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IBM and Aetna's ActiveHealth Management subsidiary have unveiled a new clinical information management system based on cloud computing architecture. The Collaborative Care Solution, as the product is called, aims to bring together information from disparate sources like "electronic medical records, claims, medication and lab data" for easy access by any relevant party during a patient's clinical regimen. Additionally, the system features ActiveHealth's evidence-based clinical decision support CareEngine which can signal to clinicians when suspected abnormalities creep up in the data. Some details from IBM: With all healthcare data and IT resources managed in a cloud environment, the system will enable the coordination of patient care among teams, so doctors, nurses, nurse practitioners, aides, therapists and pharmacists can easily access, share and address information about patients from a single source. The solution can also show trends in how patients are responding, for example, to treatment for chronic asthma or adhering to drug regimens and automatically alert doctors to conflicting or missed prescriptions. For one fixed monthly fee, healthcare organizations have access to all the tools and services without having to make significant upfront investments – avoiding the challenge of updating systems when clinical guidelines or reporting requirements change or when patient loads grow. Additionally, the solution provides advanced analytics that help physicians or entire healthcare organizations measure their performance against national or hospital quality standards. Press release: ActiveHealth and IBM Pioneer Cloud Computing Approach to Help Doctors Deliver High Quality, Cost Effective Patient Care...... Michael

By DAVID ERICKSON, Federal Reserve Bank of San Francisco and JAMES S. MARKS, Robert Wood Johnson Foundation We all have a vision of the “Main Street” we would like to live near – tree-lined, friendly and safe. But our “Main...

Microsulis Medical Limited out of Denmead, England has received FDA 510(k) clearance to bring to the US the company's Acculis Accu2i percutaneous microwave tissue ablation (pMTA) system. The applicator is administered via a 1.8 mm puncture of the skin to deliver microwave energy at 2.45 GHz for coagulation of soft tissue during endoscopic procedures. Features from the product brochure: Product • 1.8mm shaft, ceramic trocar cutting tip • Internally cooled • 14cm and 27cm shaft lengths • 2m cable reach (cooled cable) • 2.45GHz operating frequency • Generator powers from 30W to 180W • Ablation time 0 - 6 minutes (per use) • Multiple use per patient Performance • Up to 5.6cm coagulation zone in 6 minutes at 180W based on ex-vivo tests (nb in-vivo performance may be greater) • Scaleable near spherical coagulation zones • Power and time controls for coagulation rate and size • Real time visualisation with IOUS / CT Technical • 1.4cm emitting tip length • Integrated coolant and microwave supply cable • High pressure manifold handle with coolant visualisation • Closed loop sterile saline coolant • Independent tissue temperature measurement probes Press release: Microsulis Medical Limited Receives FDA 510(k) Clearance of Accu2i Percutaneous Microwave Tissue Ablation Device... Product page: pMTA ...... Michael

Revolutions Medical out of Charleston, South Carolina has developed an image processing technology that brings a bit of color to MRI images. Color MRI uses proprietary algorithms to segment and colorize regions of the scan to hopefully make the images more readable, and the firm has partnered with the Philadelphia College of Osteopathic Medicine to apply the technology to differentiation and characterization of intracranial hemorrhages and characterization of intracranial masses From the product page: The technology consists of software, which uses various color masks to produce full-color composite images from gray-scale MRI output. The resulting color images can be quickly viewed individually or all together as a “riffle stack”. A riffle stack consists of the individual MRI images assembled to create a single composite image that contains the data from the individual images. The riffle stack allows a radiologist, using a computer mouse, to page through the images, creating a 3-D appreciation of the colorized MRI output even though the images themselves are not 3-D. The software program can also segment the data and create a true 3-D image of the area to be examined. For instance, bone, fluid and other tissue displayed in an MRI scan of the head can be electronically eliminated to allow a 3-D rendering of just the brain. Press release: Revolutions Medical Corporation Begins Clinical Applications and Validation Process of Its MRI Software Tools... Product page: Rev ColorMRI...... Michael

Diamond-like carbon (DLC) coatings are commonly used in medical implants to greatly improve their resistance to environmental factors. Though impressively strong and impermeable, DLC will often break off from the implants to become a nuisance within the body. Now scientists at Empa, a Swiss research institution, have discovered why that happens and what can be done to prevent the chipping. "When two materials are placed in contact with each other, the result is a reaction layer at the interface between them, which is only several atomic layers thick. Thus a new material is formed, which we investigated now for the first time", explains Roland Hauert of Empa's "Nanoscale Materials Science" laboratory. His team showed that the so far barely considered reaction layer, which is not always completely corrosion resistant, is responsible for the detachment of the DLC layer. On the one hand, stress corrosion cracking occurred in the reaction layer. The mechanical load in conjunction with the penetration of body fluids led to slow-growing cracks, which in turn caused the DLC substrate to detach little by little. In other cases, crevice corrosion was responsible for the damage. Over time, an aggressive, acidic medium develops in fine crevices and slowly dissolves the reaction layer or the additional adhesive layer, likewise leading to detachment. But the Empa team didn't stop there; together with their industry partners Synthes and Ionbond, they developed a corrosion-resistant intermediate layer at the interface to the DLC layer. What's more, the researchers also developed a process that can determine a crack's growth rate under conditions similar to those experienced in the human body as well as the dissolution rate of the reaction layer in cases of crevice corrosion. Full story from Empa: Nanocorrosion causes implants to fail...... Michael

Scientists from Case Western Reserve and Vanderbilt universities are reporting a surprising finding that lasers can be used to pace the contractions of embryonic quail hearts. It has been reported previously that light can excite cardiac tissue, but this is the first time that a heart rate was set to a particular frequency using light. According to the scientists, this non-invasive device may prove an effective tool in understanding how environmental factors that alter an embryo's heart rate lead to congenital defects. It may also lead to investigations of cardiac electrophysiology at the cellular, tissue and organ levels, and possibly the development of a new generation of pacemakers. "The mechanisms behind many congenital defects are not well known. But, there is a suspicion that when the early embryonic heart beats slower or faster than normal, that changes gene regulation and changes development," said Michael Jenkins, a postdoctoral researcher in biomedical engineering at Case Western Reserve. Jenkins came up with the idea to try the infrared laser on an embryonic heart. He stumbled on an obscure paper from the 1960s in which researchers found that continuous exposure to visible light accelerated the heart rate of an embryonic chicken. He also knew of the success that Eric D. "Duco" Jansen, a professor of biomedical engineering at Vanderbilt University, had using an infrared laser to stimulate nerves. He then hypothesized that pulsed infrared light may enable pacing of the embryonic heart. Case Western press release: A heart beats to a different drummer... Article in Nature Photonics: Optical pacing of the embryonic heart... Michael

A new discovery, reported in the latest Nature, hints at higher universal laws of the physical world, as well as new ways to approach and understand life in general. Even though the European discovery actually dealt with superconductors, it has an interesting twist with implications for the life sciences. A group of physicists from London Centre for Nanotechnology at UCL and their collaborators at Sapienza University of Rome and European Synchrotron Radiation Facility in Grenoble, France were studying properties of so-called high-transition-temperature (high-Tc) copper oxide superconductors. They were looking at the microstructures that these superconductors form as they are cooled down. To the surprise of investigators, they discovered that microstructures, exhibited by oxygen atoms, seemed to organize into self-repeating fractals. Moreover, these fractal shapes, some extending almost to the millimeter scale, were correlating to superconductivity. In fact, larger fractals correlated with higher superconductivity temps. What does it have to do with life? We think, plenty. Fractals, known for their geometric morphologies that are made up of patterns that repeat themselves at smaller scales infinitely, were first discovered by mathematician Benoit Mandelbrot in 1960s. Since then, they took the world of natural sciences by storm. As mathematicians and physicists discovered more and more interesting properties of these unique constructs, we started to notice fractals' ubiquitous presence everywhere we look. Whether in the living world or in inorganic one, they seem to pop up in unexpected places. Somehow, there are laws of physics that favor these structures for whatever reason. To us, the discovery of fractal function is eerily reminiscent of polarization in pre-quantum mechanical physics. Not until Niels Bohr, Albert Einstein and others laid the foundations of quantum mechanics, polarization of light has remained a mystery. Now we have a new puzzle to answer. Fractals are ubiquitous in the physical and living world for some unknown reason, and there is a function to them. Paper in Nature: Scale-free structural organization of oxygen interstitials in La2CuO4+y UCL press release: Fractals make better superconductors ... More from Wired: Inexplicable Superconductor Fractals Hint at Higher Universal Laws... Side image: Heat treatment improves the superconductivity of a ceramic copper oxide by creating a fractal network of connected channels of ordered oxygen defects. The green and red spheres represent the paired electrons responsible for superconductivity. Artwork by Manuel Vogtli (LCN).... Michael

By JANE SARASOHN-KAHN Best Buy is teaming up with Cardiac Science, targeting potential purchasers of electronic health records (EHRs) and noninvasive cardiac devices. The venture looks to take advantage of economic stimulus funding available through the HITECH Act aimed at...

It has been known for a while now that cooling the body after cardiac arrest improves neurological outcome, and therapeutic hypothermia has become a standard measure in many hospitals. However, in a study in this month's Circulation, a new nasopharyngeal device was used to initiate cooling during cardiac arrest. The RhinoChill Intra-Nasal Cooling System from BeneChill (San Diego, CA) uses a non-invasive nasal catheter that sprays a rapidly evaporating coolant liquid into the nasal cavity, adjacent to the major vascular structures of the brain. The system is compact, battery operated and easy and fast to insert, making it more practical in emergency situations than surface or intravascular cooling devices. In the study witnessed cardiac arrest patients were randomized to either intra-arrest cooling with the RhinoChill device while CPR was being conducted (n=96) or standard care (n=104), with both groups being cooled after hospital arrival. The target temperature of 34°C was reached much faster in the RhinoChill group. Although the study was not powered to detect outcome differences, in subgroup analysis nasal cooling and early CPR within 10 minutes after arrest, when combined, resulted in a 27% absolute increase in survival over CPR alone and a 26% increase in neurologically intact survival. These are pretty impressive results for such a simple device and we are sure you will hear more about this one when larger trials are able to confirm these results. Article abstract in Circulation: Intra-Arrest Transnasal Evaporative Cooling. A Randomized, Prehospital, Multicenter Study (PRINCE: Pre-ROSC IntraNasal Cooling Effectiveness)... Product page: RhinoChill Intra-Nasal Cooling System...... Wouter Stomp

The UK supermarket chain Sainsbury's is running a trial with two different drug vending machines in two of its West Sussex stores. Basically you can drop your prescription at the machine, the pharmacy will collect the prescriptions and deliver the medications which you can later pick up. As the machines are placed in stores with an in-store pharmacy service, the only benefit seems to be the lack of face-to-face contact (for those people who consider that a benefit). The trial will run for a year after which it will be decided whether they will be rolled-out across all of England. Some UK hospitals plan to trial a more useful drug vending machines this winter, which have a video-link and can dispense medication directly. Patient and pharmacists can talk to each other and a photograph of the prescription is sent over at the same time. The pharmacist can then authorize the machine to deliver drugs from an internal stock. This might prove a useful application for remote places and to provide coverage during evenings, nights and weekends. Although law currently only permits use of these machines in hospitals and healthcare centers, PharmaTrust, the company supplying the machines, hopes that in the future they will be able to place them in High Streets, shopping malls and rural locations. Source: BBC News...... Wouter Stomp

Just a decade after HAL 9000 was supposed to make its appearance, researchers at the University of Hertfordshire have unveiled a prototype of a robot capable of developing emotions through interactions with human caregivers and getting emotionally attached to them. The robots are programmed to learn to interact with humans the same way babies do, using the same expressive and behavioral cues. This has been implemented by modeling early attachment processes in human and chimpanzee infants. They will become attached to their primary caregiver, developing a stronger bond as they interact. They can express anger, fear, sadness, happiness, excitement and pride, or show distress if not cared for in stressful situations. Still to be added is understanding of non-verbal cues and emotions expressed through physical postures, gestures and body movements. The robots have been developed as part of a project of several universities and robotics companies funded by the European Commission called FEELIX GROWING (Feel, Interact, eXpress: a Global approach to development with Interdisciplinary Grounding). One of the future goals is to have the robot be a carer/companion for diabetic children in the hospital. Here's a video of an earlier prototype: Press release: Robots That Develop Emotions in Interaction with Humans...... Wouter Stomp

By Matthew Holt Mary Hiller is Executive Director at MedExpert International -- one of the companies behind Safeway's remarkable results in reducing health care costs. The company manages a system that aligns best practices from intensive literature searches (although Mary...

By BOB WACHTER Don’t read this. That is, if you have a limited amount of time for reading today, I’d rather you read Atul Gawande’s essay on end-of-life care in this month’s New Yorker than this blog. But if you...

Proteus Biomedical has received CE Mark approval from the European Union to bring to market the firm's Raisin ingestible drug sensors and monitoring system. When a patient swallows tablets that have individually tagged beacons on them, a sensor can automatically record the precise time and basic vital signs of the patient at that time. The system allows physicians to get a better picture of how a patient responds to a given medication. The system received FDA regulatory approval back in April. Additionally MobiHealthNews is reporting that UK's National Health Service will be testing the system in a trial involving 40 patients over four months. Proteus’s ingestible sensor and personal monitor system, called the RaisinTM System, is indicated under the CE Mark to timestamp, via ingestion, any discrete event (such as the ingestion of a specific pharmaceutical) and to record this event along with physiologic information such as heart rate, activity, body angle and patient-logged information. The unique ingestion event and personalized physiologic information are then communicated via Bluetooth to any computerized device, such as a mobile phone for emerging mHealth applications. The Raisin System is being developed as part of Proteus’s integrated intelligent medicine system to link sensor-based formulations of pharmaceutical products to individualized physiologic response and outcomes-based treatment systems. Proteus and its partners are currently developing these integrated product systems in diabetes, cardiovascular disease, psychiatric disorders, organ transplantation and infectious disease. Press release: Proteus Biomedical Announces European CE Mark Approval of Ingestible Sensor and Monitor System Proteus Biomedical technology page... Flashbacks: Proteus' Wireless Personal Health Monitor Receives 510(k) Clearance; A Quick Look at The Status of Smart Pill Technology; Microchipped BP Pills Remind Patients to Take Their Meds; NextGen Pharmaceuticals: Pills That Talk, Sensors That Listen; Chip-on-a-Pill, and Other Micro-Electro-Medical Devices (hat tip: MassDevice)... Michael

In two papers presented at the meeting of the Society of Experimental Mechanics in Indianapolis and at the Nanotech 2010 Conference and Expo in Anaheim, California, Purdue University scientists detail a new mechanism that allows for precise automatic calibration of micro electromechanical systems (MEMS). Current methods of calibration are about 10% off the correct number in small scale systems, but the new technique promises near perfect readings leading to precise micro-sensors. MEMS accelerometers and gyroscopes currently are being used in commercial products, including the Nintendo Wii video game, the iPhone, walking robots and automotive airbags. "Those MEMS work well because they don't need ultra-high precision or accuracy," Clark said. "It is difficult for conventional technology to accurately measure very small forces, such as van der Waals forces between molecules or a phenomenon called the Casimir effect that is due to particles popping in and out of existence everywhere in the universe." These forces are measured in "piconewtons," a trillionth of the weight of a medium-size apple. "If we are trying to investigate or exploit picoscale phenomena like Casimir forces, van der Waals forces, the hydrogen bond forces in DNA, high-density data storage or even nanoassembly, we need much higher precision and accuracy than conventional methods provide," Clark said. "With conventional tools, we know we are sensing something, but without accurate measurements it is difficult to fully understand the phenomena, repeat the experiments and create predictive models." Press release: Innovation could bring super-accurate sensors, crime forensics... Michael

By KENT BOTTLES, MD Not long ago I was lucky to be invited to a New England Healthcare Institute discussion entitled “From Evidence to Practice: Making Comparative Effectiveness Research Findings Work for Providers and Patients “ in Washington, DC. How...

Engineers at Saitama University's Human-Robot Interaction Center in Saitama, Japan have created a wheelchair movement system that keeps it always next to a walking person wearing a radio beacon. The wheelchair is smart enough to realize both its position and orientation relative to the person guiding it and realizes when its best to follow behind rather than on the side in tight and congested areas. Undoubtedly this is a big deal for people with disabilities for whom controlling the wheelchair is in itself a challenge. Judging by the video below, which demonstrates the wheelchair in a public area, it looks like it's just about ready for commercial production. More at DigInfo TV... (hat tip: Engadget)... Michael

By ROGER COLLIER I’ve been reading a recent paper from the Committee for Economic Development, one of the less doctrinaire business research groups, that should give health care reform advocates (and opponents) food for thought. " Health Care in California...

Fenwal, Inc. (Lake Zurich, Illinois) has announced 510(k) clearance for use of the company's Amicus separator with the new InterSol platelet additive. InterSol can take the place of plasma, which is currently used as a storage medium for platelets collected from donated blood. This frees up additional plasma for hospital use without requiring an increase in blood donations. From the press release: While practices vary at blood centers, healthy donors may donate platelets as often as once a week, but no more than 24 times in a 12-month period. In granting the new 510(k) clearance, the FDA has approved an addition to Fenwal labeling that defines specific conditions under which the volume of plasma replaced by InterSol® solution may be collected without increasing the donor deferral period. Press release: FDA Grants Fenwal New 510(k) Clearance... Product page: AMICUS® Separator...... Smit

Researchers from Ohio State University just published a paper in Nature describing a new MRI technique that is capable of imaging the insides of micro-scale magnets, providing the highest ever resolution of magnetic fields. The technology, known as scanned probe ferromagnetic resonance imaging, promises the development of small scale biosensors that depend on tiny magnets to do their work. From the article abstract: Conventional ferromagnetic resonance (FMR) provides quantitative information about ferromagnetic materials and interacting multicomponent magnetic structures with spectroscopic precision and can distinguish components of complex bulk samples through their distinctive spectroscopic features. However, it lacks the sensitivity to probe nanoscale volumes and has no imaging capabilities. Here we demonstrate FMR imaging through spin-wave localization. Although the strong interactions in a ferromagnet favour the excitation of extended collective modes, we show that the intense, spatially confined magnetic field of the micromagnetic probe tip used in FMR force microscopy can be used to localize the FMR mode immediately beneath the probe. We demonstrate FMR modes localized within volumes having 200 nm lateral dimensions, and improvements of the approach may allow these dimensions to be decreased to tens of nanometres. Our study shows that this approach is capable of providing the microscopic detail required for the characterization of ferromagnets used in fields ranging from spintronics to biomagnetism. This method is applicable to buried and surface magnets, and, being a resonance technique, measures local internal fields and other magnetic properties with spectroscopic precision. Abstract in Nature: Nanoscale scanning probe ferromagnetic resonance imaging using localized modes... Press release: Scientists achieve highest-resolution MRI of a magnet...... Michael