Florida overcomes GOP barriers to enroll uninsured

MIAMI (AP) — Florida's Republican leaders have fought the Affordable Care Act at every turn, banning navigators from county health departments, offering no state dollars to boost outreach efforts to 3.5 million uninsured and leading the fight to repeal the law. Yet the state has emerged as a tale of what went right with President Barack Obama's health care overhaul.

More than 440,000 Florida residents had been enrolled through the federal marketplace through the end of February.

Florida's success is due partly to infrastructure created in the swing state by Democratic-affiliated groups during the last three presidential elections, along with continued investment by the Obama administration and nonprofit advocacy groups in the diverse state that will be competitive in November's midterm election.

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Treasury says Lew leaves hospital after surgery

WASHINGTON (Reuters) - U.S. Treasury Secretary Jack Lew was discharged from a hospital on Wednesday following a surgery to treat a benign enlarged prostate, a Treasury spokesperson said.

"(Lew) is now at home recuperating from his surgical procedure yesterday," Treasury spokeswoman Natalie Wyeth Earnest said in a statement. "He is in good spirits, talking with staff, and looks forward to being back in the office next week."

The spokeswoman had said on Tuesday the surgery went well but that Lew's doctor decided to keep him in the hospital overnight because he was running a low fever.

Lew, 58, was sworn in as Treasury secretary in February 2013 after serving as President Barack Obama's chief of staff.

(Reporting by Timothy Ahmann; Editing by Chizu Nomiyama)

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Doctors Really Do Raise Your Blood Pressure

WEDNESDAY, March 26, 2014 (HealthDay News) -- Patients' blood pressure readings are notably higher when they're taken by a doctor than by a nurse, a new study finds.

This link between doctors and higher blood pressure readings is known as the "white coat effect," and is believed to be the result of patients being more nervous when examined by a physician.

This effect has been noted in a number of previous studies, but this new paper is the first to confirm it, according to the study authors.

The investigators analyzed data from more than 1,000 people who had blood pressure readings taken by both doctors and nurses during the same visit. The readings taken by doctors were significantly higher than those taken by nurses, the study authors found.

The findings, published in the current issue of the British Journal of General Practice, should lead to changes in the way blood pressure readings are taken, according to lead author Dr. Christopher Clark, of the University of Exeter Medical School, in England.

"Doctors should continue to measure blood pressure as part of the assessment of an ill patient or a routine check-up, but not where clinical decisions on blood pressure treatment depend on the outcome," Clark said in a university news release.

"The difference we noted is enough to tip some patients over the threshold for treatment for high blood pressure, and unnecessary medication can lead to unwanted side-effects," he said.

"Some patients may be erroneously asked to continue to monitor their own blood pressure at home, which can build anxiety. These inappropriate measures could all be avoided by the simple measure of someone other than a doctor taking the blood pressure recording," Clark added.

He suggested that researchers "should also think carefully about how to account for this effect in studies that compare treatment by doctors and nurses. Some studies have concluded that nurses are better at treating [high blood pressure], when in fact those findings could be down to this recording bias."

More information

The U.S. National Heart, Lung, and Blood Institute explains how to prevent high blood pressure.

Copyright c 2014?HealthDay. All rights reserved.

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Virginia lawmakers recess without Medicaid, budget deal

By Gary Robertson

RICHMOND, Virginia (Reuters) - Virginia's legislature has recessed without reaching agreement with Democratic Governor Terry McAuliffe over a budget or Medicaid expansion.

McAuliffe, a former Democratic Party fundraiser, and the Republican-dominated House of Delegates are deadlocked over a two-year pilot expansion of Medicaid, the federal healthcare program for the poor the governor has proposed.

House lawmakers meeting in a two-day special session defeated McAuliffe's proposed $96 billion two-year budget late on Tuesday. The House then passed its own version of the budget without Medicaid expansion, seen as a priority for the governor, before adjourning.

The Democratic-controlled state Senate will reconvene April 7 to take up the budget fight anew. A budget must be approved by June 30 or risk state operations starting to shut down.

Republicans are asking McAuliffe to deal with the budget and Medicaid in separate sessions.

"We would be more than happy to debate Medicaid in a special session," said Kirk Cox, Republican House majority leader. "I think is afraid he loses all his leverage without the budget."

McAuliffe, who made Medicaid expansion the centerpiece of his gubernatorial campaign last year, has not responded to the rebuff.

But he has said that accepting $2 billion in federal funds to expand Medicaid under the Affordable Care Act would release money that could be used to create jobs, raise state salaries, bolster pensions and implement health reforms.

(Editing by Ian Simpson and Gunna Dickson)

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One in 25 patients battling hospital-acquired infections: CDC

By Gene Emery

NEW YORK (Reuters Health) - On any given day, one in 25 hospitalized patients - 4 percent - is battling an infection picked up in a hospital or other healthcare facility, according to a new survey by the Centers for Disease Control and Prevention (CDC).

That translates to more than 600,000 hospital patients each year. Roughly 74,000 of them have to fight more than one hospital-acquired infection, researchers found.

About half of those infections were either linked to a device attached to the patient, like a catheter or ventilator, or occurred after a surgical procedure at the site of the surgery.

Previous estimates had pegged the annual number of infections at 2.1 million in the 1970s and 1.7 million from 1990 through 2002.

"The trend, in magnitude, seems to be going in the right direction," Dr. Mike Bell, deputy director of the Division of Healthcare Quality Promotion at the CDC, told Reuters Health.

Despite continuing concern about hospital-acquired infections, especially ones that are resistant to antibiotics, the U.S. does not have a national system for collecting information on the problem.

The new study, led by Dr. Shelley S. Magill of the CDC and published in the New England Journal of Medicine, was based on an analysis of 11,282 patients treated at 183 hospitals in 10 states. The survey in each hospital was done over the course of a day, involving as many as 100 patients per facility.

Pneumonia accounted for about 22 percent of the hospital-acquired infections. Another 22 percent were infections at the surgical site, and 17 percent were stomach or intestinal illnesses. Urinary tract and bloodstream infections ranked fourth and fifth, respectively.

The most common bacterium responsible was Clostridium difficile, which kills an estimated 14,000 people in the U.S. each year. It was detected in 12 percent of the hospital-acquired illnesses and was responsible for 71 percent of gastrointestinal infections in particular.

Nursing homes, emergency departments, rehabilitation hospitals and outpatient treatment centers were not included in the tally.

The researchers estimated that in 2011, 648,000 hospitalized patients had to battle at least one hospital-acquired infection. The total number of infections was estimated at 721,800. To put that number in perspective, about 34 million people are admitted to 5,000 community hospitals in the U.S. each year.

The new report "validates the work we've been doing, focusing on some of the severe infections related to intensive care, related to devices such as catheters in the bloodstream or the bladder, mechanical ventilation or surgical procedures," Bell said.

To prevent infections, the National Patient Safety Foundation recommends patients wash their hands regularly and remind their doctors and nurses to do the same. Patients should also make sure both bandages and the skin around any catheters are kept clean and dry, it says.

SOURCE: http://bit.ly/1rzGOHe New England Journal of Medicine, online March 26, 2014.

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Exclusive: Baxter explores sale of its vaccines business - sources

By Olivia Oran and Arno Schuetze and Soyoung Kim

NEW YORK/FRANKFURT (Reuters) - Baxter International Inc is exploring a sale of its vaccines business, according to people familiar with the matter, the latest healthcare company to look at divesting non-core assets to focus on key strengths.

The medical equipment and pharmaceuticals company is working with Goldman Sachs Group to find a buyer for the unit and has reached out to potentially interested parties including private equity firms, the people said on Wednesday, asking not to be named because the matter is not public.

The Baxter unit, which includes vaccines for meningitis C and tick-borne encephalitis as well as collaborations for the development of seasonal and pandemic influenza vaccines, had 2013 sales of close to $300 million according to regulatory filings.

It could not be learned how much the business could fetch in a sale, as the deliberation is at an early stage and Baxter has yet to send out detailed financial information to potential buyers, the people added.

Representatives for Baxter did not immediately respond to requests for comment. Goldman Sachs declined to comment.

The vaccines business, which is part of Baxter's $6.5 billion BioScience segment, is profitable but the company has determined it is not core, one person said.

Deerfield, Illinois-based Baxter makes medical devices, pharmaceuticals and biotechnology products, focusing on areas including hemophilia, immune disorders and infectious diseases.

It divides its operations between the BioScience division, which makes products including plasma-based proteins to treat hemophilia, and a Medical Products division. The medical products unit makes equipment used to inject fluids and drugs and had 2013 sales of nearly $8.7 billion.

Baxter is yet another example of large healthcare companies seeking to sell or spin off smaller divisions so they can focus on their mainstay products and allocate capital better. They have shown a new willingness to consider whether other companies may be better owners for certain assets.

Novartis AG is taking a hard look at its sub-scale businesses -- animal health, vaccines and over-the-counter medicines -- for a potential divestiture, chief executive Joe Jimenez told Reuters last week, adding that at least one of the three is not expected to make the cut.

Merck & Co Inc is also in talks with several companies about selling its consumer healthcare business, a deal that could value the unit at between $10 billion and $12 billion, Reuters previously reported.

(Reporting by Olivia Oran, Soyoung Kim in New York and Arno Schuetz in Frankfurt; editing by Andrew Hay)

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Breast Cancer Startup Challenge Inventions and Winners

March 5, 2014, 1:00PM

By Anthony Beal

Posted in: cancer

The Avon Foundation for Women, in partnership with NCI and the Center for Advancing Innovation (CAI), have announced the ten winners of a world-wide competition to accelerate the process of bringing emerging breast cancer research technologies to market.

Each team was required to produce a short video explaining and highlighting their ideas.? The videos are from the winners of the Breast Cancer Startup Challenge.? This listing does not constitute NCI’s endorsement of the companies or potential products and does not guarantee a grant of license for any federally-owned technology.

Videos from the winning teams are below.

Challenge #1. Diagnostic from Biopsies with Software Analysis
Category: Diagnostics/Health IT
Lead Inventor: Tom Misteli, PhD, NCI
Winner: University of Cambridge

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Challenge #2 -Immunotherapy Using Modified Self Tumor Cells
Category: Therapeutic
Lead Inventor: Dennis Klinman, M.D., Ph.D., NCI
Winner: Washington University in Saint Louis

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Challenge #3 – Combination of Tissue Reconstruction and Recurrence Prevention
Category: Device/Therapeutic
Lead Inventor: Karen Burg, Ph.D., Clemson University
Winner: Tulane University

Finalist: Clemson University

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Challenge #4 – Human monoclonal Antibody Based Cancer Therapies
Category: Therapeutic, Diagnostic
Lead Inventor: Mitchell Ho, Ph.D., NCI
Winner: Stanford University

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Challenge #5 -Immunotherapy Using Granulysin Activated Monocytes
Category: Therapeutic
Lead Inventor: Alan Krensky, M.D., Northwestern University
Winner: Northwestern University

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Challenge #6 – Anti-cancer Toxin
Category: Therapeutic
Lead Inventor: Nadya Tarasova, Ph.D., NCI
Winner: Rutgers, The State University of New Jersey

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Challenge #7 – Versatile Delivery Method for Cancer Therapeutics
Category: Vaccine or Drug Delivery (Protein or RNA)
Lead Inventors: Stanislaw J Kaczmarczyk, Ph.D. & Deb Chatterjee, Ph.D., NCI
Winner: University of Cambridge

Finalist: Wake Forest University

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Challenge #8 -Genomic Based Diagnostic Assay
Category: Diagnostics and prognostic
Lead Inventor: Steven Libutti, M.D., FACS, NCI
Winner: University of California, Berkeley

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Challenge #9 -Tissue-based Diagnostic Assay
Category: Diagnostic
Lead Inventor: Stephen M. Hewitt, M.D., Ph.D., NCI
Winner: McGill University

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Challenge #10 – Diagnostic Kit for Therapy Benefit Prediction
Category: Diagnostic
Lead Inventor: Sherry Yang, MD., Ph.D., NCI
Winner: Tulane University

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Biologists use sound to identify breeding grounds of endangered whales

Remote acoustic monitoring among endangered whales is the subject of a major article by two doctoral students in The College of Arts and Sciences.

Leanna Matthews and Jessica McCordic, members of the Parks Lab in the Department of Biology, have co-authored "Remote Acoustic Monitoring of North Atlantic Right Whales Reveals Seasonal and Diel Variations in Acoustic Behavior." The article appears in the current issue of PLOS ONE, an inclusive, peer-reviewed, open-access resource from the Public Library of Science in San Francisco.

Susan Parks, assistant professor of biology for whom the lab is named, says the article confirms what many conservationists fear -- that Roseway Basin, a heavily traveled shipping lane, off the coast of Nova Scotia, is a vital habitat area for the endangered North Atlantic right whale.

"Remote acoustic monitoring is an important tool for understanding patterns in animal communication, and studies on the seasonality of context-specific acoustic signals allow inferences to be made about the behavior and habitat use of certain species," says Parks, an expert in behavioral ecology, acoustic communication and marine science. "Our results support the hypothesis that the North Atlantic right whale's breeding season occurs mostly from August to November and that this basin is a widely used habitat area."

More than 30 percent of all right whales use Roseway Basin, part of a larger geological formation called the Scotian Shelf, throughout the year. With only 400-500 in existence, these whales, says Parks, must congregate in the basin to feed and find mates.

Already, the U.S. and Canadian governments have taken steps to redirect shipping traffic, in response to several fatal collisions with right whales.

Matthews, whose research includes animal behavior and physiology, says the object of the article is to determine how and when Roseway Basin is used for male breeding activities.

"Part of the answer lies in a loud 'gunshot' sound, made by the male whale," says Matthews, the article's lead author. "We're not exactly sure what the gunshot is, but we think it may be a male-to-male antagonistic signal or an advertisement to females. … During a two-year period, we used non-invasive acoustic monitoring to analyze gunshots at two locations on the Scotian Shelf. The resultant data has provided tremendous insights into the whales' feeding and mating habits."

Matthews and her team found that gunshot sound production occurred mainly in the autumn and, more often than not, at night. Researchers say this kind of information is essential to not only the individual fitness of each whale, but also the survival of the species, in general.

McCordic, whose research spans animal behavior and communication, says the observed seasonal increase in gunshot sound production is consistent with the current understanding of the right whale breeding season.

"Our results demonstrate that detection of gunshots with remote acoustic monitoring can be a reliable way to track shifts in distribution and changes in acoustic behavior, including possible mating activities," she says, acknowledging David Mellinger, associate professor of marine bioacoustics at Oregon State University, who collected and provided access to the recordings used in the study. "It also provides a better understanding of right whale behavior and what needs to be done with future conservation efforts."

Parks, who assisted with the article, is proud of her students' accomplishments.

"Right whales are increasingly rare, and Leanna's and Jessica's research helps us understand how to better protect them," she says. "By identifying potential breeding areas, we might be able to save this critically endangered species."

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New video-based teaching tool helps students learn animal-based lab work

For students and scientists beginning animal-based lab work, seeing a research procedure performed by experts is by far the most effective method of learning. Now the Cambridge-based company, JoVE, releases the new online video-based tool, Model Organisms II, to revolutionize the teaching of fundamental experiments in the three most common laboratory organisms -- the mouse, chick and zebrafish.

"Each of these species makes unique demands upon researchers, both in terms of the steps required for their maintenance and reproduction, as well as the tools and techniques available to study them," said Aaron Kolski-Andreaco, PhD., JoVE's Chief Product Officer, "The Model Organisms II collection provides a great overview of these nuances, in addition to providing visual demonstrations of techniques essential to working with each model."

Contrary to the traditional, text-based educational materials, Model Organisms II presents a powerful combination of scientific animation with video demonstrations by scientists from leading research institutions around the world. This novel tool is the latest installment in JoVE Science Education database dedicated to teaching laboratory fundamentals through simple, easy-to-understand visual presentations. For universities and colleges, the JoVE Science Education videos are a valuable new resource for efficient teaching and research.

"I wanted to find justification for buying it, so I sent around a message to faculty in biology," said Michael Newman, a Head Librarian and Bibliographer at Stanford University, "Those things usually don't get much response, but this time I got some pretty enthusiastic replies."

Stanford subscribed to the JoVE Science Education database in December 2013, shortly after JoVE released this database. Over 100 institutions -- including those ranging from the Ivy League to community colleges -- also purchased a subscription within only three months following the product launch.

"I've used it as a class tool where students can watch a technique on the screen and then do it immediately afterwards, and for what they're going to do the next time the class meets, so they'll come in a little less blind," said assistant professor, Dr. Jason Kuehner of Emmanuel College in Boston, MA, "For something like western blotting this is really good. That's a fairly laborious technique with multiple steps, and for students it's very easy to get confused as to what each step in the protocol means."

You can view the Science Education content at www.jove.com/se.

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Sensing gravity with acid: Scientists discover role for protons in neurotransmission

While probing how organisms sense gravity and acceleration, scientists at the Marine Biological Laboratory (MBL) and the University of Utah uncovered evidence that acid (proton concentration) plays a key role in communication between neurons. The surprising discovery is reported this week in the Proceedings of the National Academy of Sciences.

The team, led by the late MBL senior scientist Stephen M. Highstein, discovered that sensory cells in the inner ear continuously transmit information on orientation of the head relative to gravity and low-frequency motion to the brain using protons as the key means of synaptic signal transmission. (The synapse is the structure that allows one neuron to communicate with another by passing a chemical or electrical signal between them.)

"This addresses how we sense gravity and other low-frequency inertial stimuli, like acceleration of an automobile or roll of an airplane," says co-author Richard Rabbitt, a professor at University of Utah and adjunct faculty member in the MBL's Program in Sensory Physiology and Behavior. "These are very long-lasting signals requiring a a synapse that does not fatigue or lose sensitivity over time. Use of protons to acidify the space between cells and transmit information from one cell to another could explain how the inner ear is able to sense tonic signals, such as gravity, in a robust and energy efficient way."

The team found that this novel mode of neurotransmission between the sensory cells (type 1 vestibular hair cells) and their target afferent neurons (calyx nerve terminals), which send signals to the brain, is continuous or nonquantal. This nonquantal transmission is unusual and, for low-frequency stimuli like gravity, is more energy efficient than traditional synapses in which chemical neurotransmitters are packaged in vesicles and released quantally.

The calyx nerve terminal has a ball-in-socket shape that envelopes the sensory hair cell and helps to capture protons exiting the cell. "The inner-ear vestibular system is the only place where this particular type of synapse is present," Rabbitt says. "But the fact that protons are playing a key role here suggests they are likely to act as important signaling molecules in other synapses as well."

Previously, Erik Jorgensen of University of Utah (who recently received a Lillie Research Innovation Award from the MBL and the University of Chicago) and colleagues discovered that protons act as signaling molecules between muscle cells in the worm C. elegans and play an important role in muscle contraction. The present paper is the first to demonstrate that protons also act directly as a nonquantal chemical neurotransmitter in concert with classical neurotransmission mechanisms. The discovery suggests that similar intercellular proton signaling mechanisms might be at play in the central nervous system.

Stephen Highstein, who died in January 2014, was associate director of the MBL's Program in Sensory Physiology and Behavior. Mary Anne Mann, a research associate in the program, also participated in this research, as did Gay Holstein of Mt. Sinai School of Medicine.

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Blood-brain barrier repair after stroke may prevent chronic brain deficits

Following ischemic stroke, the integrity of the blood-brain barrier (BBB), which prevents harmful substances such as inflammatory molecules from entering the brain, can be impaired in cerebral areas distant from initial ischemic insult. This disruptive condition, known as diaschisis, can lead to chronic post-stroke deficits, University of South Florida researchers report.

In experiments using laboratory rats modeling ischemic stroke, USF investigators studied the consequences of the compromised BBB at the chronic post-stroke stage. Their findings appear in a recent issue of the Journal of Comparative Neurology.

"Following ischemic stroke, the pathological changes in remote areas of the brain likely contribute to chronic deficits," said neuroscientist and study lead author Svitlana Garbuzova-Davis, PhD, associate professor in the USF Health Department of Neurosurgery and Brain Repair. "These changes are often related to the loss of integrity of the BBB, a condition that should be considered in the development of strategies for treating stroke and its long-term effects."

Edward Haller of the USF Department of Integrative Biology, the coauthor who performed electron microscopy and contributed to image analysis, emphasized that "major BBB damage was found in endothelial and pericyte cells, leading to capillary leakage in both brain hemispheres." These findings were essential in demonstrating persistence of microvascular alterations in chronic ischemic stroke.

While acute stroke is life-threatening, the authors point out that survivors often suffer insufficient blood flow to many parts of the brain that can contribute to persistent damage and disability. Their previous investigation of subacute ischemic stroke showed far-reaching microvascular damage even in areas of the brain opposite from the initial stroke injury. While most studies of stroke and the BBB explore the acute phase of stroke and its effect on the blood-brain barrier, the present study revealed the longer-term effects in various parts of the brain.

The pathologic processes of stroke-induced vascular injury tend to occur in a "time-dependent manner," and can be separated into acute (minutes to hours), subacute (hours to days), and chronic (days to months). BBB incompetence during post-stroke changes is well-documented, with some studies showing the BBB opening can last up to four to five days after stroke. This suggests that harmful substances entering the brain during this prolonged BBB leakage might increase post-ischemic brain injury.

In this study, the researchers used laboratory rats modeling ischemic stroke and observed injury not only in the primary area of the stroke, but also in remote areas, where persistent BBB damage could cause chronic loss of competence.

"Our results showed that the compromised BBB integrity detected in post-ischemic rat cerebral hemisphere capillaries -- both ipsilateral and contralateral to initial stroke insult -- might indicate chronic diaschisis," Garbuzova-Davis said. "Widespread microvascular damage caused by endothelial cell impairment could aggravate neuronal deterioration. For this reason, chronic diaschisis poses as a therapeutic target for stroke."

The primary focus for therapy development could be restoring endothelial and/or astrocytic integrity towards BBB repair, which may be "beneficial for many chronic stroke patients," senior authors Cesar V. Borlongan and Paul R. Sanberg suggest. The researchers also recommend that cell therapy might be used to replace damaged endothelial cells.

"A combination of cell therapy and the inhibition of inflammatory factors crossing the blood-brain barrier may be a beneficial treatment for stroke," Garbuzova-Davis said.

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Patient safety merits new review for modified medical devices, physician says

For patient safety, the U.S. Food and Drug Administration (FDA) should require that clinical data be submitted as part of a more rigorous re-evaluation of medical devices that are modified after approval, according to UC San Francisco physician scientists in a commentary published online March 24, 2014 in the Annals of Internal Medicine. According to authors Rita Redberg, MD, UCSF professor of medicine, and UCSF second-year medical student Sarah Zheng, such a requirement could prevent deaths due to insufficiently tested device modifications.

"The need for rapid approval of design improvements to marketed devices must be weighed against the possibility of introducing unknown risks to patient health from such modifications," the authors wrote in their commentary.

In addition, Redberg said, "A requirement that post-marketing clinical data, including adverse events, be collected and deposited into a public data base would allow for the best identification of patients who could benefit from a device, without slowing market entry."

The growing medical device industry is expected to generate $228 billion in sales by 2015 for technologies ranging from orthopedic knee replacements to cochlear implants, to infusion pumps. Many devices are invasively installed within the body, and the potential complications when they fail can be great.

Examples of avoidable outcomes, according to Redberg and Zheng, include hundreds of failures and five deaths arising from use of the modified Sprint Fidelis defibrillator electrical lead wire made by Medtronic, Inc., prompting a recall, and a similar recall of defibrillator leads marketed by St. Jude Medical, Inc., after 227,000 had been implanted in patients.

The FDA evaluates safety and effectiveness of new, high-risk medical devices before they are marketed, through a process known as premarket approval (PMA). This procedure involves the submission and review of clinical-trials data. However, modifications of existing devices may be approved without additional clinical data, through a less rigorous procedure called a PMA supplement.

"Companies often submit changes to a device one supplement at a time instead of submitting multiple changes in a single application," Redberg and Zheng stated in the commentary. "As a result, each submitted modification is evaluated separately, a process that makes it difficult, if not impossible, to take into account the cumulative effects and interactions of multiple modifications."

The Medtronic and St. Jude Medical devices were modified multiple times through PMA supplements without additional clinical data submission, the authors noted.

Clinicians may favor use of a device based on original research on a much earlier version, with no knowledge of substantial, untested modifications that have been made to the currently available device, they said.

The authors advocated for clear labeling of devices to highlight modifications to physicians and alert them to unevaluated risks.

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Robotic arm probes chemistry of 3-D objects by mass spectrometry

When life on Earth was first getting started, simple molecules bonded together into the precursors of modern genetic material. A catalyst would have been needed, but enzymes had not yet evolved. One theory is that the catalytic minerals on a meteorite's surface could have jump-started life's first chemical reactions. But scientists need a way to directly analyze these rough, irregularly shaped surfaces. A new robotic system at Georgia Tech's Center for Chemical Evolution could soon let scientists better simulate and analyze the chemical reactions of early Earth on the surface of real rocks to further test this theory.

In a proof-of-concept study, scientists selected a region for analysis on round or irregularly-shaped objects using a 3-D camera on a robotic arm, which mapped the 3-dimentional coordinates of the sample's surface. The scientists programmed the robotic arm to poke the sample with an acupuncture needle. The needle collected a small amount of material that the robot deposited in a nearby mass spectrometer, which is a powerful tool for determining a substance's chemical composition.

"You see the object on a monitor and then you can point and click and take a sample from a particular spot and the robot will go there," said Facundo Fernandez, a professor in the School of Chemistry and Biochemistry, whose lab led the study. "We're using an acupuncture needle that will touch very carefully on the surface of the object and then the robot will turn around and put the material inside of a high resolution mass spectrometer."

The research was published online February 28 in the journal Analyst, a publication of the Royal Society of Chemistry. The work was supported by a National Science Foundation (NSF) Major Research Instrumentation Program (MRI) grant and by the National Science Foundation (NSF) and NASA Astrobiology Program, under the NSF Center for Chemical Evolution.

Mass spectrometry is a powerful tool for analyzing surface chemistry or for identifying biological samples. It's widely used in research labs across many disciplines, but samples for analysis typically have to be cleaned, carefully prepared, and in the case of rocks, cut into thin, flat samples. The new robotic system is the first report of a 3-D mass spectrometry native surface imaging experiment.

"Other people have used an acupuncture needle to poke a sample and then put that in mass spec, but nobody has tried to do a systematic, three-dimensional surface experiment," Fernandez said. "We are trying to push the limits."

To show that the system was capable of probing a three-dimensional object, the researchers imprinted ink patterns on the surfaces of polystyrene spheres. The team then used the robotic arm to model the surfaces, probe specific regions, and see if samples collected were sufficient for mass spectrometry analysis. The researchers were able to detect inks of different colors and create a 3-D image of the object with sufficient sensitivity for their proof-of-principle setup, Fernandez said.

The research was the result of collaboration between Fernandez's group, which specializes in mass spectrometry, and Henrik Christensen's robotics group in the College of Computing. Christensen is the KUKA Chair of Robotics and a Distinguished Professor of Computing. He is also the executive director of the Institute for Robotics and Intelligent Machines (IRIM) at Georgia Tech.

"The initial findings of this study mark a significant step toward using robots for three-dimensional surface experiments on geological material," Christensen said. "We are using the repeatability and accuracy of robots to achieve new capabilities that have numerous applications in biomedical areas such as dermatology."

"It doesn't happen very often that a group in mass spectrometry will have a very talented robotics group next to them," Fernandez said. "If we tried to learn the robotics on our own it could take us a decade, but for them it's something that's not that difficult."

Christensen's team loaned a Kuka KR5 sixx R650 robot to Fernandez's lab for the study. Afterwards, Fernandez's lab purchased their own robot from Universal Robots. They have also upgraded to a new mass spectrometer capable of resolution nearly eight times higher than the one used in the study. They will soon begin replicating early Earth chemistry on rocks and analyzing the reaction products with their robotic sampling system.

"We really want to look at rocks," Fernandez said. "We want to do reactions on rocks and granites and meteorites and then see what can be produced on the surface."

The technology could also be applied to other research fields, Fernandez said. For example, the robot-mass spec combo might be useful to dermatologists who often probe lesions on the skin, which have distinct molecular signatures depending on if the lesion is a tumor or normal skin tissue.

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Cancer treatment revolution potential with new drug

A revolution in cancer treatment could soon be underway following a breakthrough that may lead to a dramatic improvement in cancer survival rates.

A new study at the University of Warwick, published today in the journal Angewandte Chemie International Edition, has developed a new drug that can manipulate the body's natural signalling and energy systems, allowing the body to attack and shut down cancerous cells.

Called ZL105, the drug is a compound based on the precious metal iridium. The study has found ZL105 could potentially replace currently used anticancer drugs, which become less effective over time, cause a wide-range of side-effects and damage healthy cells as well as cancerous.

Commenting on the breakthrough, University of Warwick researcher and study co-author Dr Isolda Romero-Canelon said "The energy-producing machinery in cancer cells works to the limit as it attempts to keep up with quick proliferation and invasion. This makes cancer cells susceptible to minor changes in the cell 'power-house'. Our drug pushes cancer cells over the limit causing them to slow and shut down, whilst normal cells can cope with its effects."

Preliminary data indicate that the novel drug may be ten times more effective in treating ovarian, colon, melanoma, renal, and some breast cancers, according to data obtained by the US National Cancer Institute. The researchers now aim to expand the study to cancers that are inherently resistant to existing drugs and to those which have developed resistance after a first round of chemotherapy treatments.

Study co-author Professor Peter J. Sadler said "Existing cancer treatments often become less effective after the first course, as cancer cells learn how they are being attacked. The drug we have developed is a catalyst and is active at low doses. It can attack cancer cells in multiple ways at the same time, so the cancer is less able to adapt to the treatment. This means the new drugs could be much more effective than existing treatments."

"Platinum-based drugs are used in nearly 50% of all chemotherapeutic regimens, exert their activity by damaging DNA and cannot select between cancerous and non-cancerous cells, leading to a wide-range of side-effects from renal failure to neurotoxicity, ototoxicity, nausea and vomiting.

"In contrast, the new iridium-based drug is specifically designed not to attack DNA, but to have a novel mechanism of action, meaning that it could not only dramatically slow down and halt cancer growth, but also significantly reduce the side effects suffered by patients" argues Professor Sadler.

This research could also lead to substantial improvements in cancer survival rates. "Current statistics indicate that one in every three people will develop some kind of cancer during their life time, moreover approximately one woman dies of ovarian cancer every two hours in the UK according to Cancer Research UK .It is clear that a new generation of drugs is necessary to save more lives and our research points to a highly effective way of defeating cancerous cells" said Dr Romero-Canelon.

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'Glue' holding together skin cells, other epithelial tissue more active than realized

The strong mechanical attachments -- the "glue" -- that hold together the cells of the skin and the other epithelial tissues of the body are the adherens junctions.

These junctions are responsible for maintaining the shape and integrity of the sheets of epithelial cells that line such body cavities as the digestive tract, as well as the surfaces of structures such as the heart. Defects in the proteins of these attachments have been implicated as potential contributors to the development and spread of cancer.

Recent research on Drosophila flies, combined with previous studies in cell cultures, are challenging the traditional view that adherens junctions maintain tissue integrity by passively resisting disruptive forces.

In studies with Drosophila embryos, the Princeton University lab of Nobel laureate Eric Wieschaus, Ph.D., has uncovered the first evidence in living organisms that adherens junctions actively respond to mechanical cues by remodeling their own position and intensity, which in turn restructures the cells.

Mo Weng, Ph.D., postdoctoral fellow in the lab, used live imaging and quantitative image analysis of fixed and live embryos to determine that these changes depend on mechanical force mediated by the motor protein myosin and precede the changes in the distribution of cell polarity proteins, such as Bazooka, that are responsible for spatial organization of the cells.

Understanding the regulation and functioning of adherens junctions sheds light on the organization of multi-cellularity -- from cell-cell contacts to the remodeling of tissues and organs during life.

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Fewer children at risk for deficient vitamin D

Under new guidelines from the Institute of Medicine, the estimated number of children who are at risk of having insufficient or deficient levels of vitamin D is drastically reduced from previous estimates, according to a Loyola University Chicago Stritch School of Medicine study.

The study, led by Holly Kramer, MD, MPH, and Ramon Durazo-Arvizu, PhD, is published online ahead of print in the Journal of Pediatric Endocrinology and Metabolism.

New Institute of Medicine guidelines say most people get sufficient vitamin D when their blood levels are at or above 20 nanograms per milliliter (ng/mL). The Pediatric Endocrine Society has a similar guideline. However, other guidelines recommend vitamin D levels above 30 ng/mL.

Loyola researchers studied vitamin D data from a nationally representative sample of 2,877 U.S. children and adolescents ages 6 to 18 who participated in the National Health and Nutrition Examination Survey.

The study found that under the Institute of Medicine guidelines, 10.3 percent of children ages 6 to 18 are at risk of inadequate or deficient vitamin D levels. (This translates to an estimated 5.5 million children.)

By comparison, a 2009 study in the journal Pediatrics, which defined sufficient vitamin D levels as greater than 30 ng/mL, found that an estimated 70 percent of people ages 1 to 21 had deficient or insufficient vitamin D levels.

Under previous guidelines, millions of children who had vitamin D levels between 20 and 30 ng/mL would have needed supplementation. Under the Institute of Medicine guidelines, children in this range no longer need to take vitamin D supplements.

The new study found that children at risk of vitamin D deficiency under the Institute of Medicine guidelines are more likely to be overweight, female, non-white and between the ages of 14 and 18.

The Institute of Medicine's new vitamin D guidelines are based on nearly 1,000 published studies and testimony from scientists and other experts. The IOM found that vitamin D is essential to avoid poor bone health, such as rickets. But there have been conflicting and mixed results in studies on whether vitamin D can also protect against cancer, heart disease, autoimmune diseases and diabetes. Moreover, excessive vitamin D can damage the kidneys and heart, the IOM found.

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Twenty-five percent of breast cancer survivors report financial decline due to treatment

Four years after being treated for breast cancer, a quarter of survivors say they are worse off financially, at least partly because of their treatment, according to a new study led by University of Michigan Comprehensive Cancer Center researchers. In addition, 12 percent reported that they still have medical debt from their treatment.

Financial decline varied significantly by race, with Spanish-speaking Latinas most likely to be impacted. Debt was reported more frequently in English-speaking Latinas and Blacks, the study found. Results appear in the Journal of Clinical Oncology.

"As oncologists, we are proud of the advances in our ability to cure an increasing proportion of patients diagnosed with breast cancer. But as treatments improve, we must ensure that we do not leave these patients in financial ruin because of our efforts," says study author Reshma Jagsi, M.D., D.Phil., associate professor of radiation oncology at the University of Michigan Medical School.

The researchers surveyed women in Detroit and Los Angeles who had been diagnosed with early stage breast cancer, based on data obtained from the National Cancer Institute's Surveillance, Epidemiology and End Results population-based registry. Women were surveyed about nine months after diagnosis and again about four years later, with 1,502 women responding to both surveys.

The surveys asked about patients' perceptions of whether they were worse off financially since their diagnosis, and whether that has caused long-term challenges. For example, patients were asked if they had altered their medical care because of financial concerns, by skipping medication or by missing a doctor's appointment or a mammogram. Other questions looked at broader hardships, such as going without health insurance, having utilities turned off or moving out of their home.

Blacks and English-speaking Latinas were more likely than Whites to have experienced one of these issues. Other factors that made a woman more likely to experience these hardships include age under 65, household income under $50,000, part-time work at diagnosis, reduced work hours after diagnosis, lack of substantial prescription drug coverage, breast cancer recurrence, and undergoing chemotherapy.

"These patients are particularly vulnerable to financial distress," Jagsi says. "We need to ensure appropriate communication between patients and their doctors regarding the financial implications of a cancer diagnosis and treatment decisions to help reduce this long-term burden."

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State-of-the-state on genetic-based testing, treatment for breast cancer revealed

Dartmouth researchers at its Norris Cotton Cancer Center have compiled a review of the role that information gathered through genetic testing plays in the diagnosis and treatment of breast cancer. The paper entitled "Personalized Therapy for Breast Cancer" was accepted on March 17, 2014, for publication in Clinical Genetics. The paper discusses targeted therapies, new biomarkers, and the quality of commercially available testing methods.

Genomic testing is changing the way breast cancer is diagnosed and treated. By examining a woman's genes to look for specific mutations or biomarkers, treatment can be personalized to the tumor cell's biology and a woman's genetics.

"A personalized approach increases the precision and success of breast cancer treatment," said Gregory Tsongalis, PhD, director of Molecular Pathology at Norris Cotton Cancer Center and lead author of the paper. "Molecular profiling exposes a tumor's Achilles' heel. We can see what messages the tumor cells are receiving and sending. It is a biological intelligence gathering mission in an attempt to interrupt the disease.

According to Tsongalis large scale genetic testing of breast cancer is not yet part of routine clinical care as it is with lung and colon cancers, even though he and his team run a genetics laboratory for routine cancer care. Genetic testing according to Tsongalis is a powerful weapon in the diagnosis and treatment of breast cancer.

With results from the genetic testing of a tumor cell's biology, clinicians categorize breast cancer in ways that allow them to select the most effective treatments. Based on genetic biomarkers, there are three categories of breast cancer:

1. ER-positive breast cancer needs hormones, such as estrogen to grow. Estrogen fuels cancer cell growth, stops cancer cells from dying, and helps the cells lay down roots to maintain blood supply for tumors. ER-positive cancers are less aggressive and often treated with drugs that are selective estrogen receptor modulators (SERM), such as Tamoxifen, Raloxifene, Toremifene and aromatese inhibitors (AIs) such as Letrozole, Anastrozole and Exemestane. SERM drugs block estrogen from telling cancer cells to divide and grow; they have been shown successful in treating as well as preventing ER positive breast cancer. AIs block intake of estrogen in the system and reduce estrogen levels in serum, tissue, and tumor cells. AIs are commonly used in post-menopausal women.
2. HER2 -positive breast cancer cells contain large amounts of protein that help them grow and multiply. Medications turn off the production of protein to stop tumor growth and kill cancer cells. HER2 treatments include Trastuzumab, Laptinib, Pertuzumab, and Trastuzumab Emtansine.
3. Triple negative (ER-negative/PR-negative/HER2-negative) breast cancer is the most aggressive type and has the poorest clinical outcome. There is no approved personalized therapy for triple negative, but research has identified six subtypes of tumors. This is the first step in identifying biomarkers that can lead to the development of personalized treatments.

"Genomic testing of breast cancer has expanded our understanding of the disease process and has proven more effective than traditional laboratory tests," said Tsongalis. "At NCCC all of our breast cancer patients are tested for abnormal copies of the HER2 gene using specially designed DNA probes. New biomarkers and the reclassification of cancers based on these biomarkers has led to the development of new, effective treatments that can be personalized to an individual breast cancer patient."

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Plasma tool for destroying cancer cells

Plasma medicine is a new and rapidly developing area of medical technology. Specifically, understanding the interaction of so-called atmospheric pressure plasma jets with biological tissues could help to use them in medical practice.

Under the supervision of Sylwia Ptasinska from the University of Notre Dame, in Indiana, USA, Xu Han and colleagues conducted a quantitative and qualitative study of the different types of DNA damage induced by atmospheric pressure plasma exposure, the paper is published inThe European Physical Journal D, as part of a special issue on nanoscale insights into Ion Beam Cancer Therapy. This approach, they hope, could ultimately lead to devising alternative tools for cancer therapy as well as applications in hospital hygiene, dental care, skin diseases, antifungal care, chronic wounds and cosmetics treatments.

To investigate the DNA damage from the so-called non-thermal Atmospheric Pressure Plasma Jet (APPJ), the team adopted a common technique used in biochemistry, called agarose gel electrophoresis. They studied the nature and level of DNA damage by plasma species, so-called reactive radicals, under two different conditions of the helium plasma source with different parameters of electric pulses.

They also identified the effect of water on DNA damage. To do so, they examined the role of reactive radicals involved in DNA damage processes occurring in an aqueous environment. They then compared them to previous results obtained in dry DNA samples.

The next step would involve investigating plasma made from helium mixtures with different molecular ratios of other gases, such as oxygen, nitrous oxide, carbon dioxide and steam, under different plasma source conditions. The addition of another gas is expected to increase the level of radical species, such as reactive oxygen species and reactive nitrogen species, known to produce severe DNA damage. These could, ultimately, help to destroy cancerous tumour cells.

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WHO opens public consultation on draft sugars guideline

5 March 2014 | GENEVA - WHO is launching a public consultation on its draft guideline on sugars intake. When finalized, the guideline will provide countries with recommendations on limiting the consumption of sugars to reduce public health problems like obesity and dental caries (commonly referred to as tooth decay).

Comments on the draft guideline will be accepted via the WHO web site from 5 through 31 March 2014. Anyone who wishes to comment must submit a declaration of interests. An expert peer-review process will happen over the same period. Once the peer-review and public consultation are completed, all comments will be reviewed, the draft guidelines will be revised if necessary and cleared by WHO’s Guidelines Review Committee before being finalized.

New draft guideline proposals

WHO’s current recommendation, from 2002, is that sugars should make up less than 10% of total energy intake per day. The new draft guideline also proposes that sugars should be less than 10% of total energy intake per day. It further suggests that a reduction to below 5% of total energy intake per day would have additional benefits. Five per cent of total energy intake is equivalent to around 25 grams (around 6 teaspoons) of sugar per day for an adult of normal Body Mass Index (BMI).

The suggested limits on intake of sugars in the draft guideline apply to all monosaccharides (such as glucose, fructose) and disaccharides (such as sucrose or table sugar) that are added to food by the manufacturer, the cook or the consumer, as well as sugars that are naturally present in honey, syrups, fruit juices and fruit concentrates.

Much of the sugars consumed today are “hidden” in processed foods that are not usually seen as sweets. For example, 1 tablespoon of ketchup contains around 4 grams (around 1 teaspoon) of sugars. A single can of sugar-sweetened soda contains up to 40 grams (around 10 teaspoons) of sugar.

The draft guideline was formulated based on analyses of all published scientific studies on the consumption of sugars and how that relates to excess weight gain and tooth decay in adults and children.

• Read the draft guideline and submit your comments

Note to editors

Papers published with findings of two systematic reviews (analyses of published scientific studies) commissioned by WHO that informed the development of the draft guidelines:

• Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies
  Conducted by the University of Otago, New Zealand) published in the BMJ
• Effect on caries of restricting sugars intake: Systematic review to inform WHO guidelines
  Conducted by Newcastle University, UK) published in the Journal of Dental Research

For more information please contact:

Tarik Jasarevic
WHO, Geneva
Communications Officer
Telephone: +41 22 791 5099
Mobile: +41 79367 6214
E-mail:jasarevict@who.int

Glenn Thomas
WHO, Geneva
WHO Communications Officer
Telephone: +41 22 791 3983
Mobile: +41 79 509 0677
E-mail:thomasg@who.int

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Message from WHO Director-General on International Women’s Day

On this day, WHO joins others in celebrating women’s achievements. These achievements are inspiring, and they can inspire change. In health development, as in many other areas, women are agents of change. They are the driving force that creates better lives for families, communities and, increasingly, the countries they have been elected to govern.

As I have learned from my discussions with parliaments in several countries, women are increasingly winning top leadership roles, in rich and poor countries alike, and this helps shape entire societies in broadly beneficial ways. Every time a women excels in a high-profile position, her achievement lifts the social status of women everywhere.

To inspire change, all women need to be free to achieve their full potential. This means freedom from all forms of discrimination, freedom to pursue all opportunities, including education, freedom to earn and spend their own income, and freedom to follow the career paths they decide they want.

The health sector can do much to free women by ensuring they have access to all the health services they need, including sexual and reproductive health services. Participants at last year’s London Summit on Family Planning achieved a breakthrough commitment to halve the number of girls and women in developing countries who want modern contraceptives but have no access. This commitment will give 120 million additional women the right to decide whether, when, and how many children they want to have. This, too, is freedom.

Throughout history, women have been associated with care and compassion. Worldwide, up to 80% of health care is provided in the home, almost always by women. This should inspire our admiration, but it should also underscore the need for change. Most of this work is unsupported, unrecognized, and unpaid.

Polio is on the verge of eradication largely thanks to the millions of women – from vaccinators to administrators to medical doctors and mothers – who have made the vaccination and protection of children their life’s mission. On this International Women’s Day, let me thank these women for a level of dedication that can improve the world in a permanent way.

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WHO issues new guidance on how to provide contraceptive information and service

6 March 2014 | GENEVA - In advance of International Women’s Day on 8 March 2014, WHO is launching new guidance to help countries ensure human rights are respected in providing more girls, women, and couples with the information and services they need to avoid unwanted pregnancies.

An estimated 222 million girls and women who do not want to get pregnant, or who want to delay their next pregnancy, are not using any method of contraception. Access to contraception information and services will allow better planning for families and improved health.

WHO guidance recommendations

“Ensuring availability and accessibility to the information and services they need is crucial, not only to protect their rights, but also their health.”

Dr Flavia Bustreo, WHO’s Assistant Director-General for Family, Women, and Children’s Health

The guidance recommends that everyone who wants contraception should be able to obtain detailed and accurate information, and a variety of services, such as counselling as well as contraceptive products. It also underlines the need for no discrimination, coercion or violence, with special attention given to assuring access to those who are disadvantaged and marginalized.

Other key measures are scientifically accurate sex education programmes for young people, including information on how to use and acquire contraceptives. The guidance states that adolescents should be able to seek contraceptive services without having to obtain permission from parents or guardians. It also recommends that women be able to request services without having to obtain authorization from their husbands. It emphasizes the importance of respecting the privacy of individuals, including confidentiality of medical and other personal information.

“A lack of contraception puts 6 out of 10 women in low-income countries at risk of unintended pregnancy,” says Dr Flavia Bustreo, WHO’s Assistant Director-General for Family, Women, and Children’s Health. “Ensuring availability and accessibility to the information and services they need is crucial, not only to protect their rights, but also their health. These unintended pregnancies can pose a major threat to their own and their children’s health and lives.”

Access to contraception

In low- and middle-income countries, complications of pregnancy and childbirth are among the leading cause of death in young women aged 15–19 years. Stillbirths and death in the first week of life are 50% higher among babies born to mothers younger than 20 years than among babies born to mothers 20–29 years old.

Access to contraception allows couples to space pregnancies and enables those who wish to limit the size of their families to do so. Evidence suggests that women who have more than four children are at increased risk of death from complications of pregnancy and childbirth.

Many people who cannot currently access contraception services are young, poor, and live in rural areas and urban slums. Efforts are under way to address this need. The 2012 London Summit on Family Planning committed to extend family planning services to at least 120 million more people by the year 2020.

“Global targets are stimulating much needed action to increase access to modern contraception,” says Dr Marleen Temmerman, Director of WHO’s Department of Reproductive Health and Research. “But we have to be careful that our efforts to meet those targets do not lead to human rights infringements. It is not just about increasing numbers, it’s also about increasing knowledge. It is vital for women—and men—to understand how contraception works, be offered a choice of methods, and be happy with the method they receive.”

The International Conference on Population and Development held in Cairo in 1994 highlighted the importance of a rights-based approach to family planning. The past 20 years have seen a large amount of work demanding and defining a rights-based approach to health services—including contraception. Yet there has been comparatively little practical advice how to do so. WHO’s new guidance aims to address that gap.

The guidance also suggests ways to improve supply chains and affordability, recommends additional training for health workers, and outlines a series of steps to improve access in crisis settings, in HIV clinics, and during pre-natal and post-natal care.

The new guidance complements existing WHO recommendations for sexual and reproductive health programmes, including guidance on maternal and newborn health, sexuality education, prevention of unsafe abortion, and core competencies for primary health care.

For more information, please contact:

Glenn Thomas
WHO Communications Officer
Telephone: +41 22 791 3983
Mobile: +41 79 509 0677
E-mail: thomasg@who.int

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Many countries lack capacity to prevent and treat hearing loss

28 February 2014 | GENEVA - Many of the countries who responded to a new WHO survey lack the capacity to prevent and care for hearing loss, according to a report published on International Ear Care Day, 3 March.

Results of the survey

“The results of this survey are a clear call to action for governments and partners to invest in hearing care especially at community and primary level.”

Dr Etienne Krug, Director of the WHO Department of Violence and Injury Prevention and Disability

WHO estimates that over 5% of the world’s population – 360 million people - has disabling hearing loss. The highest prevalence is found in the Asia Pacific, South Asia and sub-Saharan Africa. About half of all cases of hearing loss worldwide are easily prevented or treated.

A leading cause for hearing loss in younger ages, particularly in low- and middle-income countries, is untreated ear infections, which often presents with discharge from the ear. Vaccine-preventable infectious diseases such as rubella, meningitis, measles, or mumps can also lead to hearing loss.

Just 32 of the 76 countries who responded have developed plans and programmes to prevent and control ear diseases and hearing loss. According to the report, many lack trained health personnel, educational facilities, data and national plans to address the needs of those living with ear and hearing problems. The information received also indicates that the gap between need and services is greatest in sub-Saharan Africa.

“The results of this survey are a clear call to action for governments and partners to invest in hearing care especially at community and primary level,” says Dr Etienne Krug, Director of the WHO Department of Violence and Injury Prevention and Disability. “The programmes must aim to benefit all, including disadvantaged parts of the population who are least able to access hearing services.”

Prevention and treatment of hearing loss at primary level

Good ear care practices, such as reducing exposure to noise and avoiding insertion of objects into the ears, can prevent many from developing ear and hearing problems. A large percentage of people living with hearing loss can benefit from early identification and appropriate treatment.

For example, screening programmes for infant hearing can minimize the impact of hearing loss on a child’s development.

“Ear and hearing problems and the use of hearing aids are often associated with myths and misconceptions”, says Dr Shelly Chadha of the WHO unit for the Prevention of Blindness and Deafness. “National programmes should therefore not only focus on prevention and service provision but also on awareness raising.”

The national plans that already exist in some countries can serve as a model for countries that still lack strategies to better address disabling hearing loss. However, each country needs to develop a unique plan based on its specific situation, the prevalent causes of hearing loss as well as the available health infrastructure.

For more information please contact:

Tarik Jasarevic
WHO, Geneva
Communications Officer
Telephone: +41 22 791 5099
Mobile: +41 79367 6214
E-mail:jasarevict@who.int

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Progress in diagnosing multidrug-resistant tuberculosis

20 March 2014 | Geneva - Almost half a million people fell ill with multidrug-resistant tuberculosis (MDR-TB) in 2012, yet less than one in 4 of these people was diagnosed, mainly due to a lack of access to quality diagnostic services.

But with an innovative international project, 27 countries are making promising progress in diagnosing MDR-TB, says WHO in the lead-up to World TB Day, 24 March.

The project known as EXPAND-TB (Expanding Access to New Diagnostics for TB), financed by UNITAID, helped to triple the number of MDR-TB cases diagnosed in participating countries.

“Earlier and faster diagnosis of all forms of TB is vital,” says Dr Margaret Chan, WHO Director-General. “It improves the chances of people getting the right treatment and being cured, and it helps stop spread of drug-resistant disease.”

World TB Day 2014: Reach the 3 million

"Earlier and faster diagnosis of all forms of TB is vital. It improves the chances of people getting the right treatment and being cured...”

Dr Chan, WHO Director-General

The theme for World TB Day 2014 is “Reach the 3 Million”. One third of the estimated 9 million people falling ill with TB each year do not get the care they need. In many countries, it is hard for people to access diagnostic services – particularly for MDR-TB. Some countries have only one central laboratory, which often has limited capacity to diagnose MDR-TB. In some cases, patient samples have to be sent to other countries for testing. Moreover, traditional diagnostic tests can take more than 2 months to get results.

But the situation is beginning to change. New technologies can rapidly diagnose TB and drug-resistant TB in as little as two hours.

“The MDR-TB story is being transformed by a fertile mix of collaborators, including those working on access to diagnosis,” says Philippe Meunier, the French Government’s Ambassador for the fight against HIV/AIDS and communicable diseases. “Increased capacity and reduced prices mean more patients can be served, and global health risks would be diminished.”

In 2009, UNITAID provided US$ 87 million to support the EXPAND-TB multi-partner project to enable effective and sustained access, and use of recommended new TB diagnostic technologies in 27 low- and middle-income countries. These countries together carry 40% of the estimated global MDR-TB burden.

The project delivers positive results

The project has delivered impressive results. Over 30% of the MDR-TB cases detected globally in 2012 were from EXPAND-TB countries. 90% of India’s detected MDR-TB cases were through EXPAND-TB supported services. Use of these tests requires strengthened laboratory services. By the end of 2013, 92 laboratories were fully operational. From 2009 to 2013, the number of MDR-TB cases diagnosed in the 27 countries tripled, with 36 000 diagnosed in 2013 alone.

The project has enabled more patients to be treated with quality-assured second-line TB medicines. Through that demand, the project has helped to reduce the price of individual medicines and MDR-TB treatment regimens by one third. Prices have also dropped for diagnostic commodities.

Project partners are WHO and the Global Laboratory Initiative (GLI), the Stop TB Partnership’s Global Drug Facility and FIND. Project funds have been used to purchase testing equipment and commodities, and to train laboratory technicians.

The EXPAND-TB project complements investments in laboratory infrastructure and diagnostic services from international partners, including The Global Fund to Fight AIDS, TB and Malaria, The World Bank and the United States Government.

“The gap in access to TB diagnostics and care is far from filled, but is narrowing. With the impetus of modern laboratories, we are on the right track finally to handle MDR-TB,” says Dr Mario Raviglione, Director of WHO’s Global TB Programme.

Ministries of health are now working on securing domestic funding for the medium-term and working with partners to fill financing shortfalls for quality diagnostic tests and services.

---

Note to editors

EXPAND-TB Partners, and additional quotes from participants in the 20 March press briefing

WHO is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends.

UNITAID is a global health initiative launched in 2006 by the Governments of Brazil, Chile, France, Norway and the United Kingdom to provide sustainable funding for the fight against HIV/AIDS, malaria and tuberculosis. About 70% of UNITAID’s funds come from a small levy on airline tickets. Through implementers, UNITAID finances the purchase of quality-assured drugs and diagnostics for patients in poor countries, using its market power to expand supply, promote development of new and better products, cut delivery lead times and reduce prices.

Dr Philippe Duneton, Executive Director a.i., UNITAID said, “The EXPAND-TB project has been an important part of UNITAID’s TB investment portfolio as identifying cases has been, and remains, essential. To reach the missing three million, we must continue to find and use ever-better diagnostics technologies, but also enable access for low- and middle-income countries to the new medicines now available.”

The Stop TB Partnership’s Global Drug Facility (GDF) coordinates and manages procurement and delivery of TB commodities like quality assured medicines, diagnostic equipment and supplies to eligible countries, offering as well technical assistance for building more sustainable supply chain systems. The GDF has procured and distributed diagnostics and laboratory equipment for the project and, by pooling the global demand for Second Line anti-TB Drugs within one single procurement platform, has reached up to 32% cost reduction for MDR-TB treatment, bringing a broader basis of suppliers producing quality assured medicines and allowing more market competition.

“We need to ensure that diagnostics are accessible and closer to people. This project is a successful multi-partner strategic approach where diagnostic, treatment capacity and medicines supply have been linked together, showing the path for a stronger fight against MDR-TB " said Dr Joel Keravec, GDF Special Advisor.

FIND is an international non-profit organization that drives development and delivery of innovative diagnostic solutions for poverty-related diseases. As the main implementing partner for EXPAND-TB, FIND works closely with national TB programmes and multiple international and local partners to build laboratory capacity, accelerate uptake and establish the know-how needed for correct use of new TB technologies. FIND helps ensure that all the key components that are needed for successful diagnostic implementation are put in place, and aims to maximise patient impact.

Dr Catharina Boehme, FIND’s Chief Executive Officer, said “Without diagnostics, medicine is blind. The EXPAND TB project is critical for scaling up the capacity to detect TB drug resistance. It has also laid the ground for rapid uptake and proper use of future diagnostic innovations that are urgently needed to effectively fight TB and drug resistance. Continued commitment from the global health community in support of new tools, especially point-of-care diagnostics, should remain a high priority.”

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For more information, contact

Mr Tarik Jasarevic
Mobile: +41 79 367 6214
Tel.: +41 22 791 5099
Email: jasarevict@who.int

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7 million premature deaths annually linked to air pollution

25 March 2014 | Geneva - In new estimates released today, WHO reports that in 2012 around 7 million people died - one in eight of total global deaths – as a result of air pollution exposure. This finding more than doubles previous estimates and confirms that air pollution is now the world’s largest single environmental health risk. Reducing air pollution could save millions of lives.

New estimates

In particular, the new data reveal a stronger link between both indoor and outdoor air pollution exposure and cardiovascular diseases, such as strokes and ischaemic heart disease, as well as between air pollution and cancer. This is in addition to air pollution’s role in the development of respiratory diseases, including acute respiratory infections and chronic obstructive pulmonary diseases.

The new estimates are not only based on more knowledge about the diseases caused by air pollution, but also upon better assessment of human exposure to air pollutants through the use of improved measurements and technology. This has enabled scientists to make a more detailed analysis of health risks from a wider demographic spread that now includes rural as well as urban areas.

Regionally, low- and middle-income countries in the WHO South-East Asia and Western Pacific Regions had the largest air pollution-related burden in 2012, with a total of 3.3 million deaths linked to indoor air pollution and 2.6 million deaths related to outdoor air pollution.

“Cleaning up the air we breathe prevents non-communicable diseases as well as reduces disease risks among women and vulnerable groups, including children and the elderly...”

Dr Flavia Bustreo, WHO Assistant Director-General Family, Women and Children’s Health

“Cleaning up the air we breathe prevents noncommunicable diseases as well as reduces disease risks among women and vulnerable groups, including children and the elderly,” says Dr Flavia Bustreo, WHO Assistant Director-General Family, Women and Children’s Health. “Poor women and children pay a heavy price from indoor air pollution since they spend more time at home breathing in smoke and soot from leaky coal and wood cook stoves.”

Included in the assessment is a breakdown of deaths attributed to specific diseases, underlining that the vast majority of air pollution deaths are due to cardiovascular diseases as follows:

Outdoor air pollution-caused deaths – breakdown by disease:

• 40% – ischaemic heart disease;
• 40% – stroke;
• 11% – chronic obstructive pulmonary disease (COPD);
• 6% - lung cancer; and
• 3% – acute lower respiratory infections in children.

Indoor air pollution-caused deaths – breakdown by disease:

• 34% - stroke;
• 26% - ischaemic heart disease;
• 22% - COPD;
• 12% - acute lower respiratory infections in children; and
• 6% - lung cancer.

The new estimates are based on the latest WHO mortality data from 2012 as well as evidence of health risks from air pollution exposures. Estimates of people’s exposure to outdoor air pollution in different parts of the world were formulated through a new global data mapping. This incorporated satellite data, ground-level monitoring measurements and data on pollution emissions from key sources, as well as modelling of how pollution drifts in the air.

Risks factors are greater than expected

“The risks from air pollution are now far greater than previously thought or understood, particularly for heart disease and strokes,” says Dr Maria Neira, Director of WHO’s Department for Public Health, Environmental and Social Determinants of Health. “Few risks have a greater impact on global health today than air pollution; the evidence signals the need for concerted action to clean up the air we all breathe.”

After analysing the risk factors and taking into account revisions in methodology, WHO estimates indoor air pollution was linked to 4.3 million deaths in 2012 in households cooking over coal, wood and biomass stoves. The new estimate is explained by better information about pollution exposures among the estimated 2.9 billion people living in homes using wood, coal or dung as their primary cooking fuel, as well as evidence about air pollution's role in the development of cardiovascular and respiratory diseases, and cancers.

In the case of outdoor air pollution, WHO estimates there were 3.7 million deaths in 2012 from urban and rural sources worldwide.

Many people are exposed to both indoor and outdoor air pollution. Due to this overlap, mortality attributed to the two sources cannot simply be added together, hence the total estimate of around 7 million deaths in 2012.

“Excessive air pollution is often a by-product of unsustainable policies in sectors such as transport, energy, waste management and industry. In most cases, healthier strategies will also be more economical in the long term due to health-care cost savings as well as climate gains,” says Dr Carlos Dora, WHO Coordinator for Public Health, Environmental and Social Determinants of Health. “WHO and health sectors have a unique role in translating scientific evidence on air pollution into policies that can deliver impact and improvements that will save lives.”

The release of today’s data is a significant step in advancing a WHO roadmap for preventing diseases related to air pollution. This involves the development of a WHO-hosted global platform on air quality and health to generate better data on air pollution-related diseases and strengthened support to countries and cities through guidance, information and evidence about health gains from key interventions.

Later this year, WHO will release indoor air quality guidelines on household fuel combustion, as well as country data on outdoor and indoor air pollution exposures and related mortality, plus an update of air quality measurements in 1600 cities from all regions of the world.

For more information, contact

Mr Tarik Jasarevic
Mobile: +41 79 367 6214
Telephone: +41 22 791 5099
E-mail: jasarevict@who.int

Glenn Thomas
Telephone: +41 22 791 3983
Mobile: +41 79 509 0677
E-mail: thomasg@who.int

Nada Osseiran
Communications Officer, Department of Public Health, Environmental and Social Determinants of Health
Telephone: +41 22 791 4475
Mobile: +4179 445 1624
E-mail: osseirann@who.int

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