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America’s health care system: Emory experts weigh in

It’s broken, and it needs fixing. That much everyone can agree on when it comes to U.S. health care. Much of the conversation about health reform centers on cost, but access and quality of care are key factors, too.

Emory University experts are adding their voices to the health reform debate. Here are some of their thoughts and suggestions for fixing America’s health care system.

Modernizing Medicare

Adam Atherly, PhD, health policy professor at Emory’s Rollins School of Public Health (RSPH), says eliminating Medicare Parts A and B would make the federal program more user friendly. “It makes sense to do a good job of running the programs we already have,” says Atherly.

Medicaid promises

Kathleen Adams, PhD, RSPH health economist, says Medicaid is fragmented and should be uniformed for all states. “State Medicaid programs are our labs for health care reform,” says Adams. “Unfortunately, that is adding to the fragmentation in health care. What we really have is not one but 50 Medicaid programs.”

Universal consequences

The President, Congress, and leaders in the public and private sector need to figure out how to achieve health insurance coverage for everyone,” urges Art Kellermann, MD, MPH, Emory School of Medicine health policy dean and professor of emergency medicine. “Uninsurance has consequences for everyone,” says Kellermann. “Communities struggle to recruit and retain doctors. Specialists are reluctant to take ER and trauma calls because of payment issues, and hospitals are less likely to offer vital but unprofitable services.”

Primary care pulpit

As director of the Emory Center on Health Outcomes and Quality at the RSPH, Kimberly Rask, PhD, wants to go beyond the debate on health care costs. “In the long run, achieving cost savings depends on how we organize our health care,” she says. “We need programs that provide the right care at the right time for the right condition.”

Controlling chronic conditions

Kenneth Thorpe, PhD, chair of the RSPH department of health policy and management, reports that 75 percent of national health spending is for chronic conditions such as diabetes and hypertension. Rising rates of obesity account for 20 percent to 25 percent of the overall rise in spending. And right now, less than 1 percent of national health spending is directed to avoiding health problems rather than preventing them. Thorpe says prevention could significantly lower overall health care costs.

Arguing for basics

William Bornstein, MD, chief quality officer for Emory Healthcare, says medical innovation and discovery has shifted focus from health care fundamentals. “We have focused on the rocket science instead and have left out the basic blocking and tackling,” says Bornstein. “If we just gave regular immunizations, we’d have had more impact on saving lives than we’ve had with some groundbreaking discoveries.”

Read more Emory experts’ health care reform analysis in the new issue of Emory Health magazine.

Please note that, unless stated otherwise, the opinions of these experts do not necessarily reflect official Emory health care reform policy positions.

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Cancer survivors may have psychological distress

Long-term survivors of cancer that developed in adulthood are at increased risk of experiencing serious psychological distress, according to a report in the July 27 issue of Archives of Internal Medicine.

The estimated 12 million cancer survivors in the United States represent approximately 4 percent of the population.

Commenting on this week’s study, Michael Burke, MD, clinical director of psychiatric oncology at Emory Winship Cancer Institute, says only recently has the emotional wellbeing of cancer patients been given serious consideration by physicians and patients. Yet, easing the disease’s emotional burden on patients and families may improve patients’ treatment and prognosis.

Michael Burke, MD

Michael Burke, MD

Burke has conducted studies focused on the effects of the disease’s emotional burden on patients and families and whether easing that burden can improve patients’ treatment and coping skills. Burke and his colleagues offer a collaborative approach toward therapies for the emotional, psychological, and physical symptoms associated with cancer and its treatment.

A history of cancer may affect current mental health in several ways, says the Archives study author and Brigham and Women’s Hospital and Dana-Farber Cancer Institute researcher. The researcher reports that cancer diagnosis and treatment can produce delayed detrimental effects on physical health and functioning such as secondary cancers, cardiac dysfunction, lung dysfunction, infertility, neurological complications and neurocognitive dysfunction. A cancer history, they continue, can also affect social adaptation, employment opportunities and insurance coverage. Adjusting to these functional and life limitations may create long-term psychological stress.

Emory’s Burke says to help patients cope with a diagnosis of cancer, he and his colleagues evaluate patients’ medical and personal history, environment and health behaviors, such as whether they’re getting enough exercise or increasingly using alcohol and tobacco.

Listen to Burke’s own words on Sound Science about how he helps patients cope with the emotional aspects of cancer.

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Lampreys’ alternative immune system

Lampreys are primitive creatures – basically, tubes with teeth. Their primitive nature makes them a fascinating entry-point for studying the evolution of the immune system.

At Emory, Max Cooper and his colleagues have been studying lampreys’ versions of white blood cells. In a recent Nature paper, they show that lampreys have two kinds of cells that look very much like B and T cells in mammals, birds and fish.

Non-immunologists may shrug at this revelation.  But consider: lampreys have a completely different set of tools for fighting infections. They have proteins in their blood that glob on to invaders, but they don’t look anything like the antibodies found in mammals, birds and fish.

Lampreys in a laboratory tank

Lampreys in a laboratory tank. Courtesy of Masa Hirano.

Similarly, lampreys have cells that look like T Ray Ban outlet cells, in terms of some of the genes that are turned on. However, they don’t have MHC genes, which are important in human transplant medicine because they determine how and when T cells get excited and reject transplanted organs.

Lampreys are thought to be an early offshoot on the evolutionary tree, before sharks and fish, and way before critters that crawl on land. This suggests that the categories (B or T) came first even though the characteristic features of the cells (antibodies/responding to MHC) are different.

“Lampreys have the same types of cells, but they just use different building blocks to put them together,” Cooper says.

Cooper, now a Georgia Research Alliance Eminent Scholar and a member of Emory’s pathology department, made pioneering studies defining the role the thymus plays in immune development at the University of Minnesota in the 1960s. The thymus is where T cells develop and where they get their name.

He says he is now collaborating with Thomas Boehm in Freiburg, Germany to better understand the evolution of the thymus. Again, lampreys don’t have a thymus, but they may have an area next to their gills where the T-like cells develop.

John Travis at Science has a more extensive discussion of this research.

In a Darwin-anniversary essay, Travis tells the story of how the evolution of the immune system was a centerpiece of the 2005 Kitzmiller v. Dover trial, when a Pennsylviania school district’s requirement to teach intelligent design was successfully challenged.

Link to Sound Science podcast with Cooper

Posted on by Quinn Eastman in Immunology Leave a comment

Heart bypass surgery via a small incision

It can be daunting for a patient to hear a heart specialist say bypass surgery is needed. An image comes to mind of traditional open-heart surgery and what this would entail.

A groundbreaking advance pioneered by Emory Heart & Vascular Center doctors now means some patients can have coronary artery bypass surgery without opening up the chest cavity and without stopping the heart.

Called “Endo-ACAB,” this endoscopic surgery is the done via a small incision. In addition, the heart team can combine the Endo-ACAB with angioplasty and Ray Ban outlet stents, thus correcting all blockages a patient has while keeping the chest intact.

Most patients are able to leave the hospital within 48 hours and return to full activity, including work, in two to three weeks, versus the two to three months needed for recovery after traditional surgery. Learn more about the procedure from Thomas Vassiliades, MD, in the video below.

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Prevention counts in health care reform

As Congress and President Obama’s administration work to hammer out the details of health care reform, Emory health policy expert Kenneth E. Thorpe, PhD, says prevention and quality care for chronic diseases are an integral part of reshaping America’s health care system.

Kenneth E. Thorpe, PhD

Kenneth E. Thorpe, PhD

Nearly half of people in the United States suffer from a chronic condition. More than two-thirds of all deaths are caused by one or more of five chronic diseases: heart disease, cancer, stroke, chronic obstructive pulmonary disease (COPD) and diabetes.

Thorpe says transforming the U.S. health care system to better meet the needs of people with chronic disease will require a renewed focus on preventing disease when Ray Ban outlet possible, identifying it early when it occurs, and implementing evidence-based prevention strategies that slow disease progression and the onset of activity limitations, as well as save money for the patient and the health care system.

By preventing costly diseases or better managing them, Thorpe says we can help contain our out-of-control health spending and boost productivity. In our troubled economy, we need to do both.

Read more about Thorpe at Rollins School of Public Health, Institute for Advanced Policy Solutions/Center for Entitlement Reform, and the Partnership to Fight Chronic Disease.

Thorpe’s views can be found by visiting AJC.com, Big Think and The Huffington Post.

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Band posts salivary gland cancer news on web

In the news this week are reports that a member of the Beastie Boys hip-hop band announced on YouTube that he has salivary gland cancer – specifically of the parotid gland.

Dong Shin, MD, examines a patient at Emory

Dong Shin, MD, examines a patient at Emory

The public does not hear much about this type of cancer, and according to the American Cancer Society salivary gland cancers account for less than 1 percent of all cancers in the United States. About two out of three salivary gland cancers are found in people who are 55 or older. The average age at the time this cancer is found is 64.

The salivary gland is important because it Ray Ban outlet produces saliva, which contains enzymes that begin the process of breaking down food. It also contains substances to help prevent infections of the mouth and throat.

According to Emory Winship Cancer Institute expert Dong Shin, MD, the parotid glands are found in front of and just below each ear and most major salivary gland tumors begin in these glands.

Shin says that salivary gland tumors exhibit two major growth patterns: low grade, which is slow growing and more easily treatable, and high grade, which is usually a faster growing, more aggressive cancer that can also invade the lymph nodes. Certain types of salivary gland tumors can recur or have distant metastasis, particularly to the lungs.

Although the causes of this cancer are not definitively identified, Shin notes, there are some risk factors, including a history of radiation therapy to the head and neck area and a history being exposed to certain chemical substances, most often in the workplace.

Treatment usually includes surgery with radiation therapy afterward. Certain aggressive cell types require chemotherapy as well as radiation. However, explains Shin, at this time there are no specific chemotherapy agents that work well in attacking salivary gland tumors. Recent http://www.gafasraybanoutletes.com/ clinical trials have shown evidence of a fair response to certain molecular targeted chemotherapy, but more research is needed on these targeted therapies. wxjy6rbm4s

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Healthy lifestyle can lower blood pressure

A new study says that maintaining normal weight, daily vigorous exercise, eating a diet high in fruits, vegetables, low-fat dairy products and low in sodium, and taking a folic acid supplement is linked with lowering hypertension in women.

A healthy lifestyle helps your heart

A healthy lifestyle helps your heart

Reporting in the July 22/29 issue of the Journal of the American Medical Association, scientists say that hypertension, or high blood pressure, contributes to more excess deaths in women than any other preventable factor. The researchers looked at the link between combinations of low-risk lifestyle factors and the risk of developing hypertension.

Allen Dollar, MD, preventive cardiologist with Emory Heart & Vascular Center, says the study by Harvard Medical School researchers points to the real benefit to women of deploying a healthy lifestyle to prevent hypertension or to control hypertension.

Essentially, this new report helps to confirm what preventive cardiologists share with women everyday, says Dollar, that they can help prevent or manage hypertension through a healthy approach to diet and exercise.

Generally, blood pressure above 140/90 is considered to be high for adults. Although hypertension can produce symptoms including fatigue, confusion, nausea, vision http://www.agfluide.com problems and excessive sweating, Dollar points out that the majority of women with mild to moderate hypertension have no symptoms that indicate their blood pressure is too high.

A blood pressure reading can reveal hypertension in the early stages when a strategy of diet changes, exercise and weight control and medication, if needed, can help prevent a host of high blood pressure related ills including heart attacks, heart failure, kidney disease and stroke, says Dollar. If a woman does not know her blood pressure, she needs to find out. If a woman learns she has high blood pressure, she can use this news as an opportunity to take control of her health.

Learn more medical advances at Emory.

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New ways to pinpoint heart failure risk

Javed Butler, MD, MPH

Javed Butler, MD, MPH

An aging U.S. population, an increase in the prevalence of obesity and improved cardiovascular therapies for acute problems are boosting the number of people living with the condition of heart failure.

Javed Butler, MD, MPH, director of heart failure research at Emory Healthcare and associate professor of medicine at Emory University School of Medicine, is looking for new ways to prevent and treat heart failure.

According to Butler, heart failure is any condition in which the heart is unable to pump enough blood for the metabolic needs of the body, but that does not mean that the heart is not cheap oakleys pumping or the heart has stopped working. Heart failure is not a disease but a syndrome, so there’s a whole family of different diseases that can precede this condition. These are known collectively as heart failure.

In the clinic, Butler treats patients already diagnosed with heart failure. His research focuses on prevention through life style changes as well as models pinpointing who is at risk for heart failure.

Butler and his colleagues recently created the Health ABC Heart Failure Model for predicting risk of new onset heart failure in the elderly. That model has now been strengthened by validating it via a library of patient data from an earlier cardiovascular study. The results suggest the Health ABC risk model can be used to identify high-risk individuals for whom interventions can be cost-effectively targeted to prevent heart failure.

To hear Butler’s own discussion about heart failure, access the podcast from Emory’s Sound Science series.

Posted on by Holly Korschun in Heart Leave a comment

Health care reform: Wise allocation of resources key

Emory’s Chief Quality Officer William Bornstein, MD, PhD, says there are many issues that need to be tackled in order to achieve meaningful health care reform. He points out that one of the most fundamental questions that must be addressed is who decides about a treatment or diagnostic test that may be a little bit better than an alternative option but is much more expensive? If the patient has no “skin in the game,” he will almost certainly want the better/more expensive option.

William Bornstein, MD, PhD

William Bornstein, MD, PhD

The doctor has taken an oath to act in the best interests of the patient and this obligation takes precedence over any charge that society would like to impose to cast the Ray Ban Baratas physician in a fiduciary role for the national healthcare budget, says Bornstein, who also serves as chief medical officer for Emory Hospitals. And, the payer’s role is obviously conflicted, he says. If the patient does have skin in the that decision, Bornstein asks, are we prepared as a society to explicitly endorse the notion that “better” care that exceeds a certain cost threshold will only be available to those who can afford the additional cost?

There has been much talk about better care and preventative care being less expensive, but there are little data that support this as being a universal truth. Health care information ray ban outlet technology will also not solve this problem, he says. At some point in the near future, we need to have a national conversation about this challenge. In the past attempts to have such conversations have raised the specter of “rationing,” However, the time has come to confront the truth that our resources are finite and we need to allocate them wisely.

Bornstein is a recognized leader in quality, safety and the use of information technology in improving healthcare delivery. He has serves on national committees and advisory bodies in these areas including the University HealthSystem Consortium Clinical Evaluative Sciences Council Steering Committee, which he now chairs. He serves on the Professional and Technical Advisory Committee for the hospital accreditation process of The Joint Commission as vice-chair, and on the Information Architecture Steering Committee of the University HealthSystem Consortium staff leadership group of the Institute of Medicine Roundtable on Evidence Based Medicine.

Listen to podcasts with Bornstein on quality.

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Michael J. Fox Foundation supports Emory research

The Michael J. Fox Foundation for Parkinson’s Research just announced plans to fund Emory pharmacology researcher Zixu Mao in his work to validate therapeutic targets for Parkinson’s disease (PD).

Zixu Mao, PhD

Zixu Mao, PhD

The two-year, $250,000 grant will fund research in Mao’s lab in the departments of neurology and pharmacology. He and his team hope to verify whether a particular protein – MEF2D – may be a good drug target in models of PD. If it is, his efforts will provide the basis for further research to identify ways to manipulate the activity of this protein as a way to treat PD.

Mao says this type of study is very important Maglie Calcio to allow the transition from findings made by basic research to more clinically relevant discoveries and is generally difficult to get funded by other major funding sources.

The Michael J. Fox Foundation is dedicated to finding a cure for Parkinson’s disease through an aggressively funded research agenda and to ensuring the development of improved therapies for those living with Parkinson’s today. Learn more about Mao’s research.

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