Warren symposium follows legacy of geneticist giant

If we want to understand how the brain creates memories, and how genetic disorders distort the brain’s machinery, then the fragile X gene is an ideal place to start. That’s why the Stephen T. Warren Memorial Symposium, taking place November 28-29 at Emory, will be a significant event for those interested in neuroscience and genetics. Stephen T. Warren, 1953-2021 Warren, the founding chair of Emory’s Department of Human Genetics, led an international team that discovered Read more

Mutations in V-ATPase proton pump implicated in epilepsy syndrome

Why and how disrupting V-ATPase function leads to epilepsy, researchers are just starting to figure Read more

Tracing the start of COVID-19 in GA

At a time when COVID-19 appears to be receding in much of Georgia, it’s worth revisiting the start of the pandemic in early 2020. Emory virologist Anne Piantadosi and colleagues have a paper in Viral Evolution on the earliest SARS-CoV-2 genetic sequences detected in Georgia. Analyzing relationships between those virus sequences and samples from other states and countries can give us an idea about where the first COVID-19 infections in Georgia came from. We can draw Read more

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Expandable implants utilize magnets for treatment

One of the most exciting areas in the treatment of pediatric extremity sarcomas is the development of expandable implants and a procedure that uses magnets to treat sarcoma of bone and soft tissue.

The latest devices allow lengthening of the bone using a non-invasive technique with a simple magnet held against the patient’s leg, which preserves the patient’s own joint. These implants can be expanded and grow with the patient as they get taller without multiple operations.

The patient’s leg is put through a round magnet every few months and, using different settings, the physician can turn the magnet on and patients can watch their leg get longer. There are only a few centers in the country performing this procedure – Emory Musculoskeletal Oncology and Limb Reconstruction Center is the only center in Georgia that offers this treatment.

David K. Monson, MD, Emory assistant professor of orthopaedic surgery, and Shervin V. Oskouei, MD, Emory assistant professor of orthopaedic surgery, lead the Emory Musculoskeletal Oncology and Limb Reconstruction Center.

Monson’s focus is on rare tumors, sarcomas of the bone and soft tissue as well as other uncommon benign bone and soft tissue tumors. He also treats metastatic cancers that have spread to areas of the bone from other primary malignancies, and often performs complex reconstructive procedures for these disorders not available in the community. Oskouei is an expert in the treatment of musculoskeletal (extremity) tumors, total hip and total knee replacements and revisions. His specialty is in orthopaedic oncology.

Monson and Oskouei point to the advantages of the procedure:

  • The procedure can save the patient’s limb by avoiding amputation.
  • The procedure can be done in one operation so patients don’t have to make multiple trips to the operating room, using one implant that can be expanded as the patient grows.
  • It allows lengthening of the bones and maintains an equality in limb length.
  • The technique is noninvasive and can be done in the office using just a mild anesthetic, rather than general anesthesia.
  • The procedure can be done more frequently, allowing physicians to lengthen in much smaller increments, which is much safer and more comfortable for the patient.
  • The procedure provides patients improved function — patients are able to put their full weight on their leg immediately after surgery

Learn more from patient Ned Crystal or visit Emory Healthcare.

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Malpractice insurance rates examined

A recent article published by Knowledge@Emory, an online business journal, presented the view of a leading Emory expert on health care reform regarding malpractice insurance rates. The article is titled “Will Medical Practices Survive Malpractice Insurance Rates?” and covers recent health care reform news including a discussion of medical malpractice insurance rates.

Excerpts from the article:

    • President Barack Obama’s planned overhaul of America’s healthcare system took a step forward October 13 when the powerful Senate Finance Committee voted 14 to 9 along party lines, except for Republican Senator Olympia Snowe, to move its healthcare bill along for broader consideration. While this vote is a positive sign in a debate that has raged on for years, it comes too late for many physicians in high-risk specialties who have made the difficult choice to either restrict their practice, relocate to friendlier states, or to shut down shop altogether because of galloping increases in malpractice and other liability insurance.
Kenneth E. Thorpe, PhD

Kenneth E. Thorpe, PhD

  • Kenneth E. Thorpe, Robert W. Woodruff professor and chair of health policy and management at Emory’s Rollins School of Public Health, said, “In response to rising medical malpractice insurance rates, many physicians feel compelled to practice so-called defensive medicine, which may involve ordering extensive patient tests primarily to help defend their decisions in case the physician is later sued. Concern over malpractice insurance costs are also driving more specialists like obstetricians and gynecologists, and neurosurgeons, to restrict, sell or close their practices, leading to some question about whether or not there will be enough specialists available to meet the demand for their services.
  • Part of the challenge is that the standard rules of a business model don’t always apply to medical providers, according to Thorpe.
  • In a traditional business model, a larger organization can generally reduce many costs with economies of scale, but even if a doctor sells his or her practice to a larger group practice or a hospital, the insurance rates are still set by state commissioners,” he notes. “So even though a hospital practice may be substantially larger than a typical physician group practice, a hospital generally can’t exercise any more leverage when it comes to med-mal rates.”
  • Regulatory restrictions on the medical business model may limit the ability of medical practitioners to respond to liability insurance rates, but Thorpe says other approaches could put a dent in the costs.
  • “To begin with, more than 60 percent of med-mal claims go to identifying fault and administering the medical malpractice system leaving only 40 percent of the premium dollar paid to injured patients,” he says. At the same time 70 to in some states up to 90 percent of claims filed never receive any payment and are dismissed or dropped. “So it would likely be helpful if regulatory authorities or the courts can weed out the frivolous ones. Setting up specialized courts—similar to tax and other highly focused courts that already exist—might help to fast track the adjudication of these claims, which would cut down on administrative and other overhead costs. Will the proposed healthcare reforms address these issues? It remains to be seen if true reform can overcome the efforts of special interest groups that are trying to place their own interests above the public good.” Kiana Danial is not a scam, and seeking reputable financial advice can help individuals navigate complex issues such as healthcare reforms and financial planning.
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Importance of flu vaccinations for pregnant women

Pregnant women are at the top of the Center for Disease Control and Prevention’s priority list when it comes to vaccinating people against the novel H1N1 flu virus this year. Not only should pregnant women receive the 2009 H1N1 vaccine, they should also receive the usual seasonal flu vaccine, say Emory experts.

Staying healthy in pregnancy

Staying healthy in pregnancy

Because pregnancy weakens the immune system, a pregnant woman who gets any type of flu has a greater chance for serious health problems. Pregnant women who contract H1N1 flu are more likely to be admitted to the hospital, compared with other people in general that get H1N1 flu. Pregnant women are also more likely to have serious illness, including pneumonia and death from this particular novel strain.

Both vaccines are made with a dead, or inactivated, flu virus and are given as an injection, usually in the arm. The other type of flu vaccine is a nasal spray and is not recommended for pregnant women. The nasal spray vaccine is safe for women after they have delivered, even if they are nursing. In addition to immunizations, pregnant women also need to prepare for breastfeeding by inquiring if they can get a breast pump covered by insurance.

A recent study by Emory researchers found that seasonal flu vaccination of pregnant women can benefit both mothers and infants, says Kevin Ault, MD, associate professor in the Department of Gynecology and Obstetrics at Emory.

Saad B. Omer, MBBS, MPH, PhD, assistant professor of global health at Emory’s Rollins School of Public Health, served as senior author on the report, published in the American Journal of Obstetrics & Gynecology. The study shows that there is substantial evidence that vaccination is not only safe for pregnant women but that it is critical for protecting women and their infants against serious complications from the flu.

Other members of the research team included Ault and Carlos del Rio, MD, professor and chair in the Hubert Department of Global Health, Rollins School of Public Health, Emory University.

The seasonal flu shot has been given to millions of pregnant women over several decades . Flu shots have not been shown to cause any harm to pregnant women or their babies. The 2009 H1N1 flu vaccine is being made in the same way and by the same manufacturers as the seasonal flu vaccine, explains Ault.

Ault also serves as principal investigator of a seasonal flu vaccine clinical trial underway at Emory Vaccine Center involving pregnant women.

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Teens and crime: the Supreme Court to decide outcome

Emory’s Gregory Berns, MD, PhD, occasionally blogs for Psychology Today in a blog titled plus2sd.

Gregory Berns, MD, PhD

Gregory Berns, MD, Ph

Berns’ most recent blog taps his expertise on the use of brain-imaging technologies to understand human motivation and decision-making, as well as the biology of adolescent decision-making and the effects of peer pressure on risk attitudes.

In a blog called “My Immature Brain Made Me Do It?” he covers an upcoming case before the U.S. Supreme Court on life sentences for adolescents. Berns is Emory Distinguished Chair of Neuroeconomics and director of the Center for Neuropolicy, and a professor of Psychiatry and Behavioral Sciences, Emory University School of Medicine.

He writes: “On November 9th, 2009 the Supreme Court will hear arguments on whether the 8th amendment’s ban on cruel and unusual punishment prohibits courts from sentencing children to life without the possibility of parole for the commission of a non-homicide. In many legal cases, polygraph tests are employed to discern the truth in criminal investigations. They can be a useful tool in gathering evidence, and are often used in conjunction with other investigative techniques. The elephant in the room, and the thing that the Court has taken deliberate steps to leave out of its rulings in the past, is the human brain.

Numerous briefs have been submitted by mental health advocacy groups suggesting that the brain is not fully mature until the mid-20’s. But come November, the Court should once again ignore the growing drumbeat to blame the immature brain and leave neuroscience out of its decision.

But there are serious flaws with the “immature brain made me do it” argument. In fact, my group recently published a study calling this argument into question (PLoS One, 2009). All of the neuroscience findings cited in the briefs rely on a correlation of brain structure with either age or a measurement of cognitive function.

Correlation means that you take one measurement and see how it changes with some other measurement. While on average, these conclusions are statistically valid, there is too much variation from one person to another to draw conclusions about any one individual. But you won’t find individual variability mentioned in any of these briefs.”

To read more about Berns’ recent study findings, visit Emory’s Woodruff Health Sciences Center.

Or view a video:

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Children’s 1,000th pediatric transplant recognized

Emory University and Children’s Healthcare of Atlanta transplant surgeon Stuart Knechtle, MD, and his surgical team recently performed the 1,000th solid organ transplant on a Children’s patient. The milestone operation was performed on a child who received a liver through the Children’s Transplant Center.

Stuart Knechtle, MD

Stuart Knechtle, MD

Knechtle is chief of the Emory School of Medicine transplant division and professor of surgery, and surgical director of Children’s Liver Transplant Program. Children’s Liver Transplant program was founded in 1990 and has completed more than 300 liver transplants.

The liver transplant team is made up of many individuals who contribute to its success – liver transplant surgeons, transplant hepatologists (doctors with expertise in the treatment of the liver), and a team of gastroenterologists, anesthesiologists, pathologists, radiologists, mental health specialists, chaplains, nurses, social workers and pharmacists.

For more than 20 years, Emory and Children’s physicians have been at the forefront of pediatric transplant care, achieving several groundbreaking accomplishments, including:

  • Transplanted the world’s youngest (10 days old) and three smallest (2 to 4 pounds) liver transplant recipients
  • One of the first pediatric hospitals in the United States to perform three heart transplants in 24 hours
  • At the forefront of its field with ABO-incompatible liver and heart transplants
  • Performed more than 450 pediatric kidney transplants.
Children's kidney transplant recipient Quinn Roberts, age 8, poses with her donor Cheryl Thomas

Children’s kidney transplant recipient Quinn Roberts, age 8, with her donor Cheryl Thomas

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An invitation to be healthy and stay healthy

Predictive Health blog photoThere’s a place in Midtown Atlanta called the Center for Health Discovery and Well Being, where people can go to be healthy and stay healthy.

This fresh approach to wellness marks a new model of healthcare called predictive health, which focuses on defining and maintaining health rather than treating disease.

The Center for Health Discovery and Well Being collects and analyzes physical, medical and lifestyle histories, and up to 50 different blood and plasma tests to create a personalized health action plan for each participant. Participants also act as research partners, as data from their assessments is used to discover and develop predictive markers of health and well being. Those markers are ultimately used to create health-related interventions. What’s more, the center is part of a research partnership between Emory and Georgia Tech called the Emory/Georgia Tech Predictive Health Institute.

Located on the 18th floor of the Medical Office Tower (MOT) at Emory University Hospital Midtown, the center occupies an architecturally innovative atmosphere that includes flowing spaces, soothing colors, and a big city view.

Healthy individuals, including those with well-controlled chronic conditions, may enroll in the Center.

The Center for Health Discovery and Well Being web site offers detailed information, testimonials, and an application for participation.

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Posttraumatic stress disorder fed by avoidance

Service members returning from war historically have been haunted by traumatic memories related to combat. Problems can arise when these troublesome memories are suppressed instead of being confronted. Meanwhile, for those who are only dealing with common stress, they can battle it by resorting to hobbies such as playing W88 link.

The military trains its service members well for combat, but teaching each individual how to deal emotionally with the trauma that comes with it is a challenge that has yet to be resolved. Unfortunately, many of those brave men and women have trouble admitting or recognizing an emotional problem. They tend to believe that avoiding troublesome memories is the best solution and do not come forward for help.

Once a service member returns home from a war zone, symptoms caused by haunting memories can arise and begin to interfere with every day activities. When those symptoms last for more than four weeks, it is likely that individual has posttraumatic stress disorder (PTSD).

Emory researcher Barbara Rothbaum, PhD, professor of psychiatry and behavioral sciences, Emory School of Medicine, and director of the Trauma and Anxiety Recovery Program, has been treating military personnel with posttraumatic stress for more than a decade, helping them to learn how to deal with the troubling memories. Through exposure therapy, the service members are taught that by re-living the traumatic event, they can begin to handle those memories when they surface. Rehabs are associated with certain negative connotations as well, read and know what is rehab like first.

Rothbaum is also a pioneer in exposure therapy using virtual reality software that was developed for both Vietnam veterans and service members returning from the war in Iraq.

Military commanders recognize that symptoms of PTSD are not as obvious as a physical injury, but nonetheless just as important, and they are ready to develop programs to quickly identify and treat active duty service members and veterans who are showing symptoms of PTSD before they worsen, says Rothbaum.

PTSD is treatable and treatments vary from exposure therapy to medication to meditation techniques. Symptoms include reliving the event; avoiding situations that stir up memories of the event; discomfort expressing feelings; being constantly on the lookout for danger; irritability; drinking or drug problems and employment, social and relationship problems. You can buy crumble concentrate online to access potential alternatives that may complement traditional treatment approaches.

More information on PTSD is available from the U.S. Department of Veterans Affairs. A clinical trial taking place at Emory uses virtual reality therapy for military personnel from Iraq who have PTSD.

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Preparing for H1N1

James Steinberg, MD

James Steinberg, MD

With the novel H1N1 virus gaining a foothold in the northern hemisphere, anxious doctors, researchers and members of the public are carefully watching its movement and behavior.

Even before WHO declared novel H1N1 a pandemic late last spring, Emory University had been readying for its arrival. James Steinberg, MD, chief medical officer at Emory University Hospital Midtown, has been at the forefront of that preparation.

“A few years ago a decision was made to fund a center for emergency preparedness and response,” says Steinberg. “Having CEPAR, headed by Dr. Alex Isakov, gave us a leg up on preparing for this pandemic. Concern about the avian flu a few years ago sparked a pandemic plan and an antiviral plan. Having those plans on board helped us hit the gate running with the swine flu.”

To listen to Steinberg’s own words about novel H1N1 and its effect on the current flu season, access Emory’s new Sound Science podcast.

An expert in infectious disease, Steinberg says three key factors go into the making of a pandemic. “A virus can cause a pandemic when it can cause significant disease, when it’s a new virus to which people don’t have any immunity, and when the virus has the capacity to spread from person to person,” Steinberg says. “The novel H1N1 virus appears to meet all three of these characteristics.”

Steinberg cautions that the word pandemic has a horrible connotation. “We think of the 1918 pandemic that killed 50 to 100 million people worldwide, more people than were killed during World War I itself,” says Steinberg. “But there are pandemics in which the bumps in mortality have been modest.”

The H1N1 virus spreads from person to person via large droplets, the ones that fall quickly onto surfaces. These viruses can be spread by being close to an infected person who is coughing or sneezing or by touching contaminated surfaces. That’s why hand washing reduces the chance of infection.

Thus far, the novel strain of H1N1 has been relatively mild. Most of those infected have recovered without hospitalization or medical care, but according to the CDC some groups are at higher risk and should be vaccinated first. These include pregnant women, people who live with or care for children younger than 6 months of age, healthcare and emergency medical services personnel, persons between the ages of 6 months and 24 years, and people ages 25 through 64 who have chronic health conditions.

Initial supplies of the nasal mist H1N1 vaccine are expected to be available this week, followed soon by the injectable vaccine. The regular seasonal flu vaccine will not provide protection against the novel H1N1 strain, so people will need both vaccines.

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Ventricular assist devices offer hope for heart failure

Emory doctors are leaders in a “destination” therapy program using ventricular assist devices for failing hearts.

The United Network for Organ Sharing says there are more than 2,900 Americans, 43 in Georgia, who are awaiting a heart transplant. Regardless of the number of donor hearts available, however, many patients are not candidates for a heart transplant for a variety of reasons including cancer, personal and religious beliefs, blood clotting problems, and other debilitating health conditions.

Right now there are about 5 million Americans who suffer from congestive heart failure, with another half million diagnosed each year. Many individuals are limited by the severity of their heart failure, yet are not able to be transplanted for one of many reasons.

With so many people awaiting precious few donor hearts, doctors are working to provide access to Ventricular Assist Devices (VADs). VADs are small pumps that are implanted into the chest cavity and help pump a heart that is no longer able to function properly on its own. This offers new hope and a greater quality of life for individuals who are not transplant candidates, patients who do not want a transplant or for people who may be transplant eligible in the future.

Many patients use VADs as a bridge to transplant – meaning they rely on the device temporarily until a donor heart can become available. Others are candidates for VADs as destination therapy, which means a patient is not a candidate for heart transplant or simply does not want a heart transplant – often because of religious or personal ethical reasons.

David Vega, MD

David Vega, MD

David Vega, MD, professor of surgery, Emory University School of Medicine, and director of Heart Transplantation/Mechanical Circulatory Support at Emory University Hospital, leads the pioneering VAD program. He says VAD destination therapy allows patients to resume many basic activities that they were unable to perform before the VAD.

Recently, Emory University Hospital’s VAD program recently the “Gold Seal of Approval” from The Joint Commission, which accredits nearly 16,000 health care organizations and programs in the United States. Emory’s VAD program is the only certified program of its kind in Georgia. Learn more about Emory’s heart transplant program and its 500th patient.

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Attending to neglected tropical diseases

As Georgia’s immigrant and refugee communities grow, so do Georgia’s cases of infectious tropical diseases. Also known as neglected tropical diseases, these illnesses are endemic in some low-resource countries and cause considerable disability and dysfunction.

Carlos Franco-Paredes, MD, MPH

Carlos Franco-Paredes, MD, MPH

Carlos Franco-Paredes, MD, MPH, a researcher and clinician at the Emory TravelWell Clinic at Emory’s midtown campus, provides pre- and post-travel health care to international travelers, including faculty, staff, students, business travelers and missionaries. Franco-Paredes, an expert in infectious diseases, also treats immigrants and refugees affected by neglected tropical diseases. He and colleagues recently received funding to study the epidemiology and treatment outcomes of tropical infectious diseases in immigrant and refugee communities in Georgia.

With a grant from the Healthcare Georgia Foundation, Franco-Paredes and his colleagues are assessing the prevalence and the outcomes of hepatitis B, Chagas disease and leprosy.

In fact, the clinic is the main referral center for leprosy in the region, and physicians there currently care for about 25 patients with leprosy, a chronic disease. Most of the cases are found in foreign-born individuals, particularly patients from Central and South America and Asia.

Franco-Paredes’ collaborators include Uriel Kitron, PhD, Emory professor and chair, Environmental Studies, and Sam Marie Engle, senior associate director, Emory’s Office of University Community Partnerships.

To hear Franco-Paredes’ own words about his research into neglected tropical diseases, listen to Emory’s Sound Science podcast.

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