Friday, July 27, 2012

Emergency apps might improve our chances … if we used them

Emergency apps will help hospital staff to better care for you if you're among the 27,000 people who crash their cars tomorrow (or on any given day). Digital safeguards promise to make a difference for the one million Americans admitted to hospitals unconscious each year, but most of us put off emergency preparedness, digital or otherwise. I’m doing it now.

The above numbers come from an app company called Emergency Link, which also reports that 89 percent of Americans have not stored emergency information in their wallets or mobile phones, even though they know they should. Walt Mossberg, the personal technology guru at the Wall Street Journal, recently made the video below on Emergency Link's combination smartphone app, website and phone service. Walt likes how it combines "physical and digital safeguards."

To use the app, you enter your drug allergies, conditions, insurance policy numbers, etc., along with your emergency contact information. First responders can then find your account number on your phone's screen saver, or on tags sent by the company for your wallet, luggage and key rings. Operators are standing by 24/7 to provide your information to EMTs or nurses once the company confirms that the call is legit.

We ran Emergency Link by UAB's Henry Wang, M.D., vice chair for research within the UAB School of Medicine's Department of Emergency Medicine.


Q. What do you think of Emergency Link?

A. The app is interesting, but I favor old-fashioned technology such as Road-ID, which is popular among cyclists and athletes. It's a Velcro band with limited identification information. Medical personnel call its 800 number to get more information if you're unconscious, and it doesn't require batteries or a cell phone signal. It also still works if you drop it in the toilet.

Q. Have you ever seen an emergency app speed a patient's care in the emergency room?
A. A close friend of mine ended up critically ill in the trauma unit at UAB. The ED nurses that cared for him said the Road-ID was "extremely helpful."

Q. Are there other examples of social and mobile technologies that are changing emergency medicine for the better?
A. Real CPR lets users get feedback when performing CPR. The iPhone has the same accelerometer used by paramedics to measure CPR chest compressions, enabling regular citizens to perform proper CPR.

Fire Department sends an alert to your iPhone if there is a cardiac arrest in progress nearby. The hope is that bystanders might call them in and be able to help at the scene. Locally, people can use UAB's Mobile App to get help or B-Alert to learn about campus emergencies.

If you need to go to the ER but fear the length of "the lunch line," InQuicker can help you figure out which ER's have the shortest waits, says Wang.

Along the same lines, check out this recent Mashable story on new emergency apps.  

Whether they use new tech or old (paper), Wang encourages everyone to get their medical information into their wallets and phones.

Monday, July 23, 2012

HIV infection follows poverty south

HIV research and AIDS treatment in the United States are the focus of a recently published feature article in the journal Science. The article was timed to set the stage for the first U.S.-hosted International AIDS Conference in 22 years, which started yesterday in Washington, D.C. The meeting’s organizers had shunned the U.S. for decades due to a ban on the immigration of HIV-infected people imposed by Congress in 1987 – a ban that President Obama ended in 2010.

The AIDS epidemic has shifted over 31 years from a disease of white, economically secure gay men on the coasts to one of poor African Americans – gay and straight – in the South, home to 43 percent of the country’s HIV-infected people, according to the article.

Michael S. Saag, M.D., is director of the UAB Center for AIDS Research. Before flying to the AIDS conference, Saag sat down with us for the very first podcast from The Mix, the new UAB research blog. Saag helped to found the 1917 Clinic at UAB – a comprehensive HIV clinic serving Birmingham, Ala., and one of 10 efforts nationally highlighted in the Science feature.

Show notes from the interview

1:38 HIV infection risk has now been proven to depend less on the stereotypical notions of the past – multiple partners, lack of condom use, prison time, etc. 

1:51 Poverty is the single, overwhelming driver of HIV infection risk in African Americans, explaining why the epidemic is hitting so hard in the South.  

2:18 Many more people who are poor contract HIV due to lack of access to healthcare and the close ties between poverty and drug addiction. With more infected people living in poor communities, the risk of passing it to fellow community members is higher. Those living in poverty are also more likely to be focused on day-to-day survival, which drives risky behavior.

3:32 AIDS symptoms may be ignored or hidden more in the African American community due to cultural differences with respect to tolerance of homosexuality, says Saag. Being gay is taboo in both African American and white communities, but is especially so among African Americans, and even more so among African American churchgoers. This means that gay men often hide their orientation, living publically in heterosexual relationships while secretly having gay sex, which further spreads the disease.

5:09 HIV funding from the CDC shifted in 2012, with $40 million of its $338 million budget meant to have greater impact in harder-hit locales, according to the Science article. Medications are now available that have turned HIV into a chronic disease, enabling people to live for decades. The problem is that many poor people do not know they are infected, have little access to care or ability to maintain treatment regimens.  

5:58 Infected patients who don’t know they are infected represent 25 to 40 percent of those infected in the United States, says Saag. Public education campaigns in hard hit communities are needed to get more people tested, as are special programs that link newly diagnosed patients to treatment programs. 

7:15 UAB’s 1917 Clinic has conducted more than 300 clinical trials since its founding in 1988, and have made every major AIDS drug, and later the most powerful drug cocktails, available to poor communities. 

7:36 Testing, diagnosing and getting more patients into permanent care will be the focus of the HIV medical establishment over the next 10 years, rather than drug development, although that will continue. Excellent drugs are available. The challenge is to get people to know they need them and to keep taking them. 

8:41 The International AIDS Conference has returned to U.S. soil for first time in 22 years, which is important because the U.S. has been a major contributor to AIDS research and should participate fully in global discussions on how to improve care.

10:12 AIDS research themes that will gain the most attention at the conference should include how testing can drive people into care, how effective treatment can prevent transmission, pathways to a future cure and policy discussions about how countries afford and make accessible mass treatment, says Saag.

11:37 Treatment as prevention is a hot topic with the recent FDA approval of Truvada, shown to lower the risk of infection when given to people at high risk but not yet infected. The advent of preventive treatment creates many policy questions that will be discussed, including the potential for the use of vaccines.  

12:22 Resources for getting more information about AIDS and HIV include the CDC HIV/AIDS home page, and for researchers, the National AIDS Treatment Advocacy Project, which offers excellent coverage of meetings and abstracts, Saag says.

13:37 Support for the 1917 Clinic can take the form of volunteering and community outreach, or donations to the 1917 Clinic Development Fund, which helps program development (testing, linkage-to-care initiatives), and the 1917 Clinic Patient Assistance Fund, which helps people gain access to treatment during gaps in coverage. 

14:35 End

About the Podcaster

Greg Williams @gregscience @themixuab is research editor within Media Relations at the University of Alabama at Birmingham.  

Friday, July 20, 2012

Cancer diagnosis meets Angry Birds

Cancer diagnosis is a far cry from Angry Birds, but I found out recently that they have a few things in common. Both the online shooting gallery and a new pathology imaging tool out of UAB are web apps that analyze digital images: one to entertain; the other to see how fast cancer cells are growing.

This snapshot is the result of using an ImageJS module to determine how fast cancer cells are growing. The dark blots are the nuclei of cells dividing as part of the high-speed, abnormal growth seen in tumors.
Bioinformatics experts here this week published the code for a free Web application, called ImageJS. It lets pathologists analyze digitized pathology slides for malignancy based on how cancer cells change color when exposed to standard dyes. More exciting in some ways are future ImageJS modules that promise to deliver genomics analysis and to let doctors compare their patient’s data to similar cases stored in national databases in real time while keeping it private.

Why should we care?  Such future comparisons will make your diagnoses more accurate and rule out treatments that won’t work with your genetic signature, sparing you misery.

Most importantly, the system should realize the promise of Big Data, Web 3.0, cloud computing, the one world computer and the semantic Web. What?  

Many laymen, including me, and some researchers, have little idea about what those things are or what they will mean for healthcare and research in the coming years. Our bioinformatics guy, Dr. Jonas Almeida, tried to help me prepare to write my article on his new system by suggesting I read The Big Switch by Nicolas Carr.

The book adroitly explained the above tech jargon, but my understanding remains basic and my attempts to clearly summarize Dr. Almeida’s work imperfect. Maybe we should have broken the story into a series to make its complexity more digestible, or done separate versions for programmers, cancer docs and patients. Still, we did our best and look forward to your thoughts. 

By the way, cloud computing is much in the news, but coverage is more likely to focus on gaming than medicine. We had hoped that the tech pundits might use our publication as excuse to cover open coding or the cloud in medicine, but the ImageJS system is only a research prototype.

Neither should we argue too forcibly for the immediate importance of this work because bioinformatics as a whole is still in its relative infancy, with plenty of potential for overstatement. Dr. Almeida is the first to argue that ImageJS will only become significant if it becomes popular with pathologists and biostatisticians nationwide.  

As consumers, we can choose from free Web applications by the hundreds, most of them games. Here’s hoping our doctors will soon have access to such cheap and powerful technologies as they care for us.  At least Dr. Almeida has made a start. Just like Angry Birds or Instagram, the ImageJs modules are available at the Google Chrome App store.

PS: Under the broader heading of medical research and social computing, check out this article on 23andMe  in the Nature blog Spoonful of Medicine

Friday, July 13, 2012

Nanoscience hits home

Nanoscience became real for me when I learned that sooner or later I will need to replace my hips. Hip replacement in my case will be the cost of too much football, jogging and heavy labor as a youth. When I do switch them out, I will join more than 300,000 Americans that year.

So I now pay close attention to the technologies surrounding artificial hips. My colleague Bob Shepard, for instance, wrote a story the other day about how advances in materials like polyethylene have made hip replacement available to younger patients. UAB Surgeon Herrick Siegel, M.D., in the UAB Division of Orthopaedic Surgery, says the harder, smoother surfaces of the new joints last longer and have coatings that coax bone to grow around them. Together these technologies may soon make fake hips strong enough to last the rest of a 40-something’s life, with less likelihood of a replacement surgery. 

Along the same lines, we wrote a few months ago about how a researcher here is designing a new coating for artificial hips made of nanodiamonds. Yogesh Vohra, Ph.D., director of the UAB Center for Nanoscale Materials and Biointegration, found that nanodiamond coatings promise to further toughen artificial joints and prevent the inflammation caused when metal or composite joints, older technologies, shed debris into the body. The constant grinding force within joints causes even nanodiamond-coated hips to shed some particles. 

Vohra’s early study suggested that the size and concentration of debris shed by diamond-coated hips should cause neither inflammation nor toxicity. With applications emerging daily for nanoparticles in bio-imaging and drug delivery, we need to know if it’s safe for such debris to build up in organs (on purpose in the case of drug delivery).   

In a related example, I saw a story featured in a Discovery Magazine blog 80 beats that described how researchers at MIT and Harvard engineered nanoparticles that shrink to less than a third of their original size when exposed to ultraviolet light. In the darkness, they open back up to their larger size.  The idea is to put them in cancer cells when they are small, turn off the lights, and let them expand to kill the cancer.

Our Veena Antony, M.D., professor in the UAB Division of Pulmonary, Allergy and Critical Care Medicine, said the work reflects the trend in nanoscience toward creating particles that can be turned on when needed, and guided to reach formerly unreachable parts of the body to deliver therapeutic payloads. Some nanoparticles can be activated and moved around the body with a magnet.  Others are heat sensitive, and turn on at a set temperature.  And now, we have UV light control.

Antony and colleagues are using nanoparticles to combat mesothelioma, the cancer that is caused by asbestos exposure.  They hope to use fluorescent particles to both identify a cellular feature only present in cancer cells, and if they succeed, to diagnose and treat this cancer in one sitting.  Specifically, they discovered a biomarker for the cancer (the Ephrin receptor A2) that is not expressed on the normal cells and can target it with fluorescent particles that contain a piece of genetic material, a silencing RNA that kills the cancer cells.

For more information, a good source is the National Science Foundation’s nanoscience page

Tuesday, July 10, 2012

Experts in aging value healthspan over lifespan

Aging research made headlines when the Wall Street Journal’s Matt Ridley —@mattwridley — recently wrote about how humans may be approaching their maximum lifespan. While the number of centenarians is rising by 7 percent each year thanks to modern medicine and healthier lifestyles, the number living past 115 is not.

We asked Richard Allman, M.D., director of Center for Aging here at UAB, for this thoughts on lifespan research.

Q. Is lifespan research important?

A. If we can understand the causes of variations in life-span, we may be able to identify new ways to delay it, or to treat age-related diseases like Alzheimer's disease, atherosclerosis, cancer or diabetes. Cellular pathways associated with variations in aging rate promise to reveal disease mechanisms.

Q. Does the fact that people are living longer thanks to healthier lifestyles make them more likely to hit a genetic expiration date?

A. The evidence suggests that healthier life-styles are prolonging lives and reducing disability, but increasing obesity may reverse those trends.

Q. Will humans ever live to 150?

A. Most gerontologists agree that the maximum human lifespan is 120 years. Perhaps with scientific advances, we could see life-span increase, but should we if we cannot also prevent age-related disease and functional decline? This raises important bioethical issues. Most gerontology researchers would rather extend "healthspan" — the length of life during which an individual is healthy and functional.

Q. Taking Alabama and Birmingham as examples, how many seniors reside there?

A. According to the 2010 Census, we have 657,792 persons age 65 and older in Alabama. Of these 75,684 are age 85 or older. In 2000, there were 897 persons aged 100 or greater in Alabama. Thus, there are probably around 225 persons aged 100 or greater in the Birmingham Metro Area.

For fun, check out the Living to 100 Life Expectancy Calculator.

Tuesday, July 3, 2012

For 18 million cancer survivors, better survival

For those of us who have lost family to cancer, survivorship seems like a good problem to have. Still, survivors face tremendous challenges, being at greater risk for a second cancer, cardiovascular disease and diabetes.

According to a recent report by the American Cancer Society, the ranks of cancer survivors will grow to 18 million by 2022. One reason for increased survival is that more Americans are getting screened, which is catching their cancers early enough to do something about them, says Wendy Demark-Wahnefried, Ph.D., professor in the UAB Department of Nutrition Sciences and associate director of the Cancer Prevention and Control program at the UAB Comprehensive Cancer Center.

She is one of several researchers at the cancer center currently conducting studies aimed at improving survivor health or quality of life.

Surprisingly, among the greatest risks to survivors is poor nutrition and weight gain. Demark-Wahnefried’s work explores the cancer-obesity link and focuses on lifestyle modification, recommending that survivors exercise 150 minutes per week and eat mostly plants.

She recently helped the UAB Cancer Care Network win a $15 million Center for Medicare and Medicaid Innovation grant to create the Deep South Cancer Navigation Network. Economic, educational and social disparities faced by many Deep South communities have created an urgent need for patient navigation.

The grant will further counsel survivors on nutrition and treatment choices, providing overall better health care, and serves as a model for hospitals nationwide seeking to reduce cancer care costs in an ever-growing population..

For more information, call the ACS National Cancer Information Center, 1-800-227-2345 or read their new guidelines.