FAT BITCH

A group which represents illegal drug users in Australia is warning authorities about the danger of adopting an alarmist approach in dealing with methamphetamine abuse.

The Australian Injecting and Illicit Drug Users League have issued the warning following calls from the Australian Medical Association (AMA) for more money to be invested in the health system to deal with methamphetamine users.

AMA National President, Dr. Rosanna Capolingua, says hospital staff are subjected to threatening behaviour and violence by methamphetamine abusers which imposes a strain on hospital emergency departments.

Dr. Capolingua says methamphetamine use is an urgent and pressing health problem that is creating a serious safety issue for health care staff who are increasingly being placed in harm's way.

The AMA plans to lobby both Federal and State governments for new funding to cope with the problem and to examine how methamphetamine users are dealt with by the health system and wants specialist drugs liaison officer placed in all emergency departments to support methamphetamine and other drug users.

According to Annie Madden from the Australian Injecting and Illicit Drug Users League, while she welcomes the AMA's call for funding, there is a danger in saying that most users are violent.

Ms Madden says most methamphetamine users do not become psychotic and to categorise all methamphetamine users as potentially violent discourages those who need help, from approaching the health services.

Ms Madden says most people use methamphetamine very occasionally and recreationally, and the minority who do have a psychotic incident usually do so after extended periods of binge using, not sleeping and not eating.

The AMA however says methamphetamine should never be referred to as a recreational, soft or party drug as it is a harmful drug with dependent users suffering serious mental health problems.

The AMA also wants a public education program on the social and health consequences of methamphetamine use, and investment in GP training to recognise and deal with the problem.

Experts say people high on methamphetamine and other drugs should be treated in designated areas of hospital emergency departments as they require the same level of care as psychiatric patients and need a safe, contained place with additional staff and security so that patients can be looked after appropriately.

Methamphetamine is a stimulant drug and comes in various forms, powder or 'speed' is usually of relatively low purity and can be snorted, injected or taken orally; methamphetamine base is a more pure substance and is usually injected; 'crystal' or 'ice' is methamphetamine in its purest form and is usually smoked or injected.

Many common cold treatments available from pharmacies contain pseudoephedrine which is the usual base source for the illegal manufacture of methamphetamines.

The AMA says there are approximately 73,000 dependent methamphetamine users in Australia - there are 45,000 regular heroin users.

New findings suggest that the ancient human "cousin" known as the "Nutcracker Man" wasn't regularly eating anything like nuts after all.

A University of Arkansas professor and his colleagues used a combination of microscopy and fractal analysis to examine marks on the teeth of members of an ancient human ancestor species and found that what it actually ate does not correspond with the size and shape of its teeth. This finding suggests that structure alone is not enough to predict dietary preferences and that evolutionary adaptation for eating may have been based on scarcity rather than on an animal's regular diet.

"These findings totally run counter to what people have been saying for the last half a century," said Peter Ungar, professor of anthropology in the J. William Fulbright College of Arts and Sciences. "We have to sit back and re-evaluate what we once thought."

Ungar and his colleagues Frederick E. Grine of Cambridge University and Stony Brook University and Mark F. Teaford of Johns Hopkins University School of Medicine reported their findings in the PLoS ONE, the online, open-access journal from the Public Library of Science."

The researchers examined the teeth of Paranthropus boisei, an ancient hominin that lived between 2.3 million and 1.2 million years ago and is known popularly as the "Nutcracker Man" because it has the biggest, flattest cheek teeth and the thickest enamel of any known hominin. Since the first specimen was reported by Mary and Louis Leakey in 1959, scientists have believed that P. boisei fed on nuts and seeds or roots and tubers found on the savannas throughout eastern Africa because the teeth, cranium and mandible appear to be built for chewing and crunching hard objects.

"The morphology suggests what P. boisei could eat, but not necessarily what it did eat," Ungar said.

Anthropologists have traditionally inferred the diet of this and other ancient human ancestors by looking at the size and shape of the teeth and jaws. However, by looking at the patterns of microscopic wear on a tooth, scientists can get direct evidence for what these species actually ate.

Ungar and his colleagues used a combination of a scanning confocal microscope, engineering software and scale-sensitive fractal analysis to create a microwear texture analysis of the molars of seven specimens of P. boisei. The specimens spanned a time frame of almost a million years and were found in Kenya, Tanzania and Ethiopia. Using these techniques, they were able to create three-dimensional "point clouds" that showed the pits and scratches on the teeth.

The researchers looked at complexity and directionality of wear textures in the teeth they examined. Since food interacts with teeth, it leaves behind telltale signs that can be measured. Hard, brittle foods like nuts and seeds tend to lead to more complex tooth profiles, while tough foods like leaves lead to more parallel scratches, which corresponds with directionality.

They compared the dental microwear profiles of P. boisei to the microwear profiles of modern-day primates that eat different types of diets - grey-cheeked mangabeys and brown capuchins, which eat mostly soft items but fall back on hard nuts or palm fronds, and the mantled howling monkey and silvered leaf monkey, which eat mostly leaves and other tough foods. They also compared the microwear analysis to analyses of teeth from some of the fossil's more contemporary counterparts -- Australopithecus africanus, which lived between 3.3 million and 2.3 million years ago, and Paranthropus robustus, which lived between 2 million and 1.5 million years ago.

The P. boisei teeth had light wear, suggesting that none of the individuals ate extremely hard or tough foods in the days leading up to death. It's a pattern more consistent with modern-day fruit-eating animals than with most modern-day primates.

"It looks more like they were eating Jell-o," Ungar said.

This finding, while contradictory to previous speculation on the diet of P. boisei, is in line with a paradox that has been documented in fish. Liem's Paradox states that animals may actively avoid eating the very foods they have developed adaptations for when they can find other food sources.

It appears that this paradox may hold true for P. boisei and for some modern-day primates as well.

"If you give a gorilla a choice of eating a sugary fruit or a leaf, it will take the fruit every time," Ungar said. "But if you look at a gorilla's skull, its sharp teeth are adapted to consuming tough leaves. They don't eat the leaves unless they have to."

This finding represents a fundamental shift in the way researchers look at the diets of these hominins.

"This challenges the fundamental assumptions of why such specializations occur in nature," Ungar said. "It shows that animals can develop an extreme degree of specialization without the specialized object becoming a preferred resource."

http://www.plosone.org/doi/pone.0002044

A process to transmit medical images via cellular phones that has been developed by a Hebrew University of Jerusalem researcher has the potential to provide sophisticated radiological diagnoses and treatment to the majority of the world's population lacking access to such technology. This would include millions in developing nations as well as those in rural areas of developed countries who live considerable distances from modern medical centers.

Prof. Boris Rubinsky has demonstrated the feasibility of his new concept that can replace current systems -- which are based on conventional, stand-alone medical imaging devices -- with a new medical imaging system consisting of two independent components connected through cellular phone technology. The concept could be developed with various medical imaging modalities. This new technique is described in the latest online issue of the journal, Public Library of Science ONE (PLoS ONE).

Rubinsky is head of the Research Center for Research in Bioengineering in the Service of Humanity and Society at the Benin School of Computer Science and Engineering at the Hebrew University of Jerusalem and is also a professor of bioengineering and mechanical engineering at the University of California, Berkeley. Working with him on this project were Yair Granot and Antoni Ivorra, both of the Biophysics Graduate Group of the latter institution.

Their invention is jointly patented and owned by Yissum, the Hebrew University's Technology Transfer Company, and by the University of California, Berkeley. Commercialization efforts will be made by Yissum and by Berkeley's technology transfer organization.

According to the World Health Organization, some three-quarters of the world's population has no access to ultrasounds, X-rays, magnetic resonance images and other medical imaging technology used for a wide range of applications, from detecting tumors to confirming signs of active tuberculosis infections to monitoring the health of developing fetuses during pregnancy.

The conventional medical imaging systems in use today -- self-contained units combining data acquisition hardware with software processing hardware and imaging display -- are expensive devices demanding sensitive handling and maintenance and extensive user training. Only those treatment centers with the required financial and manpower resources are usually able to acquire and utilize them. Even when such equipment does exist in developing countries, it is often not in use because it is too sophisticated or in disrepair or because the health personnel are not trained to use it, said Rubinsky..

"Imaging is considered one of the most important achievements in modern medicine. Diagnosis and treatment of an estimated 20 percent of diseases would benefit from medical imaging, yet this advancement has been out of reach for millions of people in the world because the equipment is too costly to maintain. Our system would make imaging technology inexpensive and accessible for these underserved populations," said Rubinsky.

Under the new technology developed by Rubinsky, an independent data acquisition device (DAD) at a remote patient site that is simple with limited controls and no image display capability would be connected via cellular phone technology with an advanced image reconstruction and hardware control multiserver unit at a central site (which can be anywhere in the world).

The cellular phone technology transmits unprocessed, raw data from the patient site DAD to the cutting- edge central facility that has the sophisticated software and hardware required for image reconstruction. This data is then returned from the central facility to the cellular phone at the DAD site in the form of an image and displayed on its screen. "The DAD can be made with off-the-shelf parts that somebody with basic technical training can operate," Rubinsky noted.

The fact that the image itself is produced in a centralized location and not on the measurement device has the potential to make technological advances in medical imaging processing continuously available to remote areas of the world, which despite their lack of sophisticated equipment in general often do have cell phone communication. (Indeed, it is estimated that more than 60 percent of all cell phones currently in use in the world are in developing countries.)

Rubinsky stresses the key economic benefits of this new method: By simplifying the apparatus at the patient site, it reduces the cost of medical imaging devices in general. It also removes the need for advanced imaging training of the personnel at the patient site.

The researchers chose electrical impedance tomography (EIT) to demonstrate the feasibility of using cell phones in medical imaging. EIT is based upon the principle that diseased tissue transmits electrical currents differently from healthy tissue. The difference in resistance from electrical currents is translated into an image, which can be transmitted via cell phone technology.

Utilizing commercially available parts, the research team built a simple data acquisition device for the experiment. The device had 32 stainless steel electrodes - half to inject the electrical current and the other half to measure the voltage - connected to a gel-filled container that simulated breast tissue with a tumor.

A total of 225 voltage measurements were taken and uploaded to a cell phone, which was hooked up to the device with a USB cable. The cell phone was then used to dial into a powerful central computer that contained software to process the packet of raw data that was transmitted. An image was then reconstructed and sent back to the cell phone for viewing. The researchers verified that the simulated tumor was clearly visible in the image, demonstrating the proof-of-principle that this system is feasible.

http://www.huji.ac.il/

A report released on Sunday by a task force of the Association of American Medical Colleges that recommends new restrictions on what physicians, staff members and students at U.S. medical schools can accept from drug companies and medical device makers is "encouraging," but it "flinched" on some important issues, a New York Times editorial states (New York Times, 4/29).

The report recommends that all 129 U.S. medical schools not allow pharmaceutical and medical device companies to provide food, gifts and travel to physicians, faculty members and students. The report also recommends that medical schools "strongly discourage participation by their faculty in industry-sponsored speakers' bureaus," as well as establish centralized systems for the acceptance of medication samples from pharmaceutical companies or develop "alternative ways to manage pharmaceutical sample distribution that do not carry the risks to professionalism with which current practices are associated." Medical schools also should audit independently accredited continuing medical education programs led by faculty members "for the presence of inappropriate influence," according to the report (Kaiser Daily Health Policy Report, 4/28).

However, the report "stopped short of calling for a complete ban on the highly dubious practice" of participation in speaker bureaus by medical school faculty members and "did not call for an end to industry subsidies of continuing medical education programs that doctors must take to retain their licenses." The editorial states, "We hope the schools quickly adopt" the recommendations in the report -- and "strengthen them -- and that the entire medical profession follows their lead," adding, "Patients need to be assured that their doctors are prescribing what's best for them, not what's best for companies" (New York Times, 4/29).

Former House Speaker Newt Gingrich (R-Ga.) on Monday at a health care symposium sponsored by Siemens said that the Bush administration and Congress should do more to implement electronic health records nationwide, the Baltimore Sun reports.

Gingrich, founder of the Center for Health Transformation, said, "It's been a very great disappointment that the administration has not proposed to go to 100%" EHRs. According to Gingrich, Congress could have used funds directed toward the subprime mortgage loan bailout to help finance a conversion from paper records to EHRs.

The federal government will spend up to $150 million over the next five years for health care information technology, compared with $11 billion for the British government and $1 billion for the Canadian government. Many experts maintain that implementation of EHRs nationwide will reduce medical errors and costs and improve care. However, 90% of U.S. physicians and two-thirds of hospitals nationwide currently use paper records.

In addition to EHRs, Gingrich said that the U.S. needs to focus on preventive care. He said, "There's a big lag between the current political conversation and the next generation of ideas" (Kohn, Baltimore Sun, 4/29).

Medical Record Concerns

Two newspapers on Tuesday published articles on concerns about medical records. Summaries appear below.

• USA Today: The article examined the problems patients can face when they attempt to "obtain medical records from hospitals and other treatment facilities after something goes wrong." Under the medical privacy rule issued after passage of the Health Insurance Portability and Accountability Act, patients or their designated representatives have the right to view and copy their medical records, although the rule allows health care providers to withhold medical records in some cases, provided that they explain the reason. According to USA Today, although "there are no statistics on such cases, disputes over medical records often are at the crux of malpractice lawsuits" (Davis, USA Today, 4/29).
• Wall Street Journal: The article examined how the health care industry represents the "main threat" to the privacy of patient medical records, as hospitals, health insurers and federal employees have become involved in a "spate of recent security lapses." In an effort to prevent a "steady stream of privacy breaches" that "threatens to undermine the health care industry's effort to adopt electronic medical records," many "hospitals have been installing controls that limit by job function the types of data that employees can see," the Journal reports. However, according to the Journal, "institutions also are reluctant to control access to patients' private data too tightly, for fear that doing so could get in the way of patient care, especially in emergencies" (Rubenstein, Wall Street Journal, 4/29).