TAG: "Innovation"

UCLA Medical Group, Cigna introduce Collaborative Care program


Affiliation will improve health care and lower costs.

By Roxanne Moster, UCLA

UCLA Medical Group and Cigna have launched a collaborative care initiative to improve patients’ access to health care, enhance care coordination and achieve the goals of improved health, affordability and patient experience.

“This new affiliation provides us with an important framework in our mission to provide accountable, better coordinated patient care,” said Dr. Samuel A. Skootsky, chief medical officer of the UCLA Faculty Practice and UCLA Medical Group. “UCLA Health System has developed an innovative model of primary care to improve care coordination and provide needed services for our patients, in addition to providing exemplary specialty care. This partnership allows us to take this enhanced approach to health care for Cigna’s PPO patient population — focusing on high-value, high-quality care that is truly patient-centered and puts patients first.”

The UCLA Medical Group comprises more than 1,200 physicians who are clinical faculty members at the David Geffen School of Medicine at UCLA. They provide primary and specialty medical care at over 100 ambulatory locations as well as at the Ronald Reagan UCLA Medical Center, Mattel Children’s Hospital UCLA, UCLA Medical Center–Santa Monica and the Resnick Neuropsychiatric Hospital at UCLA.

Under the program, UCLA physicians will monitor and coordinate all aspects of an individual’s medical care. Patients will continue to see their current physician and automatically receive the benefits of the program. Individuals who are enrolled in a Cigna health plan and later choose to seek care from a UCLA doctor also will have access to the benefits of the program. There are no changes in any plan requirements regarding referrals to specialists. Patients most likely to see the immediate benefits of the program are those who need help managing chronic conditions, such as diabetes, heart disease and obesity.

Cigna Collaborative Care is the company’s approach to accomplishing the same population health goals as accountable care organizations, or ACOs. The program, which began Jan. 1, will benefit more than 5,900 people covered by a Cigna health plan who receive care from more than 1,600 UCLA primary care doctors and specialists. Cigna now has seven collaborative care arrangements in California and 114 of them nationwide.

In places where it has been introduced, Cigna Collaborative Care is helping to improve the health of Cigna customers while effectively managing medical costs. The programs are helping to close gaps in care, such as missed health screenings or prescription refills, reinforcing the appropriate use of hospital emergency rooms, increasing the number of preventive health visits and improving follow-up care for people transitioning from the hospital to the home.

“Together our goal is to change the health care system from one that pays for the number or volume of services to one that places more emphasis on the quality and results of that care,” said Gene Rapisardi, president and general manager for Cigna in Southern California. “We believe this change will lead to better health, lower costs and increased satisfaction for both our customers and their doctors.”

Critical to the program’s benefits is a UCLA care coordination system based on in-office care coordinators and registered nurse clinical advisors, employed by UCLA, who will help patients navigate the health care delivery system. The care coordinators and clinical advisors are aligned with a team of Cigna case managers to ensure a high degree of collaboration between UCLA physicians and Cigna, which will ultimately provide a better experience for the individual.

The UCLA care coordinator team will enhance care by using patient-specific data from Cigna to help identify patients being discharged from the hospital who might be at risk for readmission, as well as patients who may be overdue for important health screenings or who may have skipped a prescription refill. The care coordinators are part of the physician-led care team that will help patients get the follow-up care or screenings they need.

Care coordinators can also help people schedule appointments, provide health education and refer patients to Cigna’s clinical support programs that may be available as part of their health plan, such as disease management programs for diabetes, heart disease and other conditions; and lifestyle management programs for quitting smoking or managing weight.

Cigna will compensate UCLA physicians for the medical and care coordination services they provide. Additionally, physicians may be rewarded through a “pay for value” structure for meeting targets for improving quality of care and lowering medical costs.

Cigna has been at the forefront of the accountable care organization movement since 2008 and now has 114 Cigna Collaborative Care arrangements with large physician groups that span 28 states, reach more than 1.2 million commercial customers and encompass more than 48,000 doctors, including more than 23,000 primary care physicians and more than 25,000 specialists.

Cigna Collaborative Care is one component of the company’s approach to physician engagement for health improvement, which also includes the innovative Cigna–HealthSpring care model for Medicare customers. Today, more than 1.5 million Cigna and Cigna–HealthSpring customers benefit from nearly 280 engaged physician relationships across 31 states, with more than 79,000 doctors participating, including more than 33,000 primary care physicians and more than 46,000 specialists.

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Temporary tattoo offers needle-free way to monitor glucose


‘Proof-of-concept’ tattoo could pave way for UC San Diego to explore others uses of device.

Nanoengineers at UC San Diego have tested a temporary tattoo that both extracts and measures the level of glucose in the fluid in between skin cells.

By Ioana Patringenaru

Nanoengineers at UC San Diego have tested a temporary tattoo that both extracts and measures the level of glucose in the fluid in between skin cells. This first-ever example of the flexible, easy-to-wear device could be a promising step forward in noninvasive glucose testing for patients with diabetes.

The sensor was developed and tested by graduate student Amay Bandodkar and colleagues in professor Joseph Wang’s laboratory at the NanoEngineering Department and the Center for Wearable Sensors at the Jacobs School of Engineering at UC San Diego. Bandodkar said this “proof-of-concept” tattoo could pave the way for the center to explore other uses of the device, such as detecting other important metabolites in the body or delivering medicines through the skin.

At the moment, the tattoo doesn’t provide the kind of numerical readout that a patient would need to monitor his or her own glucose. But this type of readout is being developed by electrical and computer engineering researchers in the Center for Wearable Sensors. “The readout instrument will also eventually have Bluetooth capabilities to send this information directly to the patient’s doctor in real-time or store data in the cloud,” said Bandodkar.

The research team is also working on ways to make the tattoo last longer while keeping its overall cost down, he noted. “Presently the tattoo sensor can easily survive for a day. These are extremely inexpensive — a few cents — and hence can be replaced without much financial burden on the patient.”

The center “envisions using these glucose tattoo sensors to continuously monitor glucose levels of large populations as a function of their dietary habits,” Bandodkar said. Data from this wider population could help researchers learn more about the causes and potential prevention of diabetes, which affects hundreds of millions of people and is one of the leading causes of death and disability worldwide.

People with diabetes often must test their glucose levels multiple times per day, using devices that use a tiny needle to extract a small blood sample from a fingertip. Patients who avoid this testing because they find it unpleasant or difficult to perform are at a higher risk for poor health, so researchers have been searching for less invasive ways to monitor glucose.

In their report in the journal Analytical Chemistry, Wang and his co-workers describe their flexible device, which consists of carefully patterned electrodes printed on temporary tattoo paper. A very mild electrical current applied to the skin for 10 minutes forces sodium ions in the fluid between skin cells to migrate toward the tattoo’s electrodes. These ions carry glucose molecules that are also found in the fluid. A sensor built into the tattoo then measures the strength of the electrical charge produced by the glucose to determine a person’s overall glucose levels.

“The concentration of glucose extracted by the non-invasive tattoo device is almost hundred times lower than the corresponding level in the human blood,” Bandodkar explained. “Thus we had to develop a highly sensitive glucose sensor that could detect such low levels of glucose with high selectivity.”

A similar device called GlucoWatch from Cygnus Inc. was marketed in 2002, but the device was discontinued because it caused skin irritation, the UC San Diego researchers note. Their proof-of-concept tattoo sensor avoids this irritation by using a lower electrical current to extract the glucose.

Wang and colleagues applied the tattoo to seven men and women between the ages of 20 and 40 with no history of diabetes. None of the volunteers reported feeling discomfort during the tattoo test, and only a few people reported feeling a mild tingling in the first 10 seconds of the test.

To test how well the tattoo picked up the spike in glucose levels after a meal, the volunteers ate a carb-rich meal of a sandwich and soda in the lab. The device performed just as well at detecting this glucose spike as a traditional finger-stick monitor.

The researchers say the device could be used to measure other important chemicals such as lactate, a metabolite analyzed in athletes to monitor their fitness. The tattoo might also someday be used to test how well a medication is working by monitoring certain protein products in the intercellular fluid, or to detect alcohol or illegal drug consumption.

Bandodkar was joined on the study by UC San Diego nanoengineers Wenzhao Jia, Ceren Yardımcı, Xuan Wang, Julian Ramirez and Wang, director of the Center for Wearable Sensors and SAIC Endowed Chair and distinguished professor in the NanoEngineering Department.

The publication is “Tattoo-Based Noninvasive Glucose Monitoring: A Proof-of-Concept Study,” published Dec. 12 in the journal Analytical Chemistry.

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Iron overload disease causes rapid growth of potentially deadly bacteria


Deficiency of the hormone hepcidin makes people vulnerable to Vibrio vulnificus.

By Amy Albin, UCLA

Every summer, the news reports on a bacterium called Vibrio vulnificusfound in warm saltwater that causes people to get sick, or die, after they eat raw tainted shellfish or when an open wound comes in contact with seawater.

People with a weakened immune system, chronic liver disease or iron overload disease are most at risk for severe illness. Vibrio vulnificus infections in high-risk individuals are fatal 50 percent of the time.

Now, researchers at UCLA have figured out why those with iron overload disease are so vulnerable. People with the common genetic iron overload disease called hereditary hemochromatosis have a deficiency of the iron-regulating hormone hepcidin and thus develop excess iron in their blood and tissue, providing prime growth conditions for Vibrio vulnificus.

The study also found that minihepcidin, a medicinal form of the hormone hepcidin that lowers iron levels in blood, could cure the infection by restricting bacterial growth.

The early findings were reported online today (Jan. 14) in the journal Cell Host and Microbe.

“This is the first time that the association of hepcidin deficiency and susceptibility to Vibrio vulnificus infection was tested,” said senior author Dr. Yonca Bulut, a clinical professor of pediatrics at Mattel Children’s Hospital at UCLA and a researcher with the UCLA Children’s Discovery and Innovation Institute. “The dramatic effectiveness of the new treatment, even after the infection was established, was impressive.”

To conduct the study, researchers compared the fatality of Vibrio vulnificus infection in healthy mice with mice that lacked hepcidin, modeling human hereditary hemochromatosis. The results showed that the infection was much more lethal in hepcidin-deficient mice because they could not decrease iron levels in the blood in response to infection, a process mediated by hepcidin in healthy mice.

Giving minihepcidin to susceptible hepcidin-deficient mice to lower the amount of iron in the blood prevented infection if the hormone was given before the Vibrio vulnificus was introduced. Additionally, mice given minihepcidin three hours after the bacterium was introduced were cured of any infection.

Hereditary hemochromatosis is a genetic disease that causes the body to absorb and store too much iron. It affects as many as 1 in every 200 people in the United States. Since it can take decades for the body to store damaging levels of iron, many people may not be aware that they have the disease until signs of the condition begin to appear later in life.

The co-directors of the UCLA Center for Iron Disorders, Dr. Tomas Ganz, a professor of medicine and pathology at the David Geffen School of Medicine at UCLA, and Elizabeta Nemeth, a professor of medicine at UCLA, led the invention of minihepcidins at UCLA. Minihepcidins are being developed for treatment of iron-overload disorders, such as hereditary hemochromatosis and Cooley’s anemia. The use of minihepcidin to treat potentially lethal infections is a possible new application.

“We found that hepcidin is required for resistance to a Vibrio vulnificus infection,” said the study’s lead author Joao Arezes, a visiting graduate student from the University of Porto in Portugal. “The development of the treatment tested in mouse models could reduce the high mortality rate of this disease.”

The next stage of research is to understand why Vibrio vulnificus bacteria become so lethal when iron levels are high, and to learn which other microbes respond similarly to excess iron.

The research was conducted at the UCLA Center for Iron Disorders.

Other study authors were Grace Jung, Victoria Gabayan, Erika Valore, Piotr Ruchala, Ganz and Nemeth, all of UCLA, and Paul Gulig of the University of Florida.

The study was funded by the UCLA Today’s and Tomorrow’s Children Fund, the UCLA Stein/Oppenheimer Endowment Award, the UCLA Children’s Discovery and Innovation Institute and the National Institutes of Health (grant R01 DK090554).

The Regents of the University of California is the owner of patents and patent applications directed at minihepcidins and methods of use thereof, which are managed by UCLA’s Office of Intellectual Property and Industry Sponsored Research. This intellectual property is licensed to Merganser Biotech, for which authors Ruchala, Ganz and Nemeth are scientific advisors and equity holders. Other disclosures are available in the manuscript.

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‘NanoVelcro,’ temperature control used to extract tumor cells from blood


System could allow doctors to detect, analyze cancer to tailor treatment for individuals.

The device, developed at UCLA, enables scientists to control the blood’s temperature — the way coffeehouses would with an espresso machine — to capture and release the cancer cells in optimal conditions. (Credit: Tseng Lab, UCLA)

By Shaun Mason, UCLA

An international group led by scientists at UCLA’s California NanoSystems Institute has developed a new method for effectively extracting and analyzing cancer cells circulating in patients’ blood.

Circulating tumor cells are cancer cells that break away from tumors and travel in the blood, looking for places in the body to start growing new tumors called metastases. Capturing these rare cells would allow doctors to detect and analyze the cancer so they could tailor treatment for individual patients.

In his laboratory at the UCLA California NanoSystems Institute, Hsian-Rong Tseng, a professor of molecular and medical pharmacology, used a device he invented to capture circulating tumor cells from blood samples.

The device, called the NanoVelcro Chip, is a postage-stamp–sized chip with nanowires that are 1,000 times thinner than a human hair and are coated with antibodies that recognize circulating tumor cells. When 2 milliliters of blood are run through the chip, the tumor cells stick to the nanowires like Velcro.

Capturing the tumor cells was just part of the battle, though. To analyze them, Tseng’s team needed to be able to separate the cells from the chip without damaging them.

In earlier experiments with NanoVelcro, the scientists used a technique called laser capture microdissection that was effective in removing individual cells from the chip without damaging them, but the method was time-consuming and labor intensive, and it required highly specialized equipment.

Now Tseng and his colleagues have developed a thermoresponsive NanoVelcro purification system, which enables them to raise and lower the temperature of the blood sample to capture (at 37 degrees Celsius) and release (at 4 degrees Celsius) circulating tumor cells at their optimal purity. Polymer brushes on the NanoVelcro’s nanowires respond to the temperature changes by altering their physical properties, allowing them to capture or release the cells.

Because it could make extracting the cancer cells much more efficient and cost-effective at a time in a patient’s life when information is needed as quickly as possible, Tseng said it is conceivable that the new system will replace laser capture microdissection as the standard protocol.

“With our new system, we can control the blood’s temperature — the way coffeehouses would with an espresso machine — to capture and then release the cancer cells in great purity, ” said Tseng, who is also a member of UCLA’s Jonsson Comprehensive Cancer Center. “We combined the thermoresponsive system with downstream mutational analysis to successfully monitor the disease evolution of a lung cancer patient. This shows the translational value of our device in managing non–small-cell lung cancer with underlying mutations.”

The study, which was published online by the journal ACS Nano, brought together an interdisciplinary team from the U.S., China, Taiwan and Japan. The research was supported by the National Institutes of Health, RIKEN (Japan), Academia Sinica (Taiwan), Sun Yat-sen University (China) and the National Natural Science Foundation of China.

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Project launched to promote innovations in emergency medical services


UC San Diego, Mount Sinai seek to foster better, more efficient delivery of care.

By Scott LaFee, UC San Diego

UC San Diego Health System, in collaboration with Mount Sinai Health System in New York City, announced today (Jan. 7) the launch of a new project entitled “Promoting Innovations in Emergency Medical Services.”

Supported by the National Highway Traffic Safety Administration, Office of Health Affairs, the Department of Homeland Security and the Department of Health & Human Services, the project will address how to better disseminate and implement innovative Emergency Medical Services (EMS) delivery models, while overcoming persistent regulatory, financial and technological barriers.

The effort, which will culminate with development of a national framework tool to provide guidance and foster better, more efficient delivery of health care within EMS across the country, is funded by a two-year, $225,000 federal grant.

Co-project directors are James Dunford Jr., M.D., professor emeritus at UC San Diego School of Medicine and EMS medical director for the city of San Diego, and Kevin Munjal, M.D., assistant professor of emergency medicine at the Icahn School of Medicine at Mount Sinai.

“Our hope is to engage with a diverse group of stakeholders to create a pathway for the widespread implementation of best practices and delivery system reforms in emergency medical services across the U.S.,” said Munjal.

Experts have long recognized that EMS could serve as a vital link in a coordinated health care system focused on population health management by helping identify and modify risk, assess and facilitate treatment of chronic conditions and improve coordination of care for acute complaints.

“This is a fantastic opportunity for EMS to merge imagination, sound medicine and health information technology to improve care and lower cost,” said Dunford. “Tomorrow’s innovations will likely improve domestic preparedness, increase patient access to care, decrease health care costs and improve community resilience.”

Dunford added that novel urban and rural EMS programs have begun filling gaps in systems of care. Terms such as “community paramedicine” and “mobile integrated health care” are being used to describe how the full clinical, operational and financial capacity of EMS could be harnessed.

As EMS agencies strive to innovate within the current infrastructure, noted Munjal, they face challenges from existing laws, regulations, even fixed mind-sets. He said the project team is aware of the delicate balance between enabling innovation while still protecting public health and safety through regulatory oversight and maintaining a statewide systems approach to the provision of emergency medical care. “State offices of EMS play a vital role in fostering innovation and will be vital stakeholders in this project,” said Munjal, “which seeks to develop model legal, regulatory and financial frameworks to assist and encourage state and local health systems to test new EMS delivery models.”

Key aspects of the project include:

  • Collection of input from EMS and community health care stakeholders from around the country.
  • Regional stakeholder meetings will be held in San Diego and New York in May 2015, with a focus on incorporating national input into overcoming local barriers to EMS innovation.
  • A national steering committee will be convened in Washington, D.C., in September 2015.
  • An iterative approach to drafting materials and soliciting feedback through in-person, telephonic and online encounters with stakeholder groups.
  • Creation of a National Framework Document that will be broadly representative and thoroughly vetted and will be used as a tool to provide a useful pathway to harness the full potential of EMS.

For more information, visit www.emsinnovations.org.

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UCSF neuroscientist wins Russ Prize, bioengineering’s highest honor


Michael Merzenich lauded for contributions to cochlear implants for the deaf.

Michael Merzenich, UC San Francisco

By Pete Farley, UC San Francisco

Ohio University and the National Academy of Engineering (NAE) announced today (Jan. 7) that UC San Francisco neuroscientist Michael M. Merzenich, Ph.D., is a winner of the 2015 Fritz J. and Dolores H. Russ Prize, the bioengineering profession’s highest honor. Merzenich shares the prize with four other scientists for their fundamental contributions to the development of cochlear implants, electrical devices that enable the deaf to hear.

The cochlear implant is the most-used neural prosthesis developed to date; more than 320,000 hearing-impaired people have received implants in one or both ears.

“This year’s Russ Prize recipients personify how engineering transforms the health and happiness of people across the globe,” said NAE President C.D. Mote Jr. “The creators of the cochlear implant have improved remarkably the lives of people everywhere who are hearing impaired.”

Cochlear implants are electronic devices that allow people with severe to profound sensorineural hearing loss to hear sounds. In such implants, an externally worn audio processor detects sounds and encodes them into electrical signals that are transmitted to small, surgically implanted components that directly simulate the auditory nerve. The auditory nerve sends the signals to the brain, where they are interpreted as sounds.

Merzenich, professor emeritus of otolaryngology at UCSF, established some of the neurophysiological underpinnings of present cochlear implant designs beginning in the early 1970s. In collaboration with two UCSF colleagues, the late Robin P. Michelson, M.D., and Robert A. Schindler, M.D., professor emeritus of otolaryngology, Merzenich later conducted one of the first clinical trials of multichannel cochlear implants. These trials paved the way for the eventual commercialization of UCSF-designed devices in the late 1980s by Advanced Bionics, still one of the world’s leading manufacturers of cochlear implants.

Merzenich shares the Russ Prize with Blake S. Wilson, adjunct professor of biomedical engineering, electrical and computer engineering, and surgery at Duke University and co-director of the Duke Hearing Center; Graeme M. Clark, Ph.D., Foundation Professor of Otolaryngology at the University of Melbourne, Australia; Erwin Hochmair, DTech, professor emeritus in the Institute for Ion Physics and Applied Physics at the University of Innsbruck, Austria; and Ingeborg Hochmair-Desoyer, Ph.D., professor of biomedical engineering at the Technical University of Vienna, Austria.

“I am very, very pleased that the cochlear implant has been recognized as a significant advancement that contributes positively to the quality of life of those with hearing impairment,” said Dennis Irwin, Ph.D., dean of Ohio University’s Russ College of Engineering and Technology. “I have had the privilege of knowing and working with several individuals with profound hearing loss throughout my early life and later career, and I witnessed the difficulty several of them faced in athletic pursuits, education and their careers.”

Created by Ohio University alumnus Fritz Russ, a 1942 electrical engineering graduate, and his wife, Dolores, the Russ Prize, which carries a $500,000 award, recognizes a bioengineering achievement that has significantly improved the human condition. Awarded biennially by the NAE, the prize recognizes bioengineering achievements worldwide that are in widespread use and have improved the human condition. Previous recipients include the inventors of the implantable heart pacemaker, kidney dialysis, the automated DNA sequencer and the technology enabling LASIK and PRK eye surgeries.

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Lens-free microscope can detect cancer at cellular level


UCLA researchers develop device that can do the work of pathology lab microscopes.

Tissue sample image created by a new lens-free microscope developed in the UCLA lab of Aydogan Ozcan. (Image by Aydogan Ozcan, UCLA)

By Bill Kisliuk, UCLA

UCLA researchers have developed a lens-free microscope that can be used to detect the presence of cancer or other cell-level abnormalities with the same accuracy as larger and more expensive optical microscopes.

The invention could lead to less expensive and more portable technology for performing common examinations of tissue, blood and other biomedical specimens. It may prove especially useful in remote areas and in cases where large numbers of samples need to be examined quickly.

The microscope is the latest in a series of computational imaging and diagnostic devices developed in the lab of Aydogan Ozcan, the Chancellor’s Professor of Electrical Engineering and Bioengineering at the UCLA Henry Samueli School of Engineering and Applied Science and a Howard Hughes Medical Institute professor. Ozcan’s lab has previously developed custom-designed smartphone attachments and apps that enable quick analysis of food samples for allergens, water samples for heavy metals and bacteria, cell counts in blood samples, and the use of Google Glass to process the results of medical diagnostic tests.

The latest invention is the first lens-free microscope that can be used for high-throughput 3-D tissue imaging — an important need in the study of disease.

“This is a milestone in the work we’ve been doing,” said Ozcan, who also is the associate director of UCLA’s California NanoSystems Institute. “This is the first time tissue samples have been imaged in 3-D using a lens-free on-chip microscope.”

The research is the cover article today (Dec. 17) in Science Translational Medicine, which is published by the American Association for the Advancement of Science.

The device works by using a laser or light-emitting-diode to illuminate a tissue or blood sample that has been placed on a slide and inserted into the device. A sensor array on a microchip — the same type of chip that is used in digital cameras, including cellphone cameras — captures and records the pattern of shadows created by the sample.

The device processes these patterns as a series of holograms, forming 3-D images of the specimen and giving medical personnel a virtual depth-of-field view. An algorithm color codes the reconstructed images, making the contrasts in the samples more apparent than they would be in the holograms and making any abnormalities easier to detect.

Ozcan’s team tested the device using Pap smears that indicated cervical cancer, tissue specimens containing cancerous breast cells, and blood samples containing sickle cell anemia. In a blind test, a board-certified pathologist analyzed sets of specimen images that had been created by the lens-free technology and by conventional microscopes. The pathologist’s diagnoses using the lens-free microscopic images proved accurate 99 percent of the time.

Another benefit of the lens-free device is that it produces images that are several hundred times larger in area, or field of view, than those captured by conventional bright-field optical microscopes, which makes it possible to process specimens more quickly.

“While mobile health care has expanded rapidly with the growth of consumer electronics — cellphones in particular — pathology is still, by and large, constrained to advanced clinical laboratory settings,” Ozcan said. “Accompanied by advances in its graphical user interface, this platform could scale up for use in clinical, biomedical, scientific, educational and citizen-science applications, among others.”

In addition to Ozcan, the principal authors of the research were Alon Greenbaum, a UCLA Engineering graduate student and a research fellow at HHMI, and Yibo Zhang, a UCLA Engineering graduate student. Other authors were UCLA Engineering graduate student Wei Luo, undergraduate researchers Alborz Feizi and Ping-Luen Chung, and Dr. Shivani Kandukuri of the department of pathology and laboratory medicine at the David Geffen School of Medicine at UCLA.

The research was supported by the Presidential Early Career Award for Scientists and Engineers, the National Science Foundation, the National Institutes of Health, the Army Research Office, the Office of Naval Research and the Howard Hughes Medical Institute.

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8 top trends in health and science in 2015


From hacking the brain to diagnosing diseases through DNA.

With advances in technology and better understanding of people, the health sciences are constantly pushing toward more effective treatments and cures. The question is, where will we see the next breakthroughs?

Experts across UC San Francisco were asked to identify what’s ahead in key areas from basic science to digital health, from aging research to cancer treatments, from approaches in the lab to access at the hospital.

Here are some of the hottest areas in health and science to look out for in 2015:

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Related link:
2014: The year in review at UCSF

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A sense for biosensors


UC Irvine’s Weian Zhao has created a device that improves detection of bacterial, viral invaders in blood samples.

The Integrated Comprehensive Droplet Digital Detection system invented by Weian Zhao of UC Irvine converts blood samples directly into billions of very small droplets. (Photo by Steve Zylius, UC Irvine)

By Tom Vasich, UC Irvine

As a doctoral student at McMaster University in Hamilton, Ontario, Weian Zhao took part in a Canada-wide research effort to develop bioactive paper that would detect, capture and deactivate waterborne and airborne pathogens.

As part of this project, he helped invent gold nanoparticle-coated paper that could detect common pathogens, such as E. coli, but ultimately, the product didn’t meet his exacting standards of diagnostic speed and sensitivity. With a freshly minted Ph.D. in chemistry, Zhao moved on to a joint postdoctoral fellowship at both the Massachusetts Institute of Technology and Harvard, where he dove into stem cell research, his biosensor work seemingly left north of the border.

But the challenge of creating a technology that could rapidly and selectively identify bacterial and viral invaders in blood samples nagged at the young scientist, even as he joined UC Irvine in 2011 as an assistant professor of pharmaceutical sciences with state-of-the-art lab space in the Sue & Bill Gross Stem Cell Research Center.

And then he met Enrico Gratton. In his Laboratory for Fluorescence Dynamics, the UCI biomedical engineer and colleagues have been developing imaging tools for biomedical applications. Among them is a three-dimensional particle counter that tags low-concentration fluorescent particles in large volumes of solution within several minutes, which drew Zhao’s attention. He knew he was back in the biosensor game.

Employing this particle counter, Zhao created a bloodstream infection test that speeds up diagnosis times with unprecedented accuracy – allowing physicians to treat patients with potentially deadly ailments more promptly and effectively.

Zhao says that the Integrated Comprehensive Droplet Digital Detection system can, in as little as 90 minutes, detect bacteria in milliliters of blood with single-cell sensitivity; no cell culture is needed. He published his latest results in the November issue of Nature Communications.

“We are extremely excited about this technology because it addresses a long-standing unmet medical need in the field,” says Zhao, who also holds a faculty appointment in biomedical engineering. “As a platform technology, it may have many applications in detecting extremely low-abundance biomarkers in other areas, such as cancers, HIV and, most notably, Ebola.”

Bloodstream infections are a major cause of illness and death. In particular, infections associated with antimicrobial-resistant pathogens are a growing health problem in the U.S. and worldwide. According to the Centers for Disease Control & Prevention, more than 2 million people a year globally get antibiotic-resistant blood infections, with about 23,000 deaths. The high mortality rate for blood infections is due, in part, to the inability to rapidly diagnose and treat patients in the early stages.

Recent molecular diagnosis methods, including polymerase chain reaction, can reduce the assay time to hours but are often not sensitive enough to detect bacteria that occur at low concentrations in blood, as is common in patients with incipient blood infections.

The Integrated Comprehensive Droplet Digital Detection technology differs from other diagnostic techniques in that it converts blood samples directly into billions of very small droplets. Fluorescent DNA sensor solution infused into the droplets detects those with bacterial markers, lighting them up with an intense fluorescent signal. Zhao says that separating the samples into so many small drops minimizes the interference of other components in blood, making it possible to directly identify target bacteria without the purification typically required in conventional assays.

“The IC 3D instrument is designed to read a large volume in each measurement, to speed up diagnosis,” Gratton says. “Importantly, using this technique, we can detect a positive hit from hundreds of millions of measurement samples with very high confidence.”

But invention was only the first step. Zhao wants to commercialize IC 3D. At UCI, faculty researchers with an entrepreneurial bent can work with the Institute for Innovation, an interdisciplinary and campuswide center focused on integrating research, entrepreneurship and technology to create real-world applications that benefit the public and drive the economy. The Office of Technology Alliances, part of the institute, helped Zhao patent-protect the IC 3D technology and establish a spin-off company, Velox Biosystems, to test and manufacture a commercial IC 3D device.

Currently, Zhao is focusing on applying IC 3D to cancer treatments – an extension of the research he’s been advancing since joining UCI.

Zhao has been developing stem cell messengers that selectively migrate to cancer sites to deliver tumor-fighting drugs or probes for contrast-enhanced medical imaging. This could, potentially, enable the identification of cancer micro-metastases at their early stages and increase the effectiveness of chemotherapeutic treatments for metastatic cancer while mitigating the symptoms associated with systemic chemotherapy.

For this work, Zhao was included in the MIT Technology Review’s 2012 list of the world’s top innovators under the age of 35, and this year he earned a prestigious National Institutes of Health Director’s New Innovator Award to further his efforts to create stem cell-based detection methods and treatments for cancer.

He’s also collaborating with Dr. Jason Zell, an assistant professor of medicine and co-leader of the Colon Cancer Disease-Oriented Team at UCI’s Chao Family Comprehensive Cancer Center, to use IC 3D to identify biomarkers in colon cancers. This could enable oncologists to gauge the effectiveness of treatment during the cancer’s early stages more accurately than with current methods, which Zell says are not reliable.

Zhao is now seeking business partners to accelerate Velox Biosystems’ growth and hopes to conduct clinical studies of IC 3D’s utility in patient diagnosis and treatment.

“That’s what’s so important about this project,” he says. “We’ve created a multi-platform tool that has the potential to work with a variety of infections and diseases. I’m very excited about its future.”

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Organic electronics could lead to cheap, wearable medical sensors


UC Berkeley engineers developing new organic optoelectronic sensor.

UC Berkeley engineers have created a pulse oximeter sensor composed of all-organic optoelectronics that uses red and green light. The red and green organic light-emitting diodes (OLED) are detected by the organic photodiode (OPD). The device measures arterial oxygen saturation and heart rate as accurately as conventional, silicon-based pulse oximeters. (Image by Yasser Khan)

By Sarah Yang, UC Berkeley

Future fitness trackers could soon add blood-oxygen levels to the list of vital signs measured with new technology developed by engineers at UC Berkeley.

“There are various pulse oximeters already on the market that measure pulse rate and blood-oxygen saturation levels, but those devices use rigid conventional electronics, and they are usually fixed to the fingers or earlobe,” said Ana Arias, an associate professor of electrical engineering and computer sciences and head of the UC Berkeley team that is developing a new organic optoelectronic sensor.

By switching from silicon to an organic, or carbon-based, design, the researchers were able to create a device that could ultimately be thin, cheap and flexible enough to be slapped on like a Band-Aid during that jog around the track or hike up the hill.

The engineers put the new prototype up against a conventional pulse oximeter and found that the pulse and oxygen readings were just as accurate.

The research team reported its findings today ( Dec. 10) in the journal Nature Communications.

Giving silicon a run for its money

A conventional pulse oximeter typically uses light-emitting diodes (LEDs) to send red and infrared light through a fingertip or earlobe. Sensors detect how much light makes it through to the other side. Bright, oxygen-rich blood absorbs more infrared light, while the darker hues of oxygen-poor blood absorb more red light. The ratio of the two wavelengths reveals how much oxygen is in the blood.

For the organic sensors, Arias and her team of graduate students – Claire Lochner, Yasser Khan and Adrien Pierre – used red and green light, which yield comparable differences to red and infrared when it comes to distinguishing high and low levels of oxygen in the blood.

Using a solution-based processing system, the researchers deposited the green and red organic LEDs and the translucent light detectors onto a flexible piece of plastic. By detecting the pattern of fresh arterial blood flow, the device can calculate a pulse.

“We showed that if you take measurements with different wavelengths, it works, and if you use unconventional semiconductors, it works,” said Arias. “Because organic electronics are flexible, they can easily conform to the body.”

Arias added that because the components of conventional oximeters are relatively expensive, health care providers will choose to disinfect them if they become contaminated. In contrast, “organic electronics are cheap enough that they are disposable like a Band-Aid after use,” she said.

The National Science Foundation and Flextech helped support this research.

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UCSF nursing expands palliative care training


Nursing school starts palliative care minor for advanced practice nursing students.

UCSF School of Nursing professor DorAnne Donesky works with a patient, teaching her to exercise safely without overtaxing her lungs. (Photo by Elisabeth Fall)

By Kathleen Masterson, UC San Francisco

People who live with serious chronic illness often bounce in and out of the hospital, struggle to get the treatment they need and overall experience a poor quality of life.

Now, increasing research is supporting what many health care providers have long known: comprehensive palliative care that treats both symptoms and a person’s emotional needs can significantly improve a patient’s daily life – and in many cases prolong life, too.

These known successes are a big part of why the UCSF School of Nursing started a new palliative care minor for advanced practice nursing students.

The recent push also came from both hospitals looking to hire and nursing students who asked for more palliative care training, said DorAnne Donesky, Ph.D., ANP-BC, a nursing professor who spearheaded the creation of the minor with palliative care physician Wendy Anderson, M.S., M.D.

“Employers also came to us saying, ‘We’re hiring lots of palliative care providers and new graduates who are coming to us are not well prepared,’” said Donesky. Hospital hiring teams told Donesky that they would hire nurses specifically trained in palliative care first if they were choosing between multiple job candidates.

Donesky has seen the benefits of palliative care firsthand with her patients who have chronic lung and heart conditions.

She recalls one patient diagnosed with Chronic Obstructive Pulmonary Disease and heart failure whose doctors gave her a few months to live. The patient was put on hospice, given medication and nonpharmacologic strategies for symptom control and trained with breathing techniques. With this simple but attentive care, she “graduated” from hospice and a year later she’s medically stable, enjoying her family, home and daily gym exercise.

Meeting a growing need

The UCSF palliative care minor is designed to match the national competencies for palliative care so students can take the certification exam.  The minor includes two base courses and an elective, and Donesky also works with students to get them a clinical placement with a palliative care faculty mentor.  For certification students need 500 hours of practice, which they begin to accumulate during the minor.

Palliative care focuses on treating the whole patient with the goal of improving quality of life by addressing everything from symptoms to emotions to family members’ concerns. Research has shown that palliative care improves patients’ symptoms, including pain and depression. And some data suggest that compared to regular care, it prolongs life.

“People are realizing that symptom management and quality of life are really important, separate aspects of care,” said Donesky.

In addition to offering patients standard medications for pain and symptoms, palliative care nurses also teach patients non-pharmaceutical approaches to managing their own health. Donesky said her patients with lung illnesses benefit from learning simple breathing techniques and incorporating exercise into their daily routines. These successes aren’t only good for the patient, it also helps to avoid unnecessary and costly emergency department visits and lengthy hospital stays. While this coordinated care relies on a team of health care providers, in most cases it’s more efficient and more cost effective.

“Palliative care is a team sport,” said Donesky; the core team typically includes a nurse, a physician, a chaplain and a social worker, but varies depending on a patient’s needs. Together these providers work to give patients back some control over their health by training them with techniques to manage pain and self care.   

Donesky said when people hear palliative care, many think of the dying.  While hospice does provide palliative care for end of life patients, palliative care as a whole is really about creating the best quality of life for patients with acute or chronic illnesses or cancer that can be managed, sometimes for years or decades.

Treating the emotional side, too

Oftentimes a big part of treatment is helping patients cope with the emotional distress that their diagnosis brings up.

“A lot of patients are in distress related to relationships that have not been mended, or thinking about where their place is in the world, will their life have meaning, what will be their legacy after they’re gone. Those more spiritual issues are also addressed in palliative care,” said Donesky.

That’s why a big focus of the UCSF palliative care minor is communication skills, from difficult conversations with patients’ families to addressing a patient’s emotional concerns.

Donesky has an extensive background in navigating these kinds of health care communications, including ongoing training with VitalTalk, a highly respected training program that developed out of NIH-funded research. She’s incorporating these techniques in teaching her students.

“As clinicians, it’s scary to talk about these topics, we might be afraid we’re going to open a can of worms,” said Donesky. “But if instead of resisting, we jump in, and say, ‘I suspect you’re having concern with: fill in the blank.’ Often, it just opens the floodgates, and it doesn’t take that long to solve it.”

Donesky said employers specifically want to hire nurses who have advanced training in managing and negotiating these kinds of conversations.

UCSF nursing master’s student Julia Itsikson agrees.

“I believe communication is a cornerstone of this whole program,” Itsikson said. “This is really the bottom line, how do you approach sensitive topics at critical pivotal moment of somebody’s life — it’s not easy.”

Itsikson was accepted into the palliative care minor, which just began this quarter. In addition to coursework, Itsikson is doing clinical work at Laguna Honda Hospital and Rehabilitation Center, where there’s an entire unit that focuses on palliative care.

Itsikson said learning firsthand from an experienced nurse has been invaluable: “I watch my preceptor and it just blows me away every time; the words she finds, her mannerism, her tone of voice – all of this is so critical and important.”

Donesky said as the palliative care minor becomes more established, she’d like to create a multidisciplinary continuing education training that would be open to all kinds of health care providers, including nurses, social workers, chaplains, pharmacists, physical therapists and dentists.

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UC names special advisor on innovation, entrepreneurship


Regis Kelly also will continue to direct operations at QB3.

Regis Kelly

The University of California has announced that Regis Kelly began his tenure on Dec. 1 as special advisor on innovation and entrepreneurship to UC President Janet Napolitano.

As special advisor to Napolitano, Kelly will promote and support innovation and entrepreneurship across the UC system, working closely with leaders at the university’s campuses, medical centers and national laboratories. Kelly also will develop external partnerships that drive long-term revenue for the university and maximize the public benefit of UC innovations.

Kelly’s work also will complement UC Ventures, a recently announced $250 million fund that will invest in technologies emerging from the university’s 10 campuses and three national laboratories. UC Ventures uses no state or tuition funds.

“Working throughout the UC system to recognize and nurture innovation is an exciting and ambitious endeavor,” Kelly said. “Entrepreneurship can serve the public interest in many ways. I’m committed to identifying more opportunities to convert UC discoveries into services or products that can benefit California and the world, while creating value and jobs along the way.”

“I am thrilled that Regis is now part of our systemwide efforts to better capture the economic value UC students and faculty create through their pioneering research,” said Napolitano. “The University of California is the best public research university in the world. Now, we aim to maximize the public impact brought about by innovation and entrepreneurship fostered in our classrooms and laboratories.”

Kelly, a professor emeritus of biochemistry and biophysics and a former executive vice chancellor at UC San Francisco, has served since 2004 as director of QB3, one of the four Gov. Gray Davis Institutes for Science and Innovation created by the University of California. He will continue to direct operations at QB3 while taking on his new position.

Kelly oversaw the 2006 launch of the first technology incubator at UC and the subsequent proliferation of incubator spaces including QB3@953, a San Francisco operation now supporting 45 early-stage life science companies. He also is a general partner in QB3’s venture fund, Mission Bay Capital, for which he receives no compensation.

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