Bringing nanotechnology to market

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Northeastern University's Nanoscale Science and Engineering Center for High-rate Nanomanufacturing (CHN) has received a $2 million grant to help commercialize nanotechnology and put smaller, more energy efficient electronic devices in the hands of consumers more quickly.

Arizona Telemedicine Program Receives State Medical Association Award

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Congratulations to Drs. Weinstein and Lopez and their colleagues at teh University of Arizona and Arizona Telemedicine Program. The scale of this program and the number served as part of a public health initiative is an example for other states and universities.

Ronald S. Weinstein, MD, FCAP, director, and Ana Maria López, MD, MPH, FACP, medical director, of the Arizona Telemedicine Program (ATP) at the University of Arizona College of Medicine, have been honored with Distinguished Service Awards by the Arizona Medical Association (ArMA).

 

Distingsvcawards The ArMA Distinguished Service Awards are given to individuals or organizations providing outstanding service to the community individually or collectively.

 

“In the last 15 years, Arizona has seen the development of a robust telemedicine program in our state, and these two physicians have been vital to its development and success,” notes ArMA president Gary R. Figge, MD, who presented the awards on June 4 at the ArMA 2010 President’s Banquet. “The work of these two physicians has indisputably demonstrated their service and dedication to the Arizona community.”

 

Telemedicine is the use of telecommunications technology to provide health-care services to patients who are geographically separated from a physician or other health-care providers. Since Drs. Weinstein and López began their work, the ATP has emerged as one of the largest telemedicine programs in the world and has received numerous national and international awards for its patient services, distance education programs, research and innovations. Patients in 70 communities statewide have received more than one million teleconsultations facilitated by the ATP. This year, 500 hours of continuing medical education and continuing education will be delivered to 34 communities using bi-directional video conferencing.

 

Dr. Weinstein is foundingdirector of the ATP and UA professor of pathology and public health. In 1996, he and Arizona state Rep. Robert “Bob” Burns (now state senate President Burns) established a pilot telemedicine program in Arizona. This initially consisted of eight pilot sites and included the establishment of telemedicine clinics in underserved rural communities, several Indian Health Service hospitals, and at an Arizona State Prison in Yuma. Since then, the ATP has created a large statewide broadband health-care telecommunications network, which it operates, linking dozens of health-care organizations in Arizona for the first time.

 

Dr. Weinstein also has been recognized for his innovations in the fields of pathology and telepathology and for creating a number of innovative education programs and courses. A Massachusetts General Hospital-trained pathologist and Harvard-trained cancer scientist, he served for 32 years as an academic pathology department chairman. While chairman of the Department of Pathology at Rush Medical College in Chicago (1975-1990), he developed robotic telepathology, introduced the word “telepathology” into the English language and authored a stream of scientific papers and books on telepathology. As chair of the Department of Pathology at the UA (1990-2007), he established an international telepathology diagnostic network and validated the diagnostic accuracy of telepathology. He is known as the “father of telepathology” and recently received the Eliphalet Nott Medal from Union College (Schenectady, New York), which recognizes “the perseverance of alumni who have attained great distinction in their field.” Previous Nott Medal Awardees have included a Nobel Laureate and the inventor of the laser. Dr. Weinstein has had a career-long interest in organized medicine and has had many leadership roles. He is past president of five national professional societies, including the United States and Canadian Academy of Pathology, the International Society for Urologic Pathology (ISUP) and the American Telemedicine Association (ATA). He has received Distinguished Service Awards from both the ATA and the ISUP. Dr. Weinstein also has been an innovator in other areas. He and Richard A. McNeely, former director of Biomedical Communications at the Arizona Health Sciences Center, co-designed the T-Health amphitheater in Phoenix. The T-Health amphitheater received the 21st Century Achievement Award, Education and Academia, from the Computerworld Honors Program. Dr. Weinstein is the author or co-author of more than 500 scientific articles, book chapters, monographs and published abstracts. A popular teacher, Dr. Weinstein is a recipient of the UA Basic Science Teacher-of-the-Year Lifetime Teaching Award and has been honored at five UA College of Medicine graduation ceremonies.

 

Dr. López is founding medical director for the ATP. She also is associate dean for outreach and multicultural affairs at the UA College of Medicine, UA professor of medicine and pathology, and a member of the Arizona Cancer Center and the UA BIO5 Institute. She serves on the board of directors of University Physicians Healthcare, the non-profit corporation created in 1985 as the medical practice of the physicians of the UA College of Medicine. She also serves as elected governor of the Arizona chapter of the American College of Physicians. In 2005, the National Library of Medicine recognized her as a Local Legend as part of a program highlighting the positive, enduring contributions of women physicians nationally to the health care of their communities.

 

Drs. Weinstein and López have continuously collaborated on developing and managing innovative academic programs since 1990, when Dr. López was chief resident in medicine at University Medical Center.

 

About the Arizona Telemedicine Program

 

Established in 1996, the Arizona Telemedicine Program (ATP) is a large, multidisciplinary, university-based program that provides telemedicine services, distance learning, informatics training and telemedicine technology assessment capabilities to communities throughout Arizona and in neighboring states. A division of the ATP, the Institute for Advanced Telemedicine and Telehealth (T-Health), is housed in the historic Phoenix Union High School building on the campus of the University of Arizona College of Medicine – Phoenix. One of the nation’s first regional demonstration learning centers, T-Health incorporates both telemedicine and telehealth – distance learning and health care delivery – using a wide range of technologies, including real-time videoconferencing, electronic transmission of digital medical images and data and the Internet. For more information, visit the website, http://www.telemedicine.arizona.edu

 

About the Arizona Medical Association

 

The Arizona Medical Association is a voluntary membership organization for Arizona physicians. The mission of the Arizona Medical Association is to promote and provide leadership in the art and science of medicine; to preserve and improve the health of all people in Arizona by developing and maintaining the highest standards; to represent the physician and the profession in the public forum; and to defend the freedom and ability of the physician to practice medicine in the best interests of the patient.

 

Original story link: http://opa.ahsc.arizona.edu/newsroom/news/2010/arizona-telemedicine-program%E2%80%99s-drs-weinstein-and-lopez-receive-distinguished-serv

Tonight at Observatory! "Morbid Ink: Field Notes on the Human Memorial Tattoo" with Dr. John Troyer

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Morbid Anatomy presents at Observatory Tonight (!!!), July 20th. Hope to see you there!

Morbid Ink: Field Notes on the Human Memorial Tattoo
An Illustrated lecture with Dr. John Troyer, Deputy Director, Centre for Death and Society, University of Bath
Date: Tuesday July 20th
Time: 8:00
Admission: $5
Presented by Morbid Anatomy

In 1891, Samuel F. O’Reilly of New York, NY patented the first “…electromotor tattooing-machine,” a modern and innovative device that permanently inserted ink into the human skin. O’Reilly’s invention revolutionized tattooing and forever altered the underlying concept behind a human tattoo, i.e., the writing of history on the body. Tattooing of the body most certainly predates the O’Reilly machine (by several centuries) but one kind of human experience remains constant in this history: the memorial tattoo.

Memorial tattooing is, as Marita Sturken discusses the memorialization of the dead, a technology of memory. Yet the tattoo is more than just a representation of the dead. It is a historiographical practice in which the living person seeks to make death intelligible by permanently altering his or her own body. In this way, memorial tattooing not only establishes a new language of intelligibility between the living and the dead, it produces a historical text carried on the historian’s body. A memorial tattoo is an image but it is also (and most importantly) a narrative.

Human tattoos have been described over the centuries as speaking scars and/or the true writing of savages; cut from the body and then collected by Victorian era gentlemen. These intricately inked pieces of skin have been pressed between glass and then hidden away in museum collections, waiting to be re-discovered by the morbidly curious. The history of tattooing is the story of Homo sapiens’ self-invention and unavoidable ends.

Tattoo artists have a popular saying within their profession: Love lasts forever but a tattoo lasts six months longer.

And so too, I will add, does death

Dr. John Troyer is the Death and Dying Practices Associate and RCUK Fellow at the Centre for Death and Society at the University of Bath. He received his doctorate from the University of Minnesota in Comparative Studies in Discourse and Society in May 2006. From 2007-2008 he was a Visiting Assistant Professor in the Department of Comparative Studies at The Ohio State University teaching the cultural studies of science and technology. Within the field of Death Studies, he analyzes the global history of science and technology and its effects on the dead body. He is a co-founder of the Death Reference Desk website and his first book, Technologies of the Human Corpse, will appear in spring 2011.

You can find out more about this presentation here. You can get directions to Observatory--which is next door to the Morbid Anatomy Library (more on that here)--by clicking here. You can find out more about Observatory here, join our mailing list by clicking here, and join us on Facebook by clicking here.

Californians give a whoop – or I hope they do.

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I’m certain by now many of our readers have come across news of the current pertussis, aka whooping cough, epidemic in California.  Beginning this February and accelerating dramatically through May and June, California has so far seen a ~500% increase in pertussis cases compared to last year, and only two days ago announced the death of a sixth baby from infection.  Public health officials in California are currently working to control its spread and determine the factors that allowed this outbreak to occur, unfortunately, at this time the available data is very rough.

The number of confirmed cases as of 6/30/2010 is growing rapidly (1,377), with an additional ~700 cases pending investigation.  General geographic location, ages, and ethnicity have been identified, and general vaccination rates and exemption rates are known, but other important demographic and epidemiologic data, including vaccination status of infected children and adults, has yet to be fully described.  Lack of data notwithstanding, I have read equally hasty stories and comments blaming the outbreak on vaccine refusal, a large immigrant population, an inadequate adult vaccination program, and normal cyclical variation in pertussis incidence, among other factors.  Finding where the system has broken down enough to allow this resurgence is exceedingly important, but in this situation pointing fingers is not as important as taking action.

Pertussis

A bit of background first.  Pertussis is a highly contagious infection of the respiratory tract by a bacteria Bordetella pertussis.  After an incubation period of 7-10 but up to 42 days, the disease progresses through three stages.  The catarrhal stage is often indistinguishable from the symptoms of the common cold, with runny nose, mild cough, and lasts 1-2 weeks.  During the second or “paroxysmal” stage infected people will have fits or “paroxysms” of uncontrollable rapid-fire coughing.  Examples can be seen here (caution, may be disturbing to watch). At the end of these paroxysms people take a large, rapid intake of breath through raw and often partially closed vocal cords, producing a high-pitched “whoop.”  The paroxysmal stage can last anywhere from 1-6 weeks.  The final stage is one of prolonged convalescence with a persistent dry cough lasting weeks to months (this is where pertussis got its other name, the “hundred day cough”).

A persistent cough isn’t the worst of pertussis.  60% of children under 6 months of age infected with pertussis need to be hospitalized, 5-10% get pneumonia, 1 in 125 have seizures, and 1 in 1000 suffer from an encephalopathy (inflammation of the brain) that frequently causes permanent brain damage.  And of course pertussis can kill.  Children under 3 months of age are at the greatest risk, and make up 84% of all pertussis related deaths.

Treatment is possible, but limited in utility.  Even though pertussis is bacterial and we have multiple antibiotics that reliably kill it, treatment after the first stage (when it becomes clear someone has more than a cold) only limits the ability of a person to spread it to others, it does not reduce the severity or length of the disease.  Once symptoms start, we are forced to ride out the illness.  Prevention is far better than treatment.  And speaking of prevention…

The Vaccine

The first vaccine to prevent pertussis was licensed in the US in the 1940s.  At that time we had an average yearly of 157 per 100,000 people, though this is likely to be a low-ball figure, given the state of medicine at the time and under-reporting.  From its release through the 1970s we saw a steady drop in cases from the pre-vaccination rate of 157 down to <1 infection per 100,000 people per year.  Though effective, the original vaccine had multiple side effects, including inducing a febrile seizure in 1 in 10,000 children.  These serious complications were enough to begin to undermine the public trust in the vaccine in the US, and to prompt several countries to stop pertussis immunization entirely.

In the 1980s and 90s several countries ceased or severely curtailed their use of DTP, including Japan, Sweden, and the UK.  Each of them saw a sharp and immediate rise in pertussis incidence to levels 10-100 times that of countries that continued to have high rates of vaccination with DTP.  This is a pattern we see repeated time and again when vaccines are withdrawn; it represents one of the best and most tragic demonstrations of vaccine efficacy you could ask for.

Effectiveness aside, the original DTP vaccine had legitimate problems, so a new vaccine was developed, tested, and eventually licensed for use.  By 1997 DTaP had fully replaced the original DTP vaccine.  Subsequent testing confirmed that it was just as effective as its predecessor, and induced significantly fewer side effects.  DTaP replaced DTP in the US before significant outbreaks could occur, and when instituted in countries that had stopped vaccination with DTP, quickly brought pertussis back under control.

DTaP, like all vaccines, continues to be studied, and is holding up very well to scrutiny.  Just this month, a self-controlled case series study in Pediatrics including 433,654 children and 7191 seizure events failed to find any significant association between DTaP and febrile seizures.

That the current pertussis vaccine is effective is beyond any serious contention, and its safety profile is excellent, but it’s not perfect.  The immune response the vaccine generates is relatively weak, necessitating multiple doses at 2, 4, 6, 15-18 months and 4-6 years to generate an adequate response (this isn’t unique to the vaccine; natural pertussis infection isn’t capable of providing long-lasting immunity either), and protection wanes after 5-10 years.

These characteristics predispose the vaccine, when used exclusively in childhood, to leave a couple of populations susceptible to infection.  First, the children most at risk of death from pertussis, those under the age of 3 months, have little to no direct protection from the vaccine or from maternal antibodies; this population relies heavily on herd immunity for protection.  The second vulnerability is that since neither the childhood vaccine nor natural infection provides lasting immunity, adults can become repeatedly infected, and serve as the primary reservoir of disease.  This is grimly illustrated by the fact that infants are most frequently infected not by other children, but by their parents.

Of course, this has been known for some time, and the vaccination schedule isn’t focused exclusively on early childhood.  A late childhood booster dose of TDaP (a reformulation of DTaP) at 11-18 years has been recommended since 2005, and adults are supposed to receive TDaP once between the ages of 19-64 to address this very problem.  Unfortunately, these doses are infrequently given for a variety of reasons, creating vulnerable populations to act as reservoirs for pertussis.

Though I may wish to have a vaccine that is somewhat less burdensome to use, it’s hard to complain about the current pertussis vaccine’s safety record, and properly administered, it’s capable of controlling and preventing epidemics (some even optimistically speculate the possibility of eradication).  To be fully effective though, it requires the dedicated support of both public health officials and the community.

The California Epidemic

Without a doubt, the relatively high-maintenance vaccination schedule contributes to our inability to fully control pertussis, but even if we had a vaccine capable of inducing lifelong immunity from birth onward, we would still have sections of the population that remain vulnerable to infection.  An embarrassingly large fraction of our fellow citizens lack access to health care.  Some immigrant populations may not have had the benefit of a modern medical system and immunization before arriving in the US, and some again lack access to health care after arrival.  A relatively small number of people are unable to be vaccinated or are immunocompromised due to medical conditions.  Finally, there are people who utilize California’s notoriously lax Personal Belief Exemption (PBE) policy to opt out of vaccination.

To what degree each of these factors is to blame for the current epidemic is not yet clear.  While it is true that some of the counties with the highest attack rates also happen to be counties where PBEs are common and vaccination rates low, other counties with reasonable vaccination rates are also being heavily affected.  (The attack rates of individual California counties can be found here.)  We simply do not yet have the entire epidemiologic picture, and it appears likely that several, if not all of these factors are in play.  That doesn’t mean, however, that we don’t know what action needs to be taken.

The California Department of Public Health is approaching this problem in the right way by addressing all of these elements at once, educating the public and expanding their TDaP program (TDaP program FAQ here, CDPH’s current activities and news releases here, and local California public health services here), though I think they may need to be even more aggressive.  In particular, I’d like to see a heavy revision of California’s PBE policy to make PBEs more difficult to obtain.

At the beginning of this post I said that in this pertussis epidemic, pointing fingers isn’t as important as taking action; to some this may have sounded hasty, but I hope you now understand my rationale.  An increase in size of any of any vulnerable group pushes the population as a whole closer to that nebulous cliff where herd immunity can no longer prevent an outbreak from becoming an epidemic.  No matter what the underlying cause(s) turns out to be, the single best intervention to control the spread of the current epidemic is the same: Vaccination. There may be multiple reasons for an outbreak of pertussis… but in our society there really is no excuse for it.


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Arctic Voyage Illuminating Ocean Optics

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During NASA's ICESCAPE voyage to the Arctic, scientists have been looking at the phytoplankton in the Arctic's Chukchi Sea -- how many, how big and at what depths they are found. But there are other ways of looking at these small life forms.

"We measure phytoplankton in terms of their pigments and light absorption properties," said Stan Hooker of NASA's Ocean Biology and Biogeochemistry Calibration and Validation Office at Goddard Space Flight Center, Greenbelt, Md. Hooker, Joaquin Chaves and Aimee Neeley, also of NASA, measure the color of the water. Anything in the water, plankton or not, can influence that color.

On July 2, a crane maneuvered a small boat halfway down the side of the U.S. Coast Guard Cutter Healy – the platform for the five-week ICESCAPE mission, NASA's first dedicated oceanographic field campaign, which is studying the physics, chemistry and biology of the ocean and sea ice within a changing Arctic.

Hooker, Chaves and Coast Guard crew boarded the small boat and readied for an expedition away from the stirred water and shadow of the 420-foot Healy. Lowered to the ocean surface, Hooker's team powered away, entering uncharted waters.

Maneuvering over smooth water and around chunks of sea ice, the small boat slowed to a stop near the edge of an ice floe.

"This is new for us because we usually haven't been able to work this close to the ice before," Hooker said. "Satellites can't measure near the ice, so we do this to help specify the next generation of equipment, and to contribute to the science objectives."

First over the side was a small red instrument that the crew dropped on a line into the ocean and then reeled by hand, as if wrangling a fish. Sensors on the instrument measured the wavelengths of sunlight at different depths - both what's coming into the ocean and what's reflected back out which is similar to what is "seen" by satellites.

Next the crew lowered a second, larger package of instruments into the depths of the ocean. One pair of sensors emits light and measures how much is scattered back. Another pair measures the fluorescence of chlorophyll and colored dissolved organic matter, an important distinction as both appear green to satellites.

Last, the crew collected water samples to be returned to the Healy for analysis in the lab.

"We can measure the changes in the color to find out what's happening with the ecology," said Greg Mitchell, a research biologist at Scripps Institution of Oceanography in San Diego, who analyzes the water samples. "We can relate color back to how much chlorophyll is in the ocean, how much algae biomass there is, and processes such as the rate of photosynthesis."

Similar, more frequent measurements are made from the Healy, which marked its one-hundredth ocean station of the mission on July 8. The small boat deploys less often -- almost daily -- but reaches more targeted regions.

"We do the measurements at sea in order to relate what's going on in the ocean with the optics," Mitchell said. "Then we apply those relationships to the optical data from the ocean color satellites and we can make estimates of processes and distributions globally."

Onboard the Healy to help scientists figure out where to sample is Bob Pickart, a physical oceanographer from Woods Hole Oceanographic Institution. Pickart can decipher water type and circulation to guide where to make measurements.

A great unknown, for example, is a picture of what's feeding the evolution of a "hotspot" in Barrow Canyon. Right now, winter water -- rich with nutrients -- has been carried across the shallow shelf where the Healy is surveying.

"This is a really interesting, important time of year," Pickart said. "As the ice recedes, productivity is starting and things are getting cranked up."

But for how long will these hotspots thrive? While this is dictated by light and nutrients, the circulation near Barrow and Herald canyons -- two fissures that channel water off the shelf -- plays a vitally important role as well.

On July 12, after a night of cutting through sea ice, ICESCAPE scientists caught a glimpse of the hotspot. As an instrument lowered from the Healy descended through the water, real-time fluorescence information showed low levels of chlorophyll.

Scientists on the Healy will analyze the hotspot data and water samples, but whether a plankton bloom has come and gone, the region remains a hotspot for ground-dwelling communities, according to Karen Frey of Clark University. Feeding off plankton that sink to the seafloor, species here are diverse and large. A single sample retrieved from the ocean floor turned up a large crab, sponges and a sea star.

Meanwhile, samples returned from the near-ice survey July 2 on the small boat are turning up mixed results – sometimes indicating the presence of phytoplankton communities and sometimes not, according to Atsushi Matsuoka, of Laboratoire d'Oceanographie de Villefranche. To find out why, his group will look at trends after returning home from ICESCAPE.

For more information visit http://www.nasa.gov/topics/earth/features/icescape2010_arctic_optics.html

Own a Piece of an Island

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long-island-sitka-1Although Private Island ownership is the ideal for many people, for most it isn’t practical.  For this reason more and more islands are being sold fractionally, that is an island is divided into a select number of lots or parcels.  One island to recently offer this is Long Island, Alaska an oceanfront property of 6.88 acres. Located 15 minutes by boat, approx 5 miles south of Sitka, Alaska’s former Russian capital. Tract M is a somewhat triangular shaped lot is facing the sea towards North and South. The north side would typically be the preferred access to the lot, as there is a unique natural sheltered harbour in between Long Island and Mertz Island providing safe mooring possibilities for all island property owners.

The larger south side is marked by three ravines, providing an interesting topography for building purposes. The lot is heavily forested with Hemlocks, Sitka spruces and other trees and brushes. The highest point on the lot, closer to the south shore, is approximately 80 feet above sea level and provides a panoramic view towards the open Pacific.

To learn more about this opportunity visit Private Islands Online.

Road Trip by Harley-Davidson and Model T

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You know it's summer in Vermont when the motorcycles start ripping by the Hemmings offices on their way to Lake George or Rhinebeck or Laconia or simply out for a ride. Looking through the photos of the Landscape Change Program at the University of Vermont, we see some things haven't changed in

Philips and Dako join forces in digital pathology

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Eindhoven, the Netherland and Glostrup, Denmark – Royal Philips Electronics (NYSE: PHG, AEX: PHI) and Dako, yesterday announced that they have signed an agreement to integrate a selection of Dako’s image analysis applications into Philips’ future digital pathology solutions.

 http://www.research.philips.com/initiatives/digitalpathology/news/100721-dako.html

“Anatomic pathology is an essential element of virtually every cancer diagnosis and the demand for it is ever-increasing. Our goal is to develop integrated digital solutions that enhance the operational efficiency and productivity of pathology departments, as well as increasing diagnostic confidence,” says Bob van Gemen, General Manager of Philips Digital Pathology. “I am convinced that our partnership with Dako, with its leading market position and expert knowledge in detecting and quantifying specific biomarkers in cancer tissue, will significantly accelerate our clinical applications development program.”

“We are very pleased to announce this collaboration with Philips, a leading company in the healthcare industry that is committed to entering the digital pathology market,” says Lars Holmkvist, CEO of Dako. “By joining forces with Philips, we will be able to deliver highly competitive diagnostic tools based on Philips’ extensive clinical expertise and technology know-how and Dako’s expertise in advanced staining and image analysis in order to benefit pathology laboratories, pathologists and ultimately patients.”

Currently, anatomic pathology workflows to examine tissue samples are based on the microscope, through which pathologists examine tissue sections mounted on glass slides and treated with different stains. The staining enhances the contrast between, or reveals the presence of, cellular and molecular components such as cell nuclei or specific proteins. Accurate interpretation of the results is critical to the diagnosis and staging of each individual patient’s disease and requires a great deal of skill and experience.Digitizing the images that pathologists normally view through a microscope may enable the introduction of objective and quantitative image analysis tools.

Dr. Clive Taylor, MD, PhD, Professor at University of Southern California, USA, and a renowned expert in pathology, expresses about the collaboration: “Digital pathology has been long in gestation, in comparison to radiology, where images also are the currency of practice, and where image acquisition, transfer, interpretation and storage is almost entirely digital. In part, this lag is because acquisition of histopathology images is dependent upon a 100 year old technique of ‘tissue fixation’, sectioning and staining. In part, it is because, somewhat surprisingly, fully digitized histopathology images are much larger than CT files, and difficult to manage and analyze. Progress has been slow because there has been no single institution, or company, that embraces both of these areas. It is exciting that collaborations like that between Dako and Philips are now bringing diverse but appropriate expertise to bear on implementing a full digital pathology program.”

A fast pathology slide scanner and an associated image management system form the basis of Philips’ proposed integrated solutions for digitizing pathology workflows. The Philips-Dako collaboration will initially focus on leveraging Dako’s image analysis software for tissue-based breast cancer diagnosis using its reagents for staining HER2, Estrogen Receptor (ER), Progesterone Receptor (PR), p53 and Ki-67 proteins. The detection and quantification of these proteins in biopsy tissue are highly relevant for the classification of breast cancers and the selection of appropriate therapy. Philips and Dako will also explore the possibility of extending the collaboration to include image analysis software for immunohistology-based prostate and colon cancer diagnostics.