CBC -The Nature of Things with David Suzuki - - The Nano Revolution: More than Human
This video apparently is only viewable in Canada. It is an excellent view of the future of nano technology at the "point of care" in medicine. It also has an excellent scenario of "post humans". It is worth watching just for the computer graphics effects on nanotechnology models.
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Hacking Health in Hamilton Ontario - Let's hear that pitch!
What compelled me to register for a weekend Health Hackathon? Anyway, I could soon be up to my ears in it. A pubmed search on Health Hack...
Sunday, March 17, 2013
Saturday, March 9, 2013
Medicine Buddha
Scientific information on medicine is essential but sometimes no information is the best information - the kind of consciousness that is only concerned about awareness of breathing.
Friday, March 8, 2013
Cochrane Reviews for Patients Seeking Health Information?
I heard a story on CBC radio about "Plain Language" summaries available for patients (or healthcare consumers) who need to make decions on health information via Cochrane Reviews. I tried to google to find a textual piece on this story and there was "nada", which means the radio and the internet don't always interface or there is no automatic speech to text translation between the two media. A woman who I believe was also a volunteer with a Cochrane Review was describing how helpful it was for her to search the Plain Language summaries to find exactly the information she was seeking on the new research for her own health condition.
Anyway, it has been a year or two since I have visited the Cochrane Library website and I think there have been some improvements in the website and it's usability. Still, I am not sure how it can become one of the more trusted sources of health information on the net for the general public (like Mayo Clinic, WebMD, Medline) but I fully endorse it as a gold mine of health information. They now have a blog called Evidently Cochrane, and they are starting to use social media a lot more.
In fact, based on one of their reviews for acupuncture for shoulder pain, I have decided to cancel an appointment and rethink future treatment options.
Anyway, it has been a year or two since I have visited the Cochrane Library website and I think there have been some improvements in the website and it's usability. Still, I am not sure how it can become one of the more trusted sources of health information on the net for the general public (like Mayo Clinic, WebMD, Medline) but I fully endorse it as a gold mine of health information. They now have a blog called Evidently Cochrane, and they are starting to use social media a lot more.
In fact, based on one of their reviews for acupuncture for shoulder pain, I have decided to cancel an appointment and rethink future treatment options.
Cochrane Reviews
How do you know if one treatment will work better than another, or if it will do more harm than good?"
Cochrane Reviews are systematic reviews of primary research in human health care and health policy, and are internationally recognised as the highest standard in evidence-based health care. They investigate the effects of interventions for prevention, treatment and rehabilitation. They also assess the accuracy of a diagnostic test for a given condition in a specific patient group and setting. They are published online in The Cochrane Library.Each systematic review addresses a clearly formulated question; for example: Can antibiotics help in alleviating the symptoms of a sore throat? All the existing primary research on a topic that meets certain criteria is searched for and collated, and then assessed using stringent guidelines, to establish whether or not there is conclusive evidence about a specific treatment. The reviews are updated regularly, ensuring that treatment decisions can be based on the most up-to-date and reliable evidence.“We care that you care enough to help us provide people all over the world, with a personal or professional interest in health care, with reliable information.”
- Sonja Henderson, Managing Editor of the Cochrane Pregnancy and Childbirth Group, Liverpool, UK
Cochrane Reviews are designed to facilitate the choices that practitioners, consumers, policy-makers and others face in health care.No other organisation matches the quality, volume, scope and range of healthcare topics addressed by Cochrane Reviews.
As well as covering hundreds of medical conditions and diverse healthcare topics such as injury prevention and natural treatments, Cochrane Reviews have an international appeal through their global coverage of healthcare issues affecting people in all countries and contexts, including resource-poor settings, where it is vital to ensure that funds are used to maximum benefit.Without Cochrane Reviews, people making decisions are unlikely to be able to access and make full use of existing healthcare research.
“To ensure that the work of The Cochrane Collaboration is relevant to low and middle-income countries it is essential that people from those countries actively participate.”
- Jimmy Volmink, Director of the South African Cochrane Centre and Coordinator of the Cochrane Developing Countries Network, Tygerberg, South Africa
Why are Cochrane Reviews different?Cochrane Reviews enable the practice of evidence-based health care.
Health care decisions can be made based on the best available research, which is systematically assessed and summarised in a Cochrane Review.Narrative reviews of healthcare research have existed for many decades, but are often not systematic. They may have been written by a recognised expert, but no one individual has the time to try to identify and bring together all relevant studies. Of more concern, an individual or company might actively seek to discuss and combine only the research which supports their opinions, prejudices or commercial interests. In contrast, a Cochrane Review circumvents this by using a predefined, rigorous and explicit methodology.Users of the medical literature should start paying more attention to the Cochrane Database of Systematic Reviews [the database of Cochrane Reviews in The Cochrane Library], and less attention to some better known competitors."
Richard Horton, Editor of The Lancet, July 2010A Cochrane Review is a scientific investigation in itself, with a pre-planned methods section and an assembly of original studies (predominantly randomised controlled trials and clinical controlled trials, but also sometimes, non-randomised observational studies) as their ‘subjects’. The results of these multiple primary investigations are synthesized by using strategies that limit bias and random error. These strategies include a comprehensive search of all potentially relevant studies and the use of explicit, reproducible criteria in the selection of studies for review. Primary research designs and study characteristics are appraised, data synthesized, and results interpreted.Each review is prepared by an 'author team' with support from specialist librarians, methodologists, copy and content editors, and peer reviewers, taking hundreds of hours of work from start to finish.
“The Cochrane Collaboration has consistently involved consumers in its editorial processes, in the firm belief that the more consumers are involved, the more health services and research will grow in democracy, and will be tailored to people’s needs.”
- Silvana Simi, Consumer Coordinator for the Cochrane Multiple Sclerosis Group, Pisa, Italy
Updated on: March 19, 2012, 13:36
Copyright © The Cochrane Collaboration
Comments for improvement or correction are welcome.
Email: web@cochrane.org
Comments for improvement or correction are welcome.
Email: web@cochrane.org
Sunday, March 3, 2013
HeLa High School will Teach Health Informatics
HeLa High School, opening in the Fall 2013 in Vancouver, Washington State USA is astonishing in a number of different ways:
digg0 points on reddit
- It has Health Informatics as major concentration in the curriculum
- It makes the term "pre-med" even more pre-med
- It honours naming the school after Henrietta Lacks, stem cell medical research participant who's cancerous tumours became the HeLa stem cell line
- It follows maybe the Swiss education model which is based more on apprenticeship and job training models?
I've read the book by Rebecca Skloot about the life of Henrietta Lacks, and it is highly recommended. Quite appropriate for ethical reasons to name a STEM (Science, Technology, Engineering and Math) school for her. Well they named it for the stem cells too. I know some Canadian university Health Science undergrad programs have a reputation being thought of as "pre-med", but this is even more competitive. How are students chosen for admission? If students are studying Health Informatics that early, what will that do the applied M.Sc. in Health Informatics in the future?
New Vancouver high school will focus on health, bioscience
Evergreen Public Schools' HeLa High will open in fall
Photo by Zachary Kaufman
By Susan Parrish
Columbian staff writer
Columbian staff writer
Saturday, February 23, 2013
PHOTO GALLERY
Inside He-La High
A sneak peek in to Evergreen's new Henrietta Lacks Health and Bioscience High School.
MAP
HeLa High School
9105 N.E. Ninth St., Vancouver
• School opens: Fall 2013. •Total estimated construction cost:
$23.7 million.
• Maximum number of students: 500.
• Size: 60,000 square feet.
• Curriculum focus: A biosciences and health care curriculum that includes extensive partnerships with Peacehealth Southwest Medical Center and others to provide opportunities for hands-on learning.
Programs of study
• Nursing and patient services.
• Health informatics.
• Biotechnology.
• Biomedical engineering.
• Pharmacy.
The pharmacy is nearly ready. The state-of-the-art nursing station is down the hall. But this isn't a hospital. It's Vancouver's newest high school.
Henrietta Lacks Health and Bioscience High School — HeLa High for short — is such a rare model that a very small number of similar schools exist nationwide. When its doors open in September, students will experience hands-on learning with state-of-the-art technology and partnership opportunities with PeaceHealth Southwest Medical Center, just a block away.
"The state has a number of schools focused on STEM — science, technology, engineering and math, " said Julie Tumelty, the school's principal. "But we haven't heard about another school in Washington that is specifically focused on health and bioscience."
As baby boomers age, studies point to an increasing need for well-trained health care workers. An Evergreen Public Schools study indicated about 20 percent of its ninth-graders planned to pursue a career in health care. It seemed an opportune time to pursue the specialty school. PeaceHealth Southwest Medical Center has worked with the school district for almost a decade to help plan the school. The medical center benefits by helping funnel more local students into health care fields.
How HeLa is funded
In 2002, Evergreen Public Schools received a $200,000 federal Workforce Investment Act grant to investigate how to develop employees to meet the growing demand for the health care industry. That led to the decision to build a heath-focused high school.
The total estimated construction cost is $23.7 million. To help with construction, the district received a $17.4 million Qualified School Construction Bond, federal stimulus money that is part of the American Recovery and Reinvestment Act of 2009. The remaining money comes from a $1 million grant from the Washington State Department of Community, Trade and Economic Development (CTED), proceeds from the district's previous land sales and state matching money.
The fast-growing district qualified for matching money because it has more than 1,200 high school students taking classes in portables. Moving about 500 of the district's high school students to the new school will ease the overcrowding and prevent the district from having to build another large, comprehensive high school in the near future.
Small footprint
The school's footprint of 2.9 acres is miniscule compared with the district's comprehensive high schools with between 40 and 50 acres each, including large sports fields and much larger parking lots. The outdoor space at HeLa includes four basketball hoops but no sports fields. The parking lot is small. In a nod of cooperation to the neighborhood, the district agreed that all students would arrive at the school via school bus. That'll prevent traffic congestion.
The 60,000-square-foot building was designed by LSW Architects and constructed by Skanska USA. If needed, an additional 20,000 square feet may be added later. Its high-tech design is apparent both inside and out. Two levels of solar panels on the south side will help provide power. The floors on the first level are polished concrete, and in the student commons the floor is heated for comfort.
Students will learn real-world nursing skills in the four-bed nursing station, complete with a simulated, interactive robot patient called SimMan. A simulation pharmacy and well-equipped laboratories will provide more hands-on learning. The library, called the research lab, will be stocked with a combination of electronic books and traditional paper textbooks.
Not traditional
HeLa isn't a traditional high school. It won't have sports teams, so instead of a large gym, the school has a fitness room where students will learn lifelong fitness using resistance training, mats, Pilates and medicine balls. There won't be a marching band or pep band, but a scaled-down music program may offer orchestra or symphony.
The first school year, the student body will consist of about 125 freshmen and 125 sophomores. The next two years, 125 freshmen will be added each year, so that 500 students eventually will be enrolled there. Students interested in attending the school completed an application and are being chosen via a lottery system from the district's comprehensive high schools, with an equal number of students coming from each school.
Classes will be integrated to create an overall focus on health and biosciences, Tumelty said. As an example, she said in English class, students will use informational texts and literature that are science-based.
"The goal is for students to see the connections between the disciplines so that they get a better view of how the real world works," Tumelty said. "Teachers will be working on creating these connections in authentic ways for students."
Freshmen and sophomores will take anatomy and physiology along with chemistry and biology "to give them a really good base in science," said Elisabeth Harrington, the district's director of curriculum and instruction. Before they enter their junior year, students will have to choose one of five pathways: nursing and patient care; health informatics (data processing); biomedical engineering; pharmacy; or biotechnology.
"In the first two years, as they're doing A&P, there will be a heavy emphasis on medical terminology," Harrington said. "Once they've picked their pathway, as juniors they'll partner with PeaceHealth with job shadowing opportunities. Seniors will have internships at PeaceHealth."
Who was Henrietta Lacks?
The cancerous cells of Henrietta Lacks, a poor black woman from Virginia, were harvested in 1951 without her knowledge and cultured for medical research to create an immortal cell line. Her cells were used to develop the polio vaccine, gene mapping, in vitro fertilization and cloning, among other things. Although billions of her cells have been sold for research, her family can't afford health insurance. Her story was told in the nonfiction book "The Immortal Life of Henrietta Lacks" by Portland author Rebecca Skloot. This is the first school building in the nation named after her.
Susan Parrish: 360-735-4515;http://www.twitter.com/Col_Schools;susan.parrish@columbian.com.
Tuesday, February 19, 2013
Not why eHealth but when
I was reading COACH - Canada's Health Informatics Association "eHealth Convergence Forum Report: Addressing Key Issues in First Nations Health" report. Somewhere in there I read that the consensus or attitude towards eHealth among First Nations was no longer a question of why but when. eHealth representatives among First Nations have presented at recent eHealth conferences and I think it is a smart move on their part.
Friday, February 15, 2013
The Case of the Missing Data
This news story resonates on several different levels, not so much on the scientific merit of the research ( I recommend reading a book called Good Calories, Bad Calories by Gary Taub), but on the technology that is involved and the policies for research data. First, the 9-track magnetic computer tape found in a box in a garage - it was really difficult to find a machine to actually play it it is so out of date. Next around - it is an example of why the current "Open Access" policy, is so relevant. I still have a shoe box of 3 1/2 inch diskettes I keep wondering what to do with.
The case of the missing data
By Kelly Crowe, CBC News
Posted: Feb 11, 2013 4:36 PM ET
Last Updated: Feb 11, 2013 4:35 PM ET
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External Links
- Use of dietary linoleic acid for secondary prevention of coronary heart disease and death, BMJ
- Photo of missing data reel
- JAMA warning on failure to publish clinical trials
- Medical journal amnesty
- Kamran Abbasi's editorial on compulsory registration of trials
- GSK trial registry announcement
- Study raises dietary fats and heart disease guidance, BMJ
(Note:CBC does not endorse and is not responsible for the content of external links.)
Scientists don't always report everything they discover. Sometimes loose bits of data can be packed up in a box with a bunch of old books and research papers and left in a garage in Sydney, Australia. And that means intriguing, puzzling findings that didn't make sense back in the day, can slowly retreat into scientific oblivion, about to be lost to humankind for all eternity.
Except that, in this case, the phone rang and a determined scientist from Bethesda, Md. having managed to track down one of the last surviving members of a research team, asked Boonseng Leelarthaepin if he knew what happened to the dataset from the Sydney Diet Heart Study that wrapped up in 1973. Luckily Leelarthaepin is a packrat and he knew where to look.
It's now clear that there are multiple polyunsaturated fatty acids, and that each of them may have different biochemical and clinical effects, said Dr. Christopher Ramsden.
"I knew in my mind where it was" he told me. He went into his garage in Sydney and started moving piles of boxes. "It did take quite some time. I opened up all the boxes. There were a lot of old books and different things, like hard copies of published papers," he said. Buried deep in the pile, he found what Dr. Christopher Ramsden, back in Bethesda, was anxious to see. An obsolete 9-track magnetic computer tape from the original Sydney Diet Heart Study. It was an unremarkable looking brown spool with a faded 3M label that had the words "LEE 3" printed in blue ink.
"The recovery actually took a substantial amount of time because it was in a format that wasn't readable by today's standards," Dr. Ramsden told me. He's a researcher with the U.S. National Institutes of Health, and he knew there was some potentially important information on that magnetic tape.
Dr. Ramsden tracked down some old equipment, recruited some experts, and after much technical handwringing, and format configuring, the data, that had originally been stored on punch cards, was translated into modern computer language so that it could be reanalyzed and interpreted. And what Dr. Ramsden found in that data made headlines this week.
It was a second look at an old clinical trial, first published in the 1970s, that had set out to measure the dietary effects of saturated versus unsaturated fat. It was assumed that if blood cholesterol could be lowered by reducing saturated fat in the diet, lives would be saved. But in this study, the subjects who switched to unsaturated fat had a higher risk of death.
"That was really unexpected," Leelarthaepin told me on the phone from Sydney. Because unsaturated fat can lower cholesterol, "in theory, survival would be better," he said. "But it was the other way around."
Back then, Leelarthaepin was a research assistant on the study and, at the same time, he was collecting data for his own PhD on a different aspect of the research. I asked him what they were saying to each other in the lab when they were faced with a puzzling increase in mortality. "We had no idea" he said. "We thought there must be some other factor influencing that." They adjusted the data, factoring in other risk factors like smoking, and still the observation held up. There seemed to be an increased risk of death from simply eating more vegetable oil.
"You control for age and all the other things, and that still did not explain it," Leelarthaepin said.
Almost half a century passed, and the Sydney Diet Heart Study languished in the medical literature, occasionally surfacing with a passing mention as a confounding example of the mysteries of dietary fat.
"Back in those days, all polyunsaturates were sort of considered the same," Dr. Ramsden said. "Mainly because they lowered blood cholesterol." Today, scientists know that polyunsaturated fat is much more complex. "In the last few decades there's been an increased recognition, and advancement in the science of this field," Dr. Ramsden said. "And it's now clear that there are multiple polyunsaturated fatty acids, and that each of them may have different biochemical and clinical effects."
Those polyunsaturated fats include omega-6 fatty acids and and omega-3 fatty acids. Most vegetable oils contain a combination of the two, but some oils are almost exclusively composed of omega-6s. Both are considered healthier than saturated fats, from animal sources.
So why did the Sydney Diet Heart Study report an increase risk of death in a group that ate a supposedly healthier oil? As an investigator in the emerging science of nutritional biochemistry, Dr. Christopher Ramsden wanted to know more. His first question: what kind of vegetable oil were the men in the study asked to eat?
"So, in that context, knowing there was an increased risk of death in the past, I really wanted to find out, number one, which oils were used."
Safflower oil affords rare glimpse
What he found out provided a unique research opportunity, because the original trial used safflower oil, which contains only omega-6 fatty acids, instead of a combination of omega-3s and 6s. An oil with a significant amount of omega-3s would complicate things, because omega-3s have been shown to have positive effects on the body, while omega-6s might cause inflammation and have other negative effects on the arteries. So by choosing safflower oil, with its concentrated levels of omega-6s, the Sydney Diet Heart Trial became one of the only clinical trials to investigate what happens if saturated fats are replaced with omega-6 polyunsaturated fatty acids.
"This trial, by the nature of the oil it provided, only increased omega-6 fats, specifically linoleic acid," Dr. Ramsden said. "And therefore it's really a rare opportunity."
In 1966, when they designed the trial, the Sydney researchers had no idea they were testing a future omega-6 hypothesis. They were just trying to find out what happened when middle aged men who'd already had cardiac events tried to replace saturated fat with unsaturated fat in their diet. What happened is that they did lower their blood cholesterol. Why then did they have increased mortality? The Sydney authors had no answer.
"Because we couldn’t explain it," Leelarthaepin said, they reported the findings, and waited to "see if another study showed the same thing."
Forty years later, as Dr. Ramsden searched all of the scientific literature for research on polyunsaturates, the Sydney Diet Heart Study emerged as one of only three that were relevant to his meta-analysis. But there was a problem. While the other studies focused on death or illness from coronary and cardiovascular disease, for some reason, the Sydney authors didn't report the specific causes of death. Instead they the grouped the data into one large category: "all cause mortality."
Why didn't they analyze the mortality data in more detail? "The main reason is that we were running out of time, and had no funds," Leelarthaepin said. "We felt we had only one shot at it, and 'all cause mortality' was the one we chose." The other data was set aside. But now Dr.Ramsden wanted to see it.
"We recognized there was missing data from this trial that was stopping us from completing a thorough analysis," Dr. Ramsden said.
So that started the hunt through the boxes in Leelarthaepin’s garage, and ultimately led to the headlines this week: "Omega-6 Fats Linked to Increased Risk of Heart Disease." Because, when he updated the meta analysis, crunching the old Sydney numbers, Dr. Ramsden found there was "no evidence of cardiovascular benefit” when omega 6 was increased, "and a substantial signal for increased risk," he said.
There are limitations to the finding. Experts point out that the level of omega-6s in the Sydney Heart Diet Study was much higher than would be found in an average diet. But it was convincing enough for many to recommend taking a second look.
But there's another aspect to this study, one that has implications for the entire field of scientific research. And that is: what a difference missing data can make.
It prompted some finger wagging from the British Medical Journal, as an example of why all data from clinical trials should be made permanently accessible to the entire scientific community.
In a press release, BMJ editors said "We are … asking researchers to tell us about any other documented examples of missing data, to build a picture of the full extent of the problem which is undermining evidence based medicine worldwide."
It's a crisis of lost information. Even though people volunteer to be test subjects, and scientists complete years of research, a large amount of clinical trial data never sees the light of day.
"The current best estimate is that half of all the clinical trials that are conducted and completed are never published," the BMJ press release said. And even when trials are published, without a chance to see all of the raw data, other scientists are not able to do an independent analysis and come to their own conclusions about what it all means.
"Missing clinical trial data may have an important impact on our overall ability to review the evidence base," Dr. Ramsden said.
Distorted scientific record
Two decades ago, the Journal of the American Medical Association published this warning: "Failure to publish an adequate account of a well-designed clinical trial is a form of scientific misconduct, that can lead those caring for patients to make inappropriate treatment decisions."
But so far efforts to recover missing data have failed. Back in 1997, dozens of medical journals offered an "amnesty," an open call for information about unpublished trials, so they could be tracked down and added to the international scientific record.
What happened? "Five years of industry resistance, government impotence and public confusion followed," Kamran Abbasi, acting editor of the BMJ, wrote in 2004.
"The failure to open up clinical trial data to independent scrutiny 'distorts the scientific record,' Abbasi wrote. "By suppressing negative findings and exaggerating positive ones, by downplaying harms and talking up benefits, healthcare decisions, are based on incomplete data and ultimately harm the patients."
So now 'open access' is being pursued once again. The Canadian Institutes of Health Research, and other public research funding agencies have put policies in place requiring open access to the data generated from studies they sponsor. But others warn that those policies do not apply to industry sponsored studies, "and cannot prevent biased publication and reporting of results from industry sponsored research."
There have been a series of well publicized examples of industry sponsored trials that failed to disclose potentially dangerous effects of the drug. Today, many scientific journals have a policy of compulsory registration, refusing to publish the results of any clinical trials that were not registered at the start of the study, with end points clearly defined, so everyone knows what the trial was setting out to investigate, and whether it worked, rather than choosing to highlight a secondary finding that was not part of the original inquiry.
But decades of research has already been lost, in the attics and basements and garages of scientists all over the world. Efforts to try to track it down have not always had the happy ending that Christopher Ramdsen was able to report. "And you know, we really think that's a testament to Leelarthaepin for his willingness to help us recover the data, go through it with us and help us evaluate it in detail," he said.
So how important is this missing data? In this case, the BMJ press office reported the relevance this way:
"The researchers conclude that recovery of these missing data 'has filled a critical gap in the published literature archive' and that these findings 'could have important implications for worldwide dietary advice to substitute omega-6 linoleic acid (or polyunsaturated fatty acids in general) for saturated fatty acids.'"
All of that because someone found an abandoned spool of magnetic tape sitting in a box in a Sydney garage.
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