Study shows that in the face of an epidemic, even moderate government-mandated travel restrictions would slow contagion

Main Category: Infectious Diseases / Bacteria / Viruses
Also Included In: Public Health
Article Date: 01 Aug 2013 - 1:00 PDT Current ratings for:
Study shows that in the face of an epidemic, even moderate government-mandated travel restrictions would slow contagion

In an epidemic or a bioterrorist attack, the response of government officials could range from a drastic restriction of mobility - imposed isolation or total lockdown of a city - to moderate travel restrictions in some areas or simple suggestions that people remain at home. Deciding to institute any measure would require officials to weigh the costs and benefits of action, but at present there's little data to guide them on the question of how disease spreads through transportation networks.

However, a new MIT study comparing contagion rates in two scenarios - with and without travel restrictions - shows that even moderate measures of mobility restriction would be effective in controlling contagion in densely populated areas with highly interconnected road and transit networks. The researchers called the difference between infection rates in the two scenarios the "price of anarchy," a concept from game theory that's frequently used as a metric in studies of the controlled use of transportation networks.

The study, published online July 31 in the Journal of the Royal Society Interface, is the first to link the concept of price of anarchy to the spread of contagion. It assumes that transmission of the news of the epidemic (which influences how people select travel routes) and the epidemic itself follow the same mobility network, and uses standard epidemiological models to simulate the flow of contagion.

The researchers - Ruben Juanes, the ARCO Associate Professor in Energy Studies in MIT's Department of Civil and Environmental Engineering, graduate student Christos Nicolaides and research associate Luis Cueto-Felgueroso - used data from the 2000 U.S. census to establish the aggregate daily flux of people commuting between counties.

Previous research had shown that when individuals become aware of an epidemic, they travel not by taking the shortest route, but by taking the shortest route that avoids infected areas - even if they're already infected - a strategy that exposes people in uninfected areas to disease. Such "selfish behavior," as it's called in game theory, is in direct opposition to the strategy of policymakers, who presumably would act in the benefit of the greater social good by routing infected individuals through areas where infection rates were already high.

The MIT study shows that the price of anarchy in some regions of the United States, such as along Interstate 95 in the Northeast, would be considerable. For a moderately contagious disease - one in which every infected person infects, on average, two others - restricting individuals to specific travel routes would decrease infection rates by as much as 50 percent.

"In an area with high connectivity, the outcome of action coordinated by officials is going to be better than selfish action, but the economic and social costs of disruption could sometimes be too high," Juanes says. "In other cases, there would be an enormous benefit to having authorities impose travel restrictions. The price of anarchy is a quantitative measure that identifies areas where intervention might pay off."

"Although the study is an idealized scenario, it does give insight to authorities about when and where it would be important to impose route restrictions on human mobility in the case of an emergent outbreak or in the extreme case of bioterrorism," says Nicolaides, the paper's first author, who was funded by a Vergottis Fellowship from the MIT School of Engineering. "But you have to take into account the structure of the underlying mobility network and its traffic properties. Imposing policy-initiated action in areas with low traffic would not render substantial benefits for the containment of an epidemic."

In their models, the researchers tracked an infectious disease as it spread via commuting networks in the contiguous United States, and found that the price of anarchy for contagion varies depending on the proximity of a network to major commuting corridors.

"A commuting network may be very local, but some contagion is related to more distant travel networks," Cueto-Felgueroso says. "That's why we see a higher price of anarchy near major arteries, like Interstate 95 in the northeastern United States."

The researchers had previously studied the spread of disease through the air transportation network and found that the interconnectivity and location of an airport in the network, not just the number of travelers moving through it, were key to its ability to spread disease.

Juanes says the next step in this work is to measure the price of anarchy for contagion in the world's 7,000 airports.

Written by Denise Brehm

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Research shows that people are remaining healthier later in life

Main Category: Seniors / Aging
Also Included In: Public Health
Article Date: 30 Jul 2013 - 1:00 PDT Current ratings for:
Research shows that people are remaining healthier later in life

A new study, conducted by David Cutler, the Otto Eckstein Professor of Applied Economics, shows that, even as life expectancy has increased over the past two decades, people have become increasingly healthier later in life.

"With the exception of the year or two just before death, people are healthier than they used to be," Cutler said. "Effectively, the period of time in which we're in poor health is being compressed until just before the end of life. So where we used to see people who are very, very sick for the final six or seven years of their life, that's now far less common. People are living to older ages and we are adding healthy years, not debilitated ones."

The study results are based on data collected between 1991 and 2009 from nearly 90,000 individuals who responded to the Medicare Current Beneficiary Survey (MCBS). Cutler reported these findings in work with Mary Beth Landrum of Harvard Medical School and Kaushik Ghosh of the National Bureau of Economic Research.

To understand whether people are becoming healthier, Cutler first had to answer a question that, at least initially, seemed impossible to solve: How far are people from death?

"There are two basic scenarios that people have proposed about the end of life," he said. "The first argues that what medical science is doing is turning us into light bulbs - that is, we work well until suddenly we die. This is also called the rectangularization of the life curve, and what it says is that we're going to have a fairly high quality of life until the very end.

"The other idea says life is a series of strokes, and medical care has simply gotten better at saving us," he continued. "So we can live longer because we've prevented death, but those years are not in very good health, and they are very expensive - we're going to be in wheelchairs, in and out of hospitals and in nursing homes."

While researchers have tried to tackle the question of which model is more accurate, different studies have produced competing results. One reason for the confusion, Cutler suggested, is that such efforts are simply looking at the wrong end of someone's life.

"Most of our surveys measure health at different ages, and then use a model to estimate how long people have to live," he said. "But the right way to do this is to measure health backwards from death, not forwards. We should start when someone dies, then go back a year and measure their health, then go back two years, three years, and so on."

The MCBS allows researchers to do just that, Cutler said, by linking survey responses to participants' Medicare records for the rest of their life, meaning researchers can calculate - in some cases to the day - exactly how far participants were from death when they answered the survey.

By comparing that data with survey responses on how well people were able to care for themselves - whether they were able to cook, clean, bathe themselves, dress themselves, walk and manage money - Cutler was able to determine how healthy people were relative to how close or far away they were from dying.

Going forward, Cutler hopes to unravel the reasons why some conditions are today less debilitating than in the past. Part of the change, he said, will certainly be chalked up to increased access and improvements to care, but there are a host of other factors that make answering the question "very very difficult."

"There seems to be a clear relationship between some conditions that are no longer as debilitating as they once were and areas of improvement in medicine," he said. "The most obvious is cardiovascular disease - there are many fewer heart attacks today than there used to be, because people are now taking cholesterol-lowering drugs, and recovery is much better from heart attacks and strokes than it used to be. A person who suffered a stroke used to be totally disabled, but now many will survive and live reasonable lives. People also rebound quite well from heart attacks."

What's more, he said, as standards of care have improved, so too has the public's knowledge of how to live healthier lives.

"People are much better educated about their health now," Cutler said. "People are taking steps to help prevent long-term cognitive decline. We don't have any way yet to slow down something like Alzheimer's or Parkinson's, but there is a lot we can do for other health problems."

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The research reported here was sponsored by the National Institute on Aging.

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Study shows how viruses in gut bacteria change over time

Main Category: Infectious Diseases / Bacteria / Viruses
Also Included In: GastroIntestinal / Gastroenterology
Article Date: 30 Jul 2013 - 0:00 PDT Current ratings for:
Study shows how viruses in gut bacteria change over time

Humans are far more than merely the sum total of all the cells that form the organs and tissues. The digestive tract is also home to a vast colony of bacteria of all varieties, as well as the myriad viruses that prey upon them. Because the types of bacteria carried inside the body vary from person to person, so does this viral population, known as the virome.

By closely following and analyzing the virome of one individual over two-and-a-half years, researchers from the Perelman School of Medicine at the University of Pennsylvania, led by professor of Microbiology Frederic D. Bushman, Ph.D., have uncovered some important new insights on how a viral population can change and evolve ?" and why the virome of one person can vary so greatly from that of another. The evolution and variety of the virome can affect susceptibility and resistance to disease among individuals, along with variable effectiveness of drugs.

Their work was published in the Proceedings of the National Academy of Sciences.

Most of the virome consists of bacteriophages, viruses that infect bacteria rather than directly attacking their human hosts. However, the changes that bacteriophages wreak upon bacteria can also ultimately affect humans.

"Bacterial viruses are predators on bacteria, so they mold their populations," says Bushman. "Bacterial viruses also transport genes for toxins, virulence factors that modify the phenotype of their bacterial host." In this way, an innocent, benign bacterium living inside the body can be transformed by an invading virus into a dangerous threat.

At 16 time points over 884 days, Bushman and his team collected stool samples from a healthy male subject and extracted viral particles using several methods. They then isolated and analyzed DNA contigs (contiguous sequences) using ultra-deep genome sequencing .

"We assembled raw sequence data to yield complete and partial genomes and analyzed how they changed over two and a half years," Bushman explains. The result was the longest, most extensive picture of the workings of the human virome yet obtained.

The researchers found that while approximately 80 percent of the viral types identified remained mostly unchanged over the course of the study, certain viral species changed so substantially over time that, as Bushman notes, "You could say we observed speciation events."

This was particularly true in the Microviridae group, which are bacteriophages with single-stranded circular DNA genomes. Several genetic mechanisms drove the changes, including substitution of base chemicals; diversity-generating retroelements, in which reverse transcriptase enzymes introduce mutations into the genome; and CRISPRs (Clustered Regularly Interspaced Short Palindromic Repeats), in which pieces of the DNA sequences of bacteriophages are incorporated as spacers in the genomes of bacteria.

Such rapid evolution of the virome was perhaps the most surprising finding for the research team. Bushman notes that "different people have quite different bacteria in their guts, so the viral predators on those bacteria are also different. However, another reason people are so different from each other in terms of their virome, emphasized in this paper, is that some of the viruses, once inside a person, are changing really fast. So some of the viral community diversifies and becomes unique within each individual."

Since humans acquire the bacterial population -- and its accompanying virome -- after birth from food and other environmental factors, it's logical that the microbial population living within each of us would differ from person to person. But this work, say the researchers, demonstrates that another major explanatory factor is the constant evolution of the virome within the body. That fact has important implications for the ways in which susceptibility and resistance to disease can differ among individuals, as well as the effectiveness of various drugs and other treatments.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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The research was supported by Human Microbiome Roadmap Demonstration Project (UH2DK083981) the Penn Genome Frontiers Institute, and the University of Pennsylvania Center for AIDS Research (CFAR; P30 Al 045008).

Samuel Minot, Alexandra Bryson, Christel Chehoud, Gary D. Wu, James D. Lewis, all from Penn, are co-authors.

University of Pennsylvania School of Medicine

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Inovio Pharmaceuticals' potent hTERT DNA cancer vaccine shows potential to reduce tumors and prevent tumor recurrence

Main Category: Cancer / Oncology
Also Included In: Immune System / Vaccines
Article Date: 24 Jul 2013 - 4:00 PDT Current ratings for:
Inovio Pharmaceuticals' potent hTERT DNA cancer vaccine shows potential to reduce tumors and prevent tumor recurrence

Inovio Pharmaceuticals, Inc. (NYSE MKT: INO) announced today that in a preclinical study with two animal models, Inovio's hTERT (human telomerase reverse transcriptase) DNA cancer vaccine administered with Inovio's CELLECTRA® adaptive electroporation delivery technology generated robust and broad immune responses, broke the immune system's tolerance to its self-antigens, induced T-cells with a tumor-killing function, and increased the rate of survival. Because high levels of hTERT expression are found in 85% of human cancers, regardless of type, Inovio's cancer candidate holds the potential to perform as a "universal" cancer therapeutic based on these early but unprecedented results. Following this strong preclinical data, Inovio plans to advance its synthetic hTERT cancer vaccine, INO-1400, into clinical trials in 2014.

These results appear in the American Association for Cancer Research journal, Cancer Immunology Research, in a paper entitled: "Highly optimized DNA vaccine targeting human telomerase reverse transcriptase stimulates potent antitumor immunity," authored by Inovio researchers and collaborators.

Dr. J. Joseph Kim, Inovio's president and CEO, said: "Inovio has demonstrated in multiple published human studies that our synthetically optimized DNA vaccines delivered with our CELLECTRA delivery system generate best-in-class T-cell immune responses. Here we show that in monkeys our hTERT DNA cancer vaccine generated T-cell immune responses more than 18-fold higher than the previous best results of a peer's hTERT therapeutic vaccine, which was also a DNA vaccine delivered with electroporation. We are particularly enthusiastic about our vaccine's potential use as a "universal" cancer therapeutic, given that hTERT is present in the vast majority of cancer types yet rare in normal cells. We plan to develop INO-1400 to treat breast and lung cancers and then expand to other cancer types. This hTERT therapy adds to a growing Inovio oncology franchise spearheaded by our phase II candidate, VGX-3100 for treating HPV-related pre-cancers and cancers, as well as our near clinical INO-5150 to treat prostate cancer."

Data from both murine and human systems over the past 10 years have demonstrated that TERT-specific cytotoxic T-lymphocytes (CTLs) can recognize and kill TERT-expressing tumor cells in multiple types of cancers. In fact, previous research has shown that breast cancer patients who mounted an hTERT-specific CTL response exhibited significantly longer rates of survival. However, the immune system's tolerance of cancer cells and their associated antigens produced in the body, which exists to prevent autoimmune diseases, often restricts the immune system's antitumor response. A major challenge for cancer vaccine development has been to develop approaches to break this tolerance in tumor-bearing hosts. Recent advances in our understanding of antigen presentation and tolerance have led Inovio to create this synthetic DNA vaccine targeting the hTERT antigen.

Inovio constructed a highly optimized synthetic DNA vaccine with multiple proprietary features. Using its novel consensus design approach, two differentiating mutations were incorporated in the vaccine sequence to assist T-cells to more readily recognize self-made hTERT antigens and kill the cancer cells to which these antigens are attached (i.e. break tolerance). In addition, Inovio's use of a full length antigen DNA sequence encompasses multiple epitopes (parts of an antigen that are recognized by the immune system), potentially helping the immune system by providing multiple opportunities to overcome a tumor's ability to evade recognition by T-cells.

In the study, Inovio researchers confirmed that vaccination with Inovio's DNA vaccine delivered by adaptive electroporation induced hTERT-specific cellular immune responses with significantly greater T-cell magnitude compared to prior non-Inovio studies. Over four vaccinations there was a significant dose response, showing the value of multiple vaccinations to increase the immune response and highlighting the limitation of alternative technologies that are not amenable to multiple vaccinations such as viral vectors. Vaccination elicited multiple epitopes not only in mice, but also in monkeys, indicating a broad vaccine-induced immune response.

Study results showed that mice vaccinated with Inovio's DNA cancer vaccine and then challenged with a cancerous tumor experienced delayed tumor growth and longer overall survival compared with non-vaccinated mice. Mice first challenged with a tumor and then treated with the hTERT DNA vaccine displayed killing activity of the targeted cancer cells expressing the hTERT antigen, with no killing of normal cells that did not express the hTERT antigen. The treated mice experienced significantly smaller tumors and also longer overall survival. Vaccinated animal results were compared to a control group of animals that did not receive Inovio's DNA cancer vaccine.

In monkeys, whose TERT is 96% similar to human TERT and therefore a highly relevant model for immunotherapeutic vaccine development, the hTERT DNA vaccine elicited strong and broad TERT-specific immune responses and demonstrated the potential to eliminate tumor cells.

Overall, in these studies researchers observed that administration of a synthetic highly optimized hTERT DNA vaccine delivered with electroporation was capable of breaking immune tolerance, and eliciting robust and diverse antigen-specific CTLs, which are responsible for clearing cancerous cells, as well as a potent antitumor response. A favorable safety profile emerged from this study, showing that the vaccine-induced CTLs appeared not to be associated with any major toxicities or organ damage.

The expression of hTERT is thought to correlate with tumor survival and hTERT is associated with 85% of human tumors. Furthermore, there is growing recognition that it may be necessary to target stem cells that produce cancerous cells and recent studies have suggested that cancer stem or stem-like cells also express hTERT. These factors highlight the importance of an effective hTERT-targeting vaccine/immunotherapy and point to the potential benefit of Inovio's novel cancer vaccine.

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Planned Parenthood American Journal of Public Health Study Shows Public Clinics Provide More Choices More Care

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American Journal of Public Health Study Shows Public Clinics Provide More Choices, More Care WASHINGTON - August 14 - A new study in the

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Telehealth Can Safely Replace Follow-Up Clinic Visits, Study Shows

Editor's Choice
Main Category: Primary Care / General Practice
Also Included In: Public Health
Article Date: 11 Jul 2013 - 6:00 PDT Current ratings for:
Telehealth Can Safely Replace Follow-Up Clinic Visits, Study Shows

A study has revealed that telehealth, a way of monitoring a patient's health in their own home, can be used safely with actively mobile patients in place of the standard post-operative clinic visit.

Researchers from the Palo Alto Veterans Administration Healthcare System in California analyzed 115 patients who were recovering from open hernia repair (herniorrhaphy), and 26 patients who were recovering from gallbladder removal (laparoscopic cholecystectomy).

All patients participated in a telehealth post-operative follow-up program in place of a traditional follow-up clinic visit over a 10-month period. Patients were called by a physician assistant and assessed using a scripted template 2 weeks after surgery.

The study revealed that 78% of patients (110 patients) were successfully contacted. Of these patients: 70.8% of hernia patients (63) and 90.5% of gallbladder patients (19) agreed to telehealth as the main way of follow-up.

Throughout the follow-ups, there were no complications with the gallbladder patients and only 3 (4.8%) with the hernia patients.

The study also revealed that all patients were satisfied with the telephone follow-up method, and time and travel expense for patients was reduced, leaving more clinic time to schedule with other patients.

The authors concluded:

"This pilot study demonstrated that a scripted telehealth visit by an allied health professional can be safely and effectively used for the postoperative care of open herniorrhaphy and laparoscopic cholecystectomy patients."

Telehealth uses various technology, aiming to help people with health problems live at home. Blood pressure or blood glucose levels, for example, can be measured at home and transmitted electronically to a health professional.

The Whole System Demonstrator (WSD) program, a trial set up by the Department of Heath in order to show what telehealth, found that telehealth is capable of a 15% reduction in visits to A&E, a 20% reduction in emergency admissions and a 45% reduction in mortality rates.

Telehealth development is something that many technology and healthcare companies are investigating as a way of enabling clinical resources to be managed more effectively. In 2009, General Electric and Intel formed a Healthcare Alliance and invested $250 million in developing and marketing new telehealth technologies.

However, some studies have suggested that home-based telehealth care does not help patients who need long-term assistance. Research from a UK study showed that telehealth does not improve generic health-related quality of life or psychological outcomes for patients with long-term conditions over 12 months.

Written by Honor Whiteman

Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today Visit our primary care / general practice section for the latest news on this subject. Please use one of the following formats to cite this article in your essay, paper or report:

MLA

Whiteman, Honor. "Telehealth Can Safely Replace Follow-Up Clinic Visits, Study Shows." Medical News Today. MediLexicon, Intl., 11 Jul. 2013. Web.
11 Jul. 2013. APA

Please note: If no author information is provided, the source is cited instead.

'Telehealth Can Safely Replace Follow-Up Clinic Visits, Study Shows'

Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

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Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.

View the original article here

Telehealth Can Safely Replace Follow-Up Clinic Visits, Study Shows

Editor's Choice
Main Category: Primary Care / General Practice
Also Included In: Public Health
Article Date: 11 Jul 2013 - 6:00 PDT Current ratings for:
Telehealth Can Safely Replace Follow-Up Clinic Visits, Study Shows

A study has revealed that telehealth, a way of monitoring a patient's health in their own home, can be used safely with actively mobile patients in place of the standard post-operative clinic visit.

Researchers from the Palo Alto Veterans Administration Healthcare System in California analyzed 115 patients who were recovering from open hernia repair (herniorrhaphy), and 26 patients who were recovering from gallbladder removal (laparoscopic cholecystectomy).

All patients participated in a telehealth post-operative follow-up program in place of a traditional follow-up clinic visit over a 10-month period. Patients were called by a physician assistant and assessed using a scripted template 2 weeks after surgery.

The study revealed that 78% of patients (110 patients) were successfully contacted. Of these patients: 70.8% of hernia patients (63) and 90.5% of gallbladder patients (19) agreed to telehealth as the main way of follow-up.

Throughout the follow-ups, there were no complications with the gallbladder patients and only 3 (4.8%) with the hernia patients.

The study also revealed that all patients were satisfied with the telephone follow-up method, and time and travel expense for patients was reduced, leaving more clinic time to schedule with other patients.

The authors concluded:

"This pilot study demonstrated that a scripted telehealth visit by an allied health professional can be safely and effectively used for the postoperative care of open herniorrhaphy and laparoscopic cholecystectomy patients."

Telehealth uses various technology, aiming to help people with health problems live at home. Blood pressure or blood glucose levels, for example, can be measured at home and transmitted electronically to a health professional.

The Whole System Demonstrator (WSD) program, a trial set up by the Department of Heath in order to show what telehealth, found that telehealth is capable of a 15% reduction in visits to A&E, a 20% reduction in emergency admissions and a 45% reduction in mortality rates.

Telehealth development is something that many technology and healthcare companies are investigating as a way of enabling clinical resources to be managed more effectively. In 2009, General Electric and Intel formed a Healthcare Alliance and invested $250 million in developing and marketing new telehealth technologies.

However, some studies have suggested that home-based telehealth care does not help patients who need long-term assistance. Research from a UK study showed that telehealth does not improve generic health-related quality of life or psychological outcomes for patients with long-term conditions over 12 months.

Written by Honor Whiteman

Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today Visit our primary care / general practice section for the latest news on this subject. Please use one of the following formats to cite this article in your essay, paper or report:

MLA

Whiteman, Honor. "Telehealth Can Safely Replace Follow-Up Clinic Visits, Study Shows." Medical News Today. MediLexicon, Intl., 11 Jul. 2013. Web.
11 Jul. 2013. APA

Please note: If no author information is provided, the source is cited instead.

'Telehealth Can Safely Replace Follow-Up Clinic Visits, Study Shows'

Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam)

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.

View the original article here