Microphysiological systems will revolutionize experimental biology and medicine

PUBLIC RELEASE DATE:

2-Sep-2014

Contact: John P. Wikswo john.wikswo@vanderbilt.edu 615-343-4124 Society for Experimental Biology and Medicine

The Annual Thematic issue of Experimental Biology and Medicine that appears in September 2014 is devoted to "The biology and medicine of microphysiological systems" and describes the work of scientists participating in the Microphysiological Systems Program directed by the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH) and funded in part by the NIH Common Fund. The Defense Advanced Research Projects Agency (DARPA) and the Food and Drug Administration (FDA) are collaborating with the NIH in the program. Fourteen of the research teams supported by the program have contributed papers and represent more than 20 institutions, including Baylor College of Medicine, Columbia University, Cornell University, Duke University, Johns Hopkins University, Massachusetts General Hospital and Harvard Medical School, the Massachusetts Institute of Technology, Northwestern University, Nortis, Inc., the University of California, Irvine, the University of Central Florida, the University of Pennsylvania, the University of Pittsburgh, the University of Texas Medical Branch, and Vanderbilt University.

Dr. John P. Wikswo, founding Director of the Vanderbilt Institute for Integrative Biosystems Research and Education and Editor of the Thematic Issue, explains in his introductory review that microphysiological systems (MPS) often called "organs-on-chips" are interacting sets of constructs of human cells. Each construct is designed to recapitulate the structure and function of a human organ or organ region, and when connected in an MPS, they may provide in vitro models with great physiological accuracy for studying cell-cell, drug-cell, drug-drug, and organ-drug interactions. The papers in the Thematic Issue describe the ongoing development of MPS as in vitro models for bone and cartilage, brain, gastrointestinal tract, lung, liver, microvasculature, reproductive tract, skeletal muscle, and skin, as well as the interconnection of organs-on-chips to support physiologically based pharmacokinetics and drug discovery and screening, and the microscale technologies that regulate stem cell differentiation. Wikswo notes that the initial motivation for creating MPS was to increase the efficiency and human relevance of pharmaceutical development and testing. Obvious applications of the technology include studies of the effect of environmental toxins on humans, identification, characterization, and neutralization of chemical and biological weapons, controlled studies of the microbiome and infectious disease that cannot be conducted in humans, controlled differentiation of induced pluripotent stem cells into specific adult cellular phenotypes, and studies of the dynamics of metabolism and signaling within and between human organs.

In his commentary for the Thematic Issue, Dr. William Slikker Jr., Director of the FDA's National Center for Toxicological Research, writes "The goal [is] to accomplish this human-on-a-chip capability in a decade a feat somewhat equivalent to the moon shot of the 1960s and, like landing man on the moon, simulating a human being from a physiological/toxicological perspective may indeed be possible. But even if ultimately it is not, a great deal of fundamental biology and physiology will be elucidated along the way, much to the benefit of our understanding of human health and disease processes."

Dr. D. Lansing Taylor, Director of the University of Pittsburgh Drug Discovery Institute, says "The Thematic Issue brings together the leaders of the field of Human-on-a-Chip to discuss the early successes, great potential and continuing challenges of this emerging field. For complete success, we must integrate advances in multiple technical areas, including microfluidics, stem cell biology, 3D microstructures/matrices, multi-cell engineering, universal blood substitutes, and a variety of biological detection technologies, database tools, and computational modeling for both single and a combination of organ systems. Success will be transformative for basic biology, physiology, pharmacology, toxicology and medicine, as well as the new field of quantitative systems pharmacology, where iterative experimentation and computational modeling of disease models and pharmacodynamics and pharmacokinetics are central. The focus is to create physiologically relevant, robust, reproducible and cost-effective tools for the scientific community."

Dr. Danilo A. Tagle, NIH NCATS Associate Director for Special Initiatives, adds "This special issue highlights the exciting and rapid progress towards development of MPS for drug safety and efficacy testing. Much progress has been achieved in the two years of the program, and these articles describe the efforts by an outstanding group of investigators towards realizing the goal of fully integrated 10 organ systems. There are tremendous scientific opportunities and discoveries that could be had in the future utility of these tissues/organs on chips."

Dr. Steven R. Goodman, Editor-in-Chief of Experimental Biology and Medicine, agrees. "We are proud to publish this Thematic Issue dedicated to "The biology and medicine of microphysiological systems." Dr. John Wikswo is to be congratulated for assembling an exceptional group of researchers who are leaders in the field of MPS and the many uses of this exciting technology. MPS has the potential to revolutionize experimental biology and medicine. Because of the great importance and promise of organs-on-chips and MPS technology, it has now become a major area of emphasis for the Systems Biology category of Experimental Biology and Medicine."

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Microphysiological systems will revolutionize experimental biology and medicine

SMFM releases paper on activity restriction in pregnancy

PUBLIC RELEASE DATE:

2-Sep-2014

Contact: Vicki Bendure Vicki@bendurepr.com 540-687-3360 Society for Maternal-Fetal Medicine

WASHINGTON, Sept. 2, 2014In a new guideline, the Society for Maternal-Fetal Medicine has recommended against the routine use of bed rest in pregnancy.

"There is no evidence that bed rest improves outcomes", says Anthony Sciscione, DO, director of Delaware Center for Maternal and Fetal Medicine and one of the co-authors of the guideline. "However, there is evidence that bed rest can be harmful for moms, babies, and families."

About one in five women are placed on bed rest during their pregnancy. Surveys have shown that both ob/gyns and maternal-fetal medicine specialists prescribe activity restriction and bed rest, even though most of the physicians surveyed do not expect that doing so will actually improve pregnancy outcomes.

Restriction of activity in pregnancy is also known as "bed rest," or "modified bed rest" and has been recommended for a number of potential complications such as preterm (before 37 weeks gestation) contractions, a dilated cervix from preterm labor, a short cervix, preterm premature rupture of membranes (water breaking before 37 weeks gestation and before the onset of labor), elevated blood pressure, preeclampsia, inadequate growth of baby, placenta previa, risk of miscarriage, multiple gestations (e.g. twin pregnancies), and others.

In the guideline, the Society points out that bed rest has not been shown to reduce the chance of preterm delivery in women either at risk or already experiencing preterm labor. One study found that preterm birth was more common in women already at risk of preterm birth when they were placed on any type of work or non-work related activity restriction, both at home and in the hospital. There is also no data indicating that activity restriction is of benefit for any obstetric condition.

Inadequate growth of the baby is often attributed to problems with blood flow to the placenta and activity restriction or bed rest is often prescribed in an effort to improve placental blood flow. Again, studies fail to show a benefit to this practice.

While there is no evidence the bed rest improves outcomes, there are several potentially harmful side effects. It's widely known though that extended periods of activity restriction can result in muscle and bone loss. This "deconditioning" happens to pregnant and non-pregnant individuals. Changes can occur after only a few days of immobility and there is not a lot of information on the full impact these changes have in pregnant women.

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SMFM releases paper on activity restriction in pregnancy

EAMCET 2014 Medicine Counselling starts in Two states – 6tv Special Focus – Video


EAMCET 2014 Medicine Counselling starts in Two states - 6tv Special Focus
Watch 6TV, the 24/7 Telugu news channel. dedicated in delivering breaking news, live reports, exclusive interviews, sports, weather, entertainment, business updates and current affairs. To...

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EAMCET 2014 Medicine Counselling starts in Two states - 6tv Special Focus - Video

Lucas King – Shelter You (Unplugged @ Land Of Medicine Buddha) – Video


Lucas King - Shelter You (Unplugged @ Land Of Medicine Buddha)
I went to Yin Yoga Teacher Training with Paul and Suzee Grilley in Santa Cruz this summer 2014 and played a an unplugged concert for all my fellow yogis and yoginis @ Land Of Medicine Buddha....

By: Lucas King

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Lucas King - Shelter You (Unplugged @ Land Of Medicine Buddha) - Video

U. of C. Medicine gets state approval to build Orland Park outpatient center

University of Chicago Medicine has received state approval to build a $66.9 million outpatient center in Orland Park and spend $123.5 million to develop the third and fourth floor of its flagship hospital in Hyde Park.

The Illinois Health Facilities and Services Review Board voted unanimously Wednesday in favor of the Orland Park project despite criticism that it could hurt other southwest suburban hospitals with similar specialties.

A lot of sick people and parents of sick people don't want to spend an hour and a half on the Dan Ryan, review board member Philip Bradley said.

In a letter to the review board opposing the project, south suburban Affiliated Oncologists LLC listed 11 nearby facilities offering radiation oncology and infusion therapy, two specialties U. of C. officials said they will feature in Orland Park.

U. of C. Medical Center President Sharon O'Keefe defended the location, saying the project had not prompted opposition from nearby hospitals, and it received letters of support from local officials, patients and physicians.

The university's market research data show the area, with a growing and aging population, is expected to need additional exam rooms and physicians by the time the project is completed, O'Keefe said. She also said it would provide a more convenient location in the south suburbs. To remain competitive, University of Chicago needs to improve accessibility to specialty care.

Some critics at the review board meeting said University of Chicago Medicine should open an adult trauma center on Chicago's South Side before planning a more lucrative expansion in the suburbs.

University of Chicago Medicine said in a statement Tuesday that it is deeply committed to the South Side, citing its emergency rooms, burn unit and children's trauma center. But we also believe all our patients deserve to have the chance to benefit from our expertise in treating very complex disorders, in their own communities, the university said in the statement, adding that developing a Level 1 adult trauma center would be a massive undertaking that could hurt other Cook County trauma centers.

According to plans filed with the review board, the 120,000-square-foot facility in Orland Park would offer specialized treatment in radiation oncology, with 80 exam rooms for other medical specialties, including orthopedics, women's health, pediatrics, cardiology and surgical consulting.

Review board approval was the final regulatory hurdle for the project, which is expected to break ground this fall and open in 2016, said Lorna Wong, a University of Chicago Medicine spokeswoman.

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U. of C. Medicine gets state approval to build Orland Park outpatient center

The wonders of Dok Alternatibo

An employee at a Dok Alternatibo clinic shows the health drink turmeric juice and camote rolls that form part of the natural food program of the thriving health enterprise. GERMELINA LACORTE

Edgar Delibos foray into alternative medicine was driven by the search for a cure to his wifes many ailments.

She had asthma since she was a child. She had myoma after childbirth. She was diagnosed with a rheumatic heart, hypertension and hyperthyroidism. She had insomnia, migraine and a lot more, said Delibo, who is now known here as Dok Alternatibo.

Doctors told the family that they had only two optionssurgery or maintenance drugs. Delibo, however, refused to accept that he was limited to the two choices.

The cost of operation was so huge for a media man to afford, so I started to look for solutions somewhere else, said Delibo, who had worked as a broadcaster before his involvement in alternative medicine.

He spent long hours doing research on the Internet and reading medical books, but they simply corroborated what doctors had told him about his wifes ailmentsthe choices were just surgery and maintenance drugs.

Eyes of faith

It was only when I stopped my search using my eyes and began to search using the eyes of faith that I began to see, Delibo said.

He said a voice inside him kept telling him that the very food that they (doctors) dont allow patients to eat may be the ones that can bring about healing.

So while doctors told him root crops were bad for patients with toxic goiter, which his wife had, he gave his wife camote, pounding it and mixing it with scraped coconut meat.

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The wonders of Dok Alternatibo

Who Will Pay For Proactive Medicine?

Last week I posted about the huge, neglected value of proactive medicine. Afterwards I talked with Bret Jorgensen, Executive Chairman of MDVIP, the pioneer Concierge Medicine company. We talked about the results that different intensive primary care models are demonstrating, and the challenges they face when they attempt to convince payers to invest resources in proactive medicine in order to enjoy those benefits.

Proactive Medicine refers to medical services that focus heavily on engaging patients while they are healthy or early in the disease process, developing strong relationships, and providing early treatment or driving behavior change that prevents or delays serious illness. Intensive primary care, often called Concierge Medicine or Direct Primary Care, has emerged recently as one of the most effective forms of Proactive Medicine. Entrepreneurs/start-up companies have led the way here: MDVIP, Iora, OneMedical, among others. (1)

Intensive primary care is important because 1) primary care impacts almost 100% of the population and 2) the benefits are big. Jorgensen reports that MDVIP has seen reductions of 80% plus in ER and hospital utilization and in hospital readmissions among a large group of Medicare patients that benefit from MDVIPs particularly intensive primary care service. This generated ~$300 millions of savings; most of the savings benefitted the Medicare program. More important, it improves the health status and quality of life of patients.

But [always a but], to implement intensive primary care someone needs to spend more money up front. Health insurance plans typically budget $25-$30 per member per month (PMPM) for primary care. Intensive primary care costs at least $65 PMPM. Total Total U.S. healthcare spending is about $700 per person per month. Spending $35 more on primary care pays off if the other $670 can be cut by 5%. Data that I have seen, both published and unpublished, indicates that intensive primary care saves 10%-20% of total health care cost (e.g.: 1, 2). At national scale, that opportunity adds up to $300-$600 billion. In addition there is the economic benefit of a healthier, more-productive population, and the social benefit of longer, healthier lives.

The bottom-line question is: who will pay for the up-front investment in primary care? In the beginning it was the patients themselves. MDVIP has 220,000 members in 41 states who pay about $135 PMPM on top of their health insurance, mainly from personal funds.High-end self-insured employers are starting to invest in intensive primary care. OneMedical has successfully sold its moderately-priced Concierge Medicine service to a number of employers, particularly silicon valley companies that compete aggressively for talent and regard benefits as a way to attract employees and keep them productive and happy. Comcast Comcast is investing in Direct Primary Care for its employees.

Mainstream commercial health plans and government payers, which together spend at least 2/3 of U.S. health care dollars, have not embraced intensive primary care significantly, however. Inertia and an awkward tax issue are factors. Beyond that, however, government and large insurers seem to be locked into the old-fashioned purchasing agent view of cost reduction: put the squeeze on every vendor every day. That approach produces short term results, but it does not capture the bigger savings that a systems view of healthcare would enable: by spending more on intensive primary care, payers can achieve a much larger savings in the cost of advanced medical care.

Another common objection goes: Primary care doctors are in short supply, so its impossible to provide more-intensive primary care. Thats a short-sighted argument. In the near term, capacity can be expanded by increasing the numbers of nurse practitioners and physicians assistants, and by exploiting the large, untapped potential of telemedicine in primary care. In the longer term increasing investment in primary care and its status will increase the supply of MDs, both from medical school and closely-related specialties.

Heres how we can accelerate enjoying the benefits of more-intensive primary care. Intensive primary care providers need to keep producing outstanding results, and they need to document those results with studies that are accepted by peer-reviewed journals and insurance actuaries. This is happening. Payers need to pull back a bit from their huge immediate challenges and take a longer term, system view of how to get more bang from the healthcare buck (2). It cant happen soon enough.

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Who Will Pay For Proactive Medicine?

New development in Chinese Medicine

March 1, 2012, 3:58 a.m.

This week has marked the beginning of an exciting and new development in Chinese Medicine.

Hi everyone,This week has marked the beginning of an exciting and new development in Chinese Medicine.The Chinese Medicine profession is finally becoming registered nationwide and is compulsory from July this year, 2012.This means that for a practitioner to be able to practice Chinese Medicine anywhere in Australia they must be registered with the Chinese Medicine Board of Australia (CMBA).The website is http://www.chinesemedicineboard.gov.auCMBA is working under the Australian Health Practitioner Regulation Agency (AHPRA).This is the same agency that overviews other health professions such as Western Medicine, Psychiatrist, Psychologists, Osteopaths, Dentists, Podiatrists and a few others.The website is http://www.ahpra.gov.auChinese Medicine has only ever been regulated prior to this, in one state and that has been Victoria.What does registration mean?This means that people, who want to practice Chinese Medicine, must apply to register with the board, where registration standards and codes of practice have to be met, setting a professional standard. What are the registration standards?To be eligible to practice Chinese Medicine one has to prove- Identity- Australian citizenship or working Visa- Completion of an approved Bachelor Degree - During 1 July 2012 to 1 July 2015, special transitional provisions, known as grandparenting provisions, are in place. This means that those who dont have the approved Bachelor Degree will still be considered for eligibility of practice provided that they can supply supporting information that proves their ability to practice. This is mainly for those who have been in the field before approved Bachelor Degrees were offered for study.- Professional Indemnity Insurance - Criminal record check- Prove ability to communicate effectively in English - Continual Professional Education known as CPEWhat does this mean for you the client?This means that you can check that a practitioner is registered and hence meeting the professional standards for Chinese Medicine. Hopefully it also means that Chinese medicine would be considered for Medicare. The other professions under AHPRA are all covered by Medicare.This would be a great step for alternative or complementary health practitioners.Traditional Chinese Medicine practitioner and counsellor Kim Bookarof promotes physical, mental and spiritual health and wellbeing, while encouraging awareness of health issues in the community.

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New development in Chinese Medicine

Weigh In: What's the Next Revolution for Medicine?

Medicine looks incredibly different than it did a century ago (which I think we can all say thank goodness for that). From new technology such as MRI scanners and antibiotics, to improvements in logistics, such as widespread immunization programs and organ-donation schemes, medicine seems to be constantly modernizing.

But for every revolution in medicine thats complete, there must be a dozen more that havent even started. Quick lab diagnostics are great now how do we make those affordable for clinics in rural Africa? Patients are gathering their own genetic and lifestyle data now how can doctors use that to improve their medical care?

Over the last couple of months here at Citizen Science Salon, weve featured ten different projects in the Exploring a Culture of Health series, brought to you by SciStarter, Discover, and the Robert Wood Johnson Foundation. These projects aim to shake up medicine as we know it.

Some of those were directed at medical professionals. We asked nurses to share their on-the-job workarounds; we encouraged medical staff to imagine a better doctors office experience; and we solicited ideas for how charts and graphs could better communicate complex health ideas.

Other questions were posed to organizations, such as hospitals, governments and schools. We challenged orgs to think up ways to reuse wasted supplies, to ensure privacy for patient-supplied data, to improve their communitys overall health, and to provide support to kids whove faced childhood trauma.

Finally, the blogs posed questions to all of us as patients. Would you use a free online course to learn more about a health condition you or someone close to you had? Would you volunteer personal information to help scientists study a disease you have? Would you use an app to track your daily habits and report them to your doctor?

We live in an interesting time, where data is paramount and whole industries are built on its sharing. Our smart phones sync with wearable sleep-trackers and pedometers, and we can share that data socially. Wired clothing and smart contact lenses are in development to provide even more real-time vitals. These devices for the moment are for personal use, but someday doctors could, with your permission, also view these feeds and use them to help improve your health.

What are your ideas for how smart gadgets could make peoples lives healthier? Maybe a new app or a new device? Perhaps a reformed approach to medical charts that could integrate user-generated data? Maybe ways to use social networks to encourage healthier behaviors? Or maybe something we havent even thought of before now

We want to hear your ideas. Leave them in the comments below, or email them to editorial@discovermagazine.com. The most inspiring ideas will be featured in an upcoming print issue and may just bring about yet another exciting revolution in healthcare.

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Weigh In: What's the Next Revolution for Medicine?

Round two points for medicine courses drop further

St Johns College Ballyfermot students with their Leaving Cert Results: from left, Dean Hogarty, Luke Noonan, Eoin de Lecy, Nathan Doyle, Robert Swaine, Jordan Doyle Mathew Murphy Kalim Teeling and Dean Cullins. Photograph: Brenda Fitzsimons/The Irish Times

Points in medicine have fallen in four out of five faculties in this years second round of CAO offers. New places were also offered by NUIG on 721 points, the same level as they were in round one last week.

The fallout this year from the restructuring of the Hpat marking scheme, to determine who gets undergraduate medical places, continues in round two offers this morning.

Points for medicine dropped from last year in all five medical faculties in round one last week, by between 14 and 18 points.

Amazingly, they have continued to drop in round two, with 64 places being offered this morning across all five medical schools, representing 15 per cent of all medical places available this year. Points are down by three in RCSI, by two in UCC and UCD, by one in Trinity and NUIG offered places to all applicants holding 721 points.

Students seeking places on other programmes in Trinity College will be pleased to find that 32 courses are offering places in round two. Points have decreased in 23 of these programmes. In contrast NUIG is offering places on only three courses, one being medicine. DCU offered a number of places in one programme, athletic therapy and training.

The large number of courses still to be filled in TCD may indicate that they offered insufficient places in round one and are now hoping to secure acceptances from those students still open to accepting a level eight programme.

Nursing and paramedical programmes have also seen a drop in points across a number of colleges. Nursing is down five points in UCC to 440 (random selection). Optometry is down five to 500 in DIT. Dentistry is down five in Trinity, as are radiation therapy and medicinal chemistry.

A number of places are offered under random selection, where not all applicants on these points got a place. These random selection offers include: veterinary medicine, down five in UCD to 575, as are veterinary nursing at 460, physiotherapy at 550, child and general nursing 490 and psychology 510. Some 38,239 applicants had accepted an offer from the CAO on round one by the closing date last Monday. This morning the CAO is offering a further 3,320 places to 3,125 people. The additional places offered by universities, institutes of technology and private colleges bring good news to these 3,125 students. Some 1,494 course places are offered at level eight and 1,626 at level seven/six. A number of students therefore have received offers at both levels.

For 761 students at level eight and 1,256 at level seven/six, todays post brings an offer of their first choice on their list of course preferences. The number of applicants who will receive an offer today represents a little over 6 per cent of those who did so in round one on August 18th.

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Round two points for medicine courses drop further