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The Complexity Matters blog features the Thursday Complexity Post as well as other complexity inspired news items.

 

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Collaboration May Improve Medical Diagnoses

Posted By Prucia Buscell, Thursday, February 5, 2015

Doctors working in teams may make more accurate diagnoses than doctors working alone, a recent study suggests.

German researchers recruited 88 fourth year medical student volunteers and showed them videos of simulated patient cases. They then asked the volunteers to select one of 20 possible diagnoses, and order from a menu of 30 possible tests. Twenty eight of the students worked individually and the remaining 60 worked in pairs. Those working in pairs were 18 percent more accurate in their diagnoses. The study also found that pairs were more likely to differ in confidence about the diagnosis when the diagnosis was incorrect.

The researchers said superior accuracy of the pairs could not be explained by differences in knowledge or relevant information. "Collaboration may have helped correct errors, fill knowledge gaps and counteract reasoning flaws," researcher Dr. Wolf E. Hautz and colleagues said. The findings appeared in a research letter in the Journal of the American Medical Association.

A story by Sabriya Rice in Modernhealthcare.com reports that as many as one out of 20 adults in the U.S. may be misdiagnosed in outpatient visits, and about half of those errors could be harmful.

While hospitals have developed systems for monitoring healthcare acquired infections and surgical errors and other patient safety issues, experts say systems for tracking diagnostic mistakes barely exist and causes of diagnostic error have not been thoroughly researched. The 1999 Institute of Medicine Report "To Err is Human" brought medical error into public consciousness but did not focus on diagnostic error. The IOM report due this fall is expected to probe diagnostic error. Complicating the issue, Rice writes, is that there is no universally accepted definition of a diagnostic error.

According to a 2014 study by CRICO Strategies, a Cambridge, Mass.-based risk-management group, about 20 percent of 23,527 medical malpractice cases filed between 2008 and 2012 were related to diagnostic concerns, she reports, and about 73 percent of the 4,705 diagnostic claims alleged lapses in clinical judgment, such as failure to order diagnostic tests, establish a differential diagnoses or give a referral.

Some surveys and research indicate time and scheduling pressures contribute to the potential for error.

At Maine Medical Center, a part of MaineHealth in Portland, began an innovative initiative to get clinicians thinking about diagnoses. The hospital's patient-safety officer and clinical educator started a pilot project that ran from January to July 2011 where doctors voluntarily discussed examples of diagnostic mistakes. During the trial period, doctors found 36 instances where diseases such as cancer, stroke and pneumonia were missed, misdiagnosed or not identified in a timely fashion. "Just about every time you talk to clinicians involved in diagnostic errors, it seems like time and volume is an issue," said Dr. Robert Trowbridge, an internal medicine physician who teaches clinical reasoning at Maine Medical Center.

Dr. Gordon Schiff, a diagnostic error researcher at Brigham and Women's Hospital in Boston, told Modernhealthcare.com that diagnosis is really a team effort. He said the idea that diagnosis is "this heroic, lone ranger thing" that doctors do behind closed doors is romantic and outdated.

Tags:  buscell  collaboration  complexity matters  health  research 

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Our Genes May Know More Than Our Minds

Posted By Prucia Buscell, Thursday, January 29, 2015

Human happiness influences human gene expression, researchers have found, and different kinds of happiness have surprisingly different effects on our physical health.

Researchers at the UCLA Cousins Center for Psychoneuroimmunology and the University of North Carolina note that philosophers since antiquity have distinguished between hedonic wellbeing-the kind of happiness that comes from satisfaction from pleasurable experiences-and eudaimonic wellbeing-the kind that comes from striving toward meaning and noble purpose beyond self gratification. It turns out the molecular mechanics of good health tend to favor people who find happiness striving for higher goals.

Steven Cole, PhD, a professor of medicine, psychiatry and behavioral sciences at UCLA and a member of the Cousins Center, and colleagues including Barbara Frederickson, director of the Positive Emotions and Psychology Lab at the University of North Carolina, have spent a decade studying how stress, fear, loneliness and other miseries impact the human genome. In his paper "Social Regulation of Human Gene Expression: Mechanisms and Implications for Public Health," Cole reported that people who experienced long term loneliness had a gene expression profile showing high inflammation and lower immune function. Inflammation related illnesses include heart disease, neurodegenerative diseases and some types of cancer.

The stress-related gene expression profile characterized by high inflammation and low immunity is known as CTRA, for "conserved transcriptional response to adversity." Cole and colleagues wanted to find whether happiness is just the opposite of misery, or whether it would activate a different kind of gene expression. They took blood samples from 80 healthy adults assessed as having either hedonic or eudaimonic happiness, and used the CTRA gene expression profile to examine potential biological differences. Both groups had high levels of positive emotion. Those in the eudaimonic wellbeing group had favorable gene expression profiles, with low inflammation and functioning immunity, while those in the hedonic wellbeing group showed the opposite gene expression profiles. The study appears in the Proceedings of the National Academy of Sciences.

"What this study shows is that doing good and feeling good have very different effects on the human genome, even though they generate similar levels of positive emotion," Cole, the lead author, said in a UCLA release. "Apparently the human genome is much more sensitive to different ways of achieving happiness than are our conscious minds." The UCLA release says this research, showing specific signals and pathways associated with a positive state of mind and gene expression, is the first of its kind.

In his paper on social regulation of genes, Cole wrote that the human genome is influenced by social environment, and that the "regulatory architecture" of the genome lies outside the cell "in the constraints and affordances present in the social ecology."

Increasing knowledge and technological advances that allow researchers to examine the way genes and environment interact on a molecular level can have profound impact in public health, he suggests. "Social regulation of gene expression implies many aspects of individual health actually constitute a form of public health in the sense that they emerge as properties of an interconnected system of human beings," the paper says.

In an interview, Frederickson suggested our bodies may respond better to happiness related to human connectedness and purpose than to hedonic wellbeing, which she called the emotional equivalent of empty calories.

Tags:  buscell  complexity matters  culture  health  research 

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Vaccine Fears and the Return of Old Diseases

Posted By Prucia Buscell, Thursday, January 22, 2015

Measles, whooping cough and other diseases thought to have been eliminated decades ago are reappearing in California and other states and health officials worry that widespread resistance to childhood vaccinations raises potential for dangerous outbreaks of infectious illnesses.

A New York Times story by Adam Nagourney and Abby Goodnough reports a measles outbreak at Disneyland infected 42 of the 59 people in California whose illnesses were reported to the state this week. The Center for Disease Control and Prevention (CDC) reported 644 cases of measles in 27 states in 2014, the biggest number since 2000. Before common use of measles vaccine in 1963, the story reports, measles infected three to four million Americans a year and 400 to 500 people died.

Stories by Gary Baum of the Hollywood Reporter document childhood immunization rates as low 57 percent and 68 percent in some in some elite preschools in wealthy neighborhoods, numbers that are on a par with immunization in Chad and South Sudan. And nearly 8,000 cases of whooping cough, including 267 that needed hospitalization, had been reported to the state during the first nine months of 2014. Whooping cough, also called pertussis, once killed thousands of people annually, but introduction of the DPT (diptheria, tetanus and pertussis) vaccine nearly eliminated the disease.

During the current measles outbreak, unvaccinated children have been banned from going to public school in Orange County. A Washington Post Wonkblog identifies Orange County as "ground zero in the current epidemic of anti-vaccine hysteria." California allows parents to avoid vaccinating their children by filling out personal belief exemptions, and Baum reports an alarmingly high number of families in many of the wealthiest communities have made that choice. The CDC recommends vaccinations, some of which need multiple doses, against 14 diseases.

Radio station WBUR in Boston reported on a study showing vaccination rates in some states, including Oregon, West Virginia and Colorado, have dropped below the level required for herd immunity. Thresholds differ based on how infectious different illnesses are. The CDC suggests that threshold is crossed for whooping cough and measles when more than six percent of the population is not immunized. Herd immunity means that where a high percentage of the population is immune, the chance of an infected person meeting a susceptible person is low, so disease is unlikely to spread. Diseases spread rapidly among people who are not immunized.

Some parents worry about discredited research linking vaccines to autism, and some have religious or philosophical objections. The National Vaccine Information Center raises concerns about vaccines and the Times story quotes a spokesperson as minimizing the hazard of rejecting vaccination. Why do many resist? A 2014 AP-GfK survey reports only 53 percent of adults are "very confident" that childhood vaccines are safe and effective. The Post Wonkblog notes wryly that's about the same percentage who think houses can be haunted by ghosts.

The World Health Organization, urging universal immunizations, asserts that vaccines save lives and prevent disability, as well as mitigating severity of many diseases, reducing secondary infections. Some vaccines provide protection against related diseases. WHO says, for instance, that measles vaccination protects against multiple complications including dysentery and bacterial pneumonia.

Tags:  buscell  complexity matters  disease  health 

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Community Health Saves Lives and Money

Posted By Prucia Buscell, Thursday, January 15, 2015

A 40 year community-wide effort to promote heart health and healthier habits in a rural low-income county in Maine has resulted in less illness, lower mortality, and millions of dollars in savings according to a study published in the Journal of the American Medical Association. Authors believe the initiative can be widely adapted and that today's new data sources and technologies can make implementation even more feasible than when the program began in the 1970s.

Franklin County Court House

Franklin County Court House

In the late 1960s community groups in Franklin County, which then had a population of about 22,000, identified cardiovascular disease prevention as a priority. A Community Action Agency and Rural Health Associates (RHA), a non profit medical group practice, which were both new at the time, coordinated their efforts with the community hospital. With the hospital's sponsorship, RHA established the Franklin Cardiovascular Health Program (FCHP), which targeted hypertension, cholesterol, smoking, diet and exercise. FCHP used county health data from the past decade as a baseline and compared Franklin with other Maine counties and state averages.

Dr. Daniel Onion, a MaineGeneral Health physician and one of the researchers, told Kaitlin Schroeder of the Kennebec Journal & Morning Sentinel the project was powered by volunteers who worked in the community to help people quit smoking and adopt other healthy behavior. An HPLive story by Gale Scott describes other details. Federal funds were used to start an insurance plan for 3,000 indigent residents. The University of Maine developed a health education degree program and trained local people to be outreach workers. Hundreds of volunteers, including 200 nurses, did health screenings and educated residents. Schools were persuaded to serve healthier meals. A health fitness center with the area's only indoor swimming pool was built with funds raised by the community. Over the years, 150,000 people had an average of five contacts each with a program worker.

A ScienceDaily story reports that between 1994 and 2006 lower than expected hospitalizations saved an estimated $5.4 million per year in hospital charges for Franklin County residents. The program, which continued through 2010, had many successes. Among people with hypertension there was a 24.7 increase in the portion of people in control of their blood pressure. Control of cholesterol increased 28.5 percent. The quit rate for smoking improved from 48.5 percent to 69.5 percent. The overall death rate and the cardiovascular death rate dropped below state levels during most of the study period.

Darwin R. Labarthe, MD, MPH, PhD, and Jerome Stamler, MD, of the Northwestern University Feinberg School of Medicine in Chicago say in a JAMA editorial that the Franklin County experience deserves to be examined and copied. They say the results reinforce importance of disease prevention at the local level. They call on communities to document and publish past experiences in community health to "inform ongoing work and foster wider application of program evaluation and implementation research, exploiting new data sources and technologies to accelerate replication and scaling up of community-based prevention. Intervening developments-not least among them the Affordable Care Act-have made this task clearly more achievable today."

Tags:  buscell  community  complexity matters  health 

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Risk, Randomness and Cancer

Posted By Prucia Buscell, Thursday, January 8, 2015

The risk of developing many kinds of cancer may rely on random luck.

Cristian Tomasetti, PhD, and Bert Vogelstein, MD, cancer scientists at Johns Hopkins University School of Medicine, report in a Science magazine article that many cancers are caused by random mutations that happen when healthy stem cells divide. Cancers are known to result from life styles, inherited proclivities, and environmental exposures, as well as causes that can't be identified. A New York Times story by Denise Grady reports that the authors found chance was a bigger factor than they'd expected. "It was about double what I would have thought," Dr. Tomasetti, a biostatistician and professor told the Times. Basically, the risk of cancer is highly correlated with the number of stem cell divisions over time.

A Johns Hopkins press release explains that Tomasetti and Vogelstein charted the number of stem cell divisions likely to occur in 31 tissue types during an average life span, and compared these rates with the lifetime risk of cancer in the same tissues among adult Americans. Adult stem cells are a specialized population of cells in each organ or tissue that divide or self-renew indefinitely to generate replacement parts as other cells wear out.

The researchers report, for example, that the large intestines have more stem cells than small intestines, and those cells divide 73 times a year, compared with cells in the small intestines that divide 24 times a year. The lifetime risk of cancer in the large intestine is 4.8 percent, which is 24 times higher than the risk of a small intestine cancer. Their calculations show that about two thirds of the variation in cancer risk was explained by the number of stem cell divisions, and about one third is explained by heredity and environment.

They compare cancer with a car accident. The longer the trip, the higher the risk of accident. They say the mechanical condition of the car is a metaphor for inherited genetic factors and road conditions are like environmental factors. We may not know which of these three conditions contributed most to a particular wreck, but well maintained roads and vehicles can reduce overall risks. Knowledge that some factors are beyond our control may reduce stigma and comfort some cancer patients who blame themselves for their illness. Findings also suggest more cancers will appear simply because aging increases the number of stem cell divisions, the authors say in the release, so research on early detection, treatment and the biology of the disease is more important than ever.

Breast and prostate cancers were not included in the study because researchers lacked data on breast and prostate stem cell division rates. Lung cancer cases were divided between smokers and non-smokers, leading some readers to note that smoking also contributes to many other cancers. The American Lung Association reports that smoking causes nearly 90 percent of all lung cancer cases.

In a lengthy blog post on the article, oncologist David Gorski, MD, cites research suggesting one third to one half of all cancers are "potentially preventable," meaning they come from environmental factors that could be altered, such as smoking, alcohol use and weight control. He has some quibbles with the article, and wishes the discussion of it had been more nuanced. Bob O'Hara and GirrlScientist writing in The Guardian complain that too many news stories about the research confuse the variation in cancer risk with absolute risk of cancer, thereby blurring what constitutes bad luck.

Sometimes luck is randomly good. In the press release, Dr. Vogelstein observes cancer free longevity in people exposed to tobacco smoke and other carcinogens, often attributed to good genes, is likely to be good luck.

Tags:  buscell  complexity matters  culture  disease  health  luck  research 

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Some Gene Mutations Are Good

Posted By Prucia Buscell, Thursday, January 1, 2015
Updated: Monday, January 5, 2015

For years, researchers have looked for gene mutations that cause disease. Two scientists who started The Resilience Project have flipped that effort upside down and started looking for gene mutations that protect against disease. Discovery of such positively deviant genes paves the way for drugs that mimic the protective qualities.

A New York Times story by Gina Kolata tells the story of a Port Orchard, Washington, man who has a gene for early onset Alzheimer's. The man's older brother, mother, nine of his mother's siblings, and six cousins began showing symptoms in their 40s, and most died in their 50s. The man, now 65, has no signs of the illness, and researchers are trying to learn whether he has a genetic mutation that is counteracting or substantially delaying the horrifying impact of the Alzheimer's gene that he has.

"Instead of trying to fix things that are broken, let's look at people where things are broken but nature finds a way around it," Dr. Eric E. Schadt, director of the Icahn Institute, a medical research institute at Mount Sinai Hospital in New York, said in an interview with the Times.

Researchers have found many gene mutations that cause disease or predispose a person to an illness, and those seem to be considerably more common than the beneficial mutations. However, with today's fast and relatively inexpensive methods of sequencing DNA, and the ever-growing databases of study subjects whose genomes have been sequenced, scientists can begin to look for the positive mutations. Dr. Schadt and Dr. Stephen H. Friend, director of Sage Bionetworks, a nonprofit research organization in Seattle, are searching databases that hold clinical and genetic information. They are looking for people who, despite having mutations for fatal diseases that strike early in life, have remained healthy far past the age when the illness should have appeared. They have analyzed data from more than 500,000 people, and found only 20 in which a good gene mutation appears to have blocked a bad one. But because no names are attached to the data, the scientists can't contact those people. So they contacted researchers studying extended families with severe genetic illnesses, and they found the Washington man.

Some amazing beneficial gene mutations have already been discovered. One prevents HIV from entering cells and causing AIDS, and that discovery has enabled scientists to treat HIV positive patients by directly editing their cells. Discovery of another gene alteration that prevents build up of LDL cholesterol led to discovery of a drug that is now in the final stage of testing. Researchers using genetic databases have also found mutations in some genes that confer partial protection against heart disease, osteoporosis and Type 2 diabetes.

The Washington man who seems to have defied his dangerous Alzheimer's gene retired recently. He told the Times his life's work now is to help scientists understand the treacherous disease that claimed the lives of so many members of his family.

Tags:  buscell  complexity matters  health  positive deviance  research 

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Innovations in Organic Transplants

Posted By Prucia Buscell, Thursday, December 4, 2014

Healthy human excrement is becoming a valuable commodity.

OpenBiome, a nonprofit launched by MIT graduate students almost two years ago, is the nation's first stool bank. Its mission is to provide doctors and hospitals with safe fecal material from screened donors for use in the growing number of fecal transplant procedures. Microbiologist Mark Smith, a co-founder, explains in a Boston.com story by Chelsea Rice that the organization is modeled after the Red Cross, to make a medical commodity available in a standardized way.

Fecal transplants-known as fecal microbiota transplants, or FMT, have been found extraordinarily effective in treating patients with Clostridium difficile infections that afflict half a million patients a year with intestinal pain and disabling diarrhea. Most are hospital patients who have been treated with antibiotics that wipe out healthy gut bacteria along with targeted pathogens. With the microbial competition wiped out, C. diff takes over, producing toxins that can cause severe and sometimes fatal illness. With introduction of donated stool into the patient's intestine or colon, healthy bacteria fight the C. diff and the normal microbial gut community can be reestablished. The Mayo Clinic first used FMT to treat a C. diff patient in 2011 and the Cleveland Clinic called FMT one of the top medical innovations of 2013.

In The New Yorker story "The Excrement Experiment," Emily Eakin traces the past and current understanding of fecal microbiota, describes its potential for treating several autoimmune disorders, and reports on recent research suggesting the mysteries of the gut biome may hold keys to many medical conditions, including obesity and mental health. Researchers at Washington University in St. Louis found that gut bacteria plays a significant role in obesity in mice. Mice implanted with gut bacteria from a fat human gained weight while those injected with gut bacteria from a thin human stayed slim even when both groups ate the same diet. Research also suggests gut bacteria influences our moods, minds and emotions.

The average human digestive tract hosts at least 100 trillion bacterial, fungal, viral and archaeal organisms that collectively makeup the gut biome. Much of the research focuses on stool, which Eakins explains "remains our best proxy for the brimming universe within." Smith told Eakin part of his inspiration for OpenBiome was a friend who cured his extreme suffering from C. diff by transplanting his room-mate's stool into himself. Transplanting can be done using enemas, colonoscopies or a turkey baster. OpenBiome absorbs the cost of screening donors, whose blood is tested for several diseases, and whose initial stool samples are screened for known harmful pathogens. It is now sending specimens of clinically prepared excrement to dozens of hospitals across the country. Boston.com reports screened doors are paid $40 a day for their contributions. To lighten a gross topic, donors, who are anonymous to recipients, are given code names such as Winnie the Poo, Poop King, and Vladimir Pootin. Note the Boston.com graphic.

Meanwhile, for-profit biotech companies are competing to get stool-based therapies through trials and into the market. Scientists are also designing fecal capsules, which some entrepreneurs call "crapsules," that will be more appealing to patients. And the FDA will have to decide what regulatory measures should be in place. The FDA has viewed medically used stool as a drug. Smith and others hope it will be reclassified as a tissue, which has to meet stringent standards but does not have to go through clinical trials required for FDA drug approval. Read the New Yorker story here.

Tags:  bacteria  buscell  complexity matters  health 

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Community Health Vital for Healthy People

Posted By Prucia Buscell, Thursday, August 28, 2014

Leana Wen, MD, an emergency physician who has worked in inner city hospitals in St. Louis, Boston and Washington, D.C., writes in her blog about the painful experience of administering short term fixes to patients whose long term afflictions lie beyond her realm.

She describes a 19-year-old who has come to the emergency room three times with cuts and broken bones and gunshot wounds. An 8-year-old without an inhaler living among relatives in an overcrowded house with lots of smokers comes to the emergency room struggling to breathe. A 38-year-old single mother diagnosed with cervical cancer four years ago never got to see a doctor as she struggled with three part time jobs, the care of four children and inadequate insurance. By the time Dr. Wen saw her in the emergency room, her cancer had spread to her lungs and intestines.

"We in the ER provide a necessary service, but it's far from being sufficient," she writes in her blog The Doctor is Listening. "We need to recognize that health does not exist in a vacuum, that it is intimately tied to issues such as literacy, employment, transportation, crime and poverty. An MRI here, a prescription there, these are Band-Aids not lasting solutions. Our communities need innovative approaches to issues like homelessness, drug addiction, obesity and lack of mental health services." The route to good health, Dr. Wen says, is in the community. Dr. Wen is coauthor of the book When Doctors Don't Listen.

When he was still writing the Wonkblog for the Washington Post, Ezra Klein described an experiment in Oregon to rebuild the state's Medicaid program around community health rather than individual fee for service treatments. Klein tells a story Oregon Gov. John Kitzhaber loves to tell. Kitzhaber, a former emergency room physician himself, calls it an illustration of what's wrong with our healthcare system. A 90-year-old woman with well-managed congestive heart failure lives in an apartment without air conditioning. When her apartment gets too hot, the strain on her cardiovascular system causes heart failure. Medicare will pay for an ambulance and $50,000 to stabilize her, but not $200 for a window air conditioner.

The 90-year-old may be hypothetical, but the story illuminates a common paradox, and Oregon's experimental approach starts with creation of 16 Coordinated Care Organizations (CCOs) that are responsible for assessing the health of their communities. Kitzhaber has given the CCOs flexibility on how they can spend Medicaid money. They can buy that air conditioner. An NPR story describes a Medicaid purchase of a minivan for community health workers who can be available around the clock to pregnant women trying to stop substance abuse, and to help mothers get to doctors' appointments, school and jobs. What makes CCOs different from accountable care organizations, or managed care, is the community component. Once they assess needs, they have to come up with ways to address them. So money can be spent on care coordination and community health workers with the aim of preventing some expensive emergency care. Gov. Kitzhaber told Klein, "We're investing in health. It's just a paradigm shift."

With thanks to Annette Garner, who teaches in the nursing program at the Health & Science University, Portland, Oregon.

Tags:  buscell  complexity matters  health  healthcare  medicine 

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Surprising Return on Enrichment for Babies

Posted By Prucia Buscell, Thursday, August 21, 2014

Policy makers concerned with income inequality need to focus more attention on improving the early environment of disadvantaged babies and toddlers, recent economic analysis suggests. Being born into poverty doesn't have to mean a lifetime of deprivation, researchers say, and the earlier the helpful intervention, the higher society's return on the investment.

High quality early childhood programs have been shown in numerous studies to have substantial benefits in reducing crime, raising earnings, and improving educational outcomes, Frances Campbell, Gabriella Conti, James Heckman and colleagues wrote recently in Science magazine, and now research shows that life's earliest experiences strongly effect adult health.

Heckman and Conti are among the top economists who have done extensive studies on human development. They have found that wealthy children and those from deprived environments have disparities in cognitive performance even before they start kindergarten, and the gap doesn't close with time. Research by Heckman and Flavio Cunha at the University of Pennsylvania shows that the divergence between rich and poor kids in math ability is about the same at age 12 as it was at age six.

Eduardo Porter writes in The New York Times that the achievement gap between rich and poor American students is one of the widest among the 65 countries that take part in the Program for International Student Assessment run by the Organization for Economic Cooperation and Development. Porter suggests the acrimonious debate over how to improve American education misses the most important time-the years from infancy though pre-school. Heckman, Conti and others report that interventions from infancy through age five pay extremely high returns. Good early programs improve cognitive skills and foster softer skills such as sociability, motivation, perseverance and self-regulation. Heckman and colleagues say those are the traits that enable kids to use their cognitive skills for future learning and adult success.

Two well documented programs are illustrative. The Perry Preschool Project offered intensive social and cognitive skills building for disadvantaged three and four year olds from 1962 to 1967 in Ypslanti, Michigan. A study found Perry graduates at age 40 were more likely than those in a control group to have finished high school, to hold jobs, and have higher earnings.

The Abecedarian Project in North Carolina started in 1972 with 111 infants who were followed from birth through their mid 30s. The children were randomly assigned with half in an intervention group and half in a control group. Children in the treatment group received regular pediatric care, good nutrition, and stimulation in language, cognition, and emotional self-regulation from infancy through age five. Parents also were trained. In the second phase, through age eight, the focus was on math and reading. The group that received the special early care did better educationally, and by age 30, members of this group were four times more likely than those in the control group to have graduated from college, be employed and have health insurance.

The health findings were a surprise. Men in the treatment group had less hypertension and none had metabolic syndrome, the cluster of conditions that raise the risk of heart disease, diabetes and stroke. One in four of the control group had metabolic syndrome. Women in the treatment group were less likely to be obese, less likely to drink before age 17, and they had healthier habits.

What about the small size of these samples? Heckman says the dramatic disparities between these treatment and control groups actually strengthen results because such differences are unusual in small sample experiments.

In a New York Times article, Heckman wrote that "the economic rate of return from Perry is in the range of 6 percent to 10 percent per year per dollar invested, based on greater productivity, and savings in expenditures on remediation, criminal justice and social dependency. This compares favorably to the estimated 6.9 percent annual rate of return of the U.S. stock market from the end of World War II to the 2008 meltdown." The Abecedarian Project lasted five years and cost $67,000 in 2002 dollars, he said, and produced substantial adult health benefits and cost savings. In Heckman's view: "Early childhood interventions are an unexplored and promising new avenue of health policy."

Tags:  buscell  complexity matters  culture  health 

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Family Photos Hold Clues to Medical Diagnoses

Posted By Prucia Buscell, Thursday, June 26, 2014
Updated: Wednesday, July 2, 2014

Family pictures may record more than milestone events and the little incidents we love to remember. New technology may help doctors identify rare genetic conditions by analyzing ordinary digital photos of faces. Facial recognition software may even be useful in identifying presently unknown rare disorders with symptoms that baffle families and doctors.

A New Scientist story by Andy Coghlan explains that while genetic tests exist for common conditions, such as Down's syndrome, genetic tests for many more unusual conditions aren't available because the gene variants that cause them haven't been discovered. A story in The Independent by Charlie Cooper explains that 30 to 40 percent of genetic disorders involve some kind of change to the face or skull. Software developed at Oxford University by medical researchers collaborating with the university's Department of Engineering Science was initially "trained" by analyzing thousands of photos of people diagnosed with eight genetic disorders. Coughlin's story explains that the computer "learned" to identify each condition from a pattern of 36 features in each face.

Christoffer Nellaker, who designed the software with Oxford colleague Andrew Zisserman, believes it can help family doctors and general pediatricians make preliminary diagnoses of health conditions that may have puzzled them. In the future, Nellaker told The Independent, a doctor anywhere in the world should be able to take an ordinary smartphone picture of a patient, run a computer analysis, and find out which genetic disorder a patient is likely to have. The technology isn't meant to replace traditional diagnoses, but to aid it by giving doctors information not otherwise available to them.

Alastair Kent, director of the Genetic Alliance UK, a charitable organization dedicated to helping people with genetic disorders, told New Scientist that because few physicians are skilled in the diagnostic use of facial analysis, families often wait years to learn the cause of their children's problems. Many of the combinations of facial characteristics that have diagnostic significance would be undetectable to a layman.

The Oxford database now has nearly 3,000 photos, and the software can recognize 90 disorders. As the database grows, the software will enable researchers to study groups of patients with undiagnosed problems who share similar facial features and skull structures. That could allow researchers to identify presently unknown disorders and the explore the gene variants that cause them, which could potentially improvement treatment.

Some visual characteristics associated with genetic disorders are well documented. Scientists studying Abraham Lincoln's height, long arms, and big hands and feet believe he had Marfan syndrome, a genetic disorder that also impacts the connective tissue and heart. NBA prospect Isaiah Austin's dreams of a basketball career were dashed by a diagnosis of Marfan syndrome. Williams syndrome and DiGeorge syndrome, both genetic disorders that impact learning and behavior, have been associated with certain combinations of facial characteristics.

Tags:  buscell  complexity matters  health  research 

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