Friday, October 31, 2008
An enormous seed bank proposed by US scientists to capture the world's plant diversity could record evolution in action. Traditional seed banks are static because they are aimed at conservation, but the proposed repository would regularly collect and study samples. This could document adaptations in plants - particularly the effects of climate change, such as early flowering
While an international seed bank in a Norwegian island has been making news about its agricultural collection, a group of U.S. are outlining a different kind of seed bank, one that proposes the gathering of wild species –– at intervals in the future –– effectively capturing evolution in action.
In the October issue of Bioscience, Steven J. Franks of Fordham University, Susan J. Mazer of the University of California, Santa Barbara, and a group of colleagues, have proposed a method of collecting and storing seeds of natural plant populations. They argue for the collection of many species in a way that evolutionary responses to future changes in climate can be detected. They call it the "Resurrection Initiative."
"In contrast to existing seed banks, which exist primarily for conservation, this collection would be for research that would allow a greater understanding of evolution," said Franks.
The Resurrection Initiative: Storing Ancestral Genotypes to Capture Evolution in Action
J Steven Franks et al
BioScience, Vol. 58, No. 9. (October 2008), pp. 870-873.
Link to BioScience abstract
People's ability to recognize abducted children is impaired when they view a photo of a smiling, clean child, but come into contact with the same child whose appearance is very different because he or she is upset, crying, disheveled or unkempt.
This is the key finding of a study published on line in Applied Cognitive Psychology.
When a child goes missing the police often rely on photographs provided by his or her parents, but the photos they usually provide, often school pictures, may not be as useful as they would like. The purpose of this new study was to identify what type of photo is most likely to help in the recognition of a missing child.
Two experiments were conducted to test the ability of adults to recognize children from photos. Over 150 adults were shown pictures of children that were either "cleaned up" as they would typically appear, in school photos, happy and clean, as well as a "dirtied up" picture, where the child looked dirty, tired, sad or angry.
Results from the study show that recognition is best when the original appearance of the child matched the appearance when memory is later tested.
"My question was, if you happened to see a missing child with their perpetrator and the child is dirty or has been physically abused, would you be able to recognize that child from a photo of him or her smiling, clean and happy?" said lead researcher, Dr. Vicki Gier, Assistant Professor of Psychology, Mississippi State University. "If an adult is shown two pictures of a child with similar appearance, both 'clean' or both 'dirty', recognition is good. However, if an adult sees two pictures of the same child but with differing appearance, then recognition is poor."
These findings could prove beneficial in the search for children who are abducted or reported missing, as typically the picture given by parents and distributed by the police is a school photo, in which a child is smiling and clean.
To combat this, the researchers have strongly suggested that parents have both types of pictures available (clean and dirty) in case their child is abducted or missing. "If both types of facial appearance were shown to the public or possible eyewitnesses, the chances of recognizing the child may increase," said Gier.
Memory of children's faces by adults: Appearance does matter
Vicki Silvers Gier &David S. Kreiner
Applied Cognitive Psychology Published Online: Oct 29 2008 8:15AM
Link to ACP abstract
A University of Calgary scientist confirms that it is how our immune system responds, not the Rhinovirus itself, that causes cold symptoms. Of more than 100 different viruses that can cause the common cold, human Rhinovirus es are the major cause.
The research, published in the American Journal of Respiratory and Critical Care Medicine, is the first study to comprehensively review gene changes in Rhinovirus . “The study’s findings are a major step toward more targeted cold prevention and treatment strategies while also serving as a valuable roadmap for the broader respiratory science community,” says David Proud, PhD, a professor in the Department of Physiology and Biophysics at the Faculty of Medicine, and lead author of the study.
Proud adds that while colds are usually considered to be minor infections of the nose and throat, they can have much more serious health repercussions. “Rhinovirus is the major cause of the common cold, but it is also an important pathogen in more serious conditions, such as asthma and chronic obstructive pulmonary disease (COPD).”
For example, children who get recurrent Rhinovirus -induced wheezing in early life are 10 times more likely to develop asthma. Rhinovirus infections are also a major cause of acute attacks of asthma and COPD and, therefore, exert a huge impact on health care costs.
In the past, researchers have measured specific compounds made by the body that may protect against a cold or may be triggered by a cold virus. This is the first time anyone has conducted a comprehensive assessment of what happens when a Rhinovirus infects a person. This is also the first time researchers have established that a recently discovered antiviral protein called viperin plays a role in our body’s defense against Rhinovirus . That discovery will lead scientists to targeted study and treatments against the common cold.
This assessment of gene changes was conducted using gene chip technology, performed by scientists at Proctor & Gamble. With this technology scientists can see every gene in the human genome, and see how genes respond to a stimulus, in this case a cold virus.
Gene Expression Profiles during In Vivo Human Rhinovirus Infection: Insights into the Host Response.
David Proud et al
American Journal of Respiratory and Critical Care Medicine, 2008; 178 (9): 962 DOI: 10.1164/rccm.200805-670OC
Link to Amer Journ Resp & Crit Care Medicine abstract
Alex Morales for Bloomberg News (October 31, 2008)
Halloween is getting spookier on Pemba, an island off Tanzania. A giant bat species on the edge of extinction more than a decade ago has quadrupled in number to at least 22,000.
The increase is due to efforts to protect the forest habitat of the creature, known as the Pemba flying fox, and to stop locals from eating the mammal, by Fauna and Flora International.
``It's considered a delicacy, and they used to roast it like a chicken, but they don't do that anymore.''. Locals now ``benefit from preservation of the bat because tourists come to the island and pay to visit the roost sites.''
Thursday, October 30, 2008
Helping children face their fears may be more productive than focusing on other techniques to help them manage their anxieties, according to research presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry in Chicago.
The research, which identified similarities between cognitive behavioral therapy administered in a clinical practice and protocols recommended in common treatment manuals, showed that as children were taught to face their fears, their ability to function increased.
The study also showed that children were able to complete exercises exposing them to their fears much earlier than suggested in the treatment manuals. The more children focused on other techniques for managing their anxieties, however, the less improvement they showed in functioning.
Stephen Whiteside, Ph.D., from Mayo Clinic in Rochester, Minn., explained that more research into treatment options for childhood anxiety needs to be conducted. "We have children face their fears and we teach them techniques for managing their anxiety, but research isn't advanced enough to show which element should be the main part of treatment or whether both parts are necessary for improvement," he says.
Dr. Whiteside also says that treatment manuals suggest introducing exposure — having children face their fears — late in the treatment process. "We wondered whether we could begin exposures closer to the beginning of the process."
"If we focused on exposures and didn't provide anxiety management techniques, would kids still get better?"
Poster Session 2.3 12:15 p.m. October 29, 2008
Exposure Therapy for Childhood Anxiety in Clinical Practice Versus an Empirically Supported Manual
Jennifer L. Vande Voort, M.D. &Stephen P. Whiteside, Ph.D.
American Academy of Child and Adolescent Psychiatry 55th Annual Meeting
Link to AACAP conference
A new study in the Canadian Journal of Economics provides the first evidence on sexual orientation and economic outcomes in Canada. The study found that gay men have 12 percent lower personal incomes and lesbians have 15 percent higher personal incomes than heterosexual men and women.
Christopher S. Carpenter of The Paul Merage School of Business at the University of California Irvine used data from the Canadian Community Health Survey which includes standard demographic questions as well as self-reports on sexual orientation.
Like previous patterns found in the U.S. and the U.K., results show that gay men have significantly lower personal incomes than similarly situated straight individuals, while lesbians have significantly higher personal incomes than straight women.
Also, similar to gay and straight differences in the U.S., gay men and lesbians in Canada are more likely to live in urban areas and more highly educated than heterosexuals.
Sexual orientation, work, and income in Canada.
Christopher S. Carpenter
Canadian Journal of Economics, Volume 41 Issue 4, Pages 1239 – 1261 November 2008
Link to Canadian Journal of Economics abstract
Medical Student Burnout and the Challenge to Patient Care
"It took nearly 20 years for the three of us to learn that we had each been miserable as medical students. It has taken even longer for researchers to discover the extent to which such feelings exist among American medical students.”
In the first large study to explore possible unconscious bias among physicians, researchers have found that doctors mirror the attitudes of the majority in society and implicitly favor whites over blacks.
"This supports speculation that subtle race bias may affect health care, but does not imply that it will," said University of Washington researcher Janice Sabin, who presented the study in San Diego (October 28) at the American Public Health Association's annual meeting. "This research is too preliminary to know if there is a direct relationship between physicians' implicit, or unconscious, racial attitudes and the quality of medical care."
Sabin, who is an acting assistant professor of medical education and biomedical informatics, said: "Our findings fit with previous research showing bias is common in the general population. But we have to remember people are not racist if they hold an implicit bias."
Data from the study were drawn from a sample of more than 400,000 anonymous people who took the race attitude Implicit Association Test online during a 28-month period between 2004 and 2006. More than 2,500 of those test-takers identified themselves as doctors. The race attitude and a variety of other tests that examine various forms of bias are found on the Web site of Project Implicit operated by the University of Washington, University of Virginia and Harvard University.
The Implicit Association Test captures subconscious, or implicit, bias by asking people to quickly associate positive or negative words with a series of photographs. In the race test the photographs are of black and white faces.
"We don't call what these tests show prejudice. We talk about it as hidden bias or unconscious bias, something that most people are unaware they even possess," said Anthony Greenwald, a UW psychology professor who created the Implicit Association Test and was part of the research team on the new study.
The people who took the test were predominantly American. Overall, 86 percent of participants said they lived in the United States. Of 2,535 physicians taking the test, 76 percent identified themselves as U.S. residents. Test-takers were predominantly white -- 69 percent of the entire sample and 66 percent of the doctors. There were smaller samples of blacks, Asians and Hispanics.
The majority of physicians in all racial and ethnic groups showed an implicit preference for white Americans compared to black Americans except for black physicians, who on average did not favor either group.
"The implicit bias effect among all the test-takers is very strong," said Sabin. "People who report they have a medical education are not different from other people, and this kind of unconscious bias is a common phenomenon.
"Although it may be a common assumption that high levels of education expose people to diverse ideas and ways of not being biased, subtle biased associations about race are nevertheless common. We have come a long way, but people may be unaware of these common unconscious biases. In medical education, we need to include examination of personal attitudes and beliefs in diversity training and continuing medical education to increase self-awareness so that doctors are alert to hidden attitudes and beliefs that may affect care for minority populations."
Racial And Ethnic Disparities Detected In Patient Experiences
A study surveying patients in more than 1,500 physician practices has found racial and ethnic disparities in patient health-care experiences, with minority patients having worse experiences than white patients.
The findings suggest that while all doctors should be attentive to differences in patient experiences, Hispanic, Native American, and black patients are often visiting physician practices that are less patient-centered.
The study, which was led by a health services researcher at the University of Washington, appears in the October issue of the Journal of General Internal Medicine.
"Our findings suggest that there are statistically significant ethnic disparities in physician-patient communication, access to care, and care coordination, even among comparably insured patients in a variety of health-care markets," said Dr. Hector Rodriguez, lead author and assistant professor of health services at the UW School of Public Health and Community Medicine.
The study is the first of its kind to look at the contribution of individual physician practices to racial and ethnic disparities in patients' experiences of care. Rodriguez said the finding that Asian and Pacific Islander patients experience disparities in care within the same practices as whites suggests that these patients experience discrimination in physician practices or tend to report lower quality experiences because of cultural norms.
A previous study of racial and ethnic disparities in diabetes care quality found that black patients received lower quality care in the same practices as whites. The new study, however, found that Hispanic, black, and Native American patients were concentrated in lower-performing primary care practices, while Asian and Pacific Islander patients reported worse experiences in the same practices as whites. This new study relied upon surveys about the experiences of about 49,000 patients in 27 medical groups in California, as part of the Integrated Healthcare Association's public-reporting initiative.
What's the best way to reverse or improve the situation? Rodriguez said that ethnic disparities in patient experiences might be best addressed by targeting patient experience and quality improvement efforts in low-performing practices with high concentrations of racial and ethnic minority patients. Primary care practices that serve high concentrations of Latinos and some other minority groups, however, are located in health-care markets with severe physician shortages and lots of uninsured patients. As a result, efforts to improve the performance of these lower-performing practices should also consider these important market constraints.
Physician Effects on Racial and Ethnic Disparities in Patients’ Experiences of Primary Care
Hector P. Rodriguez et al
Journal of General Internal Medicine Volume 23, Number 10 : 1666-1672 / October, 2008
Link to JGIM article
David Maitland's "deadlock" is this year's winner of the competition’s Behaviour: Other Animals category.
David said the photo was just a snapshot in the struggle between a tree-frog and cat-eyed tree-snake that lasted for hours through the night in the tropical forests of Belize.
Wednesday, October 29, 2008
Science Daily (October 29, 2008)
Gender Affects Perceptions Of Infidelity
A new study in the Journal of Marital and Family Therapy explored how men and women perceive online and offline sexual and emotional infidelity. Men felt sexual infidelity was more upsetting and women felt emotional infidelity was more upsetting.
Monica T. Whitty and Laura-Lee Quigley of Queen’s University Belfast surveyed 112 undergraduate students and asked them questions about sexual and emotional infidelity both offline and on the internet.
“Men were more likely to believe that women have sex when in love and that women believe that men have sex even when they are not in love. It was not, however found that either men or women believe that having cybersex implied the other was also in love or that being in love online implied they were having cybersex.”
“Given the newness of the internet, the rules have still not been clearly defined as to what are acceptable online encounters,” the authors note. “Our results support a social-cognitive model as they demonstrate that social shifts have led men and women to think differently about sex and love.”
Emotional and Sexual Infidelity Offline and in Cyberspace.
Monica T. Whitty 1 and Laura-Lee Quigley
Journal of Marital and Family Therapy, 2008; 34 (4): 461 DOI: 10.1111/j.1752-0606.2008.00088.x
Link to JMFT abstract
A Face By Any Other Name: Seeing Racial Bias
If Barack Obama had taken his mother's surname and kept his childhood nickname, American voters might literally see "Barry Dunham" as a quite different presidential candidate, a new study suggests. A name significantly changes our perception of someone's face and race, according to research in the journal, Perception.
Participants in the study rated multi-racial faces with European names as looking significantly "more European" than exactly the same multi-racial faces when given Asian names. Earlier research had established that people tend to be better and more accurate at recognizing faces of their own race than those of a different race, an effect called the own-race bias: colloquially, the feeling that people of a different race "all look the same to me".
This bias has far-reaching negative effects, most notably the observation that eyewitnesses to crimes are more likely to incorrectly identify a perpetrator of a different race. By gaining a better understanding of the mechanisms driving the bias, researchers are hoping to devise strategies to minimize its effects.
The study by researchers at the Austrailian University of NewSouth Wales School of Psychology aimed to test the hypothesis that the presence of racially-suggestive names would influence participants' perception of identical multiracial faces, resulting in multiracial faces being judged to look more like the racial group suggested by their name.
"The study reveals how socially derived expectations and stereotypes can influence face perception," says co-author and UNSW PhD student, Kirin Hilliar. "The result is consistent with other research findings suggesting that once people categorize a face into a racial group, they look for features consistent with that categorization."
For example, a 2001 study found that multiracial (half Hispanic, half African-American) composite faces given stereotypically African-American hairstyles were perceived by both African-American and Hispanic participants as having darker skin, wider mouths, and less protruding eyes compared to the same faces given Hispanic hairstyles.
"The own-race bias is often revealed in people being relatively poor at encoding and recalling the facial characteristics of an unfamiliar racial group," according to Dr Richard Kemp, a face-recognition expert and co-author. "This study reveals that non-physical features such as a name can influence people's interpretation of facial characteristics."
Ms Hilliar adds: "The next step in our research is to investigate whether these racially-suggestive names not only influence people's perception of multiracial faces, but also how well they will recognize these same faces later on."
Barack Obama or Barry Dunham? The appearance of multiracial faces is affected by the names assigned to them
Kirin F Hilliar & Richard I Kemp
Perception 37(10) 1605 – 1608
Link to Perception abstract
Old blood 'boosts infection risk'
Storing donated blood too long increases the chance of an infection, US researchers reported at the American College of Chest Physicians conference in Philadelphia,.
The risk of blood poisoning or pneumonia doubled once the 29-day mark passed, Cooper University Hospital in New Jersey found.
The US does not allow the use of blood stored for longer than 42 days After two weeks in storage, red blood cells start to undergo changes which lead to the release of chemicals called "cytokines". These are known to hinder immune function, and in high levels could possibly make patients more susceptible to infection.
Researchers looked at the rate of hospital infections in 422 patients against the age of the blood transfusion they received.
They found that the average age of the blood was 26 days, and 70 percent of patients had received blood older than 21 days.
In total, 57 patients developed an infection - and these patients had received older blood than the others - on average it had been stored for three and a half days longer.
Patients who had received blood older than 28 days were twice as likely to develop an infection, and the more units of blood given, the higher was the chance of infection.
Dr David Gerber, who led the research and presented the results at the conference, said that any change to the time limit could lead to a blood shortage.
"More cautious utilization of blood might help to alleviate, at in least part, a diminished blood supply that might result from such a change in policy."
Initial CD4 cell counts in new seroconverters have declined over time
CD4 cell counts and CD4 percentages measured soon after infection with HIV declined significantly between 1985 and 2001 in a large group of patients who had recently seroconverted, according to a retrospective analysis of patient records by Dr Nina Crum-Cianflone and team at the AIDS Clinical Consortium, Bethesda. The downward trend in CD4 counts at seroconversion appears to have leveled off in more recent years.
This study set out to examine whether CD4 cell counts in people newly infected with HIV (seroconverters) are changing over time. Any such trends could reflect long-range changes in the virulence of the virus. Very few studies have looked at this question, with conflicting results; one large-scale analysis of multiple cohorts from Europe, Australia and Canada (published in 2007) did find that early CD4 cell counts declined between 1985 and 2002.
This latest study evaluated retrospective data from 1944 patients who seroconverted between the years 1985 and 2004. The participants were racially diverse, from differing geographic areas, antiretroviral naïve, and had a CD4 cell count recorded within six months of their HIV diagnosis. Seroconversion was documented by consecutive HIV-negative and HIV-positive tests.
The investigators concluded that a "significant decline in initial CD4 counts among seroconverters occurred during the first decade of the epidemic, with stabilization since the mid-1990s. Patterns of change in other immune cells such as the white blood cell count do not account for [this] decline. These data provide an important clinical correlate to studies suggesting that HIV may have adapted to the host, by HLA adaptation or CTL escape, resulting in a more virulent infection."
Is HIV becoming more virulent? Initial CD4 cell counts among HIV seroconverters across the HIV epidemic: 1985-2007.
Crum-Cianflone NF et al.
48th Interscience Conference on Antimicrobial Agents and Chemotherapy, poster abstract H-4051, Washington DC, 2008.
Alaska's beluga whales should be keeping their flippers crossed that Sarah Palin won't make it to the White House. This week, the US government added beluga whales in the Cook Inlet in Alaska to the endangered species list, despite Palin's efforts as state governor to prevent protection for this population being boosted.
Earlier this year, Palin expressed outrage at a decision to put the polar bear on the endangered list, and Alaska unsuccessfully sued for the potential loss of revenue from oil and gas development. She also claimed there was not enough evidence to classify the Cook Inlet beluga whale as endangered, and called for a recount.
Though the recount delayed the listing by six months, it revealed that the Cook Inlet is home to just 375 of the animals, down from 653 in 1995.
Tuesday, October 28, 2008
The Edwardian row house in Swansea, Wales, where Dylan Thomas was born in 1914 has been restored and reopened to visitors, the BBC reported. The house at 5 Cwmdonkin Drive, where Thomas spent his green and carefree youth, was restored by Geoff and Anne Haden, a couple who spent about four years returning the building, which was being used as student housing, to the way it would have been furnished in the early 1900s. “It’s the place where the finest poet of the 20th century lived for 20-odd years of his very short life and wrote two-thirds of his output,” Mr. Haden told the BBC. The Hadens plan to rent the house to vacationers and use it for literary events.
We cannot but wonder if this is what Dylan Thomas would have wanted.
The brains of people who commit suicide are chemically different to those who die from other causes, a Canadian study has suggested. Researchers analyzed brain tissue from 20 dead people and, in those who killed themselves, they found a higher rate of a process that affects behavior.
Writing in Biological Psychiatry, they said it appeared environmental factors played a part in the changes.
The researchers, from the University of Western Ontario, Carleton University and University of Ottawa, analyzed tissue from 10 people who had a serious depressive disorder and had committed suicide and 10 who had died suddenly from other causes, such as a heart attack.
They found that the DNA in the suicide group was being chemically modified by a process normally involved in regulating cell development, called methylation.
It is methylation which shuts down the unwanted genes in a cell - so the necessary genes are expressed to make a cell a skin cell rather than, for example, a heart cell.
The rate of methylation in the suicide brains was almost 10 times that of the other group, and the gene that was being shut down was a chemical message receptor that plays a major role in regulating behavior.
The researchers suggest this reprogram could contribute to the "protracted and recurrent nature of major depressive disorder".
Previous research has suggested that changes to the methylation process can be caused by a combination of genetic and environmental factors called epigenetics.
Dr Michael Poulter, who led the research, said: "The whole idea that the genome is so malleable in the brain is surprising, because brain cells don't divide.”
"You get dealt your neurons at the start of life, so the idea that there are still epigenetic mechanisms going on is pretty unusual."
Youth in their late teens who live in poor neighborhoods are four times more likely to attempt suicide than peers who live in more affluent neighborhoods, according to a new study from Canada's Université de Montréal and Sainte-Justine Hospital Research Center, as well as Tufts University in the U.S. The researchers also found youth from poor neighborhoods are twice as likely to report suicidal thoughts.
The study showed that late teens from disadvantaged neighborhoods had higher levels of depressive symptoms along with lower levels of social support, but these factors could not fully explain why these youth were at an increased risk to consider ending their own lives. "Rather, they were more vulnerable because difficult events, such as personally knowing someone who has committed suicide or experiencing a painful breakup with a romantic partner, apparently led to increased suicidal thoughts or attempts," says Véronique Dupéré, lead author and a post-doctoral fellow at Tufts University who completed the research at the Université de Montréal. "In other words, difficult events seemed to have a more dramatic impact on these teenagers."
Among teenagers from across all socioeconomic backgrounds, the research team found that hyperactivity and impulsivity, depression, substance use, low social support, exposure to suicide and negative life events increased vulnerability to suicide thoughts and attempts. "But among youth in disadvantaged neighborhoods, hyperactivity and impulsivity was even more strongly associated with suicidal behaviors," says Éric Lacourse, senior author of the study and a Université de Montréal sociology professor. "We observed that community adversity could amplify a young person's vulnerability to consider suicide."
Dr. Lacourse, who is also a scientist at the Sainte-Justine Hospital Research Center, says bolstering access to health or community services in disadvantaged neighborhoods may help reduce suicidal behavior among youth. "This is the first study to examine the independent role of neighborhood disadvantage as a risk factor in adolescent suicidal behaviors," added Dr. Dupéré. "Our study suggests that to be effective, intervention and prevention efforts must reach vulnerable adolescents living in disadvantaged communities."
Neighborhood poverty and suicidal thoughts and attempts in late adolescence.
V. Dupéré et al.
Psychological Medicine, 2008; 1 DOI: 10.1017/S003329170800456X
Link to Psych Med abstract
Monday, October 27, 2008
BBC News on line (October 27, 2008)
Jab hope for rheumatoid arthritis
A monthly injection could halt rheumatoid arthritis (RA) in half of all patients, trial data suggests.
The antibody drug tocilizumab works in conjunction with an existing treatment, methotrexate, to stop the condition in which the body attacks its own joints.
The drug, which will be sold under the brand name RoActemra by Roche, is awaiting approval by drugs regulators in Europe and the US.
The work was presented at a meeting of the American College of Rheumatology.
Nothing can be done to reverse the damage caused by RA but the new results show the two drugs taken together can achieve remission by stopping progression of the disease.
In trials involving 1,190 patients, taking tocilizumab plus methotrexate halted the condition in 47% of patients, compared to only 8% when methotrexate was taken alone.
X-rays showed the combination treatment slowed structural damage to joints by 85% on average, compared with 67% for methotrexate alone.
Professor Paul Emery, from Leeds University, who led the study said: "Results of this pivotal study convincingly demonstrate that tocilizumab can effectively and rapidly diminish the painful and debilitating effects of RA”.
"These trial findings are significant because it is critical to stop joint damage as quickly as possible to avoid joint deformity and to help people with RA maintain their quality of life."
Science Daily (October 27, 2008)
Rapid HIV Testing In The ER Boosts Diagnoses, Screening
One in every 50 people screened for a suspected sexually transmitted infection (STI) in the Emergency Department at Henry Ford Hospital was found to be infected with HIV using a rapid blood sample screening test.
Henry Ford researchers hope their study heightens awareness and directs more focus on implementing future prevention strategies in the HIV /AIDS epidemic. They say testing in the ED could diagnose new HIV infections, expand the reach of screening, and help get patients into counseling and treatment programs.
The study comes on the heels of a report by the U.S. Centers for Disease Control and Prevention that showed an estimated 56,300 HIV infections occurred in the United States in 2006, up by more than 16,000 from a previous estimate earlier this year. The CDC said the difference was due to the use of a more precise method of technology for estimating HIV incidence.
The CDC noted that while the new estimate did not represent an actual increase in new infections, it showed that the HIV epidemic is worse than previously known. An estimated 275,000 U.S. adults were living with undiagnosed HIV infection in 2006.
"This sobering news should underscore a need to look at new ways of expanding the reach of HIV testing," says Indira Brar, M.D., an Infectious Disease specialist at Henry Ford and lead author of the study.
"We know that people are more likely to modify risk behaviors and less likely to transmit or acquire infection if they know whether they are HIV positive or not. By offering more testing resources, as our study reflected, we can boost ways to diagnose infections and accelerate progress in reducing the HIV epidemic."
The study will be presented at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) and the Infectious Diseases Society of America (IDSA) Oct 25-28 in Washington D.C.
Hoping to increase efforts to better track HIV /AIDS prevalence and incidence, the CDC is working with states to implement a national system for estimating HIV incidence based on direct measurement of new HIV infections, closing a previous loophole for tracking the epidemic. The agency also says the new system, when available, will provide the "clearest picture to date" of HIV infections in the country. The new system, the CDC says, will allow better target prevention and measure progress in high-risk populations.
HIV prevalence, defined as people living with HIV /AIDS, increased from 2003-06 nationally, while HIV incidence, defined as new HIV infections, remained stable.
According to the Henry Ford study, patients who sought treatment for a STI in Henry Ford's Emergency Department from 2004-08 were screened for HIV using a rapid antibody test. The test, administered with a finger-stick for a blood sample, provides results for HIV infection in 20 minutes.
Of the 2,575 patients tested for a STI, 56 were newly diagnosed with HIV and a majority of them also tested positive for gonorrhea, chlamydia or syphilis. Patients received counseling with their results, and were given access to follow-up care within three days.
The Henry Ford study also found that 55 percent of the ER patients were infected through high-risk heterosexual sex and 35 percent were infected through male-to-male sex, in contrast to 2006 Michigan and national figures in which nearly half of all people diagnosed with HIV in the United States in 2006 were infected through male-to-male sexual contact.
AIDS treatment should start sooner, study finds
People who have the AIDS virus should start drug treatments sooner than current guidelines recommend, suggests a large new study that could change the care of hundreds of thousands of Americans.
The study found that delaying treatment until a patient's immune system is badly damaged nearly doubles the risk of dying in the next few years compared to patients whose treatment started earlier.
The study was reported Sunday at the 48th Annual ICAAC/IDSA (2008) taking place in Washington, DC (October 25-28, 2008)
Powerful drug combinations available since the mid-1990s have transformed HIV infection into a manageable chronic condition. But they can cause heart and cholesterol problems, diarrhea, nausea and other side effects. They also must be taken consistently or resistance develops and the drugs stop working.
That is why guidelines by the government and the International AIDS Society recommend that patients who are not yet having AIDS symptoms delay starting on the drugs until their T-cell counts fall below 350 per cubic millimeter of blood (healthy people have more than 800).
"There was this thinking, maybe the drugs were worse than the disease. If you could wait as long as you possibly could wait, you would have fewer side effects," said Dr. Robert Schooley, infectious diseases chief at the University of California, San Diego.
The new study is the largest to look at whether that advice is sound. Researchers led by Dr. Mari Kitahata of the University of Washington in Seattle pooled information on 8,374 people in the United States and Canada with T-cell counts of 351 to 500 from 1996 to 2006.
About 30 percent started taking AIDS drugs right away; the rest waited until their T-cell counts fell below 350, as guidelines recommend.
"We found a 70 percent improvement in survival for patients who initiated therapy between 350 and 500" compared to those who waited, Dr. Kitahata said.
Two other recent studies found that people who start taking AIDS drugs while their T-cell count is above 350 have a better chance of getting their count back to normal than those who start later. Another key study found that briefly interrupting treatment to give patients "drug holidays" puts them at grave risk.
"These studies have all shown the same thing — that we were starting too late" and need to keep treatment going once it starts, said Schooley. He helped write the AIDS society guidelines and consults for several companies that make AIDS drugs.
The bigger problem is that as many as a third of people diagnosed with HIV only discover they are infected after their T-cell counts already have fallen below 350 and they have serious complications.
"People are still being tested and identified way too late," and the new study shows how important it is to test and find people sooner, said Dr. Daniel Kuritzkes, an AIDS specialist at Brigham and Women's Hospital in Boston.
Initiating rather than deferring HAART at a CD4+ count between 351-500 cells/mm3 is associated with improved survival.
Kitahata M.M. et al
48th Intersciene Conference on Antimicrobial Agents and Chemotherapy, abstract H-896b, Washington, 2008.
Link to ICAACIDSA 2008
The Body also covers the presentation and posts a transcript of a question and answer session (as well as an audio)
link to The Body
BBC News on line (October 26, 2008)
Transsexual gene link identified
Australian researchers have identified a significant link between a gene involved in testosterone action and male-to-female transsexualism. DNA analysis from 112 male-to-female transsexual volunteers showed they were more likely to have a longer version of the androgen receptor gene.
The genetic difference may cause weaker testosterone signals. However, other genes are also likely to play a part. Increasingly, biological factors are being implicated in gender identity.
One study has shown that certain brain structures in male-to-female transsexual people are more "female like".
In the latest study, researchers looked for potential differences in three genes known to be involved in sex development - coding for the androgen receptor, the estrogen receptor and an enzyme which converts testosterone to estrogen.
Comparison of the DNA from the male to female transsexual participants with 258 controls showed a significant link with a long version of the androgen receptor gene and transsexualism.
It is known that longer versions of the androgen receptor gene are associated with less efficient testosterone signaling.
This reduced action of the male sex hormone may have an effect on gender development in the womb, the researchers speculated.
"We think that these genetic differences might reduce testosterone action and under masculinize the brain during fetal development," said researcher Lauren Hare from Prince Henry's Institute of Medical Research.
Co-author Professor Vincent Harley added: "There is a social stigma that transsexualism is simply a lifestyle choice, however our findings support a biological basis of how gender identity develops."
Although this is the largest genetic study of transsexualism to date, the researchers now plan to see if the results can be replicated in a larger population.
The study will be reported in Biological Psychiatry.