Monitoring the heart’s mitochondria to predict cardiac arrest?

IMAGE
Credit: Dr. John Kheir, Boston Children’s Hospital & Shutterstock

A new device can assess in real time whether the body’s tissues are receiving enough oxygen and, placed on the heart, can predict cardiac arrest in critically ill heart patients, report researchers at Boston Children’s Hospital and scientists from Cambridge device maker Pendar Technologies. Their study, conducted in animal models, is the cover article in today’s issue of Science Translational Medicine.

 

“With current technologies, we cannot predict when a patient’s heart will stop,” says John Kheir, MD of Boston Children’s Heart Center, who co-led the study. “We can examine heart function on the echocardiogram and measure blood pressure, but until the last second, the heart can compensate quite well for low oxygen conditions. Once cardiac arrest occurs, its consequences can be life-long, even when patients recover.”

The device uses a technology called resonance Raman spectroscopy to measure whether enough oxygen is reaching the mitochondria, the organelles that provide cells with energy. In critically ill patients with compromised circulation or breathing, oxygen delivery is often impaired, making it hard for mitochondria to do their job. This is especially a problem for the heart, which has constant high energy needs.

The current standard for measuring tissue oxygenation, known as mixed venous saturation (SvO2), requires repeated blood draws, adding extra risk in critically ill patients. More importantly, SvO2 cannot tell whether oxygen supply is sufficient to meet the dynamic demands of heart muscle.

“We wanted to create an organ-specific, continuous, reliable readout of how adequately mitochondria are being fed oxygen,” says Kheir. “This is the first demonstration of a device that can monitor mitochondria in living tissues to predict impending organ failure.”

Using light to monitor mitochondria

This technology is the product of a collaboration between the Translational Research Lab in Boston Children’s Heart Center, co-led by Kheir and Brian Polizzotti, PhD, and Pendar Technologies (Cambridge, Mass.). “At the bedside, we saw patients who had a limitation to coronary blood flow, and wanted a device that could provide an early warning sign,” Kheir says.

The team created a metric they call 3RMR that uses light readings generated by resonance Raman spectroscopy to quantify oxygenation and mitochondrial function in real time.

 

Read More: http://snip.ly/bt6o8#https://scienmag.com/monitoring-the-hearts-mitochondria-to-predict-cardiac-arrest-2/

Graham-Cassidy health care bill: What you need to know

unnamed

Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana have drafted the latest Republican attempt to repeal Obamacare. The bill would overhaul or eliminate major sections of the health care law, including its subsidized insurance coverage and Medicaid expansion. Instead, states would receive block grants, or a lump sum of money from the federal government, which they could use largely as they see fit.

How Graham-Cassidy would alter federal funding

Center on Budget and Policy Priorities analysis

The liberal-leaning think tank Center on Budget and Policy Priorities released estimates of how federal funding would change if the bill became law. In its analysis, California would be hardest hit, losing $27.8-billion in funding.

  • $-15,000
  • $-10,000
  • $-5,000
  • $0
  • $5,000
  • $8,500

ALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

Graham-Cassidy-Heller-Johnson block grant model

Cassidy’s office released its own estimates. Massachusetts takes the hardest hit with a more than $5 billion loss in funding. Overall, Southern states that did not expand Medicaid are poised to receive more in federal funding.

  • $-5,000
  • $-2,000
  • $0
  • $1,000
  • $3,000
  • $5,000
  • $10,000
  • $16,000

ALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

The bill comes after three failed GOP repeal attempts in the Senate, and a proposal from Sen. Bernie Sanders to extend the reach of government subsidized health care to all Americans.

But Republicans are up against a tight deadline. Their budget reconciliation bill, which allows them to overhaul Obamacare with a simple majority, expires on Sept. 30. The deadline could work to Graham’s and Cassidy’s advantage, however, by spurring hesitant Republicans to seize what may be their last opportunity to deliver on their seven-year promise to repeal Obamacare.

 

Read More: http://snip.ly/v5ygq#http://www.politico.com/interactives/2017/graham-cassidy-health-care-bill-what-you-need-to-know/

Shipley Center Website Offers Prostate Cancer Facts for Patients

One in every seven men in the United States will get prostate cancer, making it the second most common type, after skin cancer, for American men. It tends to be a slow-growing disease, but can sprint to life-threatening severity if detected too late. Screening for prostate cancer can yield false-positive findings, but those most at risk for the disease—men whose father or a brother had prostate cancer, African American men, overweight men, and those in their 60s and 70s who are in good health and could expect years more of life—still should ask their doctors whether screening makes sense for them.

Shipley Center Website Offers Prostate Cancer Facts for Patients.jpg

The website for the Shipley Prostate Cancer Research Center provides basic information about the prostate gland and how disease affects it.

That information comes from the just-launched website of the Shipley Prostate Cancer Research Center at the School of Medicine. Created with a $10.5 million gift from BU trustee Richard Shipley (Questrom’68,’72), the center’s labs will be in the Conte Building on the Medical Campus when it opens. The center’s research will be focused on finding genomic approaches to determine which prostate cancers are aggressive and need treatment, and which can simply be monitored.

The center’s website and its Facebook page and Twitter account are up and running now, offering easy-to-follow, impartial information on practically everything anyone needs to know about prostate cancer. There’s “Prostate 101,” an overview about the prostate, information about prostate cancer and getting a second opinion, and a checklist of symptoms; information on screening; treatment options; and the state of research.

This knowledge is available to patients everywhere, “irrespective of where they choose to get their medical care or where they are in terms of testing, diagnosis, or treatment,” says site editor Gretchen Gignac, a School of Medicine associate professor of hematology and medical oncology.

For its foundin.jpg

Most cases of prostate cancer are slow-growing tumors that have a very high cure rate, but some cases are fast-growing.

For its founding donor, the center is as much a beacon of information to patients as an incubator for medical research. Shipley was diagnosed with prostate cancer in 2014 and chose focal laser ablation, a new and less invasive treatment than surgery and other therapies.

“The website will be unique in that it will provide up-to-date information, both on diagnostic and treatment options, in a form the layman can easily understand,” Shipley says.

Read More: http://snip.ly/olj5q#http://www.bu.edu/today/2017/shipley-center-website-offers-prostate-cancer-facts-for-patients/

Hermetic Packaging, Connectors for Medical Implant Industry

Hermetic Packaging.jpg

Hermetic Implantable Packaging and Connectors for Medical Components

PA&E works with leading medical implant designers to advance integration and performance for hermetic implantable packaging and connectors in one of the most unique and critical environments known: the human body.

PA&E has created proprietary materials and encapsulations with hermetic seals that enable implantable medical devices to bypass the human body’s natural defenses and perform with greater reliability.

Precision Machining of Implantable Devices

PA&E’s unique precision machining techniques for materials and components are used to create implantable packaging and connectors for applications such as: cochlear implants, pacemakers, and other cardiac-function implants.

Here’s what PA&E can offer to medical implant designers:

Implantable Packaging and Connectors Example
PA&E’s unique brazing technologies allows materials like titanium and zirconia to be hermetically joined for applications that require an RF transparent package.

Medical Implantable Packaging — Devices implanted in the human body are at the leading edge of medical science. Advancing that technology and making more implantable medical components and devices possible requires overcoming several complex challenges. For example, medical implants must be as small as possible. However, the performance of new devices is often constrained by material selection and thickness. External communication with the implant is critical. Current communication technology relies on case material and size. Reliability and implantable viability are always issues because it is important that the body does not reject a newly-implanted device.

Read More: http://snip.ly/14fsc#http://pacaero.com/industries/medical/

FDA advisors give a thumbs-up to GlaxoSmithKline’s shingles vaccine

FDA advisors give a thumbs-up to GlaxoSmithKline's.jpg

GlaxoSmithKline’s shingles Shingrix vaccine received an unanimous vote of support by a Food and Drug Administration advisory committee Wednesday on safety and effectiveness to be used in adults 50 and older.

A decision by the FDA to commercialize Shingrix is expected later this year. The agency usually follows the recommendations of its advisory panels.

GSK said in June that the vaccine produced a strong immune response in adults 65 and older who had previously been vaccinated against shingles with Merck’s vaccine, Zostavax. Scientific data published in the New England Journal of Medicine showed that the effectiveness of Merck’s vaccine wanes over time, while GSK’s vaccine appeared to have longer-lasting protection.

GSK said data show that people who received Merck’s vaccine, the only one approved now for the herpes zoster (shingles) vaccine, can later receive the Shingrix vaccine safely and effectively.

“The risk of developing shingles increases with age and it is estimated that up to one in three people in the United States will develop shingles,” said Emmanuel Hanon, GSK head of vaccines research and development. “Today’s vote brings us one step closer to approval of Shingrix, which is specifically designed to overcome age-related weakening of the immune system.”

 

Read More: http://snip.ly/bunjk#http://www.philly.com/philly/business/fda-advisors-give-a-thumbs-up-to-glaxosmithklines-shingles-vaccine-20170913.html

Congress, keep hands off employer sponsored plans in healthcare fights

Congress, keep hands

Lawmakers are back in town and soon the Senate Health, Education, Labor and Pensions (HELP) Committee will once again take up the beast that is healthcare.

Some will be tempted to merely throw more money and the semblance of flexibility into a broken system — we urge them  to reject this Band-Aid, and to instead implement real reforms. The ERISA Industry Committee (ERIC) implores Congress not to take this opportunity to protect the employer-sponsored health insurance system, which is the single most common source of health coverage in the nation, providing 178 million Americans with access to healthcare.

Congress is focused on stabilizing endangered exchange marketplaces. ERIC heartily agrees that market stabilization is important for everyone, but addressing the cost sharing reduction (CSR) payments to insurance companies is just a small part of solving the problem.

 

Last month, ERIC, along with several other organizations, sent a letter to Congress with policy recommendations that would help stabilize the market, while also ensuring the future of affordable employer-provided health benefits.

We recommended Congress should fund CSR payments to improve affordability in the individual market. Congress should also repeal the 40 percent “Cadillac” tax on employer-sponsored health plans, with no new taxes on health benefits. And lawmakers should repeal the health insurance tax on fully insured health plans, which a recent Oliver Wyman study found will cost Americans $22 billion next year alone. They should also enable employers to innovate with Health Savings Accounts (HSAs) and protect the ability of employers to offer uniform benefits to employees and their families — no matter where they live, work, or receive medical care.

Tax relief is key to protecting the employer-sponsored system. Since World War II, the American tax code has encouraged employers to set up quality health plans for their employees by exempting company health benefit expenditures from income and payroll taxes. The Affordable Care Act placed a crippling financial burden on plan sponsors through the employer mandate and the taxes mentioned above.

An easy place to start would be fully repealing the highly unpopular Cadillac tax. It has already been delayed until 2020 and lawmakers have voted to repeal it twice. The first time in 2015 and the most recent during the healthcare votes this past July.

The Cadillac tax will hit more than 50 percent of the workforce within ten years of its implementation, according to a January study by the consulting firm Milliman —that’s 60 million Americans. These employees could see their benefits slashed by thousands of dollar while their salaries stay flat.

Some economists theorize that because of the Cadillac tax, workers might see their pre-tax wages increase as employers switch to cheaper plans. But if that happens, employees would also pay a lot more in taxes, costing 12.1 million employees upwards of $1,000 in higher payroll and income taxes.

In fact, 80 percent of the revenue raised by the Cadillac tax is expected to come from workers paying more income and payroll taxes, according to the Joint Committee on Taxation and the Congressional Budget Office.

Aside from health tax relief, another way to improve the healthcare system is updating consumer-directed health options like Health Savings Accounts (HSAs). The Committee and Congress should raise HSA contribution limits, ensuring that HSA and high-deductible plan beneficiaries have access to supplemental benefits. They should also allow consumers to use their HSAs to purchase over-the-counter medicines while updating rules to ensure those enrolled in HSA-compatible plans can benefit from first-dollar coverage for prescription drugs and other medical products and services likely to prevent or reduce catastrophic episodes in the future.

The Senate HELP Committee must also look at value-based healthcare options, which are ways plan sponsors and consumers can spend healthcare dollars smarter. Earlier this year, The ERISA Industry Committee and the Pacific Business Group on Health launched the DRIVE Health Initiative, a campaign to accelerate economic growth by controlling health costs and improving quality through the rapid adoption of value-based healthcare. The initiative calls for targeted deregulation and the use of market-based purchasing strategies by Medicare and other federal health programs.

Fixing healthcare is not easy. As lawmakers move forward in crafting new legislation, they must be sure it protects the employer-sponsored system that has provided affordable, quality coverage to more than half of the population for decades and allow for continued improvement and innovations.

If they don’t, the employer-sponsored health insurance system could be in jeopardy, creating a much bigger problem than that of the ACA exchanges.

James Gelfand is the senior vice president for health policy at The ERISA Industry Committee (ERIC). ERIC is the only national association that advocates exclusively for large employers on health, retirement and compensation public policies at the federal, state and local levels.

Gauteng Health head office: Sheriff attaches furniture due to non-payment of negligence claim

Gauteng Health head office

Staff at the Gauteng Department of Health provincial head office are without equipment to do their work after the Sheriff of the Court attached two truckloads of furniture on Thursday following a failure by the department to pay court-ordered damages related to a hospital negligence case. By ORATENG LEPODISE.

If you walk into several offices at the provincial health department’s head office at the Bank of Lisbon building in downtown Johannesburg, you are likely to find administrative staff sitting on the floor.

On Thursday the sheriff arrived at the offices and removed two truckloads of furniture from four floors in the building in a bid to force the department to settle payment of a R6.2-million negligence claim awarded against it.

The negligence claim relates to a protracted legal battle between the department and the parents of a child who suffered brain damage during birth at the Pholosong Hospital in December 2009. The seven-year legal battle drew to a close on March 8 with a cost order being awarded against the department.

But it is yet to settle.

“It is a terrible injustice that this case has dragged on for more than seven years, with further suffering for the child and her family, and now the department delays further,” said Jack Bloom, the DA’s Gauteng Shadow MEC for Health.

On Thursday, according to the writ of attachment, the sheriff removed:

• 400 desks;

• 600 chairs
;

• 400 computers;

• 200 filing cabinets
;

• 50 printers
;

• 10 fridges;

• 10 microwaves; and

• three lounge suites

Asked by Daily Maverick to comment on the attachment of its furniture, its impact on the health department staff to do their work and on the department’s failure to pay the negligence claim, department spokesman Prince Hamnca said: “All I am willing to say is that we are concerned that the furniture has been taken from the offices, but that was a court order from the Sheriff.”

“I am appalled that the department has yet again disregarded a court-ordered payment,” said Bloom, while accusing the Gauteng Health MEC, Gwen Ramokgopa, of downplaying the effect of the removal of truckloads of furniture.

An employee at the department and branch secretary of the National Health, Education and Allied Workers Union, Charles Phasa, said the working conditions were “very bad” as everything with any value was taken.

“This is not something new. Every year the sheriff comes in and the department waits until the 11th hour to negotiate some sort of way to cover their payments, but this time around it is just too much,” Phasa said.

According to Phasa the department has urged its workers to be patient while it attempted to address the issue.

The health department finds itself in a pool of debt which includes outstanding payments to suppliers and medical negligence cases and in May this year faced a R10.9-billion funding gap as budgeted funds were all taken up by salaries, accumulated debt and payments for negligence.

Medical negligence claims have increased significantly in recent years. From just over R8-million paid out by the Gauteng Department of Health in 2010/11, almost R154-million was paid out by the same department in 2013/14. Contingent liabilities for medical malpractice (money that the department would have to pay should all medical negligence claimants be successful in their claims) in 2016 in Gauteng sat at over R13-billion.

Bloom said the Gauteng Provincial Government was being destabilised by the endless financial woes of the Health Department, which faces a potential medico-legal liability of more than R13-billion and owes large sums to suppliers as well.

“Delays in payment also add to the costs as a 10.5% penalty interest is charged – in this case, this amounts to more than R300,000,” Bloom said. DM

Photo: Gauteng premier David Makhura speaks at a Gauteng township economy revitalisation summit in Soweto, Tuesday, 7 October 2014. Picture: Werner Beukes/SAPA