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For America's Aged, Surgery At Any Price?
When doctors decide whether or not to go ahead with an expensive surgery, "age is no longer the deciding factor, even for invasive treatment such as open-heart surgery," The Philadelphia Inquirer reports. One question is "whether this never-too-old approach is an example of U.S. medical progress, or an example of why Medicare -- federal health insurance for people over 64 -- is headed for insolvency. The answer, experts say, is both. Which is why the current debate over expanding federal coverage to all uninsured Americans is an ethical and economic minefield. "Forty years ago, it was taken for granted that the elderly were not good candidates for organ transplantation, dialysis, or advanced surgical procedures. That has changed," Daniel Callahan, cofounder of the Hastings Center, a bioethics research institute in Garrison, N.Y., wrote recently. "Under the best of circumstances, age should be irrelevant in the Medicare program. But so far, the cost of care has not been considered, and it can hardly remain irrelevant in a program strapped for money.""
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Orthopaedists On A Humanitarian Mission: Sustained Help For Developing Countries
"Flying into a developing country, operating on people for a few days or weeks and flying out again helps individual persons but has nothing to do with sustainable development work." Professor Martin Salzer, Vice-president of "Austrian Doctors for Disabled" -- the Austrian society for medical development assistance -- is convinced that "it makes even less sense to fly in people from such countries for difficult operations, as humanitarian the motive may be. That money can be invested more effectively." For the group of physicians and medically interested persons around Prof. Salzer it is a question of sustainability in the field of development cooperation, something to which they can contribute their medical experience. "After care for the disability or sickness, our concern is networked interdisciplinary and sustainable rehabilitation. We also hope to thereby make a contribution toward combating poverty" Prof. Salzer says in summing up the main concern of the organization.
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PLC Medical Systems Announces Publication Of Care Study Update
PLC Systems Inc. (OTC Bulletin Board: PLCSF), a company focused on innovative cardiac and vascular medical device-based technologies, announced that a follow-up study of the landmark Cardiac Angiography in Renally Impaired Patients (CARE) Study determined that Contrast-Induced Nephropathy (CIN) is associated with long-term adverse events, ranging from pulmonary edema to death, and that patients with CIN were twice as likely as those who did not develop CIN to experience adverse events.
Diagnostics

UC Berkeley Researchers Bring Fluorescent Imaging To Mobile Phones For Low-cost Screening In The Field

Researchers at the University of California, Berkeley, are proving that a camera phone can capture far more than photos of people or pets at play. They have now developed a cell phone microscope, or CellScope, that not only takes color images of malaria parasites, but of tuberculosis bacteria labeled with fluorescent markers. The prototype CellScope, described in the July 22 issue of the peer-reviewed, online journal PLoS ONE, moves a major step forward in taking clinical microscopy out of specialized laboratories into field settings for disease screening and diagnoses. "The same regions of the world that lack access to adequate health facilities are, paradoxically, well-served by mobile phone networks," said Dan Fletcher, UC Berkeley associate professor of bioengineering and head of the research team developing the CellScope. "We can take advantage of these mobile networks to bring low-cost, easy-to-use lab equipment out to more remote settings." The engineers attached compact microscope lenses to a holder fitted to a cell phone. Using samples of infected blood and sputum, the researchers were able to use the camera phone to capture bright field images of Plasmodium falciparum, the parasite that causes malaria in humans, and sickle-shaped red blood cells. They were also able to take fluorescent images of Mycobacterium tuberculosis, the bacterial culprit that causes TB in humans. Moreover, the researchers showed that the TB bacteria could be automatically counted using image analysis software. "The images can either be analyzed on site or wirelessly transmitted to clinical centers for remote diagnosis," said David Breslauer, co-lead author of the study and a graduate student in the UC San Francisco/UC Berkeley Bioengineering Graduate Group. "The system could be used to help provide early warning of outbreaks by shortening the time needed to screen, diagnose and treat infectious diseases." The engineers had previously shown that a portable microscope mounted on a mobile phone could be used for bright field microscopy, which uses simple white light - such as from a bulb or sunlight - to illuminate samples. The latest development adds to the repertoire fluorescent microscopy, in which a special dye emits a specific fluorescent wavelength to tag a target - such as a parasite, bacteria or cell - in the sample. "Fluorescence microscopy requires more equipment - such as filters and special lighting - than a standard light microscope, which makes them more expensive," said Fletcher. "In this paper we"ve shown that the whole fluorescence system can be constructed on a cell phone using the existing camera and relatively inexpensive components." The researchers used filters to block out background light and to restrict the light , a simple light-emitting diode (LED), to the 460 nanometer wavelength necessary to excite the green fluorescent dye in the TB-infected blood. Using an off-the-shelf phone with a 3.2 megapixel camera, they were able to achieve a spatial resolution of 1.2 micrometers. In comparison, a human red blood cell is about 7 micrometers in diameter. "LEDs are dramatically more powerful now than they were just a few years ago, and they are only getting better and cheaper," said Fletcher. "We had to disabuse ourselves of the notion that we needed to spend many thousands on a mercury arc lamp and high-sensitivity camera to get a meaningful image. We found that a high-powered LED - which retails for just a few dollars - coupled with a typical camera phone could produce a clinical quality image sufficient for our goal of detecting in a field setting some of the most common diseases in the developing world." The researchers pointed out that while fluorescent microscopes include additional parts, less training is needed to interpret fluorescent images. Instead of sorting out pathogens from normal cells in the images from standard light microscopes, health workers simply need to look for something the right size and shape to light up on the screen. "Viewing fluorescent images is a bit like looking at stars at night," said Breslauer. "The bright green fluorescent light stands out clearly from the dark background. It"s this contrast in fluorescent imaging that allowed us to use standard computer algorithms to analyze the sample containing TB bacteria." Breslauer added that these software programs can be easily installed onto a typical cell phone, turning the mobile phone into a self-contained field lab and a "good platform for epidemiological monitoring." While the CellScope is particularly valuable in re-poor countries, Fletcher noted that it may have a place in this country"s health care system, famously plagued with cost overruns. "A CellScope device with fluorescence could potentially be used by patients undergoing chemotherapy who need to get regular blood counts," said Fletcher. "The patient could transmit from home the image or analyzed data to a health care professional, reducing the number of clinic visits necessary." The CellScope developers have even been approached by experts in agriculture interested in using it to help diagnose diseases in crops. Instead of sending in a leaf sample to a lab for diagnosis, farmers could upload an image of the diseased leaf for analysis. The researchers are currently developing more robust prototypes of the CellScope in preparation for further field testing. Other researchers on the team include Robi Maamari, a UC Berkeley research associate in bioengineering and co-lead author of the study; Neil Switz, a graduate student in UC Berkeley"s Biophysics Graduate Group; and Wilbur Lam, a UC Berkeley post-doctoral fellow in bioengineering and a UCSF pediatric hematologist. Funding Statement: Funding for the CellScope project comes from the Center for Information Technology Research in the Interest of Society (CITRIS) and the Blum Center for Developing Economies, both at UC Berkeley, and from Microsoft Research, Intel and the Vodafone Americas Foundation. Competing Interests: The authors are co-inventors on a patent application filed by the University of California, Berkeley on the technology described in this manuscript. Citation: "Mobile Phone Based Clinical Microscopy for Global Health Applications." Breslauer DN, Maamari RN, Switz NA, Lam WA, Fletcher DA (2009) PLoS ONE 4(7):e6320. doi:10.1371/journal.pone.0006320 PLoS ONE


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