miércoles, 29 de julio de 2015

DLS|HEALTHCARE NEWS|July 23, 2015

DLS|HEALTHCARE NEWS|July 23, 2015

CDC. Centers for Disease Control and Prevention. CDC 24/7: Saving Lives. Protecting People.



A Weekly Compilation of Clinical Laboratory and Related Information
From The Division Of Laboratory Systems

July 23, 2015

News Highlights

  • CSF Biomarkers of Alzheimer's Present as Early as Middle Age
  • French Teen’s HIV in Remission despite Stopping Treatment as a Child
  • Grim Picture of Alzheimer's in Aging Baby Boomers
  • Good Laboratory Practice for Clinical Next-Generation Sequencing Informatics Pipelines
  • Theranos 2015: FDA Approves New Blood Test for Elizabeth Holmes’ Company – What’s Next for Controversial Theranos?
  • HealthTap Teams with Quest Diagnostics to Let Its Virtual Doctors Order Lab Tests
  • Drug-Resistant Bacteria Possess Natural Ability to Become Vulnerable to Antibiotics
  • Newborn’s First Stool Could Alert Doctors to Long-Term Cognitive Issues, New Case Western Reserve University Study Finds
  • $2 Paper Machine Performs DNA Disease Diagnostics
  • Lives Grow Longer, and Health Care’s Challenges Change
  • CDC Targets Seniors for Diabetes Prevention
  • Diabetes Prevention Recommendations Updated
  • Telemedicine Startup Pager Raises $14M, Eyes San Francisco
  • Georgia HIE Surges
  • Task Force Creates Roadmap for Health IT Safety Center
  

View Previous Issues - Healthcare News Archive


Leading News

CSF Biomarkers of Alzheimer's Present as Early as Middle Age
Biomarkers in cerebrospinal fluid (CSF) associated with Alzheimer’s disease are detectable in early middle age, and are associated with future amyloid deposits and cognitive decline, according to research published in JAMA Neurology. It was previously not known how early Alzheimer’s pathologies begin to develop in cognitively normal middle-aged adults. However, the detection of biomarkers in CSF may allow researchers to target asymptomatic individuals in new drug trials to try and prevent future cognitive decline. Courtney L. Sutphen, of Washington University in St. Louis, and colleagues analyzed data from a cohort of 169 cognitively normal middle-aged volunteers who were enrolled in the Adult Children Study. The cohort underwent CSF collection and longitudinal clinical assessment at three-year intervals between January, 2003 and November, 2013. Individuals in the presymptomatic stage of Alzheimer disease (AD) are increasingly being targeted for AD secondary prevention trials. How early during the normal life span underlying AD pathologies begin to develop, their patterns of change over time, and their relationship with future cognitive decline remain to be determined.
French Teen’s HIV in Remission despite Stopping Treatment as a Child
A French teenager’s HIV infection is still in remission more than a decade after her medications were discontinued, the longest hiatus on record for a young person and the best indication yet that long-term interruption of the infection is possible in children, a researcher revealed. The virus has been undetectable in the teenager’s blood since she was 21 months old, according to the information presented at the 2015 International AIDS Society conference in Vancouver, B.C. She is now older than 18 and has not received anti-HIV medication since she was almost 6. A blood test shortly before her seventh birthday showed no presence of the virus. Asier Sáez-Cirión, an assistant professor at the Pasteur Institute in Paris who conducted the research, was quick to note that the unidentified teen is not cured of HIV infection and that experts are not sure what caused her lengthy remission. “This girl is in remission,” Sáez-Cirión said in an interview. “She’s not cured.” Nevertheless, the case presents a number of possibilities for researchers seeking further progress against HIV, said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health.
Grim Picture of Alzheimer's in Aging Baby Boomers
More than 28 million baby boomers will have Alzheimer's disease (AD) by 2050, and they will account for nearly 25% of Medicare spending by 2040, according to a new analysis. "The study is important because it is based on an updated model that charts the trajectory and economic impact of Alzheimer's, based on the rate of new diagnoses, the number of people who will be living with the disease, and the cost of medical and long-term care between now and 2050," Christine Bredfeldt, PhD, from the Lewin Group, Falls Church, Virginia, told Medscape Medical News. "It shows that the number of baby boomers with AD and the cost to care for them will skyrocket between now and 2050," she noted. The study was conducted by the Lewin Group for the Alzheimer's Association and was presented here at the Alzheimer's Association International Conference (AAIC) 2015. Dr Bredfeldt said this new analysis "clearly shows that the increased demand Alzheimer's will place on the health and social services systems over the next 2 decades, coupled with the burden on those with the disease and their families, requires additional investment by the federal government." The new data reinforce the need for "strong implementation" of the US National Plan to Address Alzheimer's Disease, which calls on the government and the private sector to intensify efforts to treat or prevent AD and related dementias and to improve care and services, she added.

Laboratory Testing / Diagnostics

Good Laboratory Practice for Clinical Next-Generation Sequencing Informatics Pipelines
Currently, most clinical NGS tests are offered as laboratory-developed tests (LDTs), which are tests designed, manufactured and used within a single laboratory. These tests use commercially available sequencing platforms to generate raw sequence data that are subsequently analyzed using software algorithms (informatics pipeline). In the United States, LDTs are subject to the Clinical Laboratory Improvement Amendments (CLIA) regulations, which require that laboratories introducing a test system that has not been cleared or approved by the US Food and Drug Administration (FDA; Rockville, MD) establish analytical performance specifications for the accuracy, precision, analytic sensitivity and specificity of the assay, as well as other measures as relevant. The clinical test is therefore an LDT, and its performance specifications must be established and validated under CLIA, even though the FDA has cleared the sequencing platform. An informatics pipeline identifies a set of sequence variants that are subsequently prioritized to identify those that are relevant to diagnosis. The complexity of informatics pipelines led the workgroup to recommend that laboratories planning to implement NGS budget for, or collaborate with, one or more informaticians with relevant expertise in the design, validation and implementation of a clinical NGS test. The Nex-StoCT II workgroup provided several recommendations related to ensuring the fidelity of multiplexing and correct assignment of each read to its corresponding patient sample. The workgroup also recommended that reads from panel, exome or genome sequencing be aligned against the full human reference assembly, rather than to targeted sequences, to improve specificity. The workgroup did not consider the preparation of the laboratory test result report; however, it recognized that the uses and limitations of the informatics pipeline should be included in the test description communicated in the test result report. The workgroup recommended that laboratories consider three essential questions during the design and optimization of annotation and prioritization methods:
  1. Does the variant disrupt or alter the normal function of the gene in a manner consistent with the understanding of the disease mechanism?
  2. Does this disruption lead to, or predispose a patient to, a disease or other outcome relevant to human health?
  3. Does this health outcome have relevance to the patient's clinical presentation and indication for NGS testing?
Theranos 2015: FDA Approves New Blood Test for Elizabeth Holmes’ Company – What’s Next for Controversial Theranos?
In the latest Theranos 2015 development, the FDA has just given the Palo Alto-based company clearance to administer their already approved technology (particularly their herpes blood test) outside a lab, the first step in the company's attempt to make the technology behind their pursuits more readily available to the general public. Business Insider reports that this second Theranos 2015 breakthrough, the Clinical Laboratory Amendments waiver, allows the company not to have to comply with the same type of laboratory standards that other companies specialized in blood tests, as Theranos' tests don't include needles nor multiple blood vials, but rather getting a small pinch for the process. After their first test received clearance to be performed out of labs, the next step for Theranos in 2015 is simple: getting 120 more blood tests approved by the FDA.
HealthTap Teams with Quest Diagnostics to Let Its Virtual Doctors Order Lab Tests
Streamlining the lab test process is the next step for this virtual medical care startup. HealthTap, a startup enabling patients and doctors to connect via the Internet for consultations and care, is adding a significant weapon to the arsenal it already provides its physicians: lab tests. Founded in 2010, HealthTap now works with more than 71,000 licensed physicians in the U.S., and lets patients connect with doctors via desktop computers or mobile devices 24 hours a day. HealthTap offers both a community and network of doctors patients can turn to ask questions about symptoms or concerns for a monthly fee, and a service that lets them remotely connect with their own doctors for a pay-per-visit fee. So far, doctors have been able to provide consultations as well as prescribe medicine remotely to patients. Now, it will have access to Quest’s 2,200 patient service centers. In the telemedicine space, HealthTap competes with Doctor On Demand, Teladoc, and MDLIVe, among others.
Choosing Wisely Recommendations Highlight Foundational Role of Pathology in Health Care
The American Society for Clinical Pathology (ASCP) was invited to join the Choosing Wisely campaign in 2012, as the sole representative of pathology and laboratory medicine, to develop recommendations for the specialty. While ASCP was the only pathology organization in Choosing Wisely, it was far from the only Choosing Wisely partner with recommendations on laboratory testing. In a review of the recommendations from the more than 70 medical specialty organizations partnering with the ABIM Foundation on the campaign, nearly half listed at least one recommendation with a focus on laboratory testing, and many listed more than one. The prevalence of pathology-related Choosing Wisely recommendations reveals the integral role that laboratory medicine plays in many clinical decisions, providing both primary care providers and specialists with often pivotal information for prevention, diagnosis, treatment, and management of disease. Earlier this year, ASCP released a new set of Choosing Wisely recommendations. The recommendations expand on the first list released in February 2013, and again focus on outdated or inappropriately ordered laboratory tests. The following are ASCP’s five new recommendations:
  1. Don’t order an erythrocyte sedimentation rate to look for inflammation in patients with undiagnosed conditions. Order a C-reactive protein to detect acute phase inflammation.
  2. Don’t test vitamin K levels unless the patient has an abnormal international normalized ratio and does not respond to vitamin K therapy.
  3. Don’t prescribe testosterone therapy unless there is laboratory evidence of testosterone deficiency.
  4. Don’t test for myoglobin or CK-MB in the diagnosis of acute myocardial infarction. Instead, use troponin I or T.
  5. Don’t order multiple tests in the initial evaluation of a patient with suspected thyroid disease. Order thyroid stimulating hormone and, if abnormal, follow up with additional evaluation or treatment depending on the findings.
Five Unnecessary Tests for Newborns: Choosing Wisely
The Choosing Wisely campaign has identified the top five newborn medicine tests and treatments that cannot be justified on the basis of efficacy, safety, or cost. Timmy Ho, MD, from Beth Israel Deaconess Medical Center in Boston, Massachusetts, and colleagues published the results of their extensive selection process online July 20 in Pediatrics.
The top five for newborn medicine are:
  1. Avoid routine use of antireflux medications for treatment of symptomatic gastroesophageal reflux disease or for treatment of apnea and desaturation in preterm infants.
  2. Avoid routine continuation of antibiotic therapy beyond 48 hours for initially asymptomatic infants without evidence of bacterial infection.
  3. Avoid routine use of pneumograms for predischarge assessment of ongoing and/or prolonged apnea of prematurity.
  4. Avoid routine daily chest radiographs without an indication for intubated infants.
  5. Avoid routine screening term-equivalent or discharge brain magnetic resonance imaging scans in preterm infants.
The authors draw attention to the use of the word "routine," explaining there may be specific instances in which these tests or treatments are appropriate.
Thermo Fisher Partners with CDC to Develop Software for MicrobeNet Database
Fisher Scientific said today it has developed software that enables public health laboratories to directly access the US Centers for Disease Control and Prevention's MicrobeNet reference lab database. Developed through a partnership with the Special Bacteriology Reference Laboratory at the CDC, Thermo Fisher's MicrobeBridge software platform seamlessly connects Sanger sequencing results to the MicrobeNet online virtual reference lab database. As a result, researchers will be able to more quickly identify microbial pathogens that may underlie global outbreaks without having to search through multiple databases, Thermo Fisher said. 

Research and Development

Drug-Resistant Bacteria Possess Natural Ability to Become Vulnerable to Antibiotics
Infections with one of the most troublesome and least understood antibiotic-resistant “superbugs” are increasing at alarming rates, particularly in health-care settings. But new research, published July 13 in The Proceedings of the National Academy of Sciences Online Early Edition, suggests it may be possible to rein in the spread of such infections without the need to develop new antibiotics, reports a team at Washington University School of Medicine in St. Louis. Bacteria are natural competitors and have the capacity to kill off other bacteria. But to become bacterial assassins, the researchers found that multidrug-resistant Acinetobacter baumannii, a frequent cause of difficult-to-treat infections in hospitals, has to relinquish its ability to defy antibiotics.“If we can identify ways to force the entire population of drug-resistant bacteria to undergo this change, we stand a better chance of fighting the growing problem of antibiotic resistance,” said first author Brent Weber, a graduate student. “Instead of looking for new antibiotics, we could restore bacteria’s vulnerability to antibiotics we already have.”
Newborn’s First Stool Could Alert Doctors to Long-Term Cognitive Issues, New Case Western Reserve University Study Finds
A newborn’s first stool can signal the child may struggle with persistent cognitive problems, according to Case Western Reserve University Project Newborn researchers. In particular, high levels of fatty acid ethyl esters (FAEE) found in the meconium (a newborn’s first stool) from a mother’s alcohol use during pregnancy can alert doctors that a child is at risk for problems with intelligence and reasoning. Left untreated, such problems persist into the teen years, the research team from the Jack, Joseph and Morton Mandel School of Applied Social Sciences found. The research is part of the ongoing Project Newborn study, a longitudinal research project funded by the National Institutes of Health’s National Institute on Drug Abuse that has followed the physical, social and cognitive developments of babies born to mothers who used cocaine, alcohol and other drugs during their pregnancies. The study was among the first to examine an association between FAEEs in meconium and cognitive development during childhood and adolescence. The conclusion: There was a link between those with high levels of FAEE at birth and lower IQ scores.  
$2 Paper Machine Performs DNA Disease Diagnostics
The “Paper Machine,” as the researchers behind the project call it, is a microfluidic device made out of paper that costs about two dollars to produce. Without much training, a user can use it to prepare the liquid sample, perform loop-mediated isothermal amplification (LAMP) and finally shine ultraviolet light and use a smartphone to detect the presence of nucleic acid sequences pointing to disease. The device has a central sliding plate that is pulled by the user one notch after each step in the four-step testing process. This essentially automates the process of adding the sample, introducing the wash buffers, then the amplification master mix, followed by a stain dye once incubation is complete. A simple blacklight can then be used to illuminate the resulting sample, with a smartphone camera then spotting the presence of the dye. Study in Analytical Chemistry: “Paper Machine” for Molecular Diagnostics…
Scientist Develops Model for Robots with Bacteria-Controlled Brains
In a paper published July 16 in Scientific Reports, which is part of the Nature Publishing Group, a Virginia Tech scientist used a mathematical model to demonstrate that bacteria can control the behavior of an inanimate device like a robot. "Basically we were trying to find out from the mathematical model if we could build a living microbiome on a nonliving host and control the host through the microbiome," said Ruder, an assistant professor of biological systems engineering in both the College of Agriculture and Life sciences and the College of Engineering. Waren Ruder used a mathematical model to demonstrate that bacteria can control the behavior of an inanimate device like a robot. "We found that robots may indeed be able to have a working brain," he said. Ruder spoke about his development in a recent video. For future experiments, Ruder is building real-world robots that will have the ability to read bacterial gene expression levels in E. coli using miniature fluorescent microscopes. The robots will respond to bacteria he will engineer in his lab.
UGA Researchers Develop Breakthrough Tools in Fight against Cryptosporidium
Researchers at the University of Georgia have developed new tools to study and genetically manipulate cryptosporidium, a microscopic parasite that causes the diarrheal disease cryptosporidiosis. Their discoveries, published in the journal Nature, will ultimately help researchers in academia and industry find new treatments and vaccines for cryptosporidium, which is a major cause of disease and death in children under 2 years old. The team developed a way to genetically modify the parasite using a technique called CRISPR/Cas9, which allows scientists to make very precise changes to an organism's genome and observe the effects. By knocking out specific crypto genes, researchers can test their importance for the parasite and make predictions on their potential value as a drug target. Epidemiological studies have demonstrated that children develop immunity to crypto as they get older, but the mechanisms that provide that immunity are poorly understood. The genetic techniques developed will help identify the foundation of natural immunity, opening the possibility for vaccine development. They may also help to develop weakened parasite strains that can no longer cause disease but still induce lasting immunity. The study on "Genetic modification of the diarrhoeal pathogen Cryptosporidium parvum" is available online at:  www.nature.com/nature/journal/vaop/ncurrent/full/nature14651.html.
UW Chemists Help Develop a Novel Drug to Fight Malaria
An international team of scientists — led by researchers from the University of Washington and two other institutions — has announced that a new compound to fight malaria is ready for human trials. In a new paper published July 15 in Science Translational Medicine, they show that this compound is the first to cripple a critical protein that the malaria parasite needs to survive at different stages of its complex life cycle, and is suitable for clinical tests in humans. The team’s efforts stem from new, streamlined processes to identify and optimize chemical compounds that show promise against malaria parasites. The scientists in this international partnership — spanning 20 institutions on three continents — pooled their collective expertise to accelerate the pace of discovery and validation. DSM265 targets a cellular protein made by the malaria parasite. Malaria parasites rely on this protein — known by its acronym DHODH — to express their genes and copy those genes when it’s time to divide. Since DHODH provides a critical function, this drug could impair the parasite at multiple stages of its life cycle, including one elusive stage when it hides in the human host’s liver. “This is the first of a new class of molecules that’s going into humans,” said UW chemistry professor Pradipsinh Rathod, one of the founders and leaders of this endeavor. “Until now, everything else in humans has been variations of drugs that have been developed in the distant past.”  Rathod’s lab also developed and performed experiments to test how well the malaria parasite might evolve to become resistant against DSM265.
Scientists Solve Breast and Ovarian Cancer Genetic Mystery
Francis Crick Institute scientists, funded by Cancer Research UK, have solved a decades-old mystery and helped to unravel the genetic cause of some breast and ovarian cancers, according to new research published in the journal Cell. Following a five-year study in nematode worms, researchers have uncovered how key proteins can switch on a protein called RAD51, allowing it to repair cancer-causing DNA damage in cells. Women with faulty RAD51 and BRCA1 and BRCA2 genes are at higher risk of developing breast and ovarian cancer. Scientists already knew how proteins produced by these genes work hand-in-hand to fix DNA damage, and why faults can lead to disease. Defects in protein cousins of RAD51 also increase the risk of these cancers. But scientists didn't know how. The team has now revealed how these protein cousins work to switch on RAD51 by changing its shape – which dramatically boosts its DNA-repair powers.
Sequencing Studies Follow Progression from Barrett's Esophagus to Esophageal Cancer
A pair of studies published online today in Nature Genetics by teams in the US and UK outlined mutational and clonal architecture patterns associated with progression from Barrett's esophagus to esophageal cancer. The papers mark the latest in a series of studies aimed at understanding cancer emergence in a subset of individuals with Barrett's esophagus, a benign condition associated with gastric reflux disease in which cells in the lower esophagus begin to resemble those in the intestine. "Barrett's esophagus and the cancer share many mutations, but we are now a step closer to understanding which ones are the important mutations that tip the condition over into a potentially deadly form of cancer," co-first author Caryn Ross-Innes, with the University of Cambridge, said in a statement.

Public Health and Patient Safety

Lives Grow Longer, and Health Care’s Challenges Change
According to an analysis published last month in the British medical journal The Lancet, 2.3 billion people, almost one-third of humanity, suffered from five or more health problems in 2013. More than 80 percent of those people were younger than 65 years old. And between 1990 and 2013, the number of people in developed countries who suffered from 10 or more ailments increased by 52 percent. These figures, based on some 36,000 sources of health data gathered for an international study called the Global Burden of Disease, are only approximate. But they provide the most complete picture yet of a global population’s need for increasingly complex care. Two or three generations ago, communicable diseases and problems in pregnancy and early childhood were the leading health concerns in all but the wealthiest countries. Now, after decades of economic development, rising aid money for health, and medical advances, these problems predominate only in sub-Saharan Africa, and life expectancy averages 71 years worldwide. But progress carries a price: The longer people live, the more health problems — and simultaneous health problems — they tend to suffer. In 2013, most people worldwide experienced at least three health problems. The longer the status quo continues, the greater the cost — both human and financial. “This is a major societal challenge,” said Dr. Atun of Harvard. “It puts pressure on not just the health systems, but also the entire economy.”
CDC Targets Seniors for Diabetes Prevention
We have 86 million people in the United States with prediabetes, but very few of them—only about 10%—know that they have prediabetes. Clearly, we need to do something about that. In 2010, Congress authorized the Centers for Disease Control and Prevention (CDC) to establish the National Diabetes Prevention Program (DPP). These past few years we have been setting up the National DPP. It has caused us to work with a variety of groups and a variety of populations. The original DPP research study demonstrated that the intervention is even more effective in patients older than 60 years of age. It is 58% effective for the general population and 71% effective for those older than 60 years of age. This is certainly a population that will benefit from this intervention. To that end, the Centers for Medicare & Medicaid Services (CMS) has given out some grants to help study this. We have amazing partnerships going on in the National DPP. One of the most recent partnerships has been the American Medical Association (AMA) joining forces with a number of our partners. The AMA has made a several-year commitment to help get physicians engaged in testing their patients for prediabetes and then referring them to diabetes prevention programs that are recognized by the CDC and communities.
Diabetes Prevention Recommendations Updated
The Community Prevention Services Task Force recommends that healthcare systems and communities provide counseling and longitudinal support to individuals who are at increased risk for type 2 diabetes. Moreover, patients at risk for diabetes should be encouraged by their healthcare providers to participate in such programs. The task force also notes that economic studies show these programs are cost-effective. The Community Preventive Services Task Force Recommendation Statement was written by Nicholas Pronk, PhD, and colleagues and accompanying editorial. The task force recommendations are based on a systematic review of 53 studies describing 66 programs. The review found that combined diet and physical activity programs are effective at improving cardiometabolic risk factors and decreasing the incidence of diabetes in individuals who are at increased risk for both of these conditions. The review also noted that more intensive programs are more effective. Ann Intern Med. published online July 13, 2015.Recommendation statement full text  
Readmission Location Linked to Post-Surgical Mortality Rates
Patients with complications after major surgery are 26% more likely to survive if they return to the hospital where they had their operation, researchers find, throwing into doubt the assumption that traveling long distances to high-volume hospitals necessarily leads to the best outcomes. The observational cohort study of more than 9 million Medicare patients, published in The Lancet, found that patients with complications after major surgery are 26% more likely to survive if they return to the hospital where they had their operation compared to those readmitted to a different hospital. The findings suggest the importance of continuity of care. "Having the familiarity with that patient was more important than the fact that they did a lot of operations," Brooke says. The researchers used Medicare claims data from between January 1, 2001, and November 15, 2011, to assess patients who needed hospital readmission within 30 days after 12 different procedures:
  • Open abdominal aortic aneurysm repair
  • Infrainguinal arterial bypass
  • Aortobifemoral bypass
  • Coronary artery bypass surgery
  • Oesophagectomy
  • Colectomy
  • Pancreatectomy
  • Cholecystectomy
  • Ventral hernia repair
  • Craniotomy
  • Hip replacement
  • Knee replacement
Researchers also found that having the same surgeon taking care of patients for surgery and readmission provided the greatest mortality benefit.
Aging Doctors: Time for Mandatory Competency Testing?
The idea that all doctors turning 65 or 70 should be routinely screened for age-related physical or mental slippage to assure they won't hurt patients sounds like overkill to Paul Goldfarb, MD. "There's already so much peer review, continuing education, maintenance of certification and self-assessment" and testing, the 72-year-old San Diego oncology surgeon said last week after wrapping up a partial pancreatectomy. Yet many in the house of medicine are now disagreeing with views like Goldfarb's, saying many more doctors now practice at much older ages, and it's well known what years can do to memory, critical thinking skills, and manual dexterity, putting patients and organizations at risk. That's why the American Medical Association's House of Delegates voted in its June meeting that the time has come to address the issue more systematically, perhaps with formal guidelines for timing and methods for competency testing of older doctors who wish to keep staff privileges. Delegates approved a 21-page report from the AMA's Council on Medical Education, referencing 72 peer-reviewed papers, many of which enumerated myriad ways that advancing age diminishes a physician's abilities.
Study Show High-Risk Areas for Lyme Disease Growing
The geographic areas where Lyme disease is a bigger danger have grown dramatically, according to a new government study published Wednesday. U.S. cases remain concentrated in the Northeast and upper Midwest. But now more areas in those regions are considered high risk. "The risk is expanding, in all directions," said the lead author, Kiersten Kugeler of the Centers for Disease Control and Prevention. The article was published online in a CDC journal, Emerging Infectious Diseases. There are now 260 counties where the number of Lyme disease cases is at least twice what's expected, given the size of each county's population. That's up from 130 a decade earlier, the report shows. Overall, 17 states have high-risk counties. The entire state of Connecticut, where the illness was first identified in 1975, has been high-risk for decades. Now, high-risk zones encompass nearly all of Massachusetts and New Hampshire and more than half of Maine and Vermont. The disease is transmitted through the bites of infected deer ticks, which can be about the size of a poppy seed.
Alzheimer's Dementia Pathologies Differ by Race
Brain autopsies of African Americans who died with Alzheimer's disease (AD) show significantly higher rates of mixed pathologies compared with whites, suggesting more complex underlying causes of the dementia and the potential need for different therapeutic strategies, new research shows. "Almost everything we know about Alzheimer's disease has been learned on predominantly white populations," lead author Lisa L. Barnes, PhD, from Rush University Medical Center in Chicago, Illinois, told Medscape Medical News. "This study underscores the dangers in generalizing results from one population to another." The findings were published online July 15 in Neurology. Racial differences in terms of prevalence of Alzheimer's disease have been previously reported, including in a report from the Alzheimer's Association showing rates of the disease to be more than two times higher in blacks than whites, according to Heather M. Snyder, PhD, director of Medical and Scientific Operations for the Alzheimer's Association. "While there is nothing currently available to stop progression of the disease, understanding differences in populations is going to be important as we get to that point of being able to stop or slow progression so that we can better tailor treatments to individuals."
Child Paralysis Outbreak: UVA Identifies Potential Cause
A mysterious outbreak of child paralysis cases previously linked to enterovirus D68 may instead have another cause, doctors at the University of Virginia Children's Hospital are cautioning after determining that a stricken child appeared to be suffering from a different virus. While enterovirus D68 has been the primary suspect in the paralysis cases, test results identified a different potential culprit, enterovirus C105. "Surprisingly, it came back with this enterovirus C105, which I'll admit, when it came back, I'd never heard of," said UVA's Ronald B. Turner, MD. "It was just described in the last eight or nine years and it hasn't been seen much around the world. Now, I think you have to be careful with that, because we don't look for it. And you don't see what you don't look for. So it's possible it's out there and it's not being detected because nobody's sending specimens to be tested in this way." He emphasized that enterovirus C105 may also not be the cause of the paralysis, and that more analysis needs to be done as the federal Centers for Disease Control and Prevention gathers information. "We need to kind of step back and say, 'OK, we really don't know what's going on here,'" Turner said. "It's really more a caution than an answer we're providing, in my opinion." UVA's case study has been published online by the journal Emerging Infectious Diseases.
Burden of Dengue, Chikungunya in India Far Worse Than Understood
New Johns Hopkins Bloomberg School of Public Health research finds new evidence that an extremely high number of people in southern India are exposed to two mosquito-borne viruses -- dengue and chikungunya. These findings, the researchers say, reinforce the need for officials to be on the lookout for these diseases and to find ways to control its spread not only in India but also around the world. The researchers, reporting July 16 in PLOS Neglected Tropical Diseases, tested blood samples from 1,010 people across 50 locations in Chennai, a city with over 6 million people in South India, and found that nearly all of them had been exposed to dengue and 44 percent had been exposed to chikungunya. Surprisingly, almost none of the people who had been exposed to dengue reported having been infected by it, either because they weren’t properly diagnosed with the disease or because they didn’t show symptoms. Researchers estimated that on average, 23 percent of those who have not yet been infected become infected by dengue every year, corresponding to roughly 228,000 infections per year in Chennai alone. “This rate of infection is extremely high, almost three times higher than in areas of Brazil and Thailand where transmission was thought to be high,” says Rodríguez-Barraquer. They also found that the rate of infection in Chennai was similar in poor communities as in more affluent neighborhoods.

The research is believed to be the first to systematically measure dengue and chikungunya infection rates in India. “If you don’t understand the extent of the problem, you can’t address it,” she says.
California Officials Report Year's First Death from West Nile Virus
California health officials on Monday confirmed the state's first death this year from West Nile virus. The death of a senior citizen in Nevada County comes in a year with an unusually high number of cases of West Nile among mosquitoes and birds, officials said. Infected mosquitoes transmit the virus to humans and animals, mostly birds. Experts think California's drought may have led to the increased West Nile activity. With fewer sources of water for birds and mosquitoes, they're coming into closer contact with humans in their search for water, increasing the chance of transmission.

Health IT

Telemedicine Startup Pager Raises $14M, Eyes San Francisco
Pager has just raised $14 million to bring its on-demand doctor service to San Francisco and beyond. With cash in hand, Pager will be looking for expansion opportunities, both into new markets and through partnerships with healthcare organizations. The platform is designed so that doctors can share electronic health records within the network as well as outside of it. Pager is able to share a client’s records with their primary physician, for example, as well as with a patient’s other doctors. Partnerships with hospitals and medical networks are a big part of Pager’s plans. Though it’s not an electronic medical record company, Pager does hope to integrate more deeply with existing healthcare provider networks so that a patient’s records are always up-to-date regardless of where a patient is being treated or by whom. Pager says it’s hoping to expand to San Francisco next month. After that it will consider Los Angeles and Chicago, among other major cities, but don’t expect to hear about new regional launch plans until 2016.
Georgia HIE Surges
The number of data sources sharing information through the Georgia Regional Academic Community Health Information Exchange has grown by some 450 percent over the last half-year. The GRAChIE network was founded by Cerner and the health systems GRHealth and Navicent Health, to connect electronic health records for about a million patients at 11 different healthcare facilities across Georgia. Along with the many more data sources, usage of the HIE has increased 250 percent in the past six months. "HIEs are most needed in rural areas around the country," said Tara Cramer, executive director, GRAChIE System, in a press statement. "Here in Georgia, seventy miles is a very common commute for a patient in one health system.”
Task Force Creates Roadmap for Health IT Safety Center
Despite all the progress and safety improvements from electronic ordering and clinical decision support, researchers continue to find hazards to patient safety associated with the introduction of these systems. Now a task force of experts and health IT safety stakeholders convened by the Office of the National Coordinator for Health Information Technology has crafted a roadmap to guide the development of a proposed national Health IT Safety Center. In 2014, the Federal Communications Commission (FCC) issued a report that proposed a strategy for a risk-based regulatory framework for health IT. The draft FDASIA report identified the potential creation of a Health IT Safety Center as a key non-regulatory component of an effective risk-based framework for health IT. Task force members advocated that the center identify ways to encourage better reporting of health IT-related events by improved training, easier reporting mechanisms that are better integrated into workflows, and reduction of other barriers to reporting. They also stressed the need for the industry to consider tools that allow for automated detection, identification, and reporting of safety issues.
AHRQ to Fund Clinical Decision Support Learning Network
The federal Agency for Healthcare Research and Quality (AHRQ) plans to launch an initiative to disseminate and implement patient-centered outcomes research (PCOR) findings through clinical decision support (CDS) at the point of care. This initiative includes creating a PCOR CDS Learning Network to drive the field of CDS forward and to conduct CDS projects to extend existing or develop new CDS based on PCOR findings. In addition to promoting the dissemination and implementation of PCOR findings, another goal of the new initiative is to develop tools to help CDS artifacts become more shareable, health IT standards-based, and publicly available.
Other News
Cure Forward Aims to Advance Personalized Medicine with Genetic Testing Resources for Patients
While advances in genomic medicine have led many in the healthcare field to tout the promise of personalized medicine for years, it has eluded many consumers thus far. With genetic testing, especially, patients have little idea of how such tests work, what purpose those tests may serve, or whether they should get tested for certain conditions. In order to address that knowledge gap, Martin Naley, with the backing of venture capital firm Apple Tree Partners, founded Cure Forward, calling it a "patient activation" company. Last month, the Cambridge, Massachusetts-based shop came out of stealth mode with a $15 million Series-A financing round. Simultaneously, it announced deals with Paradigm and Cynvenio to offer their tests. The idea behind Cure Forward is to inform consumers about genomic medicine so that they can "pull themselves through the whole process and really advance the whole field," Naley, who serves as CEO of the firm, told GenomeWeb. It seeks to do so by providing them a resource to learn about genomics and genomic testing, and if needed, possibly find a test, and then discuss their testing options with their physicians. Cure Forward's platform is currently in private beta testing, but the firm will move into an open-data stage in September, followed by a commercial launch around the end of the year, said Naley. In the beta stage, the platform exists primarily as an informational system for patients and provides three resources: education, trials exchange, and social networking. 
University of Pittsburgh Medical Students Develop App for Frustrated Patients
The app allows both patients and students to rate how they think an appointment went. Patients also can give feedback on how the student performed. If the winners of a national prize competition tell us anything about the American healthcare system, it’s that patients are often frustrated with doctors who are oblivious to their sentiments. Four University of Pittsburgh medical students took home the National Board of Medical Examiners competition prize — $5,000 and the opportunity to develop their product — with a smartphone app called TOPCATS, or Trainee-Oriented Patient Communication Assessment System. The long name describes a pretty simple concept: Patients are often less than satisfied with their interactions with doctors but don’t always know how to voice their frustration. So in classic millennial fashion, the med students turned to the power of their iPhones and Androids to solve the problem. TOPCATS allows both patients and students to rate how they think an appointment went. Patients are also able to give feedback on how the student performed. The app is still only an idea and hasn’t reached the prototype stage, but the team is working with the university and the National Board of Medical Examiners to develop and roll it out.

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