MCG Nurse Scientist Investigates Trauma-Induced Sepsis

An emergency room nurse's curiosity about why some trauma patients develop sepsis while others don't has led to an expanded career as a researcher studying the question.



Dr. Beth NeSmith, assistant professor of physiological and technological nursing in the Medical College of Georgia School of Nursing, has received a three-year, $281,000 National Institutes of Health grant to examine risk factors for sepsis and organ failure following trauma.



Trauma kills more than 13 million Americans annually. Sepsis, an uncontrolled systemic infection commonly known as blood poisoning, and associated organ failure are the leading causes of in-hospital trauma deaths, yet little data exist to explain differences in population vulnerability to these deadly outcomes.



NeSmith believes lifetime chronic stress may be the culprit and a simple test on hair may identify those at risk.



"My theory is that a person who grows up with chronic stress, such as socio-economic stress or abuse, will have a different response to trauma in terms of their inflammation profile," NeSmith said. "Inflammation is a normal body response to trauma, but if it gets out of hand it's dangerous. The only care for it is supportive until - if - the body gets better."



As the trauma clinical nurse specialist at MCG Health System from 1997-2003, NeSmith was intrigued by the limited treatment options available for sepsis. "As members of the health care team, we knew there was no cure. I thought that was mysterious and we needed research to figure it out."



It's well known that chronic stress suppresses the immune response, NeSmith said. Her grant will allow her to test the theory that people with existing chronic stress respond differently physiologically to trauma than non-stressed individuals.



Chronic stress produces high levels of cortisol, a stress hormone that normally works in sync with the immune system but, when sustained, gradually interrupts the body's carefully orchestrated checks and balances system. The result may suppress the immune response to trauma in much the same way as the body's aging process.



"We know intuitively that older people are more vulnerable to complications following trauma, and therefore, we are as preventative as possible in treatment," NeSmith said. "If a younger person who has lived a chronically stressed life has the same biological changes as a chronologically older person, and we can test for that susceptibility, we could support them as well and work to prevent a sepsis episode."



Pre-trauma stress levels can be determined by testing for cortisol deposits in hair. That information, combined with screening results from a Life Events and Difficulties survey, could help determine changes in the inflammatory response to trauma and associated sepsis risk.



NeSmith also is studying the effect of heat shock protein 90 inhibitors, which show promise as anti-inflammatories in animal studies, on alleviating trauma-induced inflammation. The study, funded by a $125,000 grant from the MCG Cardiovascular Discovery Institute, examines whether a patient's inflammation profile could be changed by the addition of an hsp90 inhibitor.



Heat shock proteins play a key role in the inflammatory response. Inhibitors of heat shock protein 90 have been used as chemotherapeutic agents and are being studied in cardiovascular disease. NeSmith will investigate their ability to prevent or reverse inflammation in humans.



Collaborating on both grants with mentor Dr. John Catravas, director of the MCG Vascular Biology Center, NeSmith spends three days a week in the lab working with basic science research techniques.



"This is translational research, breaking down the silos between basic science and clinical research," said NeSmith, who received her Ph.D. from MCG in 2007. "As a nurse taking care of sepsis patients, I wanted to help, knowing the difficult road ahead of them. I had never imagined doing research like this; historically, it's not something nurses have done. Yet we are perfect for it because nurses specialize in the patient's environment."



NeSmith's grant from the National Institutes of Health is a career development grant designed for new investigators. In addition to research and mentoring components, she'll be taking advanced coursework from MCG and the University of Pittsburgh.




Buy Elavil Online no Prescription

For Fighting Infection, A Rare Immune Cell Is Both Asset And Liability

The same trait that makes a rare immune cell invaluable in fighting some infections also can be exploited by other diseases to cause harm, two new studies show.



In papers published online in Immunity, scientists at Washington University School of Medicine in St. Louis reveal that the cells, known as CD8 alpha+ dendritic cells (CD8a+ DCs), can help the body beat back infection by a common parasite, but the same cells can be hijacked by a bacterium to decimate the body's defenses.



The trait that makes the cells both an asset and a liability is the way they alert other immune cells, causing them to attack invaders. CD8a+ DCs can sound the alarm in a manner that is particularly helpful for stripping away invaders' disguises. But this process takes time, and Listeria bacteria can take advantage of that delay to wreak havoc inside the spleen.



"As we've discovered how useful these cells can be in fighting different kinds of infections, researchers have wondered why they're so rare," says Kenneth Murphy, MD, PhD, the Eugene L. Opie First Centennial Professor of Pathology and Immunology. "This may be why - overcommitting to any one defensive strategy opens up opportunities for counterstrategies that exploit it."



CD8a+ DCs make up about 10 percent of all dendritic cells in the body. By studying the basic functions of these cells, scientists are laying the groundwork to use them to fight infections. The cells also appear to be essential for some cancer vaccines, which enlist the power of the immune system to help fight tumors.



Murphy, who is a Howard Hughes Medical Institute Investigator, previously created genetically altered mice where CD8a+ DCs could be selectively eliminated. By comparing these mice with normal mice, Murphy and his collaborators have shown that CD8a+ DCs are essential to priming the body's defenses against viral infections.



Viruses often try to disguise themselves to evade defenders, but CD8a+ DCs can extract characteristic parts of a virus and display them on their surface. Other cells also can make these displays, but CD8a+ DCs do it in a way that helps peel back disguises, causing other immune cells to seek out additional copies of the virus and kill them.



In one of the new studies, doctoral student Mona Mashayekhi showed that CD8a+ DCs are early responders to infection with the Toxoplasma gondii parasite, which causes serious disease in patients with weakened or suppressed immune systems. She found only CD8a+ DCs produce a signal that causes other immune cells to fight the parasite.



In the second paper, Brian Edelson, MD, PhD, assistant professor of pathology and immunology, tested the cells against the bacteria Listeria, which can cause food poisoning. He discovered that CD8a+ DCs could make Listeria infection worse.



"Listeria likes to get into immune cells using a pathway that typically leads to the bacteria's death in garbage disposals inside the cell," Murphy explains. "But that pathway is slowed down in CD8a+ DCs to ensure that they can retain part of the invader to display to other immune cells."



Researchers watched Listeria use this delay to ride inside CD8a+ DCs as they entered the spleen, where immune cells not yet activated for attacking invaders are kept. These cells are easy targets for the bacteria, and infection worsens.



According to Murphy, CD8a+ DCs' specialized ability to initiate immune attacks makes them essential for efforts to create cancer vaccines based on DNA from tumors. He and collaborator William Gillanders, MD, professor of surgery, are working to use these vaccines to make immune cells attack cancers.



"What we're learning from basic studies, for example, has already enabled us to increase the number of CD8a+ DCs in mice until they're about 30 to 40 percent of dendritic cells," Murphy says. "Learning more about how this cell interacts with other immune cells will allow us to create effective cancer vaccines."



Funding from the Howard Hughes Medical Institute, the American Heart Association, the National Institutes of Health, the Burroughs Wellcome Fund Career Award for Medical Scientists, the Jack H. Ladenson Fellowship in Experimental Clinical Pathology at Washington University School of Medicine, the Emmy Noether Program of the German Research Foundation and the National Institutes of Health supported this research.


Buy Cystone Without Prescription

Personalized Catch-Up Immunization Schedules For Missed Childhood Vaccinations

A new downloadable software tool will help pediatricians, parents and other health care professionals determine how to adjust complex childhood immunization schedules when one or more vaccine doses aren't received at the proper time.



Children commonly miss recommended times to receive vaccines. A report issued last month by the Centers for Disease Control and Prevention (CDC) found an alarming 28 percent of toddlers have not been vaccinated according to U.S. guidelines. Another recent survey found that only nine percent of children received all of their vaccinations at the recommended times and that only half received all recommended doses by their second birthday.



Once a child falls behind in the vaccination schedule, health care professionals are left to figure out when it's appropriate to give any missed vaccines and any future vaccines. They typically have to construct a unique, personalized catch-up schedule for each child - often while the child sits in the treatment room.



Researchers at the Georgia Institute of Technology are taking the guesswork out of developing individualized catch-up vaccination schedules. A new online tool allows parents and pediatricians to ensure that the missed vaccines and future vaccines are administered without violating guidelines regarding vaccines and doses.



"Physicians have been telling us for years that they needed a computerized program to tell them when to give vaccines after a child misses scheduled immunizations," said Larry Pickering, executive secretary of the Advisory Committee on Immunization Practices (ACIP) of the CDC and a collaborator on the project. "Now this tool is available for health carThe tool, designed by Pinar Keskinocak, associate professor in Georgia Tech's H. Milton Stewart School of Industrial and Systems Engineering, and graduate student Faramroze Engineer, is available for download from the CDC Web sitee professionals and parents to use and they are excited to use it."
[cdc/vaccines/scheduler/catchup.htm].



The program removes the challenging task of simultaneously considering complex rules, guidelines and discretionary considerations when creating a catch-up schedule. A physician or caregiver simply inputs a child's date of birth and previous immunization dates, and the program displays a personalized schedule of the recommended dates to administer all future vaccines.



The tool removes the numerical and computational aspects of constructing a catch-up schedule by hand and provides two options: administer the vaccines as soon as possible or administer the vaccines when recommended.



"Sometimes a physician sees a child that he or she knows will not return for all follow-up visits. In this case, the tool provides the physician flexibility in administering as many vaccines as possible while the child is in the office rather than waiting," said Pickering.
















It is important that children are protected against diseases by getting vaccinated. Since vaccines contain weakened viruses or parts of organisms that cause disease, the body's immune system reacts to the vaccine the same as it would if it were being invaded by the disease, but without getting sick.



The body makes antibodies and stimulating cells that destroy disease-causing germs. If the immunized person is ever exposed to the real disease, the antibodies are there for protection. Sometimes additional doses of a vaccine have to be administered to boost immunity.



The vaccines included in the scheduler are those required between birth and six years of age: Hepatitis B, Rotavirus, Diphtheria/Tetanus/Pertussis, Haemophilus influenzae type b, Pneumococcal, Inactivated Poliovirus, Measles/Mumps/Rubella, Varicella, Hepatitis A and Meningococcal. Influenza is contained in the recommended schedule, but is not included in the scheduler. Each infant requires approximately 27 vaccine doses administered before two years of age for protection from 15 vaccine-preventable diseases.



A beta version of the tool was demonstrated at the AAP National Conference and Exhibition last October and presented to the Committee on Infectious Diseases as well as several pediatric clinics in Atlanta, including Children's Healthcare of Atlanta.



The scheduler follows the guidelines developed and revised each year by ACIP in collaboration with the AAP and the American Academy of Family Physicians. These guidelines include the feasible number, timing and spacing of doses of each vaccine based on the child's age, the number of doses and the age at which each dose was administered.



In addition, each dose of each vaccine has a minimum, maximum and recommended age for administration, and there are minimum and recommended gaps between doses. These gaps as well as future administrations of a particular vaccine may vary depending on the current age of the child and the age at which previous doses were administered.



If a child requires more than one live vaccine to be administered, there are two options: administer all live vaccines on the same day or wait 28 days between live vaccine shots. There also may be discretionary considerations such as limiting the number of simultaneous administrations a child receives or the number of visits required to complete the series for all vaccines.



To solve the complicated problem of developing a personalized catch-up vaccination schedule in just seconds, the researchers used a technique called dynamic programming. Dynamic programming means solving an optimization problem by efficiently sorting partial results.



For example, if two partial schedules are created for a child and they both administer the same number of doses, but one schedule administers them earlier than the other, then the partial schedule that administers the vaccines later is eliminated because a better option is already available.



The key to dynamic programming is to prove that one partial schedule is better than another without having to determine the entire schedule and without having to try every possible schedule.



"The benefit of dynamic programming is that it eliminates solutions or partial solutions that are not promising - those that won't lead to the optimal solution," said Keskinocak.



In providing such a tool, the researchers hope to improve the effectiveness of childhood vaccination programs by improving timely vaccination rates.



"In an ideal world, every child would receive their vaccines at the recommended times, but since this isn't a perfect world, this tool developed at Georgia Tech allows children to correctly catch-up once they fall behind," added Pickering.







Source: Abby Vogel


Georgia Institute of Technology Research News


Buy Chloroquine Without Prescription

Studies Examine CHIP Crowd-Out, Quality Of Care Based On Insurance Status, Behind-The-Counter Drug Class

"CHIP: CMS Should Improve Efforts To Assess Whether SCHIP Is Substituting for Private Insurance," Government Accountability Office: For the study, GAO researchers examined CMS' and states' efforts to prevent crowd-out in CHIP. Researchers analyzed federal laws and guidance, examined state annual reports, and interviewed CMS officials and CHIP officials from nine states. GAO also offers recommendations on ways to improve information about whether crowd-out should be a concern (GAO release, 3/23).


"Insurance Status and Quality of Diabetes Care in Community Health Centers," American Journal of Public Health: In the study, a team of researchers -- led by James Zhang, who at the time worked at the University of Chicago Department of Medicine -- examined how insurance status affected the quality of diabetes care in federally funded community health centers. The study found that uninsured patients were the least likely to meet quality-of-care measures and that Medicaid beneficiaries had a quality of care similar to that of uninsured patients (Zhang et al., American Journal of Public Health, April 2009).


"Nonprescription Drugs: Considerations Regarding a Behind-the-Counter Drug Class," Government Accountability Office: The study is an update on a 1995 GAO study that examined the availability of nonprescription medications in Australia, Italy, the Netherlands, the United Kingdom and the U.S. The new study looked at whether 86 drugs available in the five countries are sold over-the-counter or behind-the-counter through document reviews and interviews with pharmaceutical experts. Researchers examined the arguments supporting and opposing a U.S. BTC drug class, changes in drug availability in five countries since 1995 and the effect of restricted nonprescription classes on availability, and issues important to the establishment of a BTC drug class (GAO release, 3/23).



Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.

© 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.



Buy Anti-Bacterial Face Mask Without Prescription

A New Vaccine To Combat All Forms Of Meningococcal Disease - Fighting Disease In Developed And Developing Countries

The Health Protection Agency (UK) has announced a collaboration with the Serum Institute of India Ltd to develop a vaccine for the prevention of meningococcal septicaemia and meningitis, which it is hoped will be effective against all forms of the disease and may eventually be used to save children's lives throughout the world.


The Agency's scientists have been working for over a decade on developing a vaccine against the Group B meningococcus. This is because although the meningococcal Group C conjugate vaccine which was introduced into the UK in 1999 has proved to be extremely successful in reducing cases of that disease, there is still no effective vaccine against the Group B strains. The Agency's candidate vaccine which is currently in a phase one clinical trial in the UK uses an organism known as Neisseria lactamica , which is a harmless relative of the pathogenic Neisseria meningitidis bacterium, that causes septicaemia and meningitis, in order to prime the immune system and therefore protect against the disease.


It is aspects of this technology that the Agency has now licensed to the Serum Institute of India. The Institute will combine the components for the B vaccine with the components for the A and C conjugate vaccines which it already makes, as well as conjugates for the Y and W135 strains of the disease in order to produce a pan-meningococcal vaccine which it is hoped will be effective against all the significant bacterial strains of the disease. These different strains occur and cause disease in different parts of the world, so an effective 5-in-1 vaccine would be a significant advance, particularly for healthcare in developing countries. The new vaccine will be manufactured in India and have to undergo clinical trial testing in order to ensure that it is safe and effective before it can be made available


The Serum Institute is already working with both the World Health Organization and the PATH organisation's programme to prevent and ultimately eliminate epidemic Group A meningococcal disease in the African meningitis belt, under the umbrella of the Global Alliance for Vaccination and Immunization. Consequently the Serum Institute are ideally placed to develop this new 5-in-1 vaccine and also deliver it at affordable price to the parts of the world where it is needed most.


Welcoming the new project, Chairman of the Health Protection Agency, Sir William Stewart said: "In the fight for better health protection, vaccines are critically important. Group B meningococcus is a particular concern with a global impact and the Agency is delighted to have establish this new collaborative venture."


The Agency's Chief Executive, Professor Pat Troop said: "The collaboration between the Health Protection Agency's scientists and the Serum Institute of India Ltd to develop a universal meningococcal vaccine is most encouraging. This latest development marks the first steps on the road to eliminating all forms of this devastating disease. It represents the culmination of years of work on the part of the Agency's vaccine development team and clearly illustrates the public health benefits that can flow from scientists working in partnership in different organisations across the world."


About the Partners


The Serum Institute of India was founded in 1966 with the aim of manufacturing life-saving immuno-biologicals, originally for the Indian market but has since grown to be the world's largest producer of Measles and DTP group (Diphtheria, Tetanus and Polio) vaccines. The Institute endeavours to continues to improve the health of the world's children by preventing diseases through immunisation and has an active research, development, commercialisation and delivery strategy.


The Health Protection Agency was formed in 2003 from various parts of the UK 's public health service with the aim of protecting health, preventing harm and preparing for threats. It has three national research centres, including the one at Porton Down, as well as public health teams at regional and local levels. The Agency has an established track record of commercialising it research into healthcare products which are effective at treating or preventing a range of serious diseases.


seruminstitute


This collaboration was announced in a speech made by the Chancellor of the Exchequer Gordon Brown during his recent visit to India. Full text of this speech can be found here.

Buy Allopurinol Without Prescription

Washington, D.C., Council Members Propose Measure To Require Girls Entering Sixth Grade To Receive HPV Vaccination

Washington, D.C., City Council Members Mary Cheh (D) and independent David Catania on Tuesday proposed a bill that would require girls entering the sixth grade to receive Merck's human papillomavirus vaccine Gardasil, the Washington Post reports (Stewart/Stein, Washington Post, 1/10). Gardasil in clinical trials has been shown to be 100% effective in preventing infection with HPV strains 16 and 18, which together cause about 70% of cervical cancer cases. FDA in July 2006 approved the vaccine for sale and marketing to girls and women ages nine to 26, and CDC's Advisory Committee on Immunization Practices later that month voted unanimously to recommend that girls ages 11 and 12 receive the vaccine (Kaiser Daily Women's Health Policy Report, 1/9). According to the legislation, female students would be required to show proof of vaccination before enrolling in the sixth grade in District of Columbia Public Schools, unless their parent or legal guardian chose to "opt out" of the requirement. The bill does not specify the circumstances under which girls would be allowed an exemption. Catania said he is introducing the bill because federal funding is available so Medicaid beneficiaries and others who are uninsured or underinsured can be vaccinated at no cost. According to the Post, Catania also decided to propose the legislation in part because of the high cervical cancer incidence in the district, which the American Cancer Society reports is 13.5 cases per 100,000 females, compared with the national rate of 8.8 cases per 100,000 females. "With January being National Cervical Cancer Awareness Month, now is the perfect time for the [d]istrict to lead the nation in the fight against what is in essence a preventable disease," Catania said at the Council meeting. Stanley Gall of the American College of Obstetricians and Gynecologists said, "I think this makes perfect sense," adding, "There would certainly be a significant health benefit." Joseph Bocchini, chair of the American Academy of Pediatrics committee on infectious diseases, said, "I think it's too early. This is a new vaccine. It would be wise to wait until we have additional information about the safety of the vaccine." Iris Toyer, co-chair of Parents United for D.C. Public Schools, said whether to vaccinate girls with Gardasil is "really a decision between parents and doctors," adding that she understands the "intent" of the legislation, "but a lot of discussion must be done" (Washington Post, 1/10).

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.


View drug information on Gardasil.

Buy Benicar Online no Prescription

American Diabetes Association A Proud Supporter Of Cover The Uninsured Week

As the nation's
leading health non-profit organization supporting diabetes research,
information, and advocacy, the American Diabetes Association will join
various health associations, organizations, and supporters during "Cover
the Uninsured Week" (April 23-29). Nearly 21 million American children and
adults have diabetes, but many are uninsured and cannot access the
supplies, medications, and education necessary to successfully manage the
disease and prevent diabetes-related complications such as heart disease,
stroke, kidney failure, blindness, and lower-limb amputation. Throughout
the year, ADA is committed to ensuring that people living with diabetes
have access to affordable and adequate health care.


"Diabetes has become the greatest health crisis of the first quarter of
the twenty-first century," said Larry Deeb, MD, President, Medicine &
Science, American Diabetes Association. "With more and more Americans
diagnosed with diabetes or being at increased risk for developing this
disease, we need to ensure that proper health care is available to them. We
are not meeting this need, and if we continue to ignore this issue, we will
be setting up our health care system for failure."



Along with advocating at the state and federal level for policies that
protect and expand diabetes health coverage, ADA helps individuals with
diabetes who do not have health insurance. Through ADA's National Call
Center, trained ADA representatives respond to, on average, 600 calls a
month involving insurance-related issues, many coming from individuals
without insurance. In response, ADA is able to direct callers to resources
and programs that may provide access to diabetes management tools and
resources.



Recently, an ADA Call Center representative took a call from a woman
who has type 2 diabetes and lives in New York State.



With her voice cracking, she said, "I've lost my job. I have no
insurance. I haven't been able to test my blood sugar for a week, and I
don't know how I will pay for my insulin this month." This is an example of
the types of calls that the ADA National Call Center receives on a regular
basis. In this instance, the National Call Center representative was able
to provide her with information about community clinics in her area, the
State Commissioner's list, and phone numbers for manufacturer assistance
programs for a blood glucose monitor, test strips, and lancets. These are
all options for people who do not have health insurance and cannot pay for
the necessary supplies to manage the disease. Additionally, this woman was
sent materials to assist her in her search for affordable insurance.
Immediately following the call, the woman made contact with a local clinic.



"The Association's National Call Center is a powerful example of how
ADA is committed to helping individuals with diabetes access the health
care that is critical to their ability to stay healthy," Deeb said. "This
resource has literally served as a lifeline for thousands of Americans who
call ADA every day."



Cover the Uninsured Week brings together a broad coalition to urge
national leaders to find solutions for the more than the 46 million
Americans who live without health insurance. For more information about
Cover the Uninsured Week, please visit covertheuninsured.



Diabetes is one of this nation's most prevalent, debilitating, deadly
and costly diseases. While 20.8 million Americans live with diabetes today,
it is estimated that if current trends continue, one in three Americans
born today will develop diabetes in their lifetime. One in 10 U.S. health
care dollars is spent on diabetes and its complications.



The American Diabetes Association is the nation's leading voluntary
health organization supporting diabetes research, information and advocacy.
The Association's advocacy efforts include helping to combat discrimination
against people with diabetes; advocating for the increase of federal
diabetes research and programs; and improved access to, and quality of,
healthcare for people with diabetes. The Association's mission is to
prevent and cure diabetes and to improve the lives of all people affected
by diabetes. Founded in 1940, the Association provides service to hundreds
of communities across the country.


American Diabetes Association

diabetes

Buy Triamcinolone Without Prescription