Outbreaks of communicable disease pose major threat to endangered African primates.

Infectious disease has joined poaching and habitat loss as a major threat to the survival of African great apes as they have become restricted to ever-smaller populations. Despite the work of dedicated conservationists, efforts to save our closest living relatives from ecological extinction are largely failing, and new scientific approaches are necessary to analyze major threats and find innovative solutions.

In response to this crisis, researchers at UC Santa Barbara‘s National Center for Ecological Analysis and Synthesis (NCEAS) have conducted a pioneering study that illustrates how severely disease threatens the long-term survival of wild gorillas and chimpanzees. It also explores the status of potential interventions that may help ensure their continued existence. The article, “Consequences of Non-Intervention for Infectious Disease in African Great Apes,” was recently published in the online journal PLoS ONE. The study indicates that mortality rates comparable to those recently reported for disease outbreaks in wild populations are not sustainable.

Sadie Ryan, the lead author, is assistant professor of ecology at SUNY-ESF in Syracuse, N.Y.; and Walsh is a quantitative ecologist at the University of Cambridge, England.

Modeling demonstrated that recovery times to current population levels from a single disease outbreak, under very optimistic rates of recovery, would range from five years for a flu-like outbreak, to 131 years for an Ebola virus outbreak that killed 96 percent of the population, according to the study. Population resilience is central to assessing disease threat because gorillas and chimpanzees reproduce more slowly than virtually any other animal on earth, including humans.

“These disease mortality rates are particularly troubling, given the rising pathogen risk due to increasing human contact with wild apes, associated with their habituation for tourism, poaching and the increase in population pressure around protected areas,” said Ryan. “These small populations of great apes are the last vestiges of our closest relatives, so there is a huge emotional response when it comes to the question of intervention. Should we or can we wait, or should we use proactive intervention by vaccinating ahead of time?”

Both “naturally” occurring pathogens, such as Ebola and Simian Immunodeficiency Virus (SIV), and respiratory pathogens transmitted from humans, such as the common cold and flu viruses, have been confirmed as important sources of mortality in wild gorillas and chimpanzees, and the rate of pathogen spillover from humans to African apes is known to be increasing. Although awareness of the threat has spread throughout the scientific community, interventions such as vaccination and treatment remain very controversial, the researchers noted.

Because of the scarcity of diagnostic data on exactly which pathogens infect apes and at what rates, Ryan and Walsh found it difficult to rigorously quantify how increased tourism would translate into increased disease pressure on ape populations. As a result, they assessed and compared potential future disease spillover risk – in terms of vaccination rates among humans that may come into contact with wild apes, and the availability of vaccines against potentially threatening diseases – with non-interventionist responses, such as limiting tourist access to the primates, community health programs, increased vigilance and reactive veterinary intervention.

Based on their findings, Ryan and Walsh suggest that the great ape conservation community “pursue and promote treatment and vaccination as weapons in the arsenal for fighting the decline of African apes.” They recommend that field studies on safe and efficient methods for delivering treatments and vaccines orally be conducted, along with evaluating the cost-effectiveness of all ape conservation strategies.

“We looked at the rates of vaccination in human populations both in host countries and potential tourists, and at the potential vaccines in development that could be used for great apes,” Ryan said. “But we need to do more research when outbreaks occur by mobilizing the entire research community in order to better understand what is going on.”

To view the paper, visit: www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0029030

Analysis of Kenya study shows simultaneously confronting AIDS, malaria and waterborne illness improves health.

A volunteer in 2008 shows people from the Lurambi District in Western Kenya how to use incecticide-treated bednets to prevent the spread of malaria

The great paradox of global health efforts is that regions of the world most plagued by poverty, poor infrastructure and rampant disease are often the most difficult to support. Now, scientists have demonstrated that confronting several diseases at once can make the most of thinly-stretched donor dollars and national health care budgets, to help to save lives.

A new analysis published this week in the open-access journal PLoS ONE (Feb. 3) focused on a combined public health campaign in Western Province, Kenya led by the Swiss-based company Vestergaard Frandsen, the Kenyan Ministry of Health and the U.S. Centers for Disease Control and Prevention (CDC). The analysis looked at the cost effectiveness of simultaneously confronting the problems of HIV/AIDS, malaria and diarrhea caused by waterborne pathogens.

The researchers used the results of the campaign to build an analysis of the impact such efforts could have if carried out more broadly. The analysis found that for every 1,000 people reached through such campaigns, some $16,015 in health care costs would be avoided and more than 16 lives would be saved. As a result, local populations would gain hundreds of years of healthy life. The cost would be $32 per person, but averted health care costs would be greater, leading to the net savings.

“That’s a very attractive deal,” said James G. Kahn, M.D., M.P.H., a professor of health policy, epidemiology and global health at the University of California, San Francisco, who is the senior author on the PLoS ONE study and led the economic aspect of the research. “This kind of a campaign is an excellent use of global health dollars.”

Health care workers distributed “CarePacks” at 37 locations in Kenya over seven days in 2008. These packs contained insecticide-treated bed nets to reduce the spread of malaria, water filters for preventing diarrheal diseases, and condoms.

Some 47,000 people ultimately received the packs, which also contained educational information as incentive for local residents to participate in a voluntary HIV testing and counseling program.

By combining efforts to reduce the burdens of malaria, diarrhea and HIV/AIDS, the program efficiently stretched the impact of its funds, Kahn said, which is important in areas where per capita health expenditures may amount to little more than a few dollars a year. Combining these public health efforts into one program also saved a great deal of time, he added.

“This program was implemented in seven days, reaching 80 percent of the local population,” Kahn said. “This rapid implementation means more health benefits were quickly achieved.”

Other co-authors of the article, “Integrated HIV Testing, Malaria, and Diarrhea Prevention Campaign in Kenya: Modeled Health Impact and Cost-effectiveness” are N. Muraguri, B. Harris, E. Lugada, T. Clasen, M. Grabowsky, J. Mermin and S. Shariff.

Kahn is based in the UCSF Philip R. Lee Institute for Health Policy Studies, the Department of Epidemiology and Biostatistics, and Global Health Sciences.

In addition to UCSF, authors on this study are affiliated with the Kenyan Ministry of Public Health and Sanitation, CHF International, the London School of Hygiene & Tropical Medicine, the ESP/UN Foundation, and the CDC.

The analysis was funded by the U.S. National Institute on Drug Abuse and by the company Vestergard Frandsen, which managed the campaign and manufactured the water filters and bed nets distributed.

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care.

UC Davis pathology resident provides health care to Kenyans.

Kali Tu, UC Davis

Third-year pathology resident Kali Tu is focused on making a difference to improve health. She recently participated in a two-week elective residency training rotation in Malindi, Kenya, where she provided medical care to approximately 400 rural residents with little or no access to health-care services.

Malindi is a coastal town located on the Indian Ocean about halfway between Mombasa and Somalia In Africa. A two-hour flight from Nairobi, Malindi and the surrounding region have a population of about 200,000 residents.

The trip to Malindi was the second for Tu, who joined a team of 26 American physicians, nurses, anesthesiologists, and medical and high-school students. The trip was organized by Vanderbilt University ear, nose and throat surgeons and the Caris Foundation, a Texas nonprofit group that arranges medical care for treatable conditions for individuals in developing nations. The foundation worked with the two main hospitals in Malindi —  Tawfiq, a Muslim-mission hospital, and the public hospital, called the District Hospital — and invited local residents with visible head, neck and facial disorders for evaluation and treatment by the team.

During the trip, surgeons operated on more than 200 patients, and Tu traveled between both hospitals on a daily basis as needed to examine patients and diagnose tumors and margins. The experience broadened her horizons, advanced her training and exposed her to another culture and health-care system.

“The experience was an incredible educational opportunity,” said Tu, who joined the Department of Pathology and Laboratory Medicine‘s residency training program in 2010 in her second year of training. “I gained a lot of experience in performing fine-needle aspirations, assessing cell specimens and communicating with other physicians. It was extremely fulfilling to work directly with patients and surgeons in an area with low resources.”

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Prominent speakers to discuss population growth and global health Feb. 4.

More than 300 people — many of them University of California faculty, students and staff — will gather at UC Berkeley on Saturday, Feb. 4, for the second UC Global Health Day, sponsored by the UC Global Health Institute (UCGHI). The conference will be both a discussion about population growth and its impact on health worldwide, and a showcase for global health research being undertaken by graduate students, postdoctoral fellows and junior faculty across the 10-campus system.

The conference, from 8:30 a.m. to 5 p.m. in Dwinelle Hall, will be hosted in partnership with the UC Berkeley Center for Global Public Health, the UC Berkeley Bixby Center for Population, Health & Sustainability, and the Northern California International Health Interest Group.

Two special sessions will take place in the morning with prominent speakers from the U.S. and abroad. The first session, Population, Consumption and Human Wellbeing, will be chaired by UC Berkeley’s Malcolm Potts, director and founder of the Bixby Center for Population, Health & Sustainability. The session will feature keynote speaker Sir John E. Sulston, the 2002 Nobel laureate in medicine. He chairs the People and the Planet Working Group of the Royal Society, London. Potts and Eliya Msiyaphazi Zulu, the second keynote speaker, also are participants in the working group.

“The freedom and autonomy of women, the challenge of reducing maternal and infant mortality around the world, lifting 2 billion people out of abject poverty, forestalling more failed states like Somalia, and adapting to global warming are all heavily influenced by the population growth factor,” said Potts. “Whether women are given the right to decide when to have a child is critical to health as well as education and development.”

A second morning session, titled Consequences of High Fertility and Population Growth: The Special Case of Africa, will be chaired by UC Berkeley’s Martha Campbell, lecturer in global health, School of Public Health. The keynote speaker will be Zulu, director of the African Institute for Development Policy in Nairobi, Kenya. Both morning sessions also will feature prominent scientists from several UC campuses.

“The future of many African nations hinges on the policies that African governments develop and the investment the international community is prepared to make around voluntary family planning,” said Campbell.

In the afternoon, more than 70 UC students, faculty and other practitioners in global health will make oral presentations and lead breakout sessions, and 78 posters will be presented. A range of global health issues will be offered, including: Global Public Health Law; Global Health & the Media; Gender-based Violence in sub-Saharan Africa: Toward a Transdisciplinary Approach; Social Media How-To; From Malaria Control to Elimination; Improved Childhood Health through Reduction of Household Air Pollution from Cookstoves; and Climate Change & Vector Biology.

“Students and young faculty are the main drivers behind the incredible growth in global health research and education programs on UC campuses,” says Haile Debas, director of the UC Global Health Institute and former chancellor and dean of the School of Medicine at UCSF. “UC Global Health Day provides a forum to share their research and ignite collaborations that could lead to innovations in addressing major health problems in developing countries.”

The UC Global Health Institute was established in November 2009 in response to the growing demand from students and faculty interested in global health research and education. The UCGHI is composed of three multicampus Centers of Expertise — Migration & Health; One Health; and Women’s Health & Empowerment – that are launching projects and education and training programs to produce leaders and practitioners of global health, conduct innovative research, and develop international partnerships to improve the health of vulnerable people and communities in California and worldwide. Currently, the UCGHI is assessing the feasibility of creating a joint MS program in global health at three or more UC campuses.

The UCGHI is jointly led by Debas at UCSF and Thomas Coates, the Michael and Sue Steinberg Professor of Global AIDS Research at the UCLA David Geffen School of Medicine.

The registration deadline for UC Global Health Day is Jan. 27. The cost to attend is $25 for students, $50 for general admission and $75 for exhibitors. For more information, visit the UCGHI website.

Media contact:
Paula Murphy, Director of Communications, UCGHI
(415) 597-8240 (office); (415) 999-7241 (cell)
murphyp2@globalhealth.ucsf.edu

Turns cell phone into powerful microscope.

A groundbreaking imaging technology developed by UCLA engineering professor Aydogan Ozcan that can turn a simple cell phone into a powerful microscope has been named the top innovation of 2011 by The Scientist, a magazine focusing on the life sciences, research and technology. Ozcan’s compact, lightweight and inexpensive microscope has the potential to bring better health care and monitoring to impoverished and underserved areas of the globe.

The technology, known as LUCAS (Ultra–wide-field Cell monitoring Array platform based on Shadow imaging), was ranked No. 1 among a field of more than 65 entries judged by the magazine as part of its annual “Top 10 Innovations” contest. Other winners in the top 10 included a new high-powered DNA sequencer, a mini-MRI system, a watch-like device that measures the body’s circadian rhythm, and a first-of-its-kind 360-degree optical imager.

Ozcan’s LUCAS is an easy-to-use, pocket-sized holographic microscope that weighs less than 50 grams, uses off-the-shelf parts and costs as little as $10. It can be attached to a cell phone’s camera, and blood and saliva samples can then be loaded onto chips that slide into the side of the microscope. The technology can be used to monitor diseases like HIV and malaria and to test water quality in the field after a major disaster.

Algorithms developed by Ozcan’s research group instantly identify and count red and white blood cells and microparticles in the fluid samples, a time-consuming process typically performed by trained technicians. The image results can be sent by the cell phone to centralized hospitals for analysis by health care professionals.

“We have more than 5 billion cell phone subscribers around the world today, and because of this, cell phones can now play a central role in telemedicine applications,” said Ozcan, an associate professor of electrical engineering and bioengineering at UCLA’s Henry Samueli School of Engineering and Applied Science and a member of the California NanoSystems Institute at UCLA. “Our research group has already created a very nice set of tools that can potentially replace most of the advanced instruments used currently in laboratories.”

Ozcan has garnered a great deal of media attention and professional recognition in recent years for his work on lensless computational microscopy. He’s been honored with a Presidential Early Career Award for Scientists and Engineers, a National Science Foundation CAREER Award, a National Institutes of Health Director’s New Innovator Award, and Office of Naval Research and Army Research Office Young Investigator awards, among others.

The lensless imaging platform behind the cell phone microscope is already undergoing real-world trials. Field tests of the cell phone microscope began in Africa last summer using funds received from three major awards. Next year, Karin Nielsen, an infectious diseases pediatrician at UCLA, will take the portable microscope into the fields of the Amazon to test its ability to diagnose malaria, anemia, low white blood-cell count and intestinal parasites.

For more on Ozcan’s research, visit http://innovate.ee.ucla.edu.

Partnership will cover telehealth, scientific and technical development, and neurodevelopmental disorders.

Sergio Aguilar-Gaxiola, UC Davis

UC Davis Health System has signed a memorandum of understanding (MOU) with the state of Sinaloa, Mexico, to partner to improve the health and well-being of its residents through the exchange of ideas, data and research on telehealth, scientific and technical development, and neurodevelopmental disorders.

Sinaloa has partnered with UC Davis because of the health system’s internationally recognized leadership in telehealth technology and neurodevelopmental research, said Sergio Aguilar-Gaxiola, who directs the UC Davis Center for Reducing Health Disparities and community engagement for the UC Davis Clinical and Translational Science Center.

Approximately 27 percent of Sinaloa’s population lives in rural settings. The government and secretariat of health of Sinaloa have pledged to strengthen the state’s health infrastructure and to increase access to quality health care using telehealth technology, particularly for populations residing in remote rural areas.

“The government of Sinaloa is interested in creating the infrastructure to support telemedicine and telehealth services to significantly improve access to primary-care services for its nearly 3 million residents,” said Aguilar-Gaxiola, a professor of clinical internal medicine.

“They also would like UC Davis to share its expertise in autism and fragile X syndrome with Mexican health professionals and families to improve early identification, diagnosis and treatment,” Aguilar-Gaxiola said. “A third goal is to foster scientific and technical development to support health education primarily aimed at primary-care settings.”

UC Davis is a national leader in extending access to health-care services to rural and underserved areas through telehealth. The UC Davis Center for Health and Technology uses high-speed data lines linked to video units to connect large, urban medical centers with community hospitals and clinics. The technology allows specialists and subspecialists to consult with community physicians and their patients via live, interactive videoconferencing.

Similarly, the UC Davis MIND Institute is internationally known for its leading-edge research into neurodevelopmental disorders, such as autism spectrum disorders and fragile X syndrome. The institute’s world renowned scientists engage in research to find improved treatments, as well as  causes and cures, for autism, attention-deficit hyperactivity disorder (ADHD), fragile X syndrome, Tourette syndrome and other neurodevelopmental conditions.

The MOU with Sinaloa is the most recent affiliation between UC Davis Health System and a Mexican entity.

Earlier this year, health system leaders traveled to Mexico City to forge a similar MOU with the Instituto Carlos Slim de la Salud (the Carlos Slim Health Institute), A.C. That agreement is focused on raising awareness of mental-health issues and sharing useful and innovative information to enable the early identification of autism and fragile X syndrome. Founded in 2007, the institute promotes research, develops initiatives and funds projects to address health challenges that affect Mexico and the broader Latin American region.

And in 2010, UC Davis Health System partnered with Shriners Hospital for Children — Northern California and the Mexican Health Ministry to establish a burn fellowship program for physicians from Mexico. The 12-month fellowship program trains two physicians each year in resuscitation and burn-care management, reconstructive surgery and clinical research.

UC Davis Health System is improving lives and transforming health care by providing excellent patient care, conducting groundbreaking research, fostering innovative, interprofessional education, and creating dynamic, productive partnerships with the community. The academic health system includes one of the country’s best medical schools, a 631-bed acute-care teaching hospital, an 800-member physician’s practice group and the new Betty Irene Moore School of Nursing. It is home to a National Cancer Institute-designated cancer center, an international neurodevelopmental institute, a stem cell institute and a comprehensive children’s hospital. Other nationally prominent centers focus on advancing telemedicine, improving vascular care, eliminating health disparities and translating research findings into new treatments for patients. Together, they make UC Davis a hub of innovation that is transforming health for all. For more information, visit healthsystem.ucdavis.edu.

Interaction between immune response and later infection can mean difference between mild fever and death.

Researchers collecting samples from local children, monitored by Eva Harris (right), as part of the UC Berkeley/Sustainable Sciences Institute Pediatric Dengue Cohort Study in Managua, Nicaragua.

One of the most vexing challenges in the battle against dengue virus, a mosquito-borne virus responsible for 50-100 million infections every year, is that getting infected once can put people at greater risk for a more severe infection down the road.

Now, for the first time, an international team of researchers that includes experts from the University of California, Berkeley, has pulled apart the mechanism behind changing dengue virus genetics and dynamics of host immunity, and they are reporting their findings in today’s (Dec. 21) issue of Science Translational Medicine.

The virus that causes dengue disease is divided into four closely related serotypes (dengue virus 1, 2, 3 and 4), and those serotypes can be further divided into genetic variants, or subtypes.

The researchers showed that a person’s prior immune response to one serotype of dengue virus could influence the interaction with virus subtypes in a subsequent infection. How that interaction plays out could mean the difference between getting a mild fever and going into a fatal circulatory failure from dengue hemorrhagic fever or dengue shock syndrome.

The findings have implications for the efforts to combat a disease that has grown dramatically in recent decades, including the development of a first-ever dengue vaccine.

According to the World Health Organization, dengue disease is now endemic in more than 100 countries around the world, and recent estimates say some 3 billion people — almost half of the world’s population — are at risk.

It was already known that upon a person’s first infection with dengue virus, the immune system reacts normally by creating antibodies to fight the viral invaders. The problem is that those antibodies can then be confused if confronted later with one of the other three types of dengue virus and, as this new study revealed, even different subtypes within the same serotype.

“With the second infection, the antibodies sort of recognize the new type of viruses, but not well enough to clear them from the system,” said study lead author Molly OhAinle, postdoctoral fellow in infectious diseases at UC Berkeley’s School of Public Health. “Instead of neutralizing the viruses, the antibodies bind to them in a way that actually helps them invade the immune system’s other cells and spread.”

The study authors noted that this Trojan horse effect has been shown before, but the new research provides an analysis of the interplay between viral genetics and immune response with unprecedented detail, going beyond the main serotype.

Putting the puzzle pieces together required UC Berkeley’s expertise in immunology and virology, the genome analysis and biostatistical capabilities at the Broad Institute of Harvard University and Massachusetts Institute of Technology, and the epidemiological and clinical field work at Nicaragua’s National Virology Laboratory.

Researchers used data from two independent, Nicaragua-based studies headed by Eva Harris, professor of infectious diseases and vaccinology and director of UC Berkeley’s Center for Global Public Health, and Dr. Angel Balmaseda, director of the National Virology Laboratory in Nicaragua. One was a hospital-based study that examined children admitted to the National Pediatric Reference hospital with dengue between 2005 and 2009. The other was a prospective study that had followed 3,800 children since 2004, with blood samples collected annually.

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UCSF study shows same result can be achieved with half the antibiotics.

UCSF's Bruce Gaynor examines a patient in Ethiopia, where there is a high prevalence of trachoma, the world’s leading cause of preventable blindness.

A UC San Francisco study shows a popular treatment for a potentially blinding eye infection is just as effective if given every six months versus annually. This randomized study on trachoma, the leading cause of infection-caused blindness in the world, could potentially treat twice the number of patients using the same amount of medication.

“The idea is we can do more with less,” said Bruce Gaynor, M.D., assistant professor of ophthalmology at the Francis I. Proctor Foundation for Research in Ophthalmology. “We are trying to get as much out of the medicine as we can because of the cost and the repercussions of mass treatments.”

In a paper published this month in The Lancet, researchers conducted a cluster-randomized trial, using an antibiotic called azithromycin to treat trachoma in Ethiopia, which has among the highest prevalence in the world. They picked 24 communities and randomized the two treatment options: 12 villages were given azithromycin every six months and the other 12 were treated every 12 months.

“What we found was the prevalence of trachoma is very high at baseline. Forty to 50 percent of the children in these communities have this condition,” Gaynor said. “They are the most susceptible and it can quickly spread from person to person by direct or even indirect contact.”

Researchers tracked both groups and found the prevalence of infection decreased dramatically.

“We found that from as high as 40 percent, the prevalence of trachoma went way down, even eliminated in some villages regardless of whether it was treated in an annual way or a biannual way,” Gaynor said. “You can genuinely get same with less.”

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UC Merced researchers show burning of sugarcane fields prior to harvest can create more pollution that previously thought.

The burning of sugarcane fields prior to harvest for ethanol production can create air pollution that detracts from the biofuel’s overall sustainability, according to research published recently by a team of researchers led by scientists at the University of California, Merced.

UC Merced graduate student Chi-Chung Tsao was the lead author on the paper and was aided in the study by UC Merced professors Elliott Campbell and Yihsu Chen. The study — published online this week in the Nature Climate Change journal — focused on Brazil, the world’s top producer of sugarcane ethanol and a possible source for U.S. imports of the alternative fuel.

“There is a big strategic decision our country and others are making, in whether to develop a domestic biofuels industry or import relatively inexpensive biofuels from developing countries,” Campbell said. “Our study shows that importing biofuels could result in human health and environmental problems in the regions where they are cultivated.”

[Download a PDF of the study.]

Ethanol is seen as an alternative to fossil fuels, which emit greenhouse gasses when used and are a major contributor to air pollution and climate change. But despite some governments encouraging farmers to reduce field burning — which is done in part to protect farmworkers by removing sharp leaves and harmful animals — more than half of sugarcane croplands in Brazil continue to be burned.

That leads to a reduction in air quality that can offset the benefits of ethanol over petroleum fuels that emit more greenhouse gases during their use, something Campbell said the U.S. should consider when determining whether to import inexpensive ethanol from Brazil or continuing to invest in domestic corn ethanol production.

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UCSF part of major research initiative to improve safety, effectiveness of blood transfusions.

Edward Murphy, UC San Francisco

UC San Francisco and its affiliate Blood Systems Research Institute (BSRI) have been awarded nearly $33 million in research contracts for four projects as part of a major new research initiative designed to improve the safety and effectiveness of blood transfusions in the United States and abroad.

Suported by the National Institutes of Health (NIH) National Heart, Lung and Blood Institute, the multicenter collaboration project, titled “Recipient Epidemiology and Donor Evaluation Study III (REDS-III),’’ will span seven years.

“For decades, transfusion safety research has focused on blood donors and infectious disease testing — now for the first time, we will be looking at the patients who receive blood transfusions,’’ said Edward L. Murphy, M.D., M.P.H., professor in the UCSF Departments of Laboratory Medicine and Epidemiology/Biostatistics and senior investigator with the BSRI.

More than five million patients in the United States undergo transfusion therapy annually.

REDS-III will entail the creation of four “hubs,’’ each consisting of a regional blood center and affiliated hospitals. The San Francisco hub will involve the Blood Centers of the Pacific, UCSF Medical Center, San Francisco General Hospital & Trauma Center, and the San Francisco Veterans Administration Medical Center. Blood Centers of the Pacific supplies more than 90 percent of the blood used by the three hospitals.

One of the new projects will focus on improving the practice of blood transfusion and evaluating the positive and negative effects of blood transfusion in the hospital setting. As many as 200,000 patients annually at the assorted hubs who receive blood transfusions, and up to 500,000 blood donors a year will be studied to determine, among other things, pulmonary edema after transfusion, transfusion-related lung injury, alloimmunization and other immunological effects of transfusion, Murphy said.

Another project will look at use of plasma, currently thought to be overused for clotting disorders, Murphy said.

UCSF and BSRI also feature prominently in the international component of the initiative:  collaborative research will be conducted in Brazil and South Africa (Johns Hopkins will partner with China for the third site). International projects will focus on prevention of transfusion-transmitted infectious diseases such as HIV, dengue virus and Chagas disease. The researchers also will study obstetric hemorrhage and increased recruitment of black blood donors in South Africa as well as the treatment and genetics of sickle cell disease in Brazil.

BSRI was additionally awarded the contract for a central laboratory that will provide laboratory support and expertise to the seven clinical centers in the U.S. and overseas.

“One of the things that enabled these projects to occur is the partnership between UCSF and BSRI,’’ said Murphy. “The collaborative culture of UCSF has helped enormously.’’

The project will also use resources of the UCSF Clinical and Translational Sciences Institute.

The overall research initiative totaling $87.2 million is funded by the NIH’s National Heart, Lung, and Blood Institute (NHLBI). The research program will build upon and extend the findings of prior projects that began in 1989 in response to the emerging HIV/AIDS epidemic. As the risk of transfusion-transmitted HIV, Hepatitis B and C viruses and West Nile virus has diminished, REDS-III will shift focus toward several new research areas including health outcomes in transfused patients, health screening of blood donors and even genetic studies in the blood bank setting.

“This research effort will protect both blood donors and recipients from existing and future risks, benefitting both the United States and countries struggling to ensure blood safety and availability,’’ said Susan B. Shurin, MD, acting director of the NHLBI.

Murphy said that the nature of blood transfusions has changed dramatically in recent decades since the advent of HIV.

“Before then, physicians used to transfuse much more liberally,’’ he said. “But HIV and other diseases changed transfusion practice — blood should be given based upon evidence-based guidelines, not just because there is a drop in hemoglobin.’’

For more information, go here.

UC Santa Barbara study estimates broad effects of climate change on physical health and related economics.

Olivier Deschenes, UC Santa Barbara

When considering the health consequences of climate change, most people imagine prolonged periods of extremely high temperatures and the associated physical outcomes –– including mortality. However, according to research conducted by Olivier Deschênes, associate professor of economics at UC Santa Barbara, the effects of climate change on physical health –– and related economics –– is much broader than that. Deschênes’ findings appeared in a recent issue of the American Economic Journal: Applied Economics.

In his article “Climate Change, Mortality, and Adaptation: Evidence from Annual Fluctuations in Weather in the U.S.,” co-written with Michael Greenstone of M.I.T., Deschênes estimates the economic impacts of climate change on human health, and on expenditures for self-protection, such as air conditioning.

“I wanted to do a large-scale study of the entire continental United States, not just a handful of cities,” Deschênes said of his current research. “Too many observations about climate change and its impacts are based on isolated, extreme events, such as the 2003 heat wave in France. Second, I wanted to consider how households might adapt to extreme weather by using more energy to control their indoor climate. Third, I wanted to make predictions about future impacts that were based on state-of the-art climate models.”

Exposure to both extreme cold and extreme heat lead to increases in mortality, according to Deschênes, because such exposure stresses the cardiovascular system, which is a primary mechanism for the body to control its core temperature. This suggests that rising temperatures will lead to a decrease in the number of cold-related deaths, and an increase in those related to heat. “Some geographical areas in the United States and elsewhere in the world may, in fact, be healthier as a result of climate change,” he said. “As in many of life’s circumstances, there will be ‘winners’ and ‘losers’ as a result of climate change, at least when we evaluate its impact on human health.”

In his recent study of the United States, Deschênes predicts a net increase in mortality of about 2 percent by the end of the century. In other words, the reduction in cold-related mortality is not sufficient to compensate for the larger increase in heat-related mortality. “The second key point is the importance of adaptation, or actions that individuals can take to mitigate the effects of temperature change,” he said. “Certain adaptations are available to most of the western world, like access to air conditioning, either at home or in public places. Nevertheless, my research shows that in the United States, adaptation helps reduce the mortality impact of exposure to extreme heat.”

As technologies and infrastructures improve around the world, he noted, options for adapting to and mitigating the effects of rising temperatures and changing climate will become available to many more people. “A key aspect of the future debates on the global health implication of climate change is the extent to which availability of these adaptation technologies becomes part of the overall development policy,” Deschênes said.

Amyloid fibrils in semen, shown here in red, enhance HIV infection by helping HIV — shown in green -- find and attach to its target, CD4 T white blood cells.

Breakthrough by Gladstone Institutes offers new hope in fight against global pandemic.

Scientists at the Gladstone Institutes have discovered new protein fragments in semen that enhance the ability of HIV, the virus that causes AIDS, to infect new cells—a discovery that one day could help curb the global spread of this deadly pathogen.

HIV/AIDS has killed more than 25 million people around the world since first being identified some 30 years ago. In the United States alone, more than one million people live with HIV/AIDS at an annual cost of $34 billion.

Previously, scientists in Germany discovered that HIV transmission is linked to the presence of an amyloid fibril in semen. This fibril—a small, positively charged structure derived from a larger protein—promotes HIV infection by helping the virus find and attach to its target: CD4 T white blood cells. In tomorrow’s issue of Cell Host & Microbe, researchers in the laboratory of Warner C. Greene, M.D., Ph.D., who directs virology and immunology research at Gladstone, describe a second type of fibril that also has this ability. Gladstone is affiliated with UC San Francisco.

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