and Engineers were due to the differing ways that they approach problems. More than a personality difference, Physicians [1] and Engineers are trained with different philosophies of problem solving. Scientists are another group that is often mentioned in the same breath as Physicians and Engineers, and they are trained in a third, different way as well [2]. With this article I’ll explore these differences, and also discuss three example problems that characterize these three different ways of thinking. These three types of problem solvers (Scientist, Engineer, Physician) are meant as archetypes representing the training methods each field is known for. Of course, an individual would use a mix of these problem solving methods based on their knowledge and experience, but they may never have received formal training in methods other than the ones they are expert in. These simplistic descriptions are not meant to imply that all people in each of the described groups are only one way or that they are incapable of seeing things another way. (For more caveats please also see my footnotes at the end.)

divider How Physicians, Engineers, and Scientists Approach Problems Differently The 3 Types:

The Physician: MDs are trained in medical school to think about differentials and categories. A patient’s presenting signs and symptoms are processed, then historical information is used to determine the most common diagnosis associated with that data set. More complicated tests are given based on the most common and most dangerous diagnoses, and then treatment is often based on the outcomes of those tests. This is a categorical approach to problem solving. The MD tries to determine what category the patient belongs in, and then treatment is based on the assigned category. This is a very efficient system when a patient has a problem that has been encountered before and a pre-existing data-set that the patient can be matched too. Often, a complete picture isn’t even needed since this problem solving approach is based on probabilities. However, when the patient has something not seen before, this is a very inefficient way of treating the problem, as the MD moves to less and less common solutions. Programmers would call this searching a known set, which is often the fastest way to find a solution if the solution is in the set, but it is the slowest if the solution is not, as all possibilities have to be excluded before determining that the answer isn’t there.

The Scientist: In contrast to the MD, the Scientist is trained to look at a problem in the abstract and use testable hypotheses to isolate all the component parts of a problem and solve them (individually, if possible) in a logical way [3]. Breaking down the problem into its component parts can determine the independent root causes. Then, using those root causes, the Scientist can arrive at a solution to the overall problem. Solving problems in this way is more resource- and time-intensive than the Physician method, but if the right hypotheses are posed, this system can handle a broader range of problems and generate new data that are applicable to other problems. Programmers would call this a global search, which is often the least efficient way to find a solution, but the solution found would have a higher chance of being the optimal solution because it ideally takes into account the most information [4].

The Engineer: One way to think of the Engineer’s method is as a hybrid of the Scientist’s and Physician’s methods. The Scientist starts with a new set of hypotheses for each problem, and the Physician starts with a set of solutions that can be applied. The Engineer is trained to take a known solution and then use that as a starting point to hypothesize a solution that applies to the problem. Thus, the Engineer’s approach is also a combination of the advantages and disadvantages of the above methods. Like the Scientist, the Engineer tries to break down the problem, but doesn’t break it down all the way. Since the Engineer isn’t looking for a root cause, the problem is only simplified enough to get a solution that works with the least amount of change from the current paradigm. Going back to our programming analogy, this is a local search: again, a hybrid of the two above examples.

divider How Physicians, Engineers, and Scientists Approach Problems Differently

Three Approaches to Three Problems:

In this section, I will lay out a problem and describe how the three archetypes above would approach solving the problem. These are not random problems, each one is meant to show that none of the problem solving types is inherently better than the others, but that they are each better suited to different situations.

Patient A started coughing this morning, what should she do about it?

Physician: What are the top 5 reasons people cough? Has she been treated successfully for a cough in the past? For this patient’s age and medical history, which of those 5 causes are most likely? Would any test results change the treatment plan? Treatment will be based on what has historically worked best for the most likely diagnosis.

Scientist: What would cause this patient’s particular cough? What is the root cause of her lung or throat irritation? If it is infectious, what is causing the infection? If we find what is causing the infection, do we know how it is causing the cough or irritation?

Engineer: What is different now than when she wasn’t coughing? What was she doing this morning when the cough started? If she tries one treatment and gets a little better, then she should use more of it to get a greater effect.

In this case, the Physician probably has the fastest and most efficient route to diagnosis and treatment plan if there is a common cause for the cough. The Scientist’s method, when it eventually gets to a treatment, will have produced a lot of information, but it will take a longer time and be very resource intensive. However, if there is a uncommon cause for the cough, the Scientist method will be more likely to find it. The Engineer’s method could work as well, but doesn’t use the shortcuts of the Physician or the robust strategy of the Scientist.

Patients B,C, D, E, and F all have a form of slow growing cancer no one has seen before. They are all related, but the inheritance pattern is not one that has been observed in other cancers. What should be done?

Physician: Of all the cancer types known, which one is the closest to this one? How is that cancer treated? If that doesn’t work, what is the next closest match? How is that one treated?

Scientist: How does this cancer work? What is the cell type involved? What makes the cancerous versions of that cell type different than the non-cancerous versions? Is that difference something that can be detected in this patient? Can that information be used to determine how to kill just the rapidly growing version of that cell type and leave the rest alone?

Engineer: What makes this cancer different than the closest match that has been treated in the past? Can we use that difference to modify the treatment plan?

In this case the Scientist’s method is probably the best approach to take, since the problem itself has very little known about it. The Physician method will get to a treatment quicker, but is likely a shot in the dark and may cause more pain and discomfort with less overall benefit if the closest guess has a very different root cause. The Engineer method looks at these differences to try to get to a solution.

Patient G had her gallbladder removed by Dr. H. Dr. Hn performs the procedure laparoscopically, but the tools she uses don’t work the way she wants them to, and she feels that she spends too much time struggling with the equipment rather than doing the procedure. Other surgeons say they have the same problem too. What should be done?

Physician: What have other surgeons done to compensate for the unwieldy tools? Do any of those methods fix the problem of taking too much time struggling with equipment?

Scientist: How would we design a brand new laparoscopic system that doesn’t have those problems?

Engineer: What exactly does the surgeon like and dislike about the system. How could we modify the current system to keep the benefits and lose the difficulties?

For this issue the Engineer probably has the best approach. Rather than starting from scratch like the Scientist, or treating the problem as fixed like the Physician, the Engineer’s approach looks for the simplest novel solution using the current context. divider How Physicians, Engineers, and Scientists Approach Problems Differently

Conclusions:

A better understanding of the problem solving methods of others can go a long way in improving communication. A common response on Twitter to my last article was that a lot of communication problems could be solved by just putting everyone in the same room together. While that might work, anyone who has gone through MBTI training of some sort knows that is really just a new way to start conflict unless there exists an understanding that the other people in the room don’t think and respond the same way as you. The three archetypes detailed in this post don’t break down neatly within the MBTI categories, though some similarities exist. In a future post I will discuss other ideas for improving communication between these groups

While this simple breakdown leaves a lot to be detailed, hopefully it is a step in the right direction that allows people from different fields to work together more efficiently.

divider How Physicians, Engineers, and Scientists Approach Problems Differently

Footnotes:

[1] For the purposes of this post I am grouping Surgeons and Physicians into a single group. All MDs went through the same 4 years of medical school (at least in the US) and as different as the two groups see themselves, their training is more similar to each other than to the other two groups.

[2] If you were wondering, I don’t know where Management and Administrative types would fit on this spectrum. I suspect they would be a whole separate category when it comes to problem solving, based on my interactions with them. Unfortunately I don’t have enough experience with the training they go through to develop an informed description and I am similarly uninformed about Sales types.

[3] This is the same scientific method learned in middle school. Your teacher wasn’t wrong about how this stuff would be useful later in life.

[4] The reader may note that the author’s expertise is in the training of engineers and physicians, so where does he get his info about scientists? He is married to a very good one, and she helped him out with this part.

Medgadget editor Dan Buckland is in training to become a physician while trying to remain an engineer. Here he interviews a person cross-trained in Law and Engineering to get a broader perspective on how education in different thinking styles leads to different problem solving strategies.

In my previous articles about the problem solving skills of Physicians, Scientists, and Engineers I was not able to address some of the other professions that are clearly involved in the Med Tech industry, mostly due to my lack of knowledge and training in these other fields. Lawyers are involved in both successful and unsuccessful medical technology projects, with a lot of frustration arising from the lack of knowledge by non-Lawyers about the legal world. Even apart from the differing experiences of people involved I think some of this lack of understanding comes from the very different ways each group was trained to solve problems and even how each group formulates problems themselves. As you can see from the interview below with Anthony Wicht, Lawyers start from a very different place than the other professions we have discussed so far. Mr. Wicht is a former lawyer and engineer who now works on policy for the Australian Government. He holds degrees in Law and Civil Engineering from the University of New South Wales in Australia, and a Masters of Science in Aerospace engineering from MIT in the United States. Via email I asked Mr. Wicht about the cases from my problem solving article and his thoughts on the differences between Physicians’, Scientists’, Lawyers’ and Engineers’ approaches to problem solving. The previous caveats about discussing these diverse professions as homogeneous groups still apply.

1) Patient A started coughing this morning, what should she do about it?

Anthony Wicht How a Lawyer Approaches the Problems of Physicians, Scientists, and Engineers: Exclusive with Attorney Anthony WichtA lawyer would instantly think about responsibilities for action. As a start, a lawyer would recognize the danger of advising Patient A as to what she should do without being properly qualified to do so.

After a moment’s reflection, however, legal methods of thinking suggest possible courses of action. A lawyer is likely to look to rules as to how to behave in this situation. Are there workplace policies at Patient A’s workplace which guide whether she should or shouldn’t come into work? And how do the consequences of breaching these actions compare to Patient A’s preferences to go to work or stay home? Perhaps there is a precedent, by which lawyers mean known previous outcomes which suggest answers. If Patient A visited the physician last time she had a cough and was told “you did well to come and see me because as an asthmatic you are susceptible to complications”, then seeing a physician is indicated by precedent.

On a third layer, a legal analysis would look for desired outcomes. Does Patient A want to find a way to stay at home, in which case finding a friendly physician to excuse her from work becomes the priority? Or does Patient A want to work so she gets paid, perhaps in spite of company policy which says she should stay home, in which case finding a cough suppressant is more important.

2) Patients B,C, D, E, and F all have a form of slow growing cancer no one has seen before. They are all related, but the inheritance pattern is not one that has been observed in other cancers. What should be done?

A cynical analyst would suggest that a lawyer would look to allocate blame in this case. What is the cause of the cancer, and can someone be sued because of it? Perhaps a class action can be mounted on behalf of all of the patients. On the face of the matter this is an attractive way of thinking for the patients, because the financial windfall may cover the patients’ cost of treatment.

In truth, though, a good lawyer looks beyond the allocation of blame to a broader idea of ‘society’s rules’. Arrangements from health insurance to the writing of a will to the obligations of their employers are affected by their illness. In parallel with the treatment process, these aspects of the patients’ lives may make the difference between a recovery to a life very like the one they had previously, and a recovery beset by worries of debt and eventual poverty.

You will notice that the legal analysis does not touch the patient’s treatment, a matter of science. The lawyer knows that that is not their place. The lawyer immediately thinks of the social context of the patient’s illness, and about whether benefits, under the rules that govern the interaction between the person and society, have been triggered as a result of the illness.

3) Patient G had her gallbladder removed by Dr. H. Dr. H performs the procedure laparoscopically, but the tools she uses don’t work the way she wants them to, and she feels that she spends too much time struggling with the equipment rather than doing the procedure. Other surgeons say they have the same problem too. What should be done?

This problem can be approached from two angles. The obvious one is from the perspective of Dr. H and her colleagues, who want equipment which works better. What did the manufacturer promise to deliver? Under those agreed rules (‘contract’), can the manufacturer be made to improve the product? Or is Dr. H’s machine faulty (and her colleagues clumsy), in which case the manufacturer could be forced to replace it?

Assuming the manufacturer is not in breach of contract, lawyers can still help their clients. Many lawyers will try and facilitate mutually satisfactory agreements even when there is no compulsion for the parties to act by law. A win-win situation here might be to have Dr. H and her colleagues become a focus group for the manufacturer, trialling and critiquing new equipment so that it works better for them and so the manufacturer can sell more units.

The second angle is the perspective of Patient G. Did they get the standard of care they were reasonably entitled to? If not, was Dr H at fault for performing the procedure with tools she knew were below par? Or is the manufacturer at fault? Is the patient prepared to endure the stress of litigation for the potential payout of a successful lawsuit?

4) What is a stereotypical law school problem, and how do you solve it?

I was taught the answer to every law school problem on my first day in law school: ‘it depends’. My professor was very clear about that. And it applies to many real world law problems as well.

A law school problem is solved (in general) in the following way.

Identify (or agree on) the facts which give rise to the problem

Identify any legislation or previous judgments (‘case law’) which dealt with a similar fact situation

Apply the legislation or the case law to the facts in this case. Is it clear that the legislation applies, or is it arguable? Were there differences between the facts in the previous judgement which made the case law and the facts now?

Draw a conclusion, and say how strongly that conclusion can be supported. For example, it is likely that the defendant would be found guilty.

After law school the only difference is that the order in which the questions are answered usually starts with 4 (the preferred conclusion) and moves in reverse order thought the steps, searching for ways to support that conclusion.

Invariably, in law school, the application of the law to the facts is not straightforward – hence, it depends. The fact situations are usually a laughably improbable compilation of the facts underlying the key cases taught through the semester, with slight variations to make the application of the law to the facts not straightforward.

For example, if the semester had included a case about environmental pollution by a factory pumping chlorine into a creek, the fact situation may include a caveat where a factory thought they were pumping chlorine into a creek but in fact, due to a mistake by the construction company, were pumping water. Do the facts of the original case still apply? Why or why not?

This approach places a premium on really understanding the cases, rather than simply remembering them. In fact most law schools run open book or take-home exams to emphasize understanding over memorization.

5) As someone who is trained in both the JD and engineering way of thinking, what do individuals only trained in one way not know about the thinking process of the other? Are there any words/phrases/concepts that have differing meaning in both fields?

Law is fundamentally different to engineering, science and medicine in one important way. Law is completely a human construct. In engineering, science and medicine, as Richard Feynman famously said, “nature cannot be fooled” (1). Bridges fall down, chemicals react, and people become sick according to physical processes irrespective of human preferences, agreements or desires. In law, human perspective is everything. People make laws, interpret laws and enforce laws, and if there is total agreement to act contrary to a law, then the text of the law is irrelevant. Laws are different from state to state and country to country. Physics is invariant.

This difference means that lawyers put a premium on being convincing (as opposed to being right). The engineer, on the other hand, puts being right well ahead of being convincing (2). Is it any wonder then that both lawyers and engineers can’t believe the other “doesn’t understand the real world”. In a way, both are right.

Source : http://history.nasa.gov/rogersrep/v2appf.htm

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GW Hospital, The Wireless Foundation announce new initiative to improve cardiac care

GW Hospital, The Wireless Foundation announce new initiative to improve cardiac care

Today, the George Washington University Heart and Vascular Institute and The Wireless Foundation, in partnership with the D.C. Fire and Emergency Medical Services, announced their innovative public health initiative, which will improve cardiac care in the nation’s capital. Through this initiative, D.C.-area ambulances have been equipped with technology that enables rapid, wireless transmissions of EKGs to both the on-call physician’s wireless device and tertiary care hospitals, including The George Washington University Hospital, Howard University Hospital and Washington Hospital Center. This initiative will streamline patient care for those who have suspected acute myocardial infarction (heart attack) and reduce time from the time of reporting chest pains to treatment.

Every year, nearly 300,000 people are stricken with sudden cardiac arrest, with a survival rate of less than ten percent, according to American Heart Association. Additionally, almost every 34 seconds, someone in the United States has a myocardial infarction.

“Time is of the essence when patients experience a heart attack,” said Jonathan Reiner, MD, Professor of Medicine, George Washington University and Director, Cardiac Catheterization Laboratory, GW Hospital. “This technology will allow the medical team to make decisions early, in many cases before the patient even arrives at the hospital, and should significantly improve the outcomes of patients experiencing a heart attack in the District of Columbia.”

“Wireless technology plays an important role in improving the communications between a doctor and a patient, which is critical after a medical emergency such as a heart attack. That’s why we are pleased to provide a grant to this innovative initiative that will help doctors get as much information as quickly as possible so they can make the best decision for their patients,” said Steve Largent, President of The Wireless Foundation and President and CEO of CTIA-The Wireless Association®.

Source : http://www.news-medical.net/news/20121114/GW-Hospital-The-Wireless-Foundation-announce-new-initiative-to-improve-cardiac-care.aspx

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New 3-D digital mammography could improve accuracy of breast cancer screening

New 3-D digital mammography could improve accuracy of breast cancer screening

A new three-dimensional (3-D) digital mammography technique has the potential to significantly improve the accuracy of breast cancer screening, according to a study published in Radiology.

Two-dimensional (2-D) x-ray mammography, the current primary screening method for early detection of breast cancer in women, is a valuable tool but has some limitations. Surrounding normal tissue can mask lesions, and 2-D views do not provide direct information about the volumetric appearance-meaning the three-dimensional physical shape-of a detected lesion.

A novel technique called stereoscopic digital mammography (SDM) addresses these limitations by mimicking the way that human eyes work together to form a 3-D image. The technique uses digital mammography equipment that’s been modified to allow the X-ray tube to move separately from the cassette. The resulting images are viewed on two monitors mounted one above the other.

“Our eyes see the world from two slightly different perspectives,” said Carl J. D’Orsi, M.D., from the Department of Radiology and Imaging Sciences at Emory University School of Medicine and the Winship Cancer Institute at Emory University, both in Atlanta. “In this technique, the X-ray tube functions as the eyeball, with two different images providing slightly different views of the internal structure of the breast.”

By using a unique workstation and polarizing lenses, SDM has the ability to identify lesions at different depths within the breast volume, potentially reducing both false positive findings and recalls while enabling more accurate diagnosis.

Dr. D’Orsi and colleagues recently compared SDM to 2-D digital mammography in 779 patients at elevated risk of developing breast cancer because of personal or family history. Patients received both exams in a single visit, and two experienced radiologists independently interpreted the final total of 1,298 exams. Imaging findings were correlated with results of one-year follow up or biopsy.

SDM significantly improved the accuracy of cancer detection. The specificity of 91.2 percent was better than the 87.8 percent rate for 2-D digital mammography; and the accuracy of 90.9 percent, compared with 87.4 percent for 2-D digital mammography, was also a statistically significant improvement.

“We found that the stereoscopic technique could significantly decrease the need for calling women back for additional exams,” Dr. D’Orsi said.

Dr. D’Orsi and colleagues are expanding their research to study

SDM with a lower radiation dose in the general screening population. The radiation dose used in the study was approximately double the standard dose for mammography.

“In this study, we used a high-risk population to get an adequate number of cancers, and we acquired each of the images comprising the stereo pairs with a full standard X-ray dose,” he said. “Now that we know the technique is worthwhile, we’re repeating the study in the general population with a dose comparable to routine screening mammography.”

Source : http://www.news-medical.net/news/20121114/New-3-D-digital-mammography-could-improve-accuracy-of-breast-cancer-screening.aspx

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Atherotech VAP Lipid Panel demonstrates accuracy in personalized heart disease risk assessment

Atherotech VAP Lipid Panel demonstrates accuracy in personalized heart disease risk assessment

Researchers using the Atherotech VAP® Lipid Panel demonstrated the comprehensive lipid profile’s accuracy in risk stratification through subclass measurement in two abstracts presented today at the American Heart Association (AHA) Scientific Sessions 2012. The VAP Lipid Panel measured cholesterol subclasses in Framingham and TRIUMPH populations, highlighting the lipid panel’s accuracy and potential for improved outcomes in personalized heart disease risk assessment compared to the standard lipid panel, which is inadequate and inaccurate in select patients.

“These findings from TRIUMPH indicate that the more granular assessment of HDL subclasses adds important information beyond that provided by total HDL cholesterol levels alone”

The poster abstract #18939 Impact of LDL Pattern on Risk for CHD in the Framingham Offspring Population presented by study lead author Peter P. Toth, M.D., demonstrated that LDL pattern B (small, dense LDL particles) as measured by the VAP Lipid Panel is an independent risk factor for coronary heart disease (CHD), including acute myocardial infarction (AMI) — or heart attack — and sudden cardiac death.

“We know that traditional risk factors do not fully explain the risk for CHD events,” said Toth, Director of Preventative Cardiology at CGH Medical Center in Sterling, Illinois, and a member of Atherotech’s Medical Advisory Board.

“The results presented today are important because they suggest that LDL subclass measurement, when added to simple LDL concentration, conveys independent CHD risk assessment information leading to more accurate risk stratification and improved outcomes,” said Toth, who has authored or coauthored more than 200 publications and is also president of the National Lipid Association.

LDL can be separated into two phenotypes called pattern A and pattern B. The LDL pattern A subclasses LDL1,2 are composed of larger, more buoyant LDL particles. LDL pattern B subclasses LDL3,4 are composed of smaller, more dense LDL particles, which penetrate the vascular wall more easily.

A second abstract, #16722, HDL Cholesterol Subclasses and Mortality after Acute Myocardial Infarction: The TRIUMPH Prospective Multi-Center Registry, was the subject of an oral presentation by Seth S. Martin, M.D., Fellow, Division of Cardiology, Johns Hopkins Hospital. Using direct measurement of HDL cholesterol subfractions (HLD2 and HDL3) provided by the VAP Lipid Panel, the study showed a 50% relative increase in mortality risk among study participants at two years after hospitalization in the lowest tertile of HDL3 cholesterol versus the middle tertile after adjusting for relevant confounders in the fully adjusted model.

“These findings from TRIUMPH indicate that the more granular assessment of HDL subclasses adds important information beyond that provided by total HDL cholesterol levels alone,” said Martin. “After myocardial infarction, risk information captured in HDL2 and HDL3 cholesterol does not appear to be the same. Our findings speak to the complexity of HDL and help inform this rapidly evolving and intriguing HDL story.”

Study authors examined data from 2,465 patients from the TRIUMPH registry to determine the relative prognostic importance of HDL subclasses (larger, more buoyant HDL2 and smaller, more dense HDL3) after AMI. The Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients’ Health Status (TRIUMPH) study is a prospective, 24-center U.S. study of AMI outcomes.

VAP Lipid Panel Research highlights importance of LDL and HDL subclass identification in heart disease risk assessment and mortality.

“Both presentations add to our knowledge of residual risk and the impact that cholesterol subfractions can have on cardiovascular risk assessment and prognosis,” said Chief Medical Officer Michael E. Cobble, M.D. “These results will lead to more research that further clarifies the role of lipid subfraction measurement, beyond the capabilities of the basic lipid panel, leading to improved risk identification and management.”

source : http://www.news-medical.net/news/20121108/Atherotech-VAP-Lipid-Panel-demonstrates-accuracy-in-personalized-heart-disease-risk-assessment.aspx

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London School of Hygiene & Tropical Medicine creates International Diagnostics Centre

London School of Hygiene & Tropical Medicine creates International Diagnostics Centre

Today sees the launch of the International Diagnostics Centre (IDC), a global research collaboration hub, created at the London School of Hygiene & Tropical Medicine to undertake innovative research on the development and deployment of new diagnostic tests that enable patients to be diagnosed faster, more accurately and cost effectively.

Important recent advances in diagnostics, especially in point-of-care (POC) diagnostic tests

The first of its kind in Europe, the IDC will be a revolutionary focal point, forum and centre for learning, addressing the diagnostics priorities and challenges of today. With collaborators in more than 100 countries in Africa, Asia and South America, the centre is uniquely placed to facilitate and accelerate access to quality assured diagnostics in the developing world and improve patient care and to inform disease control strategies.

for malaria, HIV, syphilis and other infectious diseases can greatly improve the quality of clinical care for those without access to laboratory tests. The centre’s work will help countries meet Millennium Development Goals and ultimately save lives and strengthen health systems.

Pioneering work to assess the cost-effectiveness and utility of non-laboratory based rapid diagnostic tests (RDTs) for malaria.

A recent study with collaborators in Malawi on self-testing for HIV which established an important foundation for the introduction of self-testing in high HIV prevalent populations.

Recent research into new rapid diagnostic tests for syphilis which resulted in 100% of the study countries changing policy and recommending prenatal rapid test screening, saving thousands of lives.

Diagnostics are not prioritised in global health, as funding has been largely focused on the development and delivery of therapeutic interventions and vaccines. The lack of quality standards in the evaluation and regulation of diagnostics has also caused a proliferation of low-quality diagnostic tests to be sold and used without evidence of effectiveness, discouraging companies with good quality tests to compete in the same market.

The launch of the IDC brings together a critical mass of researchers committed to using multi-disciplinary and integrated approaches to address these challenges. By leading cutting-edge research and development of accessible quality-assured diagnostics, the centre will advocate for diagnostics in global health. It will play a pivotal role in ensuring this is the ‘Decade of Diagnostics’.

Rosanna Peeling, Professor and Chair of Diagnostics Research at the London School of Hygiene & Tropical Medicine, said: “A new generation of diagnostic tests could save millions of people from deadly diseases like AIDS and TB in the next few years. I am delighted to launch the International Diagnostics Centre today to give a new impetus to our work and create a critical mass of expertise to address inequity of access to diagnostics, guide evidence based management of patients and strengthen health systems.”

source : http://www.news-medical.net/news/20121108/London-School-of-Hygiene-Tropical-Medicine-creates-International-Diagnostics-Centre.aspx

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