Researchers write book using DNA

Researchers have encoded a full book in DNA, the largest amount of information stored on the biological medium yet.

The data encoded is the digital version of the book, made up of more than 50,000 words, 11 images and one computer program. The overall size of the data is around 0.7 megabytes, report the scientists, led by George Church of Harvard Medical School. For their work, the researchers have used only off-the-shelf technology.

In their article, published on-line by Science magazine, the scientists argue that DNA has unique advantages for data storage. They calculate that their method has by far the highest data density of any medium until now, beating flash media or even quantum holography by orders of magnitude. This is partly because DNA is three dimensional while other storage techniques are restricted to two dimensions.

Yet the main advantage of DNA storage may be durability. DNA can survive millennia unharmed, as demonstrated by the sequencing of genetic information from ancient fossils. At the same time, the tools and techniques necessary for reading out the information will be present in future generations, because they are ubiquitous in nature, the scientists write.

The main disadvantage at this time is expense. The authors admit that the cost and time needed to encode the information make it largely impractical at the moment, except for highly specific applications, like century-scale archiving.

But they point out that the cost of DNA synthesis and sequencing has been dropping by a factor larger than five each year, much higher than the rate for electronic media, albeit from a much higher starting point. The scientists conclude that DNA is becoming an increasingly practical storage medium, at a time when digital information is accumulating at an exponential rate.

For their work, the researchers split into pieces the information of the book Regenesis: How Synthetic Biology Will Reinvent Nature and Ourselves, co-written by Church. They then synthesized short DNA fragments of around 160 nucleotides the bits in DNA. Each fragment carries part of the book, information about its position, as well as parts necessary for reading and replicating the piece.

In the process, the scientists have created 70 billion copies of the book. When reading out the information, the data was recovered with but 10 errors overall.

The first demonstration of encoding information into DNA dates back to 1988. Until now, the largest amount of data encoded in nucleic acid has been only 7,920 bits, around one-700th what Churchs team has accomplished. The authors report on a number of improvements over previous methods that make this feat possible, including a more flexible method of encoding data, using shorter and thereby easier to handle DNA pieces, and next-generation technologies for synthesis and sequencing.

For the future, the researchers propose improvements in compression and accuracy, to make the storage denser and less error-prone.

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Researchers write book using DNA

Posted in DNA

Back-To-School Nutrition

August 19, 2012 (CHICAGO) -- Summer break is over, and as students head back to school, many are also returning to their athletic schedules. But staying fit isn't just a matter of working out. Nutrition is also important.

Registered dietitian Christine Palumbo (www.ChristinePalumbo.com), Good Sense Eating columnist for Chicago Parent magazine and a paid consultant to the California Raisin Marketing Board, says this is really a great opportunity to get young people engaged in talking about good nutrition and how they should be eating. She came into our ABC7 studio kitchen to show a recipe for a healthy snack.

Christine's Tips:

Ingredients: 6 whole wheat flour tortillas (8 inches) 6 tblsps smooth peanut butter 3/4 cup raisins

Method: 1. Warm tortillas on a hot griddle to soften enough for rolling. 2. Arrange on cutting board, and spread 1 tablespoon peanut butter evenly over each. 3. Sprinkle 2 tablespoons of raisins evenly on top of peanut butter. 4. Roll up tightly. Slice diagonally 1/2 -inch thick. 5. Serve immediately or wrap and pack into lunch box for later.

Nutrition Facts Per Serving: Calories 230 (30 percent from fat); Total Fat 9g (sat 1.5g, mono 4g, poly 2g, trans 0g ); Cholesterol 0mg; Protein 8g; Carbohydrate 38g; (Dietary Fiber 4g; Sugars 16g; ); Iron 2mg; Sodium 180mg; Calcium 23mg; Potassium 342mg

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From microbiology to macro football, Rudock readies for his time

Quarterback Jake Rudock during the media day for University of Iowa football at the practice field in Iowa City on Monday, August 6, 2012. (Cliff Jette/The Gazette-KCRG TV9)

IOWA CITY Jake Rudock and James Vandenberg have so much to talk about.

Whos the best organic chemistry professor? What about microbiology, any suggestions there? What are you going to do with those used Medical College Admissions Test prep books?

We actually do talk about classes more than youd think, Rudock said. What about this? Who do I not want [for a professor]? Who do I really have to avoid? Who do I not have to worry about?

Of course, theres also the football.

The Iowa quarterbacks are on similar paths in football and life. Vandenberg is the veteran on the field, 3,022 yards and 25 TDs last season. Hes also a fifth-year senior academically and a integrative physiology major who plans to take a run at the MCAT and medical school.

Caption: Iowa quarterback James Vandenberg (16) works out during the team's practice at Chaparral High School Tuesday, Dec. 27, 2011 in Scottsdale. The team is preparing for their Insight Bowl matchup against Oklahoma on December 30th. (Brian Ray/ SourceMedia Group News)

Rudock, a 6-3, 200-pound redshirt freshman, is the rookie. As a senior at St. Thomas Aquinas High School in Weston, Fla., he led his team to district, regional state and national titles with a 15-0 record. He took a redshirt in 2011 and now is poised for a run at No. 2 quarterback with junior-college transfer Cody Sokol also in that mix.

Iowa has been lucky in QB health. In the last five years, Iowa QBs have missed less than three games. The cautionary red flag is up at No. 2 simply based on experience. Vandenberg has 499 career attempts. The rest of the depth chart, might as well throw in true freshman C.J. Beathard and walk-ons Kyle Anderson and Dan Hartlieb, has zero.

Yes, this has first-year offensive coordinator Greg Davis attention.

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From microbiology to macro football, Rudock readies for his time

DNA evidence could bring PC Blakelock killers to trial

DNA evidence could finally bring the killers of PC Keith Blakelock to justice, 27 years after the policeman was murdered during the Broadwater Farm riots in Tottenham.

Reports yesterday claimed Scotland Yard were just weeks away from bringing charges against a man who was under 18 at the time of the murder. Two QCs agreed there is a "realistic prospect of prosecution", a key test for the Crown Prosecution Service, the Sunday Telegraph claimed.

Last night the Metropolitan Police denied charges were imminent but confirmed modern scientific techniques had been used to analyse DNA evidence from PC Blakelock's flame-retardant overalls and more than a dozen murder weapons as part of an ongoing cold case review of the crime.

Five men aged between 40 and 51 were arrested in 2010 and are still on police bail.

PC Blakelock, a 40-year-old father of three, was attacked as he tried to protect firefighters who were tackling a supermarket blaze at the height of the riot on the Broadwater Farm estate in October 1985. After stumbling he was surrounded by a mob screaming: "Kill the pig."

He was stabbed more than 40 times with different weapons, including a machete, and when he was finally dragged free by colleagues a kitchen knife was still embedded in his throat.

Winston Silcott, Mark Braithwaite and Engin Raghip were convicted in March 1987 of his murder but all three convictions were quashed four and a half years later after forensic tests on pages of key interview records suggested they had been fabricated. Silcott accepted 50,000 compensation from the Home Office but remained in prison for an unrelated murder and was released in 2003. None of the three men originally convicted is the suspect in the new case.

In 2003, Scotland Yard reopened the murder investigation after a review indicated there were possible new lines of inquiry. Fourteen men were arrested in 2010 on suspicion of involvement in PC Blakelock's murder or the attempted murder of PC Richard Coombes, who was also viciously attacked during the riot.

Since then nine of the men have been released without charge. The other five are still on police bail.

Botched convictions

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Posted in DNA

DNA checks done on family trees

Some people who have traced their family trees are now turning to science to see whether historical data is accurate.

For a few hundred dollars, a growing number of people are buying online DNA kits.

Dale Johns is president of the South Australian Genealogy Society.

"People who want to have their tests done, they can find a provider on the web and there's one we use in America," he said.

"They pay their money, they get a little kit and they take a swab out of their mouth and seal that up and send it back."

Ancestry researcher Antoinette Wade is enjoying the process.

"I recently had a test called Family Finder done and I have actually found some second cousins that I'm in communication with based on our DNA and that's very exciting," she said.

Another society member Robert Blair has had several tests done on DNA, and even had some cousins tested as well, to prove a person in his family tree did not belong there.

"The DNA tests showed that I was right. The ancestor that we thought was an ancestor wasn't really an ancestor," he said.

A DNA special interest group is among several that meet at Genealogy SA's headquarters, with others including English, Irish, German and other European groups.

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'DNA wires' could help physicians diagnose disease

ScienceDaily (Aug. 19, 2012) In a discovery that defies the popular meaning of the word "wire," scientists have found that Mother Nature uses DNA as a wire to detect the constantly occurring genetic damage and mistakes that if left unrepaired can result in diseases like cancer and underpin the physical and mental decline of aging.

That topic DNA wires and their potential use in identifying people at risk for certain diseases is the focus of a plenary talk on August 19 during the 244th National Meeting & Exposition of the American Chemical Society in Philadelphia, Pennsylvania.

"DNA is a very fragile and special wire," said Jacqueline K. Barton, Ph.D., who delivered the talk. "You're never going to wire a house with it, and it isn't sturdy enough to use in popular electronic devices. But that fragile state is exactly what makes DNA so good as an electrical biosensor to identify DNA damage."

Barton won the U.S. National Medal of Science, the nation's highest honor for scientific achievement, for discovering that cells use the double strands of the DNA helix like a wire for signaling, which is critical to detecting and repairing genetic damage. She is a professor of chemistry and is chair of the division of chemistry and chemical engineering at the California Institute of Technology in Pasadena.

Damage is constantly occurring to DNA, Barton explained damage that skin cells, for instance, receive from excessive exposure to sunlight or that lung cells get hit with from carcinogens in cigarette smoke. Cells have a natural repair system in which special proteins constantly patrol the spiral-staircase architecture of DNA. They monitor the 3 billion units, or "base pairs," in DNA, looking for and mending damage from carcinogens and other sources.

Barton and other scientists noticed years ago that the DNA architecture chemically resembles the solid-state materials used in transistors and other electronic components. And DNA's bases, or units, are stacked on top of each other in an arrangement that seemed capable of conducting electricity.

"It's like a stack of copper pennies," said Barton. "And when in good condition and properly aligned, that stack of copper pennies can be conductive. But if one of the pennies is a little bit awry if it's not stacked so well then you're not going to be able to get good conductivity in it. But if those bases are mismatched or if there is any other damage to the DNA, as can happen with damage that leads to cancer, the wire is interrupted and electricity will not flow properly."

Barton's team established that the electrons that comprise a flow of electricity can move from one end of a DNA strand to the other, just as they do through an electrical wire. In one recent advance, the team was able to send electricity down a 34-nanometer-long piece of DNA. That might not sound like much -- a nanometer is one-tenth the width of a human hair. But that is just the right scale for use in medical diagnostic devices and biosensors to pick up on mutations, or changes, in DNA that could lead to cancer and other diseases.

Barton's research suggested that DNA uses its electrical properties to signal repair proteins that fix DNA damage. If the DNA is no longer conducting electricity properly, that would be a signal for repair proteins to do their thing. Barton's team is applying that knowledge in developing "DNA chips," devices that take advantage of DNA's natural electrical conductivity and its ability to bind to other strands of DNA that have a complementary sequence of base units, and thus probe that sequence for damage. Such a DNA chip would help diagnose disease risk by changes in electrical conductivity resulting from mutations or some other damage.

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Science teachers spend week in Yellowstone studying climate change

A week in Yellowstone National Park with a bunch of climate scientists is how Shirley Greene, a biology teacher atLewis and Clark Middle School, spenther summer vacation.

"It's incredible," Greene said. "We've been talking to scientists, traveling around the park."

The teachers finished their week at the park onFriday. They'll return home just in time for classes to begin Wednesday, energized for the coming school year.

Greene attended the weeklong workshop with her husband, Steve Greene, who teaches earth science at West High and colleague Trish Loken, who also teachesbiology at Lewis and Clark.

The program at Yellowstone is part of the 12-park program called 2012 Parks Climate Change Challenge sponsored by the National Park Foundation.

Loken and the Greenes were part of a group of 15 public school teachers selected to attend the program at Yellowstone. Shirley Greene, a member of the Montana Science Teachers Association, found out about the programthrough the groupand applied.

The Parks Climate Change Challengeprogram is designed to help teachers develop engaging lesson plans, create hands-on service projects and plan field trips to help students better understand climate change and develop a strong connection to the national parks, said Al Nash, a Yellowstone National Park spokesman.

The group spent time with park scientists and staff from Montana State University covering everything from geology to biology.

Wednesday they learned about the vanishing biomes of the mountain pika, which has steadily moved its habitatup in elevation as temperatures increase.

"At some point you get to the top of the mountain and there's nowhere else to go,"Greene said.

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Couple of reasons to attend Pathology Visions 2012

 Just a couple of reasons to attend Pathology Visions 2012:

KENNETH BLOOM

IMPLEMENTING A HIGH VOLUME DIGITAL PATHOLOGY REFERENCE LABORATORY

Bio
Kenneth_BloomDr. Bloom is Chief Medical Officer of Clarient a GE Healthcare company, Medical Director of Clarient Diagnostic Services and President of Clarient Pathology Services. Dr. Bloom specializes in pathology with a special interest in breast disease and esoteric testing including immunohistochemistry, fluorescence in-situ hybridization and molecular analysis. Dr. Bloom has spent more than two decades serving in leadership and advisory roles for hospitals, medical schools and industry. He has been a prolific researcher and lecturer in the fields of pathology, cancer, telemedicine and informatics. While at Rush Dr. Bloom was a principle investigator in the design and implementation of the first commercial telepathology system as well as the information systems used for Anatomic Pathology, Surgery, Cancer Registry and Radiation Therapy. Dr. Bloom is a member of the College of American pathologists and serves as a member of the Technology Assessment Committee Personalized Healthcare Committee.

Abstract
Clarient has been a leader in digital pathology since its start in 2004. We digitize over 2000 slides each day utilizing a variety of commercial scanners for diagnostic, prognostic and predictive indications. Approximately 50-60 consults are reviewed each day by a combination of our internal pathology team, remote Clarient pathologists and our network of academic pathologists around the country. Consultation slides are scanned at 20X magnification and reviewed on-line utilizing our proprietary viewer. Since all slides are digitized, real time consultation with clients and pathologists across the country is routine. Prognostic and predictive testing is performed on over 30,000 breast cancer cases each year, and most of our clients choose to utilize image analysis algorithms to aid them in their interpretation. An expanding portfolio of non-breast prognostic and predictive markers are being added these markers become relevant to patient care. I will discuss the issues that we faced building and then scaling a digital pathology service. Our analysis of scanners, viewers, image analysis software and image storage will be presented.

Objectives
1) Define the components of a digital pathology system.

2) Describe the pros and cons of available digital pathology solutions.

3) Understand the process of implementing a digital pathology solution in a CLIA laboratory.

 

 

 

 

 

PRASHANT BAVI

USE OF DIGITAL PATHOLOGY SIGNIFICANTLY IMPROVES THE QUALITY OF TISSUE MICROARRAY CONSTRUCTION

Bio
PbPrashant Bavi is a research pathologist at Research Centre, King Faisal Specialist Hospital, Riyadh, Saudi Arabia. He has a successful track record of over 50 publications in high impact peer reviewed journals and more than 70 presentations in international meetings. With 12 years of experience, he is well versed in oncology, biobanking, digital pathology, translational research & lab administration. Over the years, he has developed a diverse set of skills in anatomical pathology, molecular pathology, data management & biomarker validation. Other areas of his competence are scientific writing including reviewing manuscripts & serving on the editorial board. An avid proponent of digital pathology, he firmly believes in inculcating principles of productivity & time management such lateral thinking, mind mapping & “Getting Things Done” in research & diagnostic pathology. His long-term goals are harvesting the best quality samples, participate in meaningful biomarker discovery & making an impact on personalized medicine.

Abstract
Background: In the last decade, tissue microarray(TMA) has been established in translational cancer research as a high throughput tool. Similar to digital pathology, traditional purists took time to adopt TMAs as a tool in biomarker discovery and validation; teaching and as a IHC control for validation. Technology transfer, setting aside funds to purchase an arrayer, and dedicated personnel to map slides and construct TMA are still major bottle necks. Final quality of a constructed TMA depends on the yield of slides and the number of representative cores arrayed. Study of rare events in pathology pose a particular challenge for the lab personnel to accurately identify the area of interest by superimposing the slide on the paraffin block before extracting the tissue core. Therefore, we studied the effect of digital pathology in mapping the region of interest and constructing TMA’s.

Methods: We constructed two identical TMA blocs of 0.6mm diameter from 50 rare histological events that included R&S cells from Hodgkin’s lymphoma, multifocal microscopic carcinoma in thyroid and lymphovasuclar embol/perineural infiltration in colorectal carcinoma. One array block was done in the traditional way and the other array we did digital mapping of scanned images from slides, printing the life-sized images. Slides were scanned with Aperio ScanscopeCS; mapping done with Imagescope and TMA constructed using Semiautomated Arrayer, CM1 Mirlacher, Neuenburg, Germany. Using a image manipulation program IrfanView, we printed the images in the same aspect ratio as it was scanned on a semi-transparent paper.

Results: Preliminary results of 10 microscopic multifocal papillary thyroid carcinoma showed a 100% accuracy in picking up the microscopic lesions as compared to 60% with the traditional approach. Remarkably accuracy was associated with a increase in speed.

Conclusions: Modifying the process of TMA construction by embracing digital pathology is beneficial and should be adopted routinely. The tangible benefits are:(i) improved accuracy; (ii) saves time (iii) increases the speed; (iv) potentially reduces errors of misidentification and (v) frees up the lab technician to be utilized for other tasks.

Objectives
Although tissue microarray technology, as a high throughput tool, has revolutionized biomarker discovery in translational research, it has some key bottlenecks. Digital pathology has been used in IHC quantification. However, there is a potential of using scanned images for constructing tissue microarrays Embracing of these 2 technologies has immediate tangible benefits of improvement in speed, accuracy, saving of time and freeing up scarce technical staff. In addition this methodology reduced risk of misidentification and provides robust documentation of mapped images on for future usage.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Breaking News: Federal Appeals Court Once Again Upholds Gene Patents, Invalidates Comparison Method Patents

The U.S. Court of Appeals for the Federal Circuit announced that it once again partially reversed a lower court’s ruling in the Myriad gene patent case. In a 2-1 decision, the federal court of appeals ruled that companies can patent genes, but cannot patent methods to compare those gene sequences.

This is the second time the Federal appeals court has considered this lawsuit. The Supreme Court vacated this court’s July 2011 decision following the high court’s unanimous ruling in favor of Mayo Collaborative Services in its medical patent suit against Prometheus Laboratories. The Supreme Court then remanded it back to the Federal appeals court in light of the Mayo decision.

The American Civil Liberties Union (ACLU) is representing plaintiffs (including the CAP) in a suit challenging gene patents on human DNA, specifically Myriad Genetics’ patent claims on BRCA 1 and BRCA 2 genes. CAP and other medical societies and organizations provided amicus briefs in support of Mayo at various points in the litigation.

“It is extremely disappointing that despite the Supreme Court’s ruling, the appeals court has failed to fully re-consider the facts of this case,” said ACLU attorney Chris Hansen. “This ruling prevents doctors and scientists from exchanging their ideas and research freely. Human DNA is a natural entity like air or water. It does not belong to any one company.”

The ACLU declined to comment on what this means for the future of the case, except to say their attorneys are weighing all legal options and will discuss future strategies with the plaintiffs.

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Should/Could the FDA Regulate Whole Slide Imaging as a Class II Device?

Frequent readers and those who have heard me speak publicly on the topic of government regulation and oversight of whole slide imaging recognize that I really do not think that manufacturers need a stamp of approval from the FDA to the effect that "FDA Approved for Primary H&E Diagnosis" on their claims and marketing materials.  Perhaps manufacturers think they do because their sense is that more and more pathologists will in fact buy the technology if it indeed has that stamp of approval that the agency concerned with regulating food, drugs and devices in the bests interests of patient safety and assuring apprropriate risk:benefit ratios says it is OK to use for primary diagnosis.

With that being said, we now know it is unlikely that these devices will be regarded as Class I devices (see below).  As they will not be regarded as Class I, I think the device or instrument in question is then regarded as a Class III device requiring pre-market approcal "for which insufficient information exists to assure safety and effectiveness solely through the general or special controls sufficient for Class I or Class II devices" (see below according to The FDA Class Classification).

Why then could whole slide imaging devices/systems not be regarded as Class II?  

FDA_salmonellaLet's assume with whole slide imaging is regarded as being higher risk for potential injury or harm than a Class I device historically and essentially, according to the definition, "for which general controls alone are insufficient to assure safety and effectiveness, and existing methods are available to provide such assurances. In addition to complying with general controls, Class II devices are also subject to special controls. A few Class II devices are exempt from the premarket notification. Special controls may include special labeling requirements, mandatory performance standards and postmarket surveillance. Devices in Class II are held to a higher level of assurance than Class I devices, and are designed to perform as indicated without causing injury or harm to patient or user."

Don't we actually have this with digital pathology today?  Special labeling requirements, i.e. certain stains from certain vendors for purposes of prognostic and therapeutic testing (ER, PR, HER2, Ki-67), mandatory performance standards, i.e. constant review, quality assurance, correlations and peer reviews in surgical pathology, a degree of scrutiny unrivaled in any specialty in medicine in terms of self-auditing ourselves and lastly, postmarket surveillance. Here we have 100s of papers written with 1000s of cases studied in peer-reviewed literature and decades worth of experience as a specialty.  In a recent survey on digital pathology conducted, 20% of respondents  mentioned using digital pathology for primary clinical diagnosis.

Usesfordp

In a more recent follow up post on the survey a couple of weeks ago, there was discussion of the best use cases for digital pathology.  They are what this survey affirms, in my opinion, image analysis, i.e. ER/PR/HER2 scoring and second opinions/consultations/expert reviews.

Unless your practice is in New York and you are in Aspen, in which case you probably either need to move your lab or move yourself, I do not understand the need for "Primry H&E Diagnosis" by digital pathology.  The instances I can think of include in-office laboratories and the occassional times when you are in Aspen, 1000s of miles from your histology laboratory on a temporary basis.  Given the number of times of these occurrences and the number of slides produced and read in these types of practice settings, it is a very small percentage of the estimated tens of millions of slides produced annually in the United States.

Nonetheless, assuming we recognize more risk than the microscope itself in this instance (a Class I exempt device) and we are held to "special controls may include special labeling requirements, mandatory performance standards and postmarket surveillance", it would seem logical that whole slide imaging devices/systems be regarded as Class II and allow the market and practioners to define the nuances of these controls, standards and postmarket surveillance conditions.

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FDA Device Class Classification (as cut and pasted from Wikipedia):

The Food and Drug Administration has recognized three classes of medical devices based on the level of control necessary to assure the safety and effectiveness of the device.  The classification procedures are described in the Code of Federal Regulations, Title 21, part 860 (usually known as 21 CFR 860).

Class I: General controls

Class I devices are subject to the least regulatory control. Class I devices are subject to "General Controls" as are Class II and Class III devices. General controls include provisions that relate to adulteration; misbranding; device registration and listing; premarket notification; banned devices; notification, including repair, replacement, or refund; records and reports; restricted devices; and good manufacturing practices. Class I devices are not intended for use in supporting or sustaining life or to be of substantial importance in preventing impairment to human health, and they may not present a potential unreasonable risk of illness or injury. Most Class I devices are exempt from the premarket notification and/or good manufacturing practices regulation. Examples of Class I devices include elastic bandages, examination gloves, and hand-held surgical instruments.

Class II: General controls with special controls

Class II devices are those for which general controls alone are insufficient to assure safety and effectiveness, and existing methods are available to provide such assurances. In addition to complying with general controls, Class II devices are also subject to special controls. A few Class II devices are exempt from the premarket notification. Special controls may include special labeling requirements, mandatory performance standards and postmarket surveillance. Devices in Class II are held to a higher level of assurance than Class I devices, and are designed to perform as indicated without causing injury or harm to patient or user. Examples of Class II devices include powered wheelchairs, infusion pumps, and surgical drapes.

Class III: General controls and premarket approval

A Class III device is one for which insufficient information exists to assure safety and effectiveness solely through the general or special controls sufficient for Class I or Class II devices. Such a device needs premarket approval, a scientific review to ensure the device's safety and effectiveness, in addition to the general controls of Class I. Class III devices are usually those that support or sustain human life, are of substantial importance in preventing impairment of human health, or which present a potential, unreasonable risk of illness or injury. Examples of Class III devices which currently require a premarket notification include implantable pacemaker, pulse generators, HIV diagnostic tests, automated external defibrillators, and endosseous implants.

 

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GOP VP Candidate calls SGR “Ridiculous”

 Courtesy of ModernHealthcare Healthcare Business News

Rep Paul Ryan VP candidate
Ryan

Exclusive interview: Rep. Paul Ryan discusses need for 'market-based' health reform

Premium support an idea whose time has come, Ryan says

By Andis Robeznieks

Posted: August 14, 2012 - 12:45 pm ET
Wisconsin Rep. Paul Ryan's selection as the Republican vice presidential nominee has put Medicare reform back in the national spotlight, as Ryan's plans for transforming Medicare into a "premium support" system gain renewed attention.

Of particular significance is how Ryan's plan to offer beneficiaries federal payments to pick the health plan of their choice goes over with voters in Florida and Pennsylvania—two presidential battleground states with large Medicare-beneficiary populations.

Ryan, who finished first last year on Modern Healthcare's 100 Most Influential People in Healthcare list, was interviewed Aug. 2 by Modern Healthcare for an upcoming story, just nine days before presumptive GOP presidential nominee Mitt Romney announced that the 42-year-old member of the House Ways and Means Committee would be his running mate.

In the interview, Ryan emphasized that premium support wasn't only his idea or a Republican idea. He pointed out that he proposed last year's Medicare-reform plan jointly with Oregon Democrat Sen. Ron Wyden. Premium support's origins, he added, can be traced to President Bill Clinton's 1999 Bipartisan Commission on the Future of Medicare and its Democratic co-chair, Rep. John Breaux of Louisiana.

"This is an idea whose time has come," Ryan said. "And it's a bipartisan idea."

Ryan acknowledged that the idea takes some getting used to and said he knew that Congress would not pass last year's proposal.

"What Ron Wyden and I tried to do was to plant the seeds of a bipartisan consensus," Ryan said. "We knew we weren't going to pass it because of the politics. We did this together to get the consensus-building started."

To that end, Ryan said the plan's chances for approval will greatly improve next year.

"I'm actually pretty optimistic," he said.

Ryan said he heard from "some of his doctor friends" at the Wisconsin Medical Society that his plan was the subject of heated debate at the annual American Medical Association House of Delegates meeting in June and that he has had "years of conversations" about premium support with physicians in his state.

“I think it's a good debate,” he said. Medicare, Ryan said, can go in two directions: toward government-directed price controls as dictated by the Independent Payment Advisory Board or toward premium support, which he said "keeps the patient-doctor relationship intact."

"That to me is the best way to deal with costs and save this program," Ryan said. "Competition does work."

Ryan said he envisions a risk-adjusted program in which beneficiaries who need more support get it and said that risk adjustment is "something CMS knows how to do."

"Physicians are also involved in getting proper incentive alignment focused on quality and cost," Ryan stated. 

“This will help everyone: Sick or healthy, wealthy and poor,” he added. “We can put society's assets where they need to go and emerge from that with a system that is in keeping with our goals of innovation, competition and quality improvement.”

Ryan also said the U.S. should undertake healthcare reform on its own and "fix this on our terms" instead of borrowing ideas from Europe.

"We believe there are far superior ways to get back to a patient-centered healthcare system, the nucleus of which is the patient and her doctor—and not the government," Ryan said. "We believe consumer-driven, market-based reforms do more to alter the cost curve of healthcare inflation."

Ryan said price controls won't bend the healthcare inflation cost curve and would lead to rationing of services.

Ryan credited his selection last year as the most influential person in healthcare to his having had a seat on the House Ways and Means Committee since 2001 and used that position to focus on the healthcare system's impact on health outcomes and economic and social issues.

"It's just something I've immersed myself in," Ryan said. "What a lot of policymakers have failed to grasp is how important healthcare is to our economy and to our future."

Ryan also predicted that Congress would approve another temporary postponement of a physician Medicare payment cut in January of around 30% under the sustainable growth-rate formula used to calculate reimbursement.

"I think the SGR is ridiculous and should have been replaced long ago," Ryan said, adding that he hopes to replace the SGR next year with a formula that furnishes doctors with something predictable and accountable so that "we don't have this can-kicking exercise every six months."

While the SGR has not worked, Ryan said something worse lurks ahead.

“I always say to the doctors, 'If you don't like the SGR, just wait until you see what the IPAB has in store,'” Ryan said.

Read more: Exclusive interview: Rep. Paul Ryan discusses need for 'market-based' health reform, Premium support an idea whose time has come, Ryan says | Modern Healthcare 

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Leslie F. Greengard, M.D., Ph.D., Appointed to AccelPath Medical Advisory Board

AccelPath, Inc. (ACLP) (“AccelPath” or the “Company”) announced today that Professor Leslie F. Greengard, M.D., Ph.D., has been appointed to the Company’s Medical Advisory Board.

Professor Greengard is a Professor of Mathematics and Computer Science at the Courant Institute of Mathematical Sciences at New York University. He received his B.A. degree in Mathematics from Wesleyan University in 1979, his M.D., and Ph.D. degree in Computer Science, from Yale University in 1987. He has been at the Courant Institute since 1989, and served as the director of the Institute from 2006-2011.

Research in Professor Greengard's group is largely focused on developing fast and adaptive algorithms for computational problems in biology, chemistry, materials science, medicine, and physics. He is best-known for having developed the fast multipole method (FMM) during the 1980s with Professor V. Rokhlin, which is now widely used in electromagnetics, astrophysics, molecular simulations, and fluid dynamics. He currently works on protein design, the analysis of "metamaterials," electromagnetic theory, diffusion in complex geometry, and magnetic resonance imaging.

Professor Greengard has been an NSF Presidential Young Investigator and a Packard Foundation Fellow. He received the Leroy P. Steele Prize from the American Mathematical Society in 2001 and the Sokol Faculty Award in the Sciences from NYU in 2004. In 2006, he was elected to both the National Academy of Sciences and the National Academy of Engineering.

“After numerous discussions with AccelPath’s management and board members, I am pleased to join the Company’s Medical Advisory Board,” stated Professor Greengard. “The Company is on an exciting road of implementing digital telepathology networks in the US and abroad. The Company also has powerful 3D imaging technology with multiple applications in medicine. I look forward to contributing to the Company’s ongoing successes.”

“We are very pleased to have formalized a collaborative relationship with Professor Greengard,” stated Shekhar Wadekar, AccelPath’s Chairman and Chief Executive Officer. “Professor Greengard’s expertise in developing fast and adaptive algorithms is a key component to enhancing efficiencies in digital whole slide imaging and 3D imaging. Professor Greengard will help enhance the Company’s proprietary 3D digital imaging technology, which has several medical applications. This 3D imaging technology was acquired as part of the Company’s acquisition of Technest Holdings in 2011. We will continue to exploit the value of this technology, as it relates to non-core applications, while pursuing our core business of digital telepathology and the applications for this technology in medicine.”

Source: AccelPath

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For Most Older Women with Early Stage Breast Cancer, Radiation after Lumpectomy Helps Prevent Need for Subsequent Mastectomy

Contrary to clinical recommendations, older women with early stage breast cancer may want to undergo radiation after lumpectomy to help ensure that they will not need a mastectomy in the future. That is the conclusion of a new study published early online in CANCER, a peer-reviewed journal of the American Cancer Society. The findings indicate that current thinking on the risks and benefits of radiation for early stage breast cancer in older women may be inaccurate.

National treatment guidelines state that older women with early stage breast cancer that has not spread to the lymph nodes and that is driven by estrogen in the body can be treated with lumpectomy and estrogen blockers without the need for radiation. Benjamin Smith, MD, of The University of Texas MD Anderson Cancer Center in Houston, and his colleagues evaluated information on 7,403 women aged 70 to 79 years who were treated with lumpectomy for such breast cancers between 1992 and 2002 and whose data were contained in the Surveillance, Epidemiology, and End Results-Medicare database, which links cancer registry information to a master file of Medicare enrollment. Approximately 88 percent of these women received radiation after their lumpectomy.

When the investigators looked to see what happened to these women after their breast cancer was treated, they found that within 10 years after treatment, 6.3 percent of women who did not get radiation eventually had their breast removed by mastectomy, compared with only 3.2 percent of women who received radiation. The reasons for mastectomy are not reported by this dataset, but the most likely reason for mastectomy in this patient group is recurrence of cancer in the breast. The researchers were also able to identify which women were more and less likely to benefit from radiation. Specifically, radiation did not seem to benefit women ages 75 to 79 years with non-high grade tumors (which contain cells that look only moderately abnormal under a microscope), suggesting that this group can probably skip radiation. Patients with high grade tumors (which contain very abnormal-looking cells), regardless of age, seemed to derive the most benefit from radiation.

“These data are important because they suggest that radiation is likely of some benefit to certain women where national guidelines say that radiation is not needed,” said Dr. Smith. “Our data could be helpful to women when they decide whether or not to undergo radiation,” he added.


Article: “Effectiveness of radiation for prevention of mastectomy in older breast cancer patients treated with conservative surgery.” Jeffrey M. Albert, I-Wen Pan, Ya-Chen Tina Shih, Jing Jiang, Thomas A. Buchholz, Sharon H. Giordano, and Benjamin D. Smith. CANCER; Published Online: August 13, 2012 (DOI: 10.1002/cncr.27457).

Author Contact: Laura Sussman of The University of Texas MD Anderson Cancer Center’s media relations office at lsussman@mdanderson.org, or +1 (713) 745-2457.

CANCER is a peer-reviewed publication of the American Cancer Society integrating scientific information from worldwide sources for all oncologic specialties. The objective of CANCER is to provide an interdisciplinary forum for the exchange of information among oncologic disciplines concerned with the etiology and course of human cancer. CANCER is published by Wiley and can be accessed online at http://wileyonlinelibrary.com/journal/cancer.

CANCER News Alert
NOTE: The information contained in this release is protected by copyright. Please include journal attribution in all coverage. A free abstract of this article will be available via the CANCER News Room upon online publication. For more information or to obtain a PDF of any study, please contact:
Jennifer Beal (UK) +44 (0) 1243 770633
Ashley Fontillas (US) 201-748-6035
sciencenewsroom@wiley.com

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Closing Party for the Great Coney Island Spectacularium and the Cosmorama of the Great Dreamland Fire, Saturday August 25th, 8:00 PM, The Coney Island Museum

I would like to cordially invite all Morbid Anatomy readers to join us in bidding farewell to the sadly ephemeral Great Coney Island Spectacularium and Cosmorama of the great Dreamland Fire. The exhibition--more on which here--will end after Labor Day weekend, so this is one of your last chances to see it. So please, come raise a glass with us, surrounded by the unfortunate taxidermy once on view at one of the oldest dime museums in the Americas, the Niagara Falls Museum. Join us for a beer in the soon to be dismantled and utterly transporting Cosmorama of the great Dreamland Fire! Help us kiss the lovely toy theater proscenium farewell!

The party will take place next Saturday, August 25th at The Coney Island Museum; There will be free beer and wine, including a special Dreamland Fire Brew, hand-crafted by our friends at the Coney Island Brewery and wine by Red Hook Winery. Artists will be in attendance, as will special guest performers. AND rogue musician Nick Yulman will perform original scores using mechanical instruments for two 1926 films, Now You Tell One and A Wild Roomer by silent comedian and stop-motion animation innovator Charlie Bowers.

The event begins at 8:00 PM; the film will begin at 8:30pm. $20 in advance or at the door. Advance Tickets here. Hope very much to see you there!

You can find out more by clicking here.

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Dried Cadavers on Display in a "Terrible Example of Tyranny," Ferdinand I, Fifteenth Century Naples

In an interesting 15th century precursor to spectacular displays of human bodies such as Gunther von Hagen's Body Worlds:

Ferdinand I [of Naples (1423 – 1494)], Alfonso II's long-reigning father, had filled an exhibition hall of Castel Nuovo with the mummified remains of his enemies. Paolo Giovio, the sixteenth-century bishop, doctor, and biographer, writes in Historiarum sue temporis: "They say that these dried cadavers were displayed, pickled with herbs, a frightful sight, in the dress they wore when alive and with the same ornaments, so that by this terrible example of tyranny, those who did not wish to be similarly served might be properly afraid."

Just one of the fascinating revelations in the wonderful book Naples Declared: A Walk Around the Bay, by Benjamin Taylor. Another writer--Jacob Burckhardt, in his The Civilization of the Renaissance in Italy of 1878 --described it thusly:

Besides hunting, which he practiced regardless of all rights of property, his pleasures were of two kinds: he liked to have his opponents near him, either alive in well-guarded prisons, or dead and embalmed, dressed in the costume which they wore in their lifetime. Fearing no one, he would take great pleasure in conducting his guests on a tour of his prized “museum of mummies.”

And wow; looks like this made an appearance on The Borgias as well; I guess I had better consider giving that show another chance.

Image source: Wikipedia

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Wax Model of a Decomposing Body in a Walnut Coffin, Italy, 1774-1800, The Science Museum, London

Wax model of a decomposing body in a walnut coffin, Italy, 1774-1800

The body in this wooden coffin is in a severe state of decomposition. It may have had two purposes: as ‘memento mori’, a reminder of death, or as a teaching aid. The figure is surrounded by three frogs. Frogs are symbols of rebirth and regeneration because they change so much in their lifetimes. Wax modelling was used in Europe to create religious effigies. From the 1600s, they were also used to teach anatomy. The creation of wax anatomical models, centred in Italy, was based on observing real corpses. The museum known as La Specola, or ‘the observatory’, in Florence was famous for its wax collection.

Found in the always delightful Macabre and Beautifully Grotesque Facebook Group.

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"A Healthy Mania for the Macabre," Stephen T. Asma, The Chronicle for Higher Education

The new morbid curiosity... may be a pendulum swing back toward the sublime and the philosophical—a new secular foray into the morbid territory that religion previously charted. One way to avoid deeper engagement with death is to paint it entirely from the crude palette of emotions like disgust and fear. We've already got plenty of that kind of "morbid" in popular culture. But awe and wonder need to be restored to our experience of death, and we're not sure how to do it in a post-religious culture.

--"A Healthy Mania for the Macabre," Stephen T. Asma, The Chronicle for Higher Education

The above is excerpted from a characteristically thoughtful and erudite piece by Stephen Asma, one of my all-time favorite scholars and author of the fantastic Stuffed Animals and Pickled Heads. The piece--entitled "A Healthy Mania for the Macabre"--explores the current uptick of interest in all things macabre, and situates it within the history ofspectacular morbid display from memento mori to Frederik Ruysch to Gunther von Hagens; It also features interesting quotations from interviews with morbid art collector Richard Harris, charnel house obsessive and Empire of Death author Paul Koudounaris, and yours truly.

You can read the entire article by clicking here. I very highly recommend it!

Image: Clemente Susini (probably): Slashed Beauty, wax, human hair, pearls, rosewood and Venetian glass case, ca 1790, La Specola, Museo di Storia Naturale, Florence, Italy; From the Anatomical Theatre exhibition

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On the Lighter Side: Comcast worth its weight in Golden Poo

One of the great things about living in America is having the opportunity to interact with great societal institutions that are dedicated to the educational advancement, cultural enrichment and spiritual enlightenment of the human race.

Such as the cable company.

The specific cable company to which I refer is Comcast, but I hold a similar level of admiration for all cable companies. Frankly, they are marvels of organization, competence and genuine concern for the welfare of the various population bases that they serve.

It was thus with great reluctance that we recently parted company with Comcast, at least in regard to its provision of cable television service to our domicile. We still get their Internet service. At least as of this morning.

For those of you not familiar with Comcast, it is a 47-year-old company headquartered in Philadelphia. It is the largest provider of cable television and home Internet service, and the third-largest provider of home telephone service, in the known galaxy.

In 2010, Comcast was honored by The Consumerist a sub-subsidiary of Consumer Reports as the worst company in America. In 2011, it lost the Golden Poo Award to oil giant BP, and this year to EA, the video game maker. I for one believe it is quite possible the 2011 and 2012 results were rigged.

The reason my wife and I decided to cancel our cable TV service from Comcast, and replace its entertainment amenities with a used Scrabble game and some postcards of the Circus World Museum in Baraboo, Wis., was what in divorce cases they delicately call "irreconcilable differences."

These differences centered on Comcast insisting that in return for more money every month, it would provide us with less product. For approximately $100 a month, we had a choice of entertainment venues that included a "travel" channel in which various people travel around for no apparent reason other than to eat fried insects; a food channel in which people who look suspiciously like the people on the travel channel share recipes for fried insects; and 135 channels imploring us to buy sequined luggage sets or faux topaz bowling balls.

I actually don't know what we paid for cable, because it was "bundled" with our Internet service. "Bundling" is a cable company term meaning "mind your own business." There were also charges for "modem rental," "digital box interface" and "oxygen molecule tax."

Now, you would think that a company with billions of customers wouldn't care if a lowly Sacramento couple wanted to drop its service. You would be wrong. Comcast clearly did not want us to leave. I think it was a pride thing. I think that Consumerist Golden Poo Award really stung. I practically had to beg.

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On the Lighter Side: Comcast worth its weight in Golden Poo

Space bugs for blood testing and more

Thanks to ideas of putting swarms of tiny robot bugs to work on a future space station, patients being medicated for blood clots may soon get a simple, home-use testing kit, here on Earth. Fifteen years ago as a graduate student, Vladislav Djakov started building these micro-electromechanical creatures that mimic the swarms of bugs found in nature.

Equipped with a power supply, limited intelligence and monitoring systems, the bugs would be small enough to send en masse to hard-to-reach places, like pipes carrying liquids on space stations.

There, monitoring changes in temperature or flow could warn of impending malfunctions.

To move the bugs, the scientist hit on using cilia-like motion, much like some deep-sea creatures use to propel themselves. They covered one face of the microchip with tiny cantilever arms.

"They would then move along on these like millipedes," said Dr Djakov, now Director of Sensor Development at Microvisk Technologies.

In the end, the space bugs were ahead of their time: they haven't yet progressed past the testing phase.

But the cilia approach - the cantilever arms to propel the bugs - has gone further.

Space cantilevers spin off STFC Innovation, ESA's Technology Transfer Programme partner that operates the agency's Business Incubation Centre Harwell in the UK, saw the business potential in the medical market and supported start-up company Microvisk to spin off the technology.

At Microvisk, Dr Djakov's team stripped down the microchips and put the intelligent sensing mechanisms right into the cantilever arms, almost like a cat's whiskers.

These whiskers turned out to be very good at monitoring liquids. Sweeping through, they note changes in viscosity and register if anything is suspended in the liquid.

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Space bugs for blood testing and more