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A gamechanger for pediatric diabetes

UC Santa Barbara scientists are developing a pediatric artificial pancreas.

UC Santa Barbara chemical engineers Frank Doyle (left) and Eyal Dassau with a model of their artificial pancreas for adults.

By Sonia Fernandez, UC Santa Barbara

Anyone who lives with Type 1 diabetes is all too familiar with the sheer amount of effort — and often round-the-clock attention — required to manage the disease. Food intake is closely monitored, as is physical activity, and the period between meals is carefully tracked in order to calculate appropriate insulin dosages, which have to be delivered at the right time.

All this to keep blood glucose levels within a healthy range.

For parents of children with Type 1 diabetes, the stress is amplified. Children’s unpredictable eating habits and food preferences, spontaneous physical activity and sensitivity to insulin require parents to be extra vigilant. The dreaded overnight hypoglycemia — a condition in which glucose levels drop to dangerously low levels between dinner and breakfast — requires parents to interrupt their own sleep habits so they can check their children’s blood sugar and give the child a snack if needed. Conversely, if the glucose reading is too high, they would need to administer insulin. And those eagerly anticipated birthday parties (complete with cake and ice cream), sleepovers and playdates? Only if the other parents involved can be trusted to monitor the child closely and respond to emergencies.

But with a $1.8-million, three-year grant from the National Institutes of Health, UC Santa Barbara chemical engineers Frank Doyle and Eyal Dassau and Yale University’s Dr. Stuart Weinzimer could make such hands-on care a thing of the past. And it could happen within a decade. The researchers and their teams are embarking on the development of artificial pancreas (AP) for children. The grant is the UC Santa Barbara researchers’ first award for a pediatric closed-loop study.

“I think one of the most important things we can do is alleviate parents’ fears of overnight hypoglycemia,” said Dassau, a research engineer in UC Santa Barbara’s Department of Chemical Engineering and the principal investigator on this study. “As a result, parents can get a full night’s sleep without having to worry what might happen at 4 a.m., or who’s awake to check their child’s glucose. That would be a big success.”

Over the past 12 years, Doyle, director of the Institute for Collaborative Biotechnologies at UC Santa Barbara, and his research group have developed the artificial pancreas, a combination of sensor technology and insulin pump, which, thanks to a control algorithm, reads levels of glucose and injects the appropriate amount of insulin based on the data, and the patient’s individual characteristics.

Thus far, the researchers have made great strides in developing UCSB’s AP for use in adults. In a collaboration with the William Sansum Diabetes Research Center in Santa Barbara, and in local and international clinical trials, the AP’s multinational team of researchers has been refining the device based on input from engineering, clinical and behavioral aspects of diabetes management.

Tailoring the device to manage pediatric diabetes, however, requires the researchers to consider an additional set of factors.

“Children have unpredictable eating habits,” said Dassau. “You can put a certain amount of food in front of them, but you don’t know whether they’re going to eat it all.” Additionally, they may graze throughout the day, and tend to be more spontaneous than adults with their physical activity. Also coming into play are the children’s general lack of awareness about their condition and their limited ability to inform parents and caregivers of any immediate health situations.

The protocols for diabetes management vary by age as well. With adults and teenagers who can predict their meals and mealtimes, insulin can be delivered subcutaneously about 15 minutes before eating to ensure an adequate amount of the hormone has reached the bloodstream by the time they eat. This “pre-meal bolus” is an ideal way to manage meal glucose control, as it allows insulin to be absorbed when the glucose surge arrives with the meal, and mimics as closely as possible the way a healthy individual’s body regulates blood sugar.

However, in younger children with Type 1 diabetes, because of unpredictable eating habits and higher sensitivity to insulin, the hormone must be delivered after the meal, which creates both a delay and the chance of a swing to the hypoglycemic extreme of the blood sugar range, due to the tendency to overcompensate.

According to the researchers, the first phase of research for the pediatric AP involves data collection. With clinical expertise from Weinzimer, a pediatric endocrinologist, professor at Yale School of Medicine and a leading expert on Type 1 diabetes in children, the researchers will tune the AP’s Zone MPC (model predictive control) algorithm to meet the specific challenges of managing pediatric diabetes.

“I would look for the following things in a pediatric version of an AP: safety above all; efficacy; reliability; and ease of use,” said Weinzimer. In addition to protecting against constant wild swings in blood sugar, which would in turn alleviate the high rates of anxiety, depression and burnout in parents, and prevent the additional problem of disrupted psychosocial development in children with Type 1 diabetes, he said. The device itself must perform in a predictable manner and not be overly complicated or burdensome to use.

“One of the things I appreciate most about Drs. Doyle and Dassau is that they are, above all, scientists. They are extremely knowledgeable about control systems for the artificial pancreas, world experts in fact, and they approach this field with scientific rigor and balance,” Weinzimer continued. “We have to be very careful as investigators not to minimize the potential risks and shortcomings in our systems as we test them. We have a moral duty to protect our patients. I firmly believe that these systems will be transformative in diabetes care, but we should not lose our scientific objectivity and skepticism. Frank and Eyal have always struck me as very balanced and circumspect in how they approach this field, and I am looking forward to working with them.”

“We’ve already proved in previous clinical trials that our medically inspired artificial pancreas design can handle unannounced meals and physical activity,” said Dassau, adding that bringing this design to the younger population of Type I diabetes patients would ease the burden on parents who worry about the extra cookie or surprise sugary treat. “We’ve already developed safety algorithms for hypo- and hyperglycemia that can be adjusted for young children.”

Because insulin requirements change as the child gets older, the algorithm will be adjusted and refined according to different age groups, the researchers noted.

The second phase of the project involves developing and in-clinic testing of an advisory system and an alert system for parents that both provides insight on strategies for the management of their children’s conditions in general, and informs them of impending hypo- or hyperglycemia.

At every phase, the researchers will conduct repeated evaluations and refinements to the algorithm as well as to the alert and advisory systems. The goal is to give parents and children the ability to be involved in the management of diabetes to the extent that they can be, while safeguarding against extremes when unexpected circumstances arise. Snacking, unscheduled naps, spur-of-the-moment activities or missed meals will no longer result in increased stress levels for both parents and children.

According to Doyle, who holds the Mellichamp Chair in Process Control at UC Santa Barbara, when his group started work on the artificial pancreas over a decade ago, the researchers found that subjects using the conventional multiple daily injection method of controlling blood sugar were able to keep their glucose level in a safe range for only slightly over 50 percent of the time.

“In our most recent trials, we have demonstrated that our algorithms can keep subjects in a safe range for 80 percent or more of the time,” he said. The UC Santa Barbara AP’s Health Monitoring System sends user alerts in the form of messages and audible signals when problems arise, such as blood sugars that are trending low. Additionally, Doyle’s AP researchers have two other active grants funding research to examine how the device can monitor its own operations and alert users to potential malfunctions.

In future studies, pediatric AP testing will move to an outpatient component, in which subjects are given free rein over what they eat and do, but at locations near the clinic, with supervision from technical staff.

“But the home is where we want to get,” said Doyle, “with the normal routine, with no interference or intrusion. The true end-game is at home.”

Research for the development of this artificial pancreas is supported by the National Institutes of Health, award number DP3DK104057.

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UC plans to require vaccinations for incoming students

The plan is being phased in over three years.

Credit: iStock

By Alec Rosenberg

The University of California will require incoming students to be screened for tuberculosis and vaccinated for measles, mumps, rubella, chicken pox, meningococcus, tetanus and whooping cough, under a plan set to take effect in 2017.

Currently, the UC system only requires students to be vaccinated against hepatitis B, though several campuses have additional requirements.

The plan — designed to help protect the health of students and campus communities — has been in the works for a year. But the need is more pressing than ever, given the current multistate measles outbreak and the re-emergence of other vaccine-preventable diseases among those not completely immunized.

“I’m really excited that there’s support and momentum for this new immunization plan,” said Dr. Gina Fleming, medical director for the UC Student Health Insurance Plan. “We know that these preventive measures are effective.”

Three-year phase-in

The plan is being phased in over three years. The first phase focuses on building awareness among students about the upcoming requirement, with all fall 2015 incoming UC students receiving notification of the recommended vaccines and the process for making them mandatory. The intent of the plan is to set a baseline for all of UC, but does not prevent individual campuses from setting immunization standards for all students, or implementing the plan more rapidly.

It was developed based on recommendations from the California Department of Public Health, and in consultation with UC’s student health center directors, vice chancellors for student affairs and the UC system senior vice president for health sciences and services.

It will require that by 2017 all incoming students show documentation not only for hepatitis B vaccination but also for TB screening and four more vaccines: measles, mumps and rubella; meningococcus; varicella (chicken pox); and tetanus, diphtheria and pertussis (whooping cough).

“The University of California is committed to protecting the health and well-being of our students,” said Mary Knudtson, executive director of the UC Santa Cruz Student Health Center and chair of the UC Immunization Policy Committee. “Therefore, all of the UC campuses are implementing procedures to ensure that students are educated about, and receive, vaccinations to prevent potentially dangerous illnesses and undergo screening to identify those who may have infectious tuberculosis.”

Starting in fall 2016, all incoming UC students will be expected to have their required vaccines and enter the data into the university’s electronic medical record platform. But the plan is not to enforce the requirement until the following year. Starting in fall 2017, UC students who do not meet the vaccination requirement will have a hold put on their registration. The rationale for the phased approach is to ensure that the process runs smoothly before potentially impacting students’ ability to register for classes.

All UC campuses have experienced cases of vaccine-preventable diseases in recent years — something not unique among college campuses, which have varying vaccination requirements. For example, only about half of states have laws requiring all college students to be vaccinated against measles, according to a U.S. Centers for Disease Control and Prevention database.

“Despite the fact that many people receive the recommended vaccines, there are still documented cases of outbreaks of vaccine-preventable diseases in California and on the campuses each year amongst those who were not properly immunized,” Knudtson said. “All students are strongly encouraged to obtain the vaccines recommended by the California Department of Public Health prior to starting classes.”

Breaking down barriers

While getting such vaccines has long been considered a good public health practice, the cost of vaccines and the difficulty for student health staff to obtain and verify the information have been barriers to implementation.

Two developments have broken down those barriers, Fleming said. Now that the Affordable Care Act provides insurance coverage for vaccines, the cost of vaccination is less of a problem. Also, a new electronic medical record platform soon will allow UC students to directly enter their vaccination date. Four campuses will be piloting the module for entering vaccination data this fall, and the remaining campuses anticipate being able to use it by fall 2016.

The issue of immunization has evolved into a hot topic of discussion in California and across the nation in recent weeks after a measles outbreak that started at Disneyland. On Wednesday, state Senators Richard Pan and Ben Allen announced they will introduce legislation that would eliminate the ability for parents of school children to opt out of vaccinating their kids based on a personal belief.

UC’s plan will allow exemptions for medical or religious purposes, Fleming said. In the coming months, officials will discuss how to handle requests for other exemptions and how to validate the vaccination information.

“We need to be mindful of the population we’re serving,” Fleming said.

UC’s plan might be extended to already enrolled students and additional vaccines could be added later, such as meningococcus B, Fleming said. Vaccines recommended for preventive care include vaccines for hepatitis A, HPV, influenza, polio and pneumococcal pneumonia.

Officials are determining whether additional approvals are needed to adopt the plan, Fleming said, even as they move forward with implementation.

Meanwhile, leadership in student affairs and student health centers are working with other campus departments to inform students about the plan.

“That’s really a critical piece,” Fleming said. “We can’t expect students to adhere to a requirement that they haven’t heard about. They need to know what the plan is.”

Related link:
Associated Press: Los Alamos National Lab creates website for measles fight

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Restoring touch to amputees

DARPA taps Livermore Lab to enable naturalistic feeling, movements in prosthetic hands.

Lawrence Livermore National Laboratory engineer Sat Pannu and his Neural Tech Group research team are developing wireless electronic packages for HAPTIX called smart packages. These packages would contain electronics that record and stimulate the peripheral nervous system to control movement and sensation in a patient’s prosthetic hand. (Photo by Julie Russell, Lawrence Livermore National Laboratory)

By Kenneth Ma, Lawrence Livermore National Laboratory

The Defense Advanced Research Projects Agency (DARPA) recently selected Lawrence Livermore National Laboratory (LLNL) to join a collaborative research team that intends to build the world’s first neural system to enable naturalistic feeling and movements in prosthetic hands.

Known as Hand Proprioception and Touch Interfaces (HAPTIX), the program seeks to provide wounded service members with dexterous control over advanced prosthetic devices that substitute for amputated hands. If successful, HAPTIX intends to give patients the psychological benefit of having natural sensation in their prosthetic hands and reduction of “phantom limb” pain, a sensation some amputees can feel despite the removal of a limb.

Lawrence Livermore’s Neural Tech Group and their collaborators (Case Western Reserve University and the Louis Stokes Cleveland Veterans Administration Medical Center) intend to develop neural interface systems that measure and decode motor signals recorded in peripheral nerves and muscles in the forearm by using tiny electrodes.

“The HAPTIX project intends to achieve a phenomenal breakthrough in prosthetics never thought possible,” LLNL’s project leader Sat Pannu said. “Its neural system intends to re-create a range of functions, including a real feeling of touch when holding another person’s hand.”

For these neural interface systems, LLNL intends to further develop the advanced prosthetic limb systems developed under DARPA’s Revolutionizing Prosthetics and Reliable Neural-Interface Technology (RE-NET) programs, which has made major steps forward in providing a direct and powerful link between user intent and prosthesis control.

The HAPTIX program intends to incorporate sensors that provide tactile and proprioceptive feedback to the patient from their hands, delivered through a patterned stimulation of sensory pathways in peripheral nerves.

The Revolutionizing Prosthetics and RE-NET programs, combined with the neural interface systems, intends to allow users to control prosthetic hand movements with their thoughts and have natural sensations. That means the bionic hand would be able to perform movements of a human hand and experience pressure, touch and texture.

One of HAPTIX’s key challenges is identifying stimulation patterning strategies that elicit naturalistic sensations of touch and movement. The ultimate goal is to create a fully implantable device that is safe, reliable, effective and approved for human use.

Pannu and his team of engineers are developing wireless electronic packages for HAPTIX called smart packages. These packages would contain electronics that record and stimulate the peripheral nervous system to control movement and sensation in a patient’s prosthetic hand.

Smart packages intend to be designed to miniaturize electronics normally the size of a third of a cell phone into a package the size of a watch battery. The electronics would be made of ceramics and titanium, biocompatible materials that would seal the package tightly, preventing components from leaking into nerves or human tissue from entering the package.

“The packages have to be really small, so they don’t put any weight or pressure on the nerves,” said Pannu, adding that the smart packages need to bond with the electrodes to function. “We don’t want to damage the nerves.”

The Neural Tech Group also is collaborating with Medtronic and Ardiem Medical. Some collaborators plan to develop the electrode arrays for sensation and muscle control, while others aim to validate and characterize it.

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UCSF Medical Center at Mission Bay opens

Large-scale transport completed with support of city of San Francisco agencies.

More than 130 patients were carefully transported from Parnassus and Mount Zion campuses to the new UCSF Medical Center at Mission Bay on Feb. 1. (Photo by Noah Berger)

>>Related: UCSF Medical Center at Parnassus and Mount Zion to expand care

>>Related: President Bill Clinton tours new UCSF hospitals

By Karin Rush-Monroe, UC San Francisco

With 40 ambulances, approximately 300 UCSF staff and faculty, as well as 100 emergency medical services personnel, UCSF Medical Center on Sunday, Feb. 1,  safely transported 131 patients to the new UCSF Medical Center at Mission Bay from its Parnassus and Mount Zion campuses.

The move day started at 7 a.m. on the UCSF Parnassus campus; later in the day patients also were transported from the UCSF Mount Zion campus. The last patient to be moved arrived at UCSF Medical Center at Mission Bay at 3:33 p.m. The new medical center also greeted the first baby born at the new hospitals, a healthy boy who entered the world at a little more than seven pounds.

The opening of the new hospitals was the culmination of more than 10 years of planning and construction of the complex, which includes UCSF Benioff Children’s Hospital San Francisco, UCSF Betty Irene Moore Women’s Hospital, UCSF Bakar Cancer Hospital and the UCSF Ron Conway Family Gateway Medical Building.

The move day, itself, reflected significant planning. “Patient safety was our top priority during the patient move, along with minimizing disruption to our neighbors. We achieved both goals, thanks to the superb work of our medical center faculty and staff as well as our partners in the City of San Francisco,” said Mark R. Laret, CEO of UCSF Medical Center and UCSF Benioff Children’s Hospitals. “We have been looking forward to this day for some time, and the opportunity to start providing care in our new location at UCSF Mission Bay.”

The majority of patients who made the trip on Sunday were children, as UCSF Benioff Children’s Hospital San Francisco moved from Parnassus to its new home at UCSF Mission Bay.

Strategically located on UCSF’s world renowned UCSF Mission Bay biomedical research campus, the new medical center puts UCSF physicians in close proximity to UCSF researchers and nearby biotechnology and pharmaceutical companies in Mission Bay and beyond who are working to understand and treat diseases ranging from cancer to cardiovascular disease to neurological conditions.

“Placing the hospitals on our Mission Bay campus underscores our commitment to driving discoveries toward patient care, ensuring that our world-class researchers are working in close proximity to our leading clinical researchers and physicians in the hospitals,“ said Sam Hawgood, M.B.B.S., chancellor of UC San Francisco.  “They also will provide invaluable training for our medical students, the next generation of clinicians who will take care of patients at health care facilities across California and nationally.

“Significantly, the move also frees up space on our Parnassus and Mount Zion campuses, which will allow us to enrich our medical programs for adult patients there. With the opening of the hospitals at Mission Bay, we now have integrated clinical care and research programs on all of our campuses, the critical factor that has contributed to UCSF’s local, regional and global impact.”

The UCSF Parnassus campus will be restructured to provide more specialized clinical services, such as transplants, and the UCSF Mount Zion campus will become a world-class hub for outpatient care.

“UCSF Medical Center’s new $1.5 billion, state-of-the-art campus in our city’s Mission Bay neighborhood will help improve the health of children, women and cancer patients,” said San Francisco Mayor Ed Lee. “This is not just a milestone for UCSF; this is a milestone for our city and our city’s health care industry, which is at the heart of our economy providing good jobs for our residents.

“Right before our eyes, we have seen the transformation of this underutilized railyard in Mission Bay into an epicenter where new discoveries and innovation in medicine are saving lives around the world. By working together with our great partner UCSF, and the many generous philanthropists that helped build these new hospitals, we will continue to ensure our residents get the highest quality of health care.”

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UC Food Observer blog launches

Learn more in Q&A with blog curator Rose Hayden-Smith.

Credit: Classic Film / CC BY 2.0

The University of California has launched UC Food Observer, a daily selection of must-read news on food policy, nutrition, agriculture and more.

Developed as part of its Global Food Initiative, the UC Food Observer blog (www.ucfoodobserver.com) and related social media channels capture and highlight important news and further discussions about the world of food.

Find out more in this Q&A with UC Food Observer curator Rose Hayden-Smith, a UC academic, author and historian.

Rose Hayden-Smith

What can readers expect from UC Food Observer?
UC Food Observer offers a daily roundup of interesting news, reports and thought pieces from a broad range of sources that represent diverse perspectives. The intent is not to focus on UC, but instead allow UC to reflect and perhaps add to the very important discussions that are occurring. Pieces will be posted throughout the day on the UC Food Observer website and social media. The goal is to achieve a balance of perspectives and topics in the lineup. If it might help the reader, larger context may be provided, through background information or additional links in a posting. There also will be an original long-form piece a couple of times each month by me and guest commentators. And UC Food Observer will be engaging actively with people across social media. The hope is to add value to the conversation and to provide a service.

What’s the inspiration for the blog?
The idea originated with our colleague, Pete King. With interest in food and agriculture at an all-time high, it seemed like there might be space for something like this: a knowledgeable, curated selection of what’s important and interesting in the dialogue around food. There’s an incredible amount of good information on any number of topics relating to food and agriculture. There are big ideas out there, and great conversations occurring. If UC Food Observer can help share some of that information, highlight key themes and connect people, it will be a good thing. The more we all know, the better.

Why is the blog needed?
To have a neutral voice pulling together the most important and interesting parts of the conversation around food gives both food insiders and the general public another source of information that hopefully will reflect the constantly evolving food landscape. We hope that the blog will add value to the myriad conversations occurring; not only by including and sharing the terrific work that’s being produced by others, but also by providing some unique, original content. We also hope that the blog may engage audiences who have not previously been as engaged in food systems work. Everyone eats. Everyone is a stakeholder in the food system.

How do you decide what to include in the blog?
It’s a process of continually scanning the environment, talking to people and organizing a well-balanced “menu” of content each day. The team has a calendar of key gatherings that one of us either attends or “watches” via social media. The content will reflect diverse interests and follow many threads of discussion. A part of the decision-making lies in thinking about what might inform and inspire others.

Included is breaking news and information that’s less time-sensitive — for example, perhaps the release of a significant report. A daily lineup generally will include news, information about events and some lighter pieces such as book reviews. We’ll share different things on each platform, so the articles shared on Facebook may differ from the articles included in the blog. Content is organized around a couple of dozen categories ranging from local events to issues of global importance. Featuring UC news is not a primary goal; institutional news finds its way into the lineup on its own merit.

The original pieces will vary, but readers can certainly expect some to include a historical perspective and how the lessons of the past might apply to contemporary issues.

You’re an author, historian and garden educator. How will that inform your curation for UC Food Observer?
I have an unusual professional background. I consider myself a “consilient” thinker (i.e., literally the “jumping together of knowledge” from various disciplines, as explained by British polymath William Whewell). I’ve worked as both a technical and more creative writer. I’ve worked in the technology industry, been an educator, a youth development professional in 4-H, a Master Gardener advisor, done some advocacy work as a W.K. Kellogg Foundation Fellow and served as leader for UC Agriculture and Natural Resources’ strategic initiative in sustainable food systems.

My training as a U.S. historian always gives me pause to consider context and to examine how current practices might be influenced by the past. I’ve curated exhibits and online content as a historian. You make decisions about content, and hopefully they are inclusive, representative and honor various perspectives. I am always eager to understand how we got here. I consider my work as a historian a scientific enterprise: I study the rate, nature and character of change over time.

My personal experience as a school and community garden educator has shaped my thinking in profound ways. I think I bridge social and cultural understandings of food systems with more technical aspects and systems thinking. Things are inextricably linked in a food system — it truly is a web — and I like to think about issues from the hands-on, local level to the broadest implications of that work (often global).

As a UC academic and alum, what led to your interest in this position?
This position combines all the things that I am most passionate about in a single enterprise. I love the opportunity to learn about new things in the food system every day, and being able to cover a broad intellectual and cultural landscape is appealing. I’m a communicator by nature: writing, interacting and connecting with others are all fundamental aspects of who I am. I think the topic of food is incredibly interesting, nuanced, varied and rich … and I think understanding food systems is vital to nearly every challenge we face in the world.

I’m thrilled that UC is engaging in this work. UC has influenced my life in amazing ways … and that experience of influence and learning is still unfolding. I participated in the 4-H program as a youth, was in-residence at UC for summer programs during high school, and attended UC as an undergraduate and graduate student (the last one: three times). Over the course of my career, I have worked in campus-based academic departments, campus extension, the Cooperative Extension service and in student affairs. I am amazed each day — anew — by how the UC system influences our day-to-day lives in the most positive of ways locally and in a more global sense. I reflected a little about all of this in a California Agriculture article I wrote on the 150th anniversary of the Morrill Land Grant Act. It’s a wonderful opportunity — and a privilege — to be part of UC’s work in this critical area.

If you could change one thing in the food system, what would it be?
That’s a difficult question. So many changes are needed. In my book, which was published last year, I identify 10 steps that I think people could take to effect change; many relate to gardening, which is a passion of mine. There’s been a great deal of discussion recently about an op-ed written by Mark Bittman, Michael Pollan, Ricardo Salvador and Olivier De Schutter. It appeared in the Washington Post and called for a national food policy. It’s a bold idea … and a necessary one.

I encourage what I term a “fundamental restructuring of agricultural and food policies.” What we have currently is a hodge-podge of regulations and policies that are often in contradiction with one another and that don’t always serve us (people and the environment) well. We need a more coherent national policy that considers all aspects of the food system. Our national policy impacts the global food system.

I remain extremely concerned about childhood nutrition and food access. As a nation, we’ve struggled with this for decades. Childhood nutrition and food access are among the great moral issues of our time – they need to be addressed and resolved.

At the outset of WWII, Vice President Henry Wallace told the nation, “On a foundation of good food we can build anything. Without it we can build nothing.”

I know Wallace has a mixed legacy, but this statement strikes me as both a profound truth and a goal we ought to aspire to.

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Tackling brain injuries head on

UC Davis scientists developing system to better assess on-field concussions.

For much of this fall, as in falls past, a Friday night crowd comes out for the weekly football game and likely witnesses the star running back getting rattled by a hard tackle.

The coach faces a decision: keep the player in the game and risk serious head injury or pull him and face the wrath of the player, the team and the crowd. What the coach needs is a way to accurately assess the player’s status – right now.

This scenario is being played out at sports fields around the world. How do we make objective decisions about a player’s health in the heat of competition?

The problem intrigues UC Davis physician Khizer Khaderi. A neuro-ophthalmologist, Khaderi is applying his expertise in the eye-brain connection to investigate traumatic brain injury (TBI). Whether the result of a car accident, explosion, skiing or a tackle, TBI can affect vision, memory and even mental health.

Imperfect solutions

Khaderi and colleagues are developing a system that will take the guesswork out of assessing an on-field concussion, an early form of TBI.

It would replace a system of neurocognitive tests that many teams use now. In these tests, a player is asked a number of questions, of which answers are compared to baseline results recorded earlier. However, with players’ strong incentive to stay in the game, some have learned to circumvent the system.

“One of the problems with the neurocognitive approach is that it’s very subjective,” says Khaderi, an assistant professor of clinical ophthalmology and head of the Sports Vision Lab. “Players will intentionally do poorly on the baseline test, so if they do get injured, it won’t look as severe.”

Khaderi’s solution focuses on the eyes. A third of the brain is devoted to the visual system, making the eyes an ideal window on brain health. Several biometric tests exist but Khaderi’s team has found that relying on three established biometric tests greatly increases the chances of accurately assessing TBI risk on the field in real time.

UC Davis neuro-ophthalmologist Khizer Khaderi tests a system he and his team developed to facilitate a quick assessment of an on-field concussion, an early form of traumatic brain injury. Helping with the test is medical resident Rachel Simpson.

Eyes, pupils and brain waves

Using eye movements to assess TBI has advantages. For example, researchers have measured how long the eye takes to move from a central to peripheral focus. This would be the motion a driver would make when shifting attention from the road to a child crossing it. This motion takes less than seven-tenths of a second for a healthy person, but much longer for those who’ve experienced a brain injury.

The opposite motion is also informative. In the same scenario, the driver could make the decision to look away from the child stepping into the road.

“The natural reaction is to look at the child,” says Khaderi, “but instead you look away. This involves cognition, so it’s a good measure of executive function.”

Pupil function can also measure an injury’s severity. A coach could use a flashlight to assess dilation, but background light can skew results. To combat this, Khaderi has adopted a psychological method called the International Affective Picture System, which uses pictures to make the pupil respond.

The third metric measures brain waves. When they’re awake, people generally have a higher ratio of fast alpha waves to slow theta waves. However, that ratio is reversed after a brain injury. High theta waves indicate a dreamy state of mind.

Moving forward

Khaderi plans to bring these tools to playing fields everywhere. Fortunately, much of this technology is being used for other purposes and can be repurposed for TBI detection.

“Our goal is to create a platform that integrates commercially available eye tracking hardware and EEG (brain wave) systems,” says Khaderi.

The group has found a development partner and is working with the UC Davis athletic department to set up clinical trials. The ultimate goal is to create a system that could be accessed through a tablet computer or other device.

“These injuries don’t just strike kids who are playing sports, but anyone who leads an active life,” says Khaderi. “Our brains are precious and we need to do all we can to protect them.”

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Related link:
UC Davis Medicine magazine

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Act of courage: Life after the ‘die-in’

UCSF med students sparked a national movement with #whitecoats4blacklives; what’s next?

UC San Francisco professional students led a national movement via social media that examined how racial disparities impact health care. (Photo by Leland Kim, UC San Francisco)

By Leland Kim and Laura Kurtzman, UC San Francisco

A group of UCSF medical students gathered in a closed meeting last month to talk about race, racism and racial disparities.

They were troubled by recent grand jury decisions not to indict white police officers who were involved in the deaths of two unarmed African American men, Michael Brown in Ferguson, Mo., and Eric Garner in New York City, and wanted to channel their frustration into something constructive.

The students, including many from the UCSF Underrepresented In Medicine (UIM) mentoring program, decided to hold a “die-in” at UCSF while wearing their white coats, symbolic of those in the health profession. They and their peers of all ethnic backgrounds tapped into student networks across the country.

In just five days, a national movement called #whitecoats4blacklives was born.

It catalyzed thousands of students, faculty and staff in more than 80 colleges across the country. At UCSF, students from all professional schools (dentistry, medicine, nursing and pharmacy) and the Graduate Division participated, as well as some faculty and staff members.

The hashtag dominated social media on Dec. 10, garnering widespread media attention and sparking a much-needed national conversation about racism being more than a just criminal justice issue.

Organizers of the student #whitecoats4blacklives die-in were invited to participate in the School of Medicine leadership retreat to share their experiences. (From left) Frederick Jamison, Angela Broad, Faby Molina, Adali Martinez, Donald Richards, Stephen Villa, Sidra Bonner and Nicolás Barceló. (Photo by Elisabeth Fall)

“As students, we were able to use the momentum from the #whitecoats4blacklives movement to demonstrate the urgency of dealing with the issues of race, micro-aggressions and inequality that affects UCSF faculty, staff, students and most importantly the patients we all serve,” said student organizer Sidra Bonner, a second-year student in the School of Medicine. “It is my hope that this movement leads to improvement of the social medicine curriculum, specifically continued learning and skill development around this issue of bias, creation of a robust mentorship/advising system for all students, as well as commitment to strengthening the pipeline for underrepresented students in medicine by increased availability of scholarships and administrative support.”

A priority for the university

The die-in had a ripple effect across UCSF.

A student-initiated town hall held two days after attracted faculty members, deans and many of the University’s top leaders, who talked openly with students about the UCSF’s ongoing challenge with diversity.

Chancellor Sam Hawgood, M.B.B.S., has made race and racial inequities a priority in his administration.

“This is an issue that goes beyond any one school or department; this is a campus issue,” he said. “Diversity is going to be an important priority for the entire UCSF community. I thank our students for initiating this conversation.”

And organizers of the School of Medicine’s annual leadership retreat this month decided to change the event’s agenda to discuss the enduring question of race in America – and how racial dynamics play out at UCSF.

“Our students are asking us to acknowledge, to think and to do something about the problem of racial and ethnic injustices,” said Bruce Wintroub, M.D., interim dean of the School of Medicine, introducing a daylong colloquy that was rich in both data and personal stories about what it means to be black and brown in America.

“It is very easy to talk about racial disparities at other places,” he said. “It is much harder for us to take an honest look at the problems we have at UCSF.”

Groundbreaking discussion of race

The leadership retreat, which took place on Jan. 8 and 9, was the first one ever to focus solely on race/ethnicity and health disparities. It came as the School of Medicine has launched a six-year, $9.6 million effort to hold its departments accountable for achieving diversity, provide the resources to recruit and retain a more diverse faculty, create a culture of diversity and inclusion and expand the pool of scientific talent, which gets smaller at each level of training.

“This retreat was the first time in my 32 years at UCSF that I feel we have started to have an authentic conversation about race and the impact of racism and unconscious bias on our students, faculty and patients,” said Renee Navarro, M.D., Pharm.D., vice chancellor of diversity and outreach. “I applaud the students who organized and implemented the #whitecoats4blacklives movement. They were the spark that led to this event.”

Some of those students were invited to participate in the leadership retreat and share their experiences with the group to help facilitate organizational change.

At times, nervous energy was palpable as students recalled instances of racism on campus. Some community members, participants noted, have accused UCSF being an “elitist ivory tower.”

White faculty members listened attentively, and some were candid enough to admit that they hadn’t really thought about racism and its impact on students and patients in a meaningful way.

“Being on the panel and speaking to an audience of accomplished and powerful people at UCSF were terrifying,” said Angela Broad, a second-year medical student. “It was really difficult sharing those experiences but the informal conversations I had throughout the day were very heartening. So many faculty, deans and staff thanked me for sharing my story.”

Compelling presentations and anecdotes by faculty of color helped shape the day’s conversation.

Neal Powe, M.D., M.P.H., M.B.A., vice chair of the Department of Medicine and chief of medical services at San Francisco General Hospital and Trauma Center, shared a story about being pulled over by the police in North Carolina while in town to give a lecture. A police officer suspiciously questioned Powe about his destination, instructed him to keep his hands on the steering wheel and asked him if he had drugs in the car.

Guest speaker Denise Rodgers, M.D., focused on the impact of race and racism on health and health care in her talk, helping the audience to understand how a climate of violence affects their patients and their health.

“When we teach about homicide, do we reinforce the stereotype of violent, lawless black men who should be feared and for whom there is little hope for change?” asked Rodgers, vice chancellor of Rutgers Biomedical and Health Sciences. “When we teach about homicide, do we talk about poverty, unemployment, poorly-performing schools, inadequate access to social and mental health services as contributors to the homicide rates we see?”

Nurturing a pipeline of UCSF talent

This year, one-third of first-year medical students are underserved minorities (black, Latino, Native American or Pacific Islander), the highest percentage of any medical school in California.

Despite having one of the most diverse student populations in the nation, a recent survey found that nearly one-third of students who are black, Latino and Native American reported feeling shunned or ignored or having experienced behavior they found intimidating, offensive or hostile, and 21 percent said it interfered with their ability to learn. That was double the percentage reported by whites and a third higher than reported by Asians.

Talmadge King, M.D., chair of the Department of Medicine, said the medical school is doing well at recruiting students, but many are not staying for their residency training.

Retention drops more at the fellowship training level and then essentially stops at the faculty level. Similar statistics also apply to the other professional schools and the Graduate Division.

King believes the best long-term strategy is for UCSF to build its own pipeline of talent, beginning with middle and high school, so students learn to love science and have an association to UCSF. “Places that have really focused on that are beginning to have success,” he said. ”It takes a long time, but it actually works.”

Turning words into action

UCSF leadership will review and evaluate ideas that were generated by the retreat participants and determine the priorities and tactics to move them forward. This effort is aligned with the campus obligation to the University of California Office of the President to identify initiatives in the UC-wide Climate Survey. Those initiatives will include one that is focused on establishing a “climate of inclusion.”

Meanwhile, the students who organized the #whitecoats4blacklives event have formalized the creation of the national White Coats for Black Lives organization that was born out of the movement. They are connected with 83 representatives of various medical schools throughout the country and are in the process of creating a national board for their student organization.

They will also be actively involved in working with faculty and leadership to achieve the goals identified during the leadership retreat.

“I have never felt so inspired by UCSF – what it is and what it can be,” said student organizer Nicolás Barceló, a fourth-year medical student who attended the retreat. “My decision to attend UCSF was motivated by the belief that its capacity to effectively address the social determinants of health, it stands alone. No other institution can bring together the resources, talent and dedication to social justice that you see at UCSF. No one.”

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Songbirds may help build a better hearing aid

Avian ability to pinpoint ‘signal’ sounds inspires algorithm at heart of new auditory device.

Zebra finches and other songbirds can distinguish a mate's song amid a cacaphony of sounds. That ability is helping researchers develop a better hearing aid for humans. (Credit: iStock)

By Kate Rix, UC Newsroom

Untreated hearing loss can have devastating and alienating repercussions on a person’s life: isolation, depression, sapped cognition, even dementia.

Yet only 1 in 5 Americans who could benefit from a hearing aid actually wears one. Some don’t seek help because their loss has been so gradual that they do not feel impaired. Others cannot afford the device. Many own hearing aids but leave them in a drawer. Wearing them is just too unpleasant.

“In a crowded place, it can be very difficult to follow a conversation even if you don’t have hearing deficits,” says UC Berkeley neuroscientist Frederic Theunissen. “That situation can be terrible for a person wearing a hearing aid, which amplifies everything.”

Imagine the chaotic din in which everything is equally amplified: your friend’s voice, the loud people a few tables over and the baby crying across the room.

In that scenario, the friend’s voice is the signal or sound that the listener is trying to hear. Tuning in to signal sounds, even with background noise, is something that healthy human brains and ears do remarkably well. The question for Theunissen — a professor who focuses on auditory perception — was how to make a hearing aid that processes sound the way the brain does.

“We were inspired by the biology of hearing,” Theunissen said. “How does the brain do it?”

Songbirds excel at listening in crowded, noisy environments

Humans aren’t the only ones able to hone in on specific sounds in noisy environments. For the past two years, Theunissen and the graduate students in his lab have studied songbirds, which are especially adept at listening in crowded, noisy environments.

By looking at songbird brain imagery, the researchers now understand how chatty, social animals distinguish the chirp of a mate from the din of dozens of other birds.

They were able to identify the exact neurons that tune into a signal and remain tuned there no matter how noisy the environment becomes. These neurons shine what Theunissen calls an “auditory spotlight” by focusing in on certain features or “edges” of a sound. Imagine you are looking for your cellphone on a table covered with objects. In the same way that your eye can find for a specific rectangular shape and color, your ear searches for and finds certain pitches and frequencies: the sound of a friend’s voice in a restaurant.

“Our brain does all this work, suppressing echoes and background noise, conducting auditory scene analysis,” Theunissen says.

A Proof of Concept Commercialization Gap grant from UC Research Initiatives in the Office of the President provided the critical funding the lab needed to take the discovery one giant step farther.

Algorithm replicates ‘auditory spotlight’

The neurological “auditory spotlight” process has been reproduced in the form of an algorithm. Theunissen’s team is working with Starkey Hearing Technologies, an international firm with a research office in Berkeley. Together, they are testing the algorithm’s potential benefits for hearing-impaired subjects if loaded into hearing aids.

This next generation of hearing aids will detect the features of the signal and separate it from any background noise. Unlike a traditional hearing aid, it will have a variable gain so that signal sounds get a boost without distortion, while background sounds are attenuated without being completely muffled out.

“This hearing aid should not eliminate all of the noise or distort the signal,” Theunissen says. “That wouldn’t sound real, and the real sound is the most pleasant and the one that we want to hear.”

The funding from UC Research Initiatives — $100,000 for one year — moved Theunissen’s research from his lab and closer to the marketplace. The hearing aid algorithm is the first potential commercial application of his lab’s work.

“We are a lab doing basic science,” he says. “There is a purist pleasure in solving problems, but also an excitement that there are real problems to be solved.”

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UC president starts $10M research awards initiative

First recipients selected.

University of California President Janet Napolitano today (Dec. 10) announced the first recipients of the President’s Research Catalyst Awards, chosen from a pool of almost 200 proposals. The projects involve multicampus, multidisciplinary efforts, incorporating research, teaching and learning for undergraduate and graduate students. The awards are designed to stimulate UC research in areas that could benefit California and the world.

The President’s Research Catalyst Awards will channel $10 million over three years to fund research in areas of strategic importance, such as sustainability and climate, food and nutrition, equity and social justice, education innovation, and health care.

“The President’s Research Catalyst Awards will spur UC research and offer our faculty and students new opportunities for cross-campus, multidisciplinary collaboration,” Napolitano said. “We want to support research endeavors that have real-world impact in areas with critical needs.”

The President’s Research Catalyst Awards will strengthen UC’s research enterprise by promoting projects that take advantage of the shared facilities, expertise and economies of scale available through UC’s 10 campuses and five medical centers. Faculty will benefit from expanded research support, and students will have access to additional training opportunities.

Recipients were chosen through the highly selective Multicampus Research Programs and Initiatives grants process. The award recipients are:

  • Understanding how California ecosystems will be affected by climate change, led by Barry Sinervo, UC Santa Cruz ($1.9 million). UC is home to the world’s largest system of university-administered natural reserves, offering an opportunity to model how climate change will affect California ecosystems. UC’s nine undergraduate campuses will study the ecological effects of climate change, involving both graduate students and citizen scientists.
  • Helping California address the prison health care crisis, led by Brie Williams, UC San Francisco ($300,000). California, with the nation’s largest prison population, faces serious challenges in providing adequate health care to inmates, who often suffer from mental illness, addiction and other chronic diseases. The UC Consortium on Criminal Justice Healthcare will bring together experts in medicine, psychology, law, sociology, economics and public policy to develop cost-effective solutions that can also serve as a national model.
  • Advancing physics, materials science and computing through quantum emulation, led by David Weld, UC Santa Barbara ($300,000). Quantum emulation uses small collections of ultra-cold atoms, ions and molecules to understand the physical properties of the smallest matter in the universe. Through the California Institute for Quantum Emulation, UC will mobilize the theoretical and experimental expertise of early-career faculty at five campuses, enhancing California’s position as a technological leader and advancing research vital to the development of novel materials.
  • Tapping big data to inform questions of health, poverty and social justice, led by Sean Young, UCLA ($300,000). Social media offers a rich trove of data about human behavior, beliefs and actions. Experts in computer, social and health sciences from four UC campuses will study how to use this information to address public health issues, poverty and inequality.
  • Using music to better understand the human brain, led by Scott Makeig, UC San Diego ($300,000). The UC Music Experience Research Community Initiative brings together UC experts on music listening, performance, neuroscience, brain imaging and data science to understand the transformative potential of music for health and cognition.

UC faculty will be invited to apply for the next round of the President’s Research Catalyst Awards funding, with an RFP process beginning later this winter. More details will be posted here.

The awards will be funded through an existing president’s fund used to support systemwide initiatives.

Media contact:
University of California Office of the President
(510) 987-9200

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Making an ‘IMPACT’ on childhood obesity

UC San Diego, San Diego Unified School District partner to get kids active.

UC San Diego student-athlete Kyra Scott shares the pull-up bar with a student from Toler Elementary. (Photo by Erika Johnson, UC San Diego)

By Jade Griffin and Gabriella Clark, UC San Diego

“I like to get out here and sweat,” said Dalton, an elementary student at Toler Elementary, as he began a series of stretches and exercises led by UC San Diego student-athletes volunteering their time at his elementary school in Clairemont.

Dalton and his classmates are benefiting from a program called IMPACT (Increasing Movement and Physical Activity in Class Time), which is designed to keep local elementary students moving despite the lack of recess and physical education classes in some schools, particularly in underserved areas of San Diego.

IMPACT was established by the San Diego Unified School District in partnership with UC San Diego Athletics and the UC San Diego School of Medicine Center for Community Health to promote healthy activity and battle the growing national epidemic of obesity among children. According to the Centers for Disease Control and Prevention, in 2012, more than one third of children and adolescents in the U.S. were overweight or obese.

Each week as part of IMPACT, UC San Diego student-athletes set up a series of circuits, including jump ropes, hula-hoops, monkey bars, stretching and more. The student-athletes assist and cheer on the students as they rotate through the stations for approximately 20 minutes. Each of the activities are designed to be fun for the students, while getting them moving and raising their heart rates — a key intention of the program.

“The IMPACT program was created to help students reach fitness standards at schools that otherwise would not have funding to maintain certain physical education programs,” said Kate McDevitt, senior manager of School Wellness Programs at UC San Diego’s Center for Community Health.

Many of the UC San Diego student-athletes who participate are members of the Triton Athletes’ Council (TAC), an organization of students from the university’s 23 intercollegiate teams who initiate campus and community service efforts. The IMPACT program was an ideal match for Triton Athletes’ because of the group’s focus on making a positive impact on the community.

Scott Acton, a member of the Triton Athletes’ Council who is also on the track and field and cross country teams, has helped coordinate UC San Diego Athletics’ role in the program this year. “It is great to see the elementary students get out and be active,” said Acton, a structural engineering major. “Word is spreading among student-athletes about what a great program this is, so more and more from UC San Diego are getting involved.”

“Having educated and physically fit athletes attend these sessions shows the children that with hard work and dedication, they can reach any goal they wish to attain in athletics, but the first step is being physically active,” said Lynn Barnes-Wallace, physical education resource teacher at San Diego Unified School District and creator of IMPACT. “The students from UC San Diego really get involved with the program and motivate the kids even more.”

IMPACT began at Edison Elementary in City Heights last spring. The program was such a success—as evidenced by the smiles and squeals of delight from the students—that it was expanded to Toler and will likely be implemented at other elementary schools in the future.

According to Peggy Lewis, principal of Toler Elementary, the program is a hit with her young students. “The kids love it,” said Lewis. “They need activity during the day. We have already seen improved student focus and concentration as a result of the program.”

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Traffic’s toll on the heart

Clogged interstates aggravate clogged arteries, according to UC Irvine research.

Credit: Jess Wheelock, UC Office of the President

By Nicole Freeling, UC Newsroom

Anyone who has experienced Los Angeles gridlock likely can attest that traffic may cause one’s blood pressure to rise. But UC Irvine researchers have found that, beyond the aggravation caused by fellow drivers, traffic-related air pollution presents serious heart health risks — not just for rush hour commuters, but for those who live and work nearby.

Research by UC Irvine joint M.D./Ph.D. student Sharine Wittkopp contributes to evidence that the increased air pollution generated by vehicle congestion causes blood pressure to rise and arteries to inflame, increasing incidents of heart attack and stroke for people who reside near traffic-prone areas.

“While the impact of traffic-related pollution on people with chronic lung diseases is well known, the link to adverse heart impacts has been less described,” said Wittkopp.

UC Irvine M.D./Ph.D. student Sharine Wittkopp is investigating genetic factors that make some people more vulnerable to pollution’s negative effects. (Photo courtesy of Sharine Wittkopp)

Her research project, funded by the National Institute of Environmental Health Sciences, focused on residents of a Los Angeles senior housing community who had coronary artery disease.

Study participants spend the vast majority of their time at home, which meant they had prolonged exposure to traffic-related air pollution at the site. Because of their age and pre-existing heart conditions, they were thought to be more vulnerable to small, day-to-day variations in air quality.

“They are really in the thick of it,” Wittkopp said. “They are the ones that are going to suffer the most, and who are the least likely to be resilient.”

Up to now, most studies on the impacts of air pollution have focused on its effects over much larger populations, with difficulty capturing accurate exposures and short-term changes. Wittkopp and her team wanted to look at how daily fluctuations in traffic and air quality would affect those residing in the immediate vicinity of congested roadways.

The research team, led by adviser Ralph Delfino, associate professor and vice chair for research and graduate studies in the Department of Epidemiology at UC Irvine’s School of Medicine, set up air quality monitors at the residences of the study participants. They looked for daily and weekly changes in traffic-related pollution such as nitrogen oxides, carbon monoxide, and particulate matter.

What they found: “Blood pressure went up with increased traffic pollutants, and EKG changes showed decreased blood flow to the heart,” Wittkopp said.

Uncovering a genetic link

Just how susceptible a person is to these negative impacts appears to depend not just upon age and proximity to traffic, but also upon genetics, the research team found.

They uncovered what they believe is the first epidemiological evidence that a person’s mitochondrial DNA could affect their susceptibility to adverse health effects related to air pollution.

“When our cells are exposed to toxins, they respond by making more proteins that enable them to detoxify pollutants,” Wittkopp said. “We can actually monitor how the protein levels are going up and down and how the gene readouts change as people are exposed.” Looking at traffic-related pollution, they discovered that a person’s ability to produce the proteins that combat pollutants varied dramatically based on their DNA.

By identifying the genetic variables that place people at greater risk, health care providers could help account for these impacts and prescribe proactive treatments — such as antioxidants that reduce inflammation — that would make people less vulnerable.

But Wittkopp also stresses such treatment would simply be a Band-Aid on the greater problem.

Impetus to improve infrastructure, lessen exposure

“Understanding the health problems that traffic-related pollution causes helps us understand why we need to change things and improve our infrastructure to reduce exposure,” said Wittkopp, who believes this research can provide policymakers and the public with a fuller picture of the impact of pollution.

“This kind of information can help us quantify the cost of traffic-related air pollution in terms of health care costs, lives lost and quality of life diminished.”

While genetic factors may make some more vulnerable than others, Wittkopp points out, “There’s no one who’s not susceptible in some way. No one gets better when they are exposed to these pollutants.”

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UC Davis awarded $100M to lead program to predict, prevent pandemic threats

Second phase of program will help attack problems like Ebola before they start.

The PREDICT program helps detect emerging viruses that move among people, livestock and wildlife, such as this macaque in Nepal. (Photo by One Health Institute, UC Davis)

The U.S. Agency for International Development has awarded up to $100 million for the second phase of the PREDICT project based at the UC Davis School of Veterinary Medicine. PREDICT is part of the Emerging Pandemic Threats, or EPT, program — an unprecedented international campaign to rapidly detect and respond to emerging viruses such as Ebola and SARS that move among people, wildlife and livestock.

PREDICT is managed by the school’s One Health Institute. The new award is one of the largest extramurally funded projects in UC Davis history.

“PREDICT and its partners have enabled a platform for effective collaboration across disciplines and geographic borders to promote global health problem solving,” said Jonna Mazet, director of the One Health Institute and principal investigator of the new award. “We can now attack problems, like Ebola, before they start — reducing fear and improving response and control.”

The award for the PREDICT project opens a second phase for the EPT program. Building on its long-standing efforts in disease surveillance and response, USAID is developing multiple initiatives to help prepare the world for emerging infectious diseases like pandemic influenza, SARS and Ebola. Other partners within USAID’s EPT program include the PREPAREDNESS & RESPONSE and ONE HEALTH WORKFORCE projects, the U.S. Centers for Disease Control and Prevention, the Food and Agriculture Organization, and the World Health Organization.

Building on success

For the past five years, the One Health Institute has led a global consortium of implementing partners in conducting pathogen surveillance, viral discovery and global health capacity strengthening in more than 20 countries. In that time, the PREDICT team:

  • Equipped, supplied and trained staff in 32 diagnostic laboratories around the world to safely and properly process and test wildlife samples for viruses of pathogenic potential.
  • Trained 2,500 government personnel, physicians, veterinarians, resource managers, laboratory technicians, hunters and students in biosafety, surveillance, laboratory techniques and outbreak investigations.
  • Discovered more than 800 novel viruses at high-risk pathogen transmission interfaces.
  • Responded to 24 disease outbreaks, including multiple Ebola outbreaks in central Africa.

The new award will build on the success of the first phase of PREDICT, funded in 2009. In collaboration with other U.S. government, international and host country partners, it will continue to strengthen health capacity and to intensify pathogen surveillance and risk assessment activities in geographic areas and animal-human interfaces identified as high-risk for the emergence and spread of disease.

Ebola response

Tragically, the world is currently responding to the worst Ebola outbreak in history. The extreme challenges faced in this response are amplified by the lack of public knowledge on the virus and its potential hosts and transmission. Unfortunately, the countries in West Africa were not expecting or prepared for this epidemic, primarily because there was previously no evidence that the Ebola virus was present in that region of Africa.

In contrast, during a separate Ebola outbreak in this same time period in the Democratic Republic of Congo, where the PREDICT team and other partners were actively engaged with the government and inserted into the public health infrastructure, sick individuals were detected much more quickly. Samples were tested and control measures implemented all within just days of the first signs of illness. The rapid response and significantly reduced death toll in DRC illustrate what can be achieved when a One Health workforce is trained, employed and able to be activated in the face of extreme health challenges.

In this second and new phase, PREDICT will continue to focus surveillance on viral families of epidemic and pandemic potential. These include coronaviruses, the viral family to which SARS and MERS belong, influenza viruses, and filoviruses, such as Ebola.

This second phase also will increase focus on the effects of human behavior and other drivers for disease emergence and spread, with a focus on livestock and people living in high-risk areas for disease spillover and transmission. By working with social and behavioral scientists in a transdisciplinary approach, PREDICT will integrate virus detection with investigations of human-animal interactions and the social and cultural reasons for those interactions. This One Health approach is designed to improve our understanding of the dynamics of zoonotic disease spillover, evolution, amplification and spread in order to inform future prevention and control measures.

Identifying and controlling emerging diseases

The One Health Institute will execute the project in a coordinated consortium with EcoHealth Alliance, Metabiota, Smithsonian Institution and the Wildlife Conservation Society, along with valued technical partners at Columbia University’s Center for Infection and Immunity, HealthMap at Boston Children’s Hospital, International Society for Infectious Disease, and UC San Francisco’s Viral Diagnostics and Discovery Center.

“Our work has shown that emerging diseases are on the rise and represent a growing threat to our health, our economies, and our global security,’ said Peter Daszak, president of EcoHealth Alliance, a partner in the PREDICT consortium. “This next phase of funding allows us to identify the activities that cause diseases to emerge in high-risk disease ‘hotspots’ so that we can minimize the impacts of a new virus spilling over and infecting people.”

The consortium will continue to work closely with partner organizations in each country, as well as with a network of laboratories, universities, government ministries and agencies in these global hotspots. PREDICT is engaged in the Africa, South Asia, and Southeast Asia regions, working in Bangladesh, Cambodia, Cameroon, China, Democratic Republic of Congo, Gabon, Indonesia, Laos, Malaysia, Myanmar, Nepal, Republic of Congo, Rwanda, Tanzania, Thailand, Uganda and Vietnam, along with a new focus in West Africa in response to the Ebola outbreak.

The consortium is united by its belief in the One Health approach, which employs the knowledge that the health of animals, people and the environment are inextricably linked to solve global health problems.

“The new funding for PREDICT will allow our One Health Institute investigators and their partners to continue to identify pandemic threats and build capacity in developing regions worldwide,” said Mazet. “The UC Davis School of Veterinary Medicine has an extensive history of excellence in public health programs that address societal needs. This new funding will ensure our research teams’ continued contributions to enhance capabilities to prevent future pandemics.”

“Attempts to date to control deadly viruses have been almost entirely reactionary due to structural and technological limitations,” Mazet said. “The world is now poised to be able to identify the key processes influencing the evolution, spillover, amplification and spread of pathogen threats in order to halt them at their source.”

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