April 1, 2008: Post-Traumatic Stress Disorder: Diagnosis and Therapy
Ross Zafonte, DO; HMS, Spaulding, MGH
Roger Pitman, MD; HMS, MGH
Steven Schachter, MD; HMS
Jordan Smaller, MD, ScD; HMS, MGH
The CIMIT Forum expanded its reach during the April 1 session at Simches Research Center of Massachusetts General Hospital when it broadcast the presentations to selected military installations, including Fort Detrick in Frederick, MD., home of TATRC (U.S. Army Telemedicine & Advanced Technology Research Center) and Walter Reed National Army Medical Center, Washington, D.C.
Speaking were Roger Pitman, MD, and Ross Zafonte, DO. Their presentations were carried to the distant locales by Adobe Acrobat Connect software.
Dr. Pitman is a professor of psychiatry at Harvard Medical School and a psychiatrist at Massachusetts General Hospital. He was speaking on the “Neurological Soft Signs in Post-Traumatic Stress Disorder.”
Moderator for this presentation was Jordan Smoller, MD, ScD, associate professor of psychiatry at Harvard Medical School; director, Psychiatric Genetics Program in Mood and Anxiety Disorders and co-director, Genetics and Genomics Unit, Clinical Research Program, at Massachusetts General Hospital.
Dr. Pitman said post-traumatic stress disorder (PTSD) is a psychiatric condition resulting from a psychologically traumatic event. His team has found evidence of subtle neurological dysfunction, manifest in more neurological soft signs (NSS) in male Vietnam combat veterans and adult females sexually abused as children.
Dr. Pitman said that in contrast to PTSD, traumatic brain injury is a neurological condition that results from a physical trauma to the brain. Mild TBI shares several symptoms with PTSD, such as detachment and difficulty concentrating, but the speakers said the two conditions are quite different.
At the question-answer session after the presentations, Army Col. Elspeth C. Ritchie of TATRC called in to say that she would like to learn more about how the Army might use tests for neurological soft signs (as outlined by Dr. Pitman) to assess veterans in its care. The two indicated that they would talk “offline” about specifics.
Dr. Zafonte spoke on “Traumatic Brain Injury Clinical Trials from the Past for the Future.” Dr. Zafonte is Earle P. and Ida S. Charlton Chairman of the Department of Physical Medicine and Rehabilitation, Harvard Medical School; visiting professor, Harvard Medical School; vice president, medical affairs, Spaulding Rehabilitation Hospital; and chief of physical medicine and rehabilitation, Massachusetts General Hospital.
Moderator was Steven Schachter, MD, professor of neurology at Harvard Medical School; director of research, Department of Neurology, Beth Israel Deaconess Medical Center; and CIMIT Program Leader at BIDMC.
Dr. Zafonte provided a comprehensive assessment of clinical trials involving traumatic brain injury, and noted differences in trials and characteristics between PTSD and traumatic brain injury.
March 25, 2008: Biomimicry and Regenerative Therapeutics
Jeffrey Karp, PhD; HMS, BWH
Robert Sackstein, MD, PhD; HMS, MGH, BWH, Dana-Farber Cancer Institute
Frederick Schoen, MD, PhD; HMS, BWH, CIMIT Site Miner
Charles Vacanti, MD; HMS, BWH
Regenerative medicine holds great hope for patients in the future, and two accomplished researchers discussed their work in the field at the March 25 Forum at the Beth Israel Deaconess Medical Center.
Jeffrey Karp, PhD, spoke on “Biomimicry: Nature as Model, Measure and Mentor.” He is an instructor in medicine and health, science and technology at Harvard Medical School and Brigham and Women’s Hospital; and director, Laboratory for Advanced Biomaterials and Stem Cell-based Therapeutics, BWH.
Moderator for his presentation was Frederick Schoen, MD, PhD, professor of pathology and health sciences and technology, Harvard Medical School; director of cardiac pathology and executive vice-chairman, Department of Pathology, Brigham and Women’s Hospital; and CIMIT site miner at BWH.
Presenting on the topic of “Steering Stem Cells to Treat Osteoporosis,” was Robert Sackstein, MD, PhD, associate professor of dermatology and of medicine, Harvard Medical School; head, the Translational Research Program of the Bone Marrow Transplantation Unit, Massachusetts General Hospital; Bone Marrow Transplant Physician at Brigham and Women’s Hospital and the Dana-Farber Cancer Institute.
Moderator was Charles Vacanti, MD, anesthesiologist-in-chief, Leroy D. Vandam/Benjamin G. Covino Professor of Anaesthesia, Harvard Medical School; director, Laboratories for Tissue Engineering and Regenerative Medicine, Brigham and Women’s Hospital.
Dr. Karp discussed his work in the field of biomedical adhesives using nano and microscale approaches. Much of his study is based on understanding the mobility of the gecko, a form of lizard. He said geckos attach to smooth vertical surfaces and support their weight on a single toe. Dr. Karp indicated this principle could be useful in understanding that evolved designs in nature offer opportunities for advances in biomedical engineering.
He also discussed the creation of materials to capture cells mimicking the vascular endothelium’s ability to initiate cell rolling in viscous shear flow. Surface engineering through covalent immobilization of selectins can achieve long-term precise control over cell rolling, which may be useful for capturing and separating cells for diagnostic and therapeutic applications.
Dr. Sackstein discussed the notion that successful clinical implementation of stem cell-based regenerative therapeutics depends on the ability to deliver stem cells to sites where they are needed. His lab has developed a platform technology called "glycosyltransferase-programmed stereosubstitution,” or GPS, for custom-modifying CD44 glycans to create HCELL (hematopoietic cell E-/L-selectin ligand) on the surface of living cells. He suggested GPS technology could have major implications in therapy of generalized bone diseases such as osteoporosis, and may also be exploited for stem-cell based regenerative therapeutics for non-skeletal diseases.
March 18, 2008: New Dimensions in Designing Medical Devices
Clive Dym, PhD, PE; Harvey Mudd College
Steven Rauch, MD; HMS, Mass Eye and Ear
Alexander Slocum, PhD; MIT
Rajiv Gupta, MD; MGH
William Wiesmann, MD,
CEO; BioSTAR Group
Harvey Mudd College and the CIMIT consortium institutions are a continent apart, but a CIMIT Forum on March 18 demonstrated that creative ideas can develop when innovative minds can be brought together.
The event was held at the Simches Research Center of Massachusetts General Hospital, and one of the featured presenters was Clive Dym, PhD, PE, who is Fletcher Jones Professor of Engineering Design at Harvey Mudd College, based in Claremont, CA.
Dr. Dym’s session was moderated by William Wiesmann, MD, founder, chairman and CEO of BioSTAR Group. Dr. Dym said that he heard dynamic and promising ideas for developing medical devices during the two-hour event.
Dr. Dym described the design experiences of his college's broad-based, general engineering curriculum. A major element of the HMC engineering program is a three-semester “capstone’ experience in which students work on design or development projects sponsored by industry, national laboratories or government agencies.
Also presenting was Steven Rauch, MD, associate professor of otology and laryngology, at Harvard Medical School, who is with the Massachusetts Eye and Ear Infirmary, where he is director of the MEEI Balance Center.
Moderating this session was Alexander Slocum, PhD, professor of mechanical engineering and MacVicar Faculty Fellow at MIT.
Dr. Rauch noted that falls are the fifth leading cause of death among the elderly, and close to 9 percent of those over 65 have balance problems. In mentioning young patients, he said many veterans of the Iraq war have sustained head injuries, and consequently have sought therapy for challenges in maintaining their balance.
One of his objectives is to develop an Ambulatory Vestibular Monitor (AVM) to record voluntary and reflexive eye movements, and other physiologic parameters. Ultimately, the AVM can be used as an ambulatory tool monitoring the patient to aid in the diagnosis of dizzy patients. It could also be used as a “vestibular lab in a box” data record that can be combined with a test battery to enable general vestibular function testing in remote and underserved areas that do not have access to conventional vestibular diagnostic services.
A post-presentation panel included Drs. Wiesmann, Dym, Slocum, Rauch and Rajiv Gupta, MD, a radiologist at MGH. Participants said that the session had provided many new ideas about how to proceed in improving their research as it relates to developing devices to cope with poor balance and the fear of falling.
March 11, 2008: Physician-Inspired Medical Device Solutions, Part 2
Rajiv Gupta, MD; MGH
Robert Levine, MD; HMS, MGH
Lynn Levitsky, MD; MHS, MGH
Ali Tavakkolizadeh, MD; HMS, BWH
Graduate engineering students at MIT who are working with supervising doctors made presentations to a Forum audience at Simches Research Center at Massachusetts General Hospital on March 11 for the second time in two weeks. Three teams discussed their proposed solutions to medical problems that doctors have posed, with Rajiv Gupta, MD, a radiologist at MGH, serving as moderator. The teams have just one semester to develop a prototype that addresses the doctor’s real-life challenge.
One team is developing an “accurate non-invasive electronic monitor for human body hydration.” It is headed by Lynne Levitsky, MD, associate professor of pediatrics at Harvard Medical School, and with MGH. Team members included Al-Thaddeus Avestruz, Michael Rinehart, Anthony Sagneri and Alexander Hayman.
There is a continued need for a non-invasive method to accurately measure the level of hydration in humans. In its development of a prototype, this team uses low-power RF energy from 100 kHz to 10 MHz to measure the loss tangent of the frontalis muscle (in the forehead). The group pays particular attention to the skin-electrode interface and employs a four-electrode geometry to measure the localized complex impedance. From this they can derive the loss tangent, which is potentially a large improvement over other techniques which use full body impedance.
Another team investigated a “catheter-based device for intra-cardiac mitral valve chord manipulation.” This project focused on the design and implementation of a catheter-guided device that has the potential to help physicians mitigate the effects of mitral valve regurgitation. The purpose of their device is to provide physicians with a tool that may be controlled externally and is capable of manipulating the charade tendinae within the heart. The proposed device is important because many patients do not have the level of health to survive open-heart surgery. The team was led by Robert Levine, MD, professor of medicine at Harvard Medical School and also with MGH. Team members included Will Bosworth, Ari Mazumdar, Miguel Saez and Alex Slocum Jr.
The third team focused on a “transfascial hernia fixation device.” Hernias represent a common surgical problem, and laparoscopic repair is becoming increasingly more common. In this approach, small incisions are made in the abdominal wall, laparoscopic ports are placed and the hernia defect repaired using a piece of prosthetic mesh. This team proposed a novel way to affix mesh to the abdominal wall during the surgery. The premise is that this device will be easier to use, thus reducing operation room time and patient costs. It could result in less post-operative pain for the patient. The team was led by Ali Tavakkolizedeh, MD, instructor of surgery at Harvard Medical School and also with Brigham and Women’s Hospital. Team members included Megan Roberts, Michael Eilenberg, Jessica Galie, and supervisors Rajiv Gupta and Martin Culpepper, PhD.
March 4, 2008: Physician-Inspired Medical-Device Solutions
Hong Ma, PhD; MIT
Rob Sheridan, MD; Shriners Hospital, MGH
MIT graduate engineering students working to aid doctors determined to solve difficult medical problems presented their prototypes of proposed medical devices at the March 4 Forum at Simches Research Center at Massachusetts General Hospital.
The students were part of a CIMIT-inspired program, the 2.996/6.971 Biomedical Devices Design Course, which links engineers with medical professionals. Moderator of this Forum was Hong Ma, PhD, postdoctoral associate, Department of Mechanical Engineering, MIT, and instructor of the 2.996/6.971 course.
The goal for the students is to deliver a working prototype and a journal-quality article in one semester. The course has been a great opportunity for clinicians to test novel ideas and stimulate new collaborations.
One prototype presented was the GRIT Chair Alarm. The Gesture Recognition Interactive Technology alarm was designed to improve wheelchair alarms for patients at risk of falling when they stand. This system responds with light and voice alarms that can encourage the patient to remain seated and/or make use of the system’s integrated nurse-call function. The team’s solution can be integrated into existing hospital WiFi network, sending messages to the nurse call system as well as providing the patient’s location. Team members included Lauren Kattany, RN, clinical nurse specialist at MGH, and students Heather Knight and Jae-Kyu Lee.
A second team presented the SmartPad, a device that displays a patient’s electrocardiogram (EKG) signal without adhesives or wires. Instead, sensors are bonded to a foam mat, on which the patient lies during an operation. The device displays an EKG waveform, which, while inferior to a cardiologist’s EKG, would be sufficient for the doctor to monitor the patient’s health. It is designed to obtain data without having to use multiple electrodes on the body, which can sometimes inhibit the success of clinician’s hands-on access to the patient. Team leader was Dr. Sheridan, who is chief, Burn Surgery Service, Shriners Hospital for Children; and co-director, Sumner Redstone Adult Burn Unit, MGH, and students Fred Chen, Pei-Lan Hsu, Brad Stronger, Henry Wu and Dr. Ma.
A third team produced a Hand-Held Endotracheal Tube Placement Sensor. This team has developed a hand-held ETT placement sensor, which is a portable device that allows a doctor or nurse to “see” the endotracheal tube’s position in the throat. Currently there are no convenient means of verifying the tube’s position in a patient’s throat. The device uses a two-dimensional array of Giant Magnetoresistance (GMR) sensors to localize the position of a tiny magnet embedded into the ETT. As the sensor is held over the sternal notch, the sensor unit measures a magnetic strength underneath the sensing area. An onboard microprocessor displays an intuitive color-coded map on an LCD screen. The device is designed to fit into a hand or pocket, and run off an internal rechargeable lithium-polymer battery. An integrated wireless module allows the device to be adapted for continuous monitoring and automated notification of hospital staff if a potential problem is detected. Team members included Dr. Sheridan, and students Keith Durand, Byron Hsu, Brandon Pierquet and Warit Wichakool.
Several engineering students said they are now interested in seeking opportunities in the medical-device field as a result of taking the course.
February 26, 2008: The Science of Sleep
Robert Thomas, MD;
HMS, BIDMC
Tom Scammell, MD;
HMS, BIDMC
Two authorities on sleep and disorders related to sleep made presentations at the CIMIT Forum on Feb. 26 at the Simulation and Skills Center at Beth Israel Deaconess Medical Center.
Speaking were Robert Thomas, MD, assistant professor of medicine at Harvard Medical School and on staff at Beth Israel Deaconess Medical Center; and Tom Scammell, MD, associate professor of neurology at Harvard Medical School, and also with BIDMC.
The topic of Dr. Thomas was “Integrated Sleep Stability: Dynamic Mapping of Sleep Oscillations in Health and Disease.” His presentation was moderated by Ary L. Goldberger, MD, director of the Margret and H.A. Rey Institute of Nonlinear Dynamics in Medicine at BIDMC, and program director, Research Resource for Complex Physiologic Signals.
Dr. Thomas said that a compelling reason for studying the science of sleep is that there is a correlation between some forms of heart disease and poor sleeping patterns. He presented a new method of studying sleep: mapping integrated / coupled sleep oscillations, using a single channel of ECG called a “sleep spectrogram.” Dr. Thomas presented examples of rich, hidden biological information that has been captured, including tracking interactions of chemoreflex control with upper airway mechanics in sleep apnea.
Dr. Scammell spoke on the topic of “Modeling the Dynamics of Sleep Using State Space Analysis.” His presentation was moderated by Clifford B. Saper, MD, PhD, James Jackson Putnam Professor of Neurology at Harvard Medical School and chairman, Department of Neurology, at BIDMC.
Dr. Scammell said that sleep disorders such as insomnia, sleep apnea and narcolepsy affect about 30 percent of the population, and can substantially impair driving, school and work performance and many other facets of life. He described a new state/space analysis technique based upon spectral characteristics of the electroencephalogram that provides perspectives on the causes of sleepiness in narcolepsy and other sleep disorders.
February 19, 2008: New Views of Inside the Body: Optical Imaging and Ultra-Miniature Endoscopy
Gary Tearney, MD, PhD; HMS, Wellman
Seok-Hyun (Andy) Yun, PhD; HMS, MGH
Two authorities on “seeing” inside the body and developing treatments for serious internal conditions spoke at the Feb. 19 CIMIT Forum at Simches Research Center at Massachusetts General Hospital.
Gary Tearney, MD, PhD, addressed the topic of “Seeing Inside: Optical Frequency Domain Imaging and Ultra-Miniature Endoscopy.” He is associate professor of pathology at Harvard Medical School; assistant physicist at the Wellman Center for Photomedicine; and program leader, Optical Diagnostics, for CIMIT. His session was moderated by Sergio Fantini, PhD, associate dean for graduate education, School of Engineering, Tufts University.
Also speaking was Seok-Hyun (Andy) Yun, PhD, assistant professor, Harvard Medical School, and assistant physicist, MGH. His topic was “Endo-Microscopy and Biomechanical Engineering: Novel Technologies and Applications.” Moderating his session was Tayyaba Hasan, PhD, professor of Dermatology at Harvard Medical School; and director, Office for Research Career Development at the Wellman Center for Photomedicine.
Dr. Tearney talked about two areas his optics lab is studying: treatment of problems related to coronary artery disease and development of tiny endoscopes that someday could be used in fetoscopic surgery and other applications.
Dr. Tearney and his lab are studying ways in which his approach to optical coherence tomography (OCT) can help patients with coronary conditions. About 1.2 million acute myocardial infarctions are reported each year in this country, and about half are fatal. He said that identifying potentially dangerous lesions in the arteries could save many lives. Dr. Tearney’s technology can identify trouble areas.
Dr. Tearney said much research on OCT has been done over the past decade, and that his work in the “second transitional phase” is directed at acquiring acceptance from the medical community. He said that his team must validate the science with drug and device companies so that firms will be interested in developing commercial tools. He added that optical diagnostics must be integrated into medical care by clinicians who are educated in its value and ready to use it in their practices.
Dr. Tearney also said his lab is working on an “ultra-miniature endoscope” that developers want to be the world’s smallest endoscope that can be put into the body without tissue damage. One use of the tiny probes could be in procedures on the fetus. He noted it could be effective in a condition called twin-twin transfusion syndrome. This is a condition where one twin gets the majority of life-sustaining fluids from the placenta. The result is that both twins are in danger of dying due to the uneven distribution of nutrients.
About 10,000 such pregnancies occur each year. Dr. Tearney said the condition would be treatable if exposed to endoscopes tiny enough to rectify the situation in vivo. “New endoscopic techniques have the potential to change the face of medicine,” he said.
Dr. Yun is exploring in vivo cellular-level fluorescence endo-microscopy for a variety of translational investigations using small-animal models. He presented some of his work in novel Brillouin microscopy which can be utilized to probe the biomechanical properties of the lens and cornea for clinical diagnosis of ocular problems.
February 12, 2008: Authorities Discuss Benign Prostate Hyperplasia
Shahin Tabatabaei, MD; MGH
Kevin Loughlin, MD; BWH
W. Scott McDougal, MD; MGH
Many middle-aged men suffer from Benign Prostate Hyperplasia (BPH) but this is a condition that has numerous therapies and much documented success, audience members were told at the Feb.12 CIMIT Forum at Thier Research Building at Massachusetts General Hospital.
The primary speaker was Shahin Tabatabaei, MD, instructor in surgery (urology) and assistant urologist at MGH, who addressed the subject, “Current Therapies for BPH and the Search for Smart Engineering Solutions.”
BPH, in general, is not malignant but contributes to lower urinary tract symptoms that affect the quality of life. Untreated, BPH may lead to urinary retention, bladder stone formation or deterioration of kidney function, he said.
Every year more than 2 million men are treated for BPH in the U.S. The treatment goal is to resolve bladder outlet obstruction and ranges from non-invasive medical therapy (including drugs) to open surgery.
Dr. Tabatabaei said that BPH is a common pathological finding in men after the age of 40. More than half of the men in their 50s and 70 percent of the men in the 70s suffer voiding symptoms due to BPH. Some sufferers, though, do not seek treatment. In the last decade many less- invasive and noninvasive therapies for BPH have been introduced, though the search for optimum therapy for BPH continues.
Doctors said that mild cases of BPH are treated with drugs; more severe conditions require minimally invasive surgery. If cancer of the prostate is detected, patient and doctor must discuss more serious therapies.
Moderator W. Scott McDougal, chief, Department of Urology at MGH, said that urology is a busy field today because the emergence of the Baby Boomers means that most aging men need testing and/or treatment for BNP.
February 5, 2008: Cardiac Devices Face Period of Change
Stephen N. Oesterle, MD; Medtronic, Inc.
Donald S. Bain, MD; Boston Scientific Corp.
James E. Muller, MD; InfraReDx, Inc.
The CIMIT Forum held on Feb. 5 at the Simches Research Center focused on the topic of “Cardiac Device Development,” and featured two lively presentations about the science and business of caring for those with heart disease.
Presenting were Stephen N. Oesterle, MD, senior vice president, medicine and technology, at Medtronic Inc.; and Donald S. Bain, MD, executive vice president and scientific officer, Boston Scientific Corp. Moderating was James E. Muller, MD, who is CEO of InfraReDx, Inc.
Dr. Oesterle’s topic was “Convergence in Health Care Technology: Devices, Biologics, Pharma, IT, Communications and Imaging.” He suggested that the era of implanted electro-mechanical devices is disappearing. Dr. Oesterle said that therapeutic proteins, cell therapies, interference RNA and gene manipulation – known as “biologics” – offer a realistic approach to restoration and cure for many of the same degenerative and chronic diseases that have been the focus of device therapy.
He said that in coming years, aging Americans will comprise a “locust swarm” that will be seeking new and minimally invasive ways to treat chronic problems.
Dr. Oesterle, who once was with CIMIT, said that “combination devices” – biologics delivered by devices such as catheters and pumps – will define many therapies in the next decade.
Dr. Bain, also once with CIMIT, spoke on “Challenges in Cardiac Device Development.” He noted that cardiovascular devices such as stents have revolutionized the treatment of coronary artery disease over the past 30 years. He said that the large number of procedures (1 million per year) and associated revenues ($8 billion per year) have fueled the development of the stent industry.
But Dr. Bain stated that studies challenging the efficacy of some drug-eluting stents over the last 18 months have caused a 20 percent drop in the use of such devices. He indicated that it will be difficult for the large medical device companies to regain their momentum, due to increased regulations from the Food and Drug Administration and added competition from new companies.
January 29, 2008: Nanotechnology Meets Cancer
Shiladitya Sengupta, PhD; HMS, BWH
Raghu Kalluri, PhD; Harvard-MIT HS&T; BIDMC
Jose Miguel Trevejo, MD, PhD; Draper, BIDMC
Jeffrey Borenstein, PhD; Draper, Site Miner, CIMIT
The subject at the CIMIT Forum on Jan. 29 was “Nanotechnology Meets Cancer,” and the well-attended event was held at the Beth Israel Deaconess Medical Center.
One speaker was Shiladitya Sengupta, assistant professor of medicine and health sciences and technology, Harvard Medical School, Brigham & Women’s Hospital and MIT.
Also presenting was Raghu Kalluri, PhD, professor of medicine, Harvard Medical School, Department of Biological Chemistry and Pharmacology, Harvard-MIT Division of Health Sciences and Technology; chief, Division of Matrix Biology, Department of Medicine, Beth Israel Deaconess Medical Center.
Moderating Dr. Sengupta’s session was Jose Miguel Trevejo, MD, PhD, senior scientist, Biomedical Engineering Group, the Charles Stuart Draper Laboratory, Department of Infectious Disease, BIDMC.
Moderating the Kalluri session was Jeffrey Borenstein, PhD, director, Biomedical Engineering Center, program leader for biomaterials and tissue engineering, and Draper Laboratory Site Miner for CIMIT.
Nanotechnologies are increasingly useful in the management of cancer. Nanoscale devices can impact cancer biology at three levels: early detection using nanocantilevers or nanoparticles (for example); tumor imaging using radiocontrast nanoparticles or quantum dots; and drug delivery using nanovectors and hybrid nanoparticles. Dr. Sengupta focused on the major milestones in the integration of nanotechnology and cancer biology, and the future of nanoscale approaches for cancer management.
Dr. Sengupta discussed current developments in his laboratory in the hybrid nanotechnologies. He noted that his team has created a company called Tempo Pharmaceutical. Since 2005 it has raised about $22 million. Based on technology licensed from MIT, Tempo is focused on improving the efficacy and safety profile of existing and new drugs employing advances in nanotechnology.
The company utilizes its proprietary nanocell technology to develop multi-compartmental, nanoparticle-based therapeutics in which two drugs with varied release rates are packaged within a single nanoparticle. This approach allows for sequential delivery of drugs, optimizing the location, rate of release and synergistic effect of the two therapies while minimizing toxicities.
Dr. Kalluri’s lab is evaluating the role of non-cancer cells in cancer progression and metastasis. He discussed the roles of extra-cellular matrix, angiogenesis, fibroblast recruitment and innate maturity in cancer progress and metastasis. He also discussed the “host defense,” and how host responses are recruited to control cancer progression or further aid in tumor growth.
January 22, 2008: A Growing Interest in Biomarkers
Robert Gerszten, MD; MGH, Broad Institute, HMS
Homer Pien, PhD; MGH
A. Gregory Sorensen, MD; MHG, HMS
The CIMIT Forum on Jan. 22 at Simches Research Center at Massachusetts General Hospital, addressed the topic, “Biomarkers: Cutting Edge Indicators to Assess Health, Monitor Disease or Determine Responsiveness to Therapy.”
Homer Pien, PhD, managing director, Center for Biomarkers in Imaging, at Massachusetts General Hospital, focused on the subject, “Imaging Biomarkers: Uses, Misuses, Successes and Failures.”
There is growing evidence that human medical imaging can help answer questions as they arise during the drug development process. Imaging modalities such as magnetic resonance imaging, computer tomography and positron emission tomography can offer insights into the bioactivity, pharmacokinetics and dosing of drugs.
Dr. Pien said that biomarkers could be an asset in the drug development process, which is both costly and risky. He said that with recent advances in genomic, proteomic, imaging and computational sciences, the time is right for pharmaco-imaging to become an important tool in drug development.
He and his team of researchers encourage the broader academic, clinical, industrial and government communities to join forces and explore the potential for using imaging to improve translational research and to significantly reduce the time and costs of developing new pharmaceuticals.
Dr. Robert Gerszten, MD, is principal investigator, Massachusetts General Hospital Center for Immunology and Inflammatory Diseases, and MGH Cardiovascular Research Center; he is Senior Associate Member, Broad Institute; and he is associate professor at Harvard Medical School. He spoke on “Metabolomic Approaches for Cardiovascular Biomarker Discovery.”
While decades of research in biochemistry, nutrition and physiology have revealed specific metabolic pathways, systemic surveys of pathways altered in human disease states such as atherosclerotic vascular disease are now possible. An emerging set of technologies, based on mass spectrometry, enables “metabolomics,” the monitoring of hundreds of metabolites from three biological samples.
These technologies promise to transform medicine’s ability to profile samples with the goal of illuminating biology and discovering valuable clinical biomarkets. Dr. Gerszten discussed the development of a targeted mass spectrometry-based metabolomics platform, and its application to perturbation studies in humans.
A. Gregory Sorensen, MD, director, Center for Biomarkers in Imaging, and associate director, Martinos Center for Biomedical Imaging, MGH; and associate professor of radiology at Harvard Medical School, moderated the session.
January 15, 2008: Providing Better Care for Kidney Patients
Joseph Bonventre, MD, PhD;
HMS, BWH
Theodore Steinman, MD;
HMS, BIDMC
Greg Erman, MBA;
Entrepreneur, former CEO of Renalworks Medical Corp.
Jeffrey Borenstein, PhD;
Draper Laboratory, CIMIT Site Miner
Authorities in the field of providing care for patients with severe kidney disease presented at the CIMIT Forum on Jan. 15 at Simches Research Center of Massachusetts General Hospital.
The title of the Forum was “The Quest for a Wearable Kidney and Renal Assist Devices: Will Nanotechnology Make a Difference.”
Nearly 400,000 patients in the U.S. have end-stage kidney disease requiring dialysis or transplantation. Health officials agree there is a scarcity of organs, so dialysis remains the major therapy.
Wearable dialysis units have been discussed for close to 40 years, and yet experts say little progress as been name. Now the advent of nanotechnology has infused new hope into this area of medicine.
Dr. Theodore Steinman, of Beth Israel Deaconess Medical Center, who is clinical professor of medicine at Harvard Medical School, spoke on “Continuously Functioning Artificial Nephron: The Promise of Nanotechnology.”
He suggested that nanotechnology researchers are getting close to developing a human nephron filter that mimics the function of the human glomerulus and tubule.
Compared to current technology, the newest nano-membranes will be two to three times greater in efficiency than current dialyzers, and will be more compact and lightweight so as to be adaptable for portable use. The goal for the future is to make such a device implantable.
Greg Erman, an entrepreneur who launched a company called Renalworks Medical Corp. to develop renal-care devices, said that progress has been slow in aiding dialysis patients despite the need. He said that developing a small, “wearable” dialysis unit has not been successful due to issues including infection and efficiency.
Erman said that that developing the implantable unit could be the best route aiding kidney-failure patients, given the complexity of the kidney and its functions.
January 8, 2008: The Future of Global Health
Catherine Klapperich, PhD; BU
Utkan Demirci, PhD; HMS, BWH, Harvard-MIT
Kristian Olson, MD, MPH; MGH, CIMIT, HMS
Numerous institutions and individuals are interested in delivering healthcare in low-income countries. CIMIT itself is moving forward with its own global health initiative. On Jan. 8, the topic of the CIMIT Forum at Simches Center at Massachusetts General Hospital was “The Future of Global Health.”
Two CIMIT-funded researchers discussed their work relating to diagnostic testing utilizing microfluidic technology directed at conditions ranging from avian flu to HIV. They said microfluidics holds promise to allow rapid and inexpensive diagnostic testing in settings without supportive laboratory infrastructure or personnel.
Moderating was Kristian Olson, MD, MPH, who heads the CIMIT Global Initiative while serving as senior advisor of the Massachusetts General Hospital Center for Global Health. Dr. Olson is developing incubators from spare auto parts for medical centers in emerging countries, while directing CIMIT and MGH initiatives overseas.
Dr. Catherine Klapperich, PhD, assistant professor of manufacturing and biomedical engineering at Boston University, spoke on “Disposable Molecular Diagnostics: Microfluidic Laboratories for the Field.”
She discussed the formulation, fabrication and testing of microfluidic solid phase extraction columns based on polymer monoliths impregnated with nanoparticulate inclusions for protein and nucleic acid isolation for patient samples.
Dr. Klapperich also addressed practical concerns about the direct use of patient samples (blood, urine, saliva and stool).
Utkan Demirci, Phd, instructor of medicine and health sciences and technology, Harvard Medical School, Brigham and Women’s Hospital, and Harvard-MIT Health Sciences and Technology Bio-Acoustic-MEMS in Medicine, also spoke.
His topic was “Disposable, Point-of-Care Microchips for CD4 Counts in Resource Limited Settings.”
Dr. Demirci said that his team’s objective is to develop novel point-of-care low-cost diagnostics to bridge emerging engineering nano- and micro-scale solutions to HIV-infected patients. The lab’s target is a point-of-care, low cost disposable, microfluidic device that uses a fingerstick blood sample and produces a CD4 count rapidly with on-chip sample handling and will accelerate CD4 counting in resource-limited settings.
December 11, 2007: Experts discuss urological issues
Shahin Tabatabaei, MD; MGH
Michael Cima, PhD; MIT
Joseph Grocela, MD, MPh; Harvard, MGH
Leading authorities on voiding dysfunction spoke at the Dec. 11 CIMIT Forum at Simches Research Center at Massachusetts General Hospital. The event was moderated by Joseph Grocela, MD, MPh, instructor of urology at Harvard University and assistant in surgery at MGH.
Voiding dysfunction is any derangement in normal voiding pattern that interferes with effective bladder filling and emptying. More than 15 million Americans suffer from this condition.
The treatment ranges from conservative medical therapy to major reconstructive surgery. Medication has only a modest effect on the symptoms and is associated with unpleasant side effects.
Direct drug delivery to bladder may obviate some of the side effects of medications, but it is not considered practical at the present time. Neuro-stimulation is an alternative approach and has generated increasing interest in recent years.
Neuro-stimulation is being used to manage patients with severe, intractable frequency, urgency and urge incontinency at MGH. We are investigating different approaches to improve the efficacy of this technology.
“Every year more than 65,000 patients are diagnosed with bladder cancer," said Shahin Tabatabaei, who is an instructor of urology and assistant urologist at MGH. “About 70 percent of bladder tumors are considered non-invasive or superficial and are managed locally. Due to high risk of recurrence, these patients are monitored closely and undergo several endoscopic procedures every year.
“Instillation of chemotherapy and biological agents into the bladder is used routinely at MGH, but safe and efficient drug delivery to bladder tissue is still a major challenge. We are investigating approaches that could deliver medications directly to the bladder.”
Dr. Cima, Sumitomo Electric Industries Professor of Engineering at MIT, spoke on “Medicine Delivery Methods for Overactive Bladder, Interstitial Cystitis and Bladder Cancer.”
December 4, 2007: Experts discuss new directions in coronary care
Ahmed Tawakol, MD; MGH
Sahil Parikh, MD; BWH
James Muller, MD; CEO, InfraReDx, Inc.
The CIMIT Forum on Dec. 4 focused on “Advances in Intracoronary Diagnostics and Therapeutics,” and several heart specialists said that research must continue if the number of deaths from cardiovascular disease is going to diminish.
Speaking were Sahil Parikh, MD, Clinical and Research Fellow, Brigham and Women’s Hospital; and James Muller, MD, who is chief executive officer of InfraReDx, Inc., a company he helped create to provide better diagnostic tests to identify cardiovascular disease. Introducing the program was Ahmed Tawakol, MD, co-program leader, CIMIT Cardiovascular Disease Program; co-director, Cardiac MR-PET-CT Program; and associate director, Nuclear Cardiology, Massachusetts General Hospital.
Each year more than 1 million Americans suffer heart attacks. In many cases, the event is the first indication of heart disease, and is often fatal.
Experts say the cause of most heart attacks is rupture of a plaque in the coronary arteries followed by formation of a clot that blocks the flow of blood to the heart muscle.
Dr. Parikh said that until recently, use of drug-eluting stents (DES) has been a key strategy in treating such conditions. But a concern about toxicity has prompted cardiologists to be more cautions in recommending DES. He said that several years ago, cardiologists would call for a drug-eluting stent 90-95 percent of the time. Now doctors are recommending DES in about 75 percent of (appropriate) conditions.
Dr. Muller said that despite progress in dealing with heart disease, predicting serious heart attacks is still difficult. The company he founded, InfraReDx, Inc., is focused on providing improved diagnostic testing in predicting coronary episodes.
Dr. Muller, who once was closely involved with CIMIT, said that his company is working with the Food and Drug Administration in an attempt to receive approval for an improved tool for testing. Then the company will launch a large study to prove cost effectiveness.
November 27, 2007: Planning for the Neonatal Intensive Care Unit of the Future
Stella Kourembanas, MD;
CHB, HMS
Anne Hansen, MD, MPH;
CHB, HMS
Jonathan Kemp, PhD;
Cambridge Sound Management
The care of premature infants is a major challenge, and the Nov. 27 CIMIT Forum featured a committed team of medical professionals who spoke about their plans to build a state-of-the-art neonatal intensive care unit at Children’s Hospital Boston.
Title of the well-attended Forum, held at Beth Israel Deaconess Medical Center, was “Technology Requirements in the NICU of the Future: A First Look at Light and Sound.”
Speakers stressed that they are striving to develop a center that will combine cutting-edge technology, noninvasive monitoring and testing, and a living laboratory that will help clinicians understand the treatment of newborn’s disease processes – and spread the knowledge to other institutions.
Stella Kourembanas, chief, Division of Newborn Medicine, Children’s Hospital Boston, and Clement A. Smith Associate Professor of Pediatrics at Harvard Medical School, said the needs of these tiny infants are many.
“Right now we have an inappropriate space for these very vulnerable patients,” said Dr. Kouorembanas. “The light is poor. It is crowded, noisy and often doesn’t provide privacy to families. But we have a great steering committee working on plans for a new center, and we feel it will provide patients and families with better care.”
Anne Hansen, MD, MPH, director of the Neonatal Intensive Care Unit at CHB and assistant professor of pediatrics at Harvard Medical School, spoke on “NICU of the Future, Sound and Light.”
She said that premature infants have unique problems, including acutely sensitive skin that makes monitoring difficult. She reviewed the functional development of the auditory and visual sensory systems as well as the neurodevelopmental consequences of excessive stimulation.
Jonathan Kemp, PhD, director of engineering at Cambridge Sound Management, spoke on the topic of “Noise in the Clinical Environment: Sources, Effects and Solutions.”
November 6, 2007: Assessing health of older adults
Alan M. Jette, PT, PhD, FAPTA;
BU, BUMC
Jonathan Bean, MD, MS, MPH;
Spaulding Cambridge Outpatient Center, HMS
The care of older adults is a major component in the health-care world, and two experts recently presented insights on the challenge and an approach to assessing the health of older Americans at the CIMIT Forum at Simches Research Center at Massachusetts General Hospital.
Presenters were Alan M. Jette, PT, PhD, FAPTA, professor of health policy and management, Boston University School of Public Health; director, Health and Disability Research Institute, BU; research director, New England Regional Spinal Cord Center, BUMC; director, post doctoral research fellowship in rehabilitation outcomes and effectiveness research, BU; and Jonathan Bean, MD, MS, MPH, assistant professor, director, Research Training and Education, Department PM&R, Harvard Medical School; medical director, Spaulding Cambridge Outpatient Center.
Dr. Jette's address was titled, “How Are You Really Doing? Innovations in Functional Outcomes Measurement in Rehabilitation.”
He talked about his plans for contemporary techniques for innovative functional outcome assessment instrument in rehabilitation. He has helped develop the Boston University Activity Measure for Post Acute Care (AM-PAC). It compiles and calibrates a set of 269 functional tasks (washing face, walking indoors) likely to be encountered within the context of a day.
The AM-PAC test is designed to be used across patient diagnoses, conditions and rehabilitation sessions. Dr. Jette discussed the promise and challenges of this approach to functional outcome assessment.
Dr. Bean outlined “Three Big Risks for Older Adults: Walking, Climbing Stairs and Rising from a Chair – Evidence-based Rehabilitative Care for Older Adults.”
Dr. Bean said as many as 25 percent of older adults are at increased risk for disability. He discussed the relative importance of rehabilitative impairments in limb power, limb velocity and trunk integrity.
He said that certain capabilities are important for seniors. One of his slides showed a woman about to cross a wide, busy street, and the light indicated she had 54 seconds to traverse it. He said that if the time comes when her propulsion and speed could not get her across, she would have to find a new part of the neighborhood at which to cross the street.
Dr. Bean suggested that older adults should be screened to find out if there is potential to be impaired. If so, there could be a need to change living arrangements.
October 30, 2007: Improving Quality and Patient Safety
Ronald Newbower, PhD; CIMIT
Gregg S. Meyer, MD, MSc; MGH/MGPO
Jeffrey Cooper, PhD; MGH
Three experts on medical safety offered their views on how hospital safety can be improved during the CIMIT Forum on Oct. 30 at the Simulation and Skills Center at Beth Israel Deaconess Medical Center.
Presenting were Ronald Newbower, PhD, strategic director and chief technology officer of CIMIT; Gregg S. Meyer, MD, MSc, senior vice president for quality and safety at Massachusetts General Hospital/MGPO; and Jeffrey Cooper, PhD, director, biomedical engineering, Partners HealthCare System, professor of anesthesia, Harvard Medical School; Department of Anesthesia and Critical Care, MGH.
At the heart of their discussion was the troubling statistic that in one recent year, up to 98,000 patients died in U.S. hospitals as the result of mistakes, some by receiving the wrong medication or an inappropriate dose of the right medicine.
Dr. Cooper spoke on the topic of “New Hazards of Medical Technology: Two Case Discussions.” He said that different systems in hospitals often don’t talk to each other. He outlined several real-life examples where patient safety was endangered because different computer systems were not combining to produce correct and essential information.
He urged listeners to make careful studies in operating rooms and special-care units when changes are made in hospital systems. The slightest differences in health-care operations can cause problems that can take months to correct.
Dr. Meyer spoke about “An Untapped Role for Patients: Online Reconciliation of Meds and Monitoring of Health Care Transitions.”
He said that consumers and medical professionals must continue to ask questions and seek improvements if medical centers are going to increase their safety records.
“I sometimes think of a giant private company like Home Depot,” said Dr. Meyer. “They try very hard to correct problems, and they’ve taken on a culture of improvement. Everyone works to make their store a better operation, and the other stores nationally.
“It might take time to implement the correct procedures or ensure that a discharged patient is leaving with the correct medications, but it is really worth it, for hospital and patient.”
Dr. Newbower spoke on the topic of “How to Protect Oneself from Injury by Human Error.”
October 23, 2007: Experts discuss biological electronics and sensors
Luke Theogarajan, PhD; MIT
Timothy Swager, PhD; MIT
Two researchers discussed the topic of “Biological electronics and sensors for medical applications” at the CIMIT Forum on Oct. 23 at Simches Research Center at Massachusetts General Hospital.
Presenting were Luke Theogarajan, PhD, of MIT, and Timothy Swager, PhD, John D. MacArthur Professor and Department Head, Department of Chemistry, MIT.
Dr. Theogarajan’s topic was “Electronic and ionic neural interfaces.” He said that neural prostheses are being developed around the world to alleviate various debilitating conditions. The key component of any neural prosthesis is the biotic-abiotic interface. He discussed the conventional electronic coupling to neurons that has been successful in areas like cochlear prosthesis.
“The main objective is to enable the design of efficient interfaces
so that we can build devices to alleviate some of the debilitating conditions that arise
from neural damage like blindness, Parkinson's disease etc. I am not with the clinic at MGH though I work with surgeons at MEEI and in the context of the Boston Retinal Implant project at the Veterans Administration, Boston. I am always looking for collaborations with like-minded people.”
Dr. Swager’s subject was “Electronic polymers and biosensors.” He focused on the applications of conjugated (electronic) polymers to detect molecules of biological origin and develop systems that can be used to measure biological activity. The mechanisms discussed will make use of optical detection and the ability of electronic polymers to amplify.”
He said, “My research program is broad and we are working on many applications in sensors (environmental, national security, and miscellaneous industries). The road to the clinic for new technologies is a difficult and slow one. I suspect if all goes well, in 5-10 years we could have something out there.”
October 16, 2007: Researchers focus on shock and recovery
Carl Hauser, MD, FACS, FCCM; BIDMC, HMS,
Alfred Ayala, PhD; Rhode Island Hospital/Brown University
Wolfgang Junger, PhD, BIDMC, HMS
Presenters at the Feb. 16 Forum at Simches Research Center of Massachusetts General Hospital reported on their work involving the body’s reaction to shock.
Dr. Carl Hauser is a visiting professor of surgery at Beth Israel Deaconess Medical Center, and Harvard Medical School. He spoke on “Post-resuscitation Injury: Translational Approaches to Cell Signaling in Shock and Resuscitation.”
He said that trauma causes about 150,000 civilian deaths per year in the U.S. and is the leading cause of death up to age 45. More than 50,000 preventable deaths occur per year when trauma, hemorrhage, sepsis or shock triggers the systemic inflammatory response syndrome (SIRS). SIRS is a clinical descriptor for the body’s immune activation in response to the dead and dying tissues injured by trauma.
His lab studies neutrophils (PMN), the most common circulating white blood cells. After injury PMN can attack vital organs causing critical illness and death. To study such human illness as directly as possible, the lab assays the effects of substances released from clinical tissue injury sites on PMN.
Dr. Hauser said, “PMN activating substances often act by increasing the concentration of calcium in the cell. These events occur via a complex pathway of signals that lead from cell surface receptors to intracellular calcium storage organs, and then back to calcium channels on the cell surface.
“Injury radically changes the dynamics of such post-receptor PMN calcium mobilization, in part by altering the fatty composition of cell membranes. All these changes alter PMN stimulus-response coupling and cell function (for example, migration and bacterial killing).
“Since cellular calcium entry is a key regulator of PMN activity and is abnormally regulated after injury, we are developing strategies to modulate PMN-mediated inflammation after shock and trauma by modulating calcium signals.”
Also speaking was Wolfgang Junger, PhD, visiting professor of surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Department of Surgery.
His topic was “Autocrine Regulation of Immune Cell Function.”
Dr. Junger said immune cells can play important roles in the defense of the host after trauma. He is studying chemotaxis, the ability of cells, such as neutrophils, to detect and move towards the source of chemoattractant signals.
He outlined some of the lab’s research, and said, “Our findings could lead to the development of novel therapeutic approaches that target PMN chemotaxis and thereby reduce the risk of host tissue damage caused by PMN in inflammatory diseases such as colitis, arthritis, asthma, and acute lung injury.”
Alfred Ayala, PhD, Division of Surgical Research/Department of Surgery, Rhode Island Hospital/Warren Alpert School of Medicine at Brown University, spoke on the topic of, “The Role of Systemic Immune Cell Signaling in While Body Ischemia/Reperfusion (I/R) Injury (Hemorrhagic Shock).”
October 9, 2007: Challenges and opportunities in office-based medicine
Keith Isaacson, MD,
HMS, NWH, BWH, site miner, CIMIT
Fred Shapiro, DO,
HMS, BIDMC
Beverly Philip, MD,
HMS, BWH
Lisa Warren, MD,
MGH
Many medical procedures are moving from the operating room to the doctor’s office, and a Forum held Oct. 9 at the Simches Research Center at Massachusetts General Hospital provided full and illuminating discussion of the significant trend.
Four speakers presented on a variety of topics, including “Office-based gynecologic procedures,” “Office-based anesthesia,” “Technology implications of office-based anesthesia safety,” and “Regional anesthesia in the office-based setting.”
Keith Isaacson, MD, medical director of the Minimally Invasive Gynecological Surgery Unit at Newton Wellesley Hospital, and CIMIT site miner at that institution, said that many gynecologists are moving toward office procedures because the net rate of reimbursement is greater.
He said that the federal Center for Medicare and Medicaid Services (CMS) is “directing” doctors to office procedures because that venue is less expensive than an OR. But there is less regulation in such facilities, and he warned that office-based medicine could become “the wild West of medicine” if it is continues to develop with a minimum of oversight.
Fred Shapiro, DO, who is with the Department of Anesthesiology, Critical Care and Pain Medicine Unit of Beth Israel Deaconess Medical Center, said that the use of anesthesia in an office setting is increasing rapidly because in the past 10 years, the number of office-based procedures has grown from 5 to 10 million cases. He noted that only 22 states have any regulations regarding office-based anesthesia, and he said that patient care could be compromised if medical professionals are not vigilant.
Beverly Philip, MD, director of the Day Surgery Unit at Brigham and Women’s Hospital, said there are both opportunities and challenges associated with OBA. She said that doctors must choose their patients carefully, and train in emergency procedures should an incident occur. She said that office-based medical personnel must excel in information management so that appropriate patients are chosen, and adequate data is available should doctors need it. Dr. Philip concurred that reimbursement is significant for those who practice outside of an operating room.
Lisa Warren, MD, director of ambulatory anesthesia at MGH’s Department of Anesthesia and Critical Care, said that regional anesthesia could be better utilized by those who use the office setting. Noting that about 25 percent of all elective surgery procedures in the U.S. are done in the office now, she suggested that doctors consider greater use of regional procedures.
October 2, 2007: Imaging leads to improvement of medical care
Gordon Harris, PhD,
MGH, HMS
Leonard Kaban, DMD, MD,
MGH, Harvard School of Dental Medicine
Imaging is providing new techniques in medicine and better outcomes to patients, two experts told the audience at the Oct. 2 Forum held at Simches Research Center at Massachusetts General Hospital.
Presenting were Gordon Harris, PhD, associate professor of radiology, and director, Radiology Computer Aided Diagnostics Laboratory, Harvard Medical School and MGH; and Leonard Kaban, DMD, MD, Walter Guralnick Professor of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, and chief of service, Department of Oral and Maxillofacial Surgery, MGH.
Introducing Dr. Harris was Hiro Yoshida, PhD, associate professor, Harvard Medical School, and director, 3D imaging, Department of Radiology, MGH. Introducing Dr. Kaban was Maria Troulis, DDS, MSc, associate professor of oral and maxillofacial surgery and director of residency training, MGH.
Dr. Kaban spoke on “Bone lengthening by distraction osteogenesis (DO): An update on CIMIT projects in maxillofacial DO.”
Dr. Kaban said that modern techniques such as three-dimensional imaging and minimal invasive endoscopic access for distraction placement have resulted in major improvements in the medical outcomes in his department.
Using slides that portrayed patients, he showed how new techniques of distraction osteogenesis help bones grow correctly in children with malformed faces. (Distraction is defined as separation of bony fragments or joint surfaces of a limb by extension).
Much of his work and that of his colleague, Dr. Troulis, focuses on improving bone structure that enhances breathing, physical appearance or both. He thanked CIMIT for supporting his work in this field, and said that such technology has aided the families of patients as well as the patients themselves.
Dr. Harris discussed “3D imaging in radiology.” He said that modern medical 3D imaging has been aided by the availability of more images, as well as the improved quality of resolution, advances in computing hardware and the evolution of visualization software.
MGH has one of the largest 3D imaging departments in the country, and Dr. Harris said the result of the new technology has been faster, more reliable response to the treatment of patients.
September 24, 2007: CIMIT introduces investigators, hears case study by Dr. Colson
Yolonda Colson, MD, PhD;
Brigham and Women's Hospital
Mark Grinstaff, PhD;
Boston University
Kirby Vosburgh, PhD;
CIMIT
CIMIT welcomed its new investigators (fiscal year 2008 awardees) at the Sept. 18 Forum at Simches Research Center at Massachusetts General Hospital, and then heard an inspiring presentation from Yolonda Colson, MD, PhD, who detailed how CIMIT’s support has helped to advance her research in treating lung cancer.
The annual orientation of investigators features site miners introducing the investigators (lead researchers) from their respective institutions. (A site miner is a liaison at a consortium medical center or institution who seeks out promising clinicians or engineers whose research might benefit from association with CIMIT).
The event was keynoted by Kirby Vosburgh, PhD, associate director of CIMIT (among other responsibilities). Dr. Vosburgh praised the site miners’ work in identifying promising researchers whose work someday could improve medical care. CIMIT earlier this year announced that it would provide Science awards to 37 investigators. The organization in recent weeks has announced more grants in categories such as Career Development, New Concept, Working Groups and Fast Forward.
After the introductions, Dr. Colson offered an oft-moving account of how CIMIT has helped her research. Dr. Colson, a thoracic surgeon on Brigham and Women’s Hospital, is researching the effectiveness of the local delivery of drugs to inhibit the recurrence of lung cancer.
Her presentation possessed a considerable amount of gravity because the morbidity rate of lung cancer is higher than another other cancer, taking 160,000 lives annually in the U.S. She said that CIMIT has been a major reason why she has been able to advance her research. Dr. Colson received a CIMIT-supported “Special Study Award” through Johnson & Johnson’s Corporate Office of Science and Technology, and more recently, a Science award.
Dr. Colson is assessing safety and feasibility of using local delivery of chemotherapeutic drugs to inhibit malignant cell growth at surgical resection using minimally invasive surgery. Through CIMIT, she has been collaborating with Mark Grinstaff, PhD, of the biomedical engineering department of Boston University, and John Frangioni, MD, PhD, a doctor and researcher at Beth Israel Deaconess Medical Center working in cancer research.
“I had an idea, but I didn’t know whether it was a good idea,” said Dr. Colson. “But CIMIT listened, and enabled me to receive an award that would help me to explore it. I was able to generate some data, and had more discussions with CIMIT. They put me in touch with Mark Grinstaff, of the biomedical engineering department at Boston University, and we have had a very successful collaboration. In something like 13 months, we have been able to combine my knowledge of medicine and his knowledge of engineering to move forward on delivering medicine to the edges of a cancer surgery. I have been fortunate in working with Dr. Frangioni and his lab. It’s early still but we think this can save or prolong lives.”
September 11, 2007: Experts discuss cardiac issues as Forum reconvenes
Patrick O'Gara, MD; BWH
Matthew Jolley, MD; Children's Hospital Boston
Jeroen Stinstra, PhD; SCI Institute Utah
The CIMIT Forum re-opened for learning and networking on Sept. 11 following an August hiatus with a discussion of issues relating to cardiac care.
After the session, CIMIT staff and guests adjourned for a reception to toast the 10th anniversary of the Forum.
One presenter was Patrick O’Gara, MD, vice chairman, clinical affairs, Department of Medicine at Brigham and Women’s Hospital. His session was moderated by Ahmed Tawakol, MD, co-director, Cardiac MR-PET-CT Program, and associate director, nuclear cardiology, Massachusetts General Hospital; and co-leader of the CIMIT Cardiovascular Disease Program.
Also presenting were Matthew Jolley, MD, of Children’s Hospital Boston, and Jeroen Stinstra, PhD, of the SCI Institute Utah. Moderator was Ron Kikinis, MD, director, Surgical Planning Laboratory of the Department of Radiology, BWH and Harvard Medical School, and professor of radiology, Harvard Medical School; and co-leader of the CIMIT Image Guided Therapy Program.
The title of Dr. O’Gara’s presentation was “Application of cardiac non-invasive imaging in clinical decision-making.”
He said challenges to the institutionalization of cardiovascular imaging include cost, safety (in relation to doses of radiation), quality of images, competence and appropriateness.
Dr. O’Gara said that clinicians have been challenged to understand the appropriate application in cardiovascular imaging, and to collaborate more effectively with imaging experts. Training programs have been developed but much work remains.
“Advances in CV imaging have been nothing short of fantastic,” Dr. O’Gara said. “In many ways they have preceded our ability to know how to use the technologies appropriately and cost-effectively. Issues about safety (radiation/contrast exposure) are still present. There are many more advances to come, particularly in the area of molecular imaging. But how will these impact treatment decisions and outcomes?”
Dr. Jolley spoke on the topic of “Modeling of optimal ICD electrode placement in children and adults.” He said that implantable defibrillators have become standard practice in large adults, but there is a reluctance to place them in the bodies of growing children. He stated that studies must continue to determine when and how such devices can be placed inside a youngster - or adults who would not normally be considered candidates for such technology.
Dr. Jolley is developing data with Dr. Stinstra, a software specialist who is based in Utah. Dr. Jolley credited CIMIT Fast Forward grants with providing the two (and their laboratories) with the resources (including financial support for transportation) to continue their work even though separated by many miles.
July 31, 2007: Series Concludes with Discussion of Brain Plasticity
John Gabrieli, PhD; MIT
Gottfried Schlaug, MD, PhD; BIDMC, HMS
Charles Jennings, PhD; McGovern Institute for Brain Research, MIT
Steven Schachter, MD; HMS, BIDMC, CIMIT Program Leader, CIMIT Site Miner
The fourth in the July series of Forums focused on neurotechnology concluded July 31 at a standing-room-only program at the MIT McGovern Institute for Brain Research.
The series was called “Neurotechnology: Translating Basic Discoveries into Clinical Promise.” Organizers of the four-session program were Charles Jennings, PhD, director of the McGovern Institute of Neurotechnology (MINT) Program, and Steven Schachter, MD, professor of neurology at Harvard Medical School; director of research, Department of Neurology, Beth Israel Deaconess Medical Center; associate director, clinical research, Harvard Medical School Osher Institute; CIMIT Program Leader, neurotechnology; and CIMIT Site Miner, BIDMC.
Presenting were John Gabrieli, PhD, Grover Hermann Professor of Health Sciences and Technology and Cognitive Neuroscience, MIT; director, Athinoula A. Martinos Imaging Center, McGovern Institute of Brain Research; and co-director, MIT Clinical Research Center; and Gottfried Schlaug, MD, PhD, associate professor of neurology; chief, Division of Cerebrovascular Disease, director, Music and Neuroimaging and Stroke Recovery Laboratories, BIDMC and Harvard Medical School.
Dr. Schlaug spoke on the topic of “Inducing and Imaging Brain Plasticity: Health Subjects and Patients Recovering from Stroke.” He said stroke recovery studies have shown that peri-lesional regions on the opposite hemisphere can either substitute for some of the lost function or be involved in the development of alternative strategies for impairment.
Dr. Schlaug’s studies sometimes use music as a means of prompting activity manifested from use of specific parts of the brain. He showed clips of a man who could not speak intelligibly. But when he was asked to sing the same words (while tapping his left hand), he was able to articulate the words that eluded him in speech.
Dr. Schlaug said such probing of parts of the brain have the potential to aid stroke victims in their attempts to regain speaking skills.
He also said non-invasive brain stimulation tools are now available to enhance desired brain changes, or depress unwanted or maladaptive brain changes.
Dr. Gabrieli spoke on the topic of “Functional Imaging of Human Brain Plasticity.”
He said that functional magnetic resonance imaging (fMRI) can reveal experience-dependent brain plasticity that can be seen in healthy people gaining new skills and in dyslexic children given remediation for reading difficulty. (View Summary with Video)
July 24, 2007: Experts discuss stroke-recovery research
Emilio Bizzi, MD, PhD, McGovern Institute for Brain Research, MIT
Alvaro Pascual-Leone, MD, PhD, HMS, BIDMC
Charles Jennings, PhD,
McGovern Institute for Brain Research, MIT
Steven Schachter, MD, HMS, BIDMC, CIMIT Program Leader, CIMIT Site Miner
The third segment of the CIMIT Summer Education Series 2007 produced thoughtful and penetrating presentations of the brain’s response to a stroke.
Presenting were Emilio Bizzi, MD, PhD, Institute Professor, McGovern Institute of Brain Research, at MIT; and Alvaro Pascual-Leone, MD, PhD, professor of neurology, Harvard Medical School; director of the Berenson-Allen Center for Noninvasive Brain Stimulation; and attending neurologist and director of research, Behavioral Neurology Unit, Beth Israel Deaconess Medical Center.
The session was part of the summer series titled, “Neurotechnology: Translating Basic Discoveries into Clinical Promise.”
Close to 1 million Americans suffer strokes each year, and it is the leading cause of disability in the developing world.
Dr. Pascual-Leone spoke on the topic of “Cortical Stimulation to Promote Recovery after Stroke.” He said that both noninvasive and invasive brain stimulation techniques have been recently tested in proof-of-principle studies with stroke patients aimed at enhancing functional recovering.
He cited techniques such as repetitive transcranial magnetic stimulation, transcranial director current stimulation and direct cortical stimulation with epidural electrodes.
Dr. Pascual-Leone said that ongoing clinical trials confirm promising results. He showed tape of a stroke patient before and after stimulation of specific parts of the brain, and the patient showed improved mobility in the hand and arm following stimulation.
Dr. Bizzi spoke on the topic of “Neural Control of Movement and Applications for Stroke Intervention.”
He said neuronal recordings from awake monkeys have revealed plasticity at the single-cell level, and some of the neurons of the cortical motor areas exhibit learning-dependent activity changes.
Whether the adapted cells represent simple command signals or the formation of internal models designed to handle a new dynamic environment is still open to question, he said, but studies continue. (View Summary with Video)
July 17, 2007: Summer series session focuses on detection of seizures
Steve Schachter, MD,
BIDMC, HMS
John Guttag , PhD,
MIT
Charles Jennings, PhD,
MIT, McGovern Institute of Neurotechnology
Statistics show that epileptic seizures affect 60 million people around the world, including about 60,000 in Massachusetts. About a third of patients continue to have seizures despite available therapies.
Many clinicians in the field say that using non-invasive technology to detect the onset of seizures in time to minimize consequences is a major unmet challenge.
Steven Schachter, MD, was one speaker at the July 17 Forum that focused on epilepsy and other ailments associated with neurotechnology. It was the second in a four part series, "Neurotechnology: Translating Basic Discoveries into Clinical Promise."
Dr. Schachter addressed the subject of "Decoding Cortical Electrophysiology for the Detection of Seizures." He is a professor of neurology at Harvard Medical School; director of research, Department of Neurology, Beth Israel Deaconess Medical Center; associate director, clinical research, Harvard Medical School Osher Institute; founder and editor of "Epilepsy and Behavior," a periodical and Epilepsy.com; CIMIT program leader for neurotechnology; and CIMIT site miner for BIDMC.
His research involves using vagus nerve stimulation, which is an adjunctive treatment for certain types of intractable forms of epilepsy. VNS uses a stimulator that sends electric impulses to the left vagus nerve in the neck via a lead implanted under the skin.
Dr. Schachter is using his skill as a clinician to develop a system that will help patients and doctor to identify the onset of a seizure.
Dr. John Guttag, is Dugald C. Jackson Professor, Department of Electrical Engineering and Computer Science at MIT. He is working closely with Dr. Schachter to determine the statistically most accurate approach to determine the success of their methods.
The team is considering looking into other diseases that result in seizures or neuro-episodes. Dr. Guttag said they are seeking collaborators in their upcoming work.
(View Summary with Video)
July 10, 2007: Summer Series opens with discussion of restorative neurotechnology
Christopher Moore, PhD; MIT
Leigh Hochberg, MD, PhD; Brown University, VA, HMS, MGH
The kick-off event of the Summer Education Series drew a capacity audience at the MIT McGovern Institute for Brain Research on July 10, and provided listeners with reasons for optimism regarding the future of restorative neurotechnology.
The series is part of the ongoing CIMIT Forum. This event marked the first of a four-part series in July titled: “Neurotechnology: Translating Basic Discoveries into Clinical Promise.”
Presenters were Christopher Moore, PhD, Mitsui CD Chair, assistant professor of neuroscience, Department of Brain and Cognitive Sciences, MIT; and Leigh Hochberg, MD, PhD, associate investigator, Department of Veterans Affairs, Providence (R.I.) VA Medical Center; investigator in neuroscience at Brown University, collaborating with the laboratory of John Donoghue; and instructor of neurology at Harvard Medical School, Massachusetts General Hospital.
Dr. Hochberg addressed the theme of “Brain-computer interfaces, restorative neurotechnology.”
He cited a small FDA-approved pilot study examining the feasibility of persons with tetraplegia controlling a computer cursor by imagining movement of their own hand.
Dr. Hochberg said that by harnessing the power of intracortically-recorded signals from motor cortex, neuronal activities are transmitted via cabling to a computer, and then decoded in real time into either the movement of a cursor or control over other external devices.
He presented video footage of a patient, with an attachment in his cranium, manipulating a cursor just by “willing it” to move. This function enabled him to open his email. The patient also was able to make a prosthetic hand open and close.
“Preliminary results have been encouraging,” said Dr. Hochberg, “There is potential for this and related neurotechnologies to re-enable the communication, mobility and independence of persons with a physical disability.”
He said that more than 100,000 worldwide are affected by serious immobility, and that such investigation has the potential to aid many patients.
Dr. Moore spoke on the subject of “Cortical Maps: New Hypotheses as to Their Computational Value and How They Might Save Neural Prosthetics.”
He suggested that changes in blood flow as it relates to neural activity could be a key factor in understanding brain-body interfaces. (View Summary with Video)
June 26, 2007: Industry, medical leaders urge interoperability in the OR
Dave Whitlinger; Intel Corp.
Zachary Zimmerman, MS, MD; Kaiser Foundation
Julian Goldman, MD; MGH
Carl Wallroth; Draeger Medical
Jeff Robbins; CEO, LiveData
The CIMIT Forum of June 26 was held at CIMIT offices in Cambridge to coincide with the national HCMDSS/MD PnP Workshop being held in that city.
HCMDSS stands for High Confidence Medical Devices, Software and
Systems, and MD PnP stands for Medical Device Plug-and-Play Interoperability.
The Forum was packed with both convention participants and local medical professionals, from the Boston area and around the country.
A key speaker was Julian Goldman, MD, driving force behind the conference. He is principal anesthesiologist at Massachusetts General Hospital’s “Operating Room of the Future;” director of CIMIT Program on Interoperability; founder, medical device “Plug-and-Play” Interoperability Program; physician advisor, Partners HealthCare Biomedical Engineering, MGH; User Vice-Chair, National Standards Committee for Anesthetic and Respiratory Equipment.
Dr. Goldman said that medical professionals must join together to develop methods of making hospital-based health care safer by ensuring that all electrical and digital systems "talk to each other" efficiently during medical procedures.
He urged support of a program that he and others at the conference are championing, that of developing standards of interoperability that can be approved by national authorities.
This would make it more attractive for commercial manufacturers to participate more actively in developing devices that work together.
Zachary Zimmerman, MS, MD, chief of the Department of Anesthesiology and chair of chiefs of anesthesia, TPMG; Kaiser Foundation Hospital, Vallejo, Calif., also said that standards should be developed and approved.
Dr. Zimmerman said that Kaiser hospitals are interested in quality health care and containing costs, in that order, and interoperability in operating rooms would foster safer conditions while eventually holding down expenditures.
Organizations involved with sponsorship of the conference included Massachusetts General Hospital, Partners HealthCare, CIMIT, TATRC (U.S. Army’s Telemedicine and Advanced Technology Research Center) and the NSF (National Science Foundation).
June 19, 2007: Specialists discuss rise of melanoma
Hensin Tsao, MD, PhD; MGH, HMS
David E. Fischer, MD, PhD; Dana-Farber CancerCare Institute, CHB
Melanoma incidence is increasing, and doctors and researchers are spending greater effort to better understand the disease, and to be more effective in preventing and/or treating it.
Two renowned experts spoke recently on the subject at the CIMIT Forum held at Simches Research Center at Massachusetts General Hospital: Hensin Tsao, MD, PhD, assistant professor of dermatology, Harvard Medical School and clinical director, Melanoma Genetics Program, Massachusetts General Hospital; and David E. Fisher, MD, PhD, director, Melanoma Program, Dana-Farber Cancer Institute; professor, pediatric hematology/oncology, Harvard Medical School and Dana-Farber Cancer Institute, Children’s Hospital, Boston.
Melanoma is a dark-pigmented, malignant, frequently widely metastasizing tumor, arising from a melanocyte and occurring most commonly in the skin.
Dr. Tsao said that advances made in genetics through the Human Genome Project are making the idea of “personalized” medicine a reality, and that understanding of this condition should expand.
He noted that research is showing that hereditary factors increase the chances for the disease, as does living in sun-drenched areas like Florida and Australia.
Dr. Tsao explained some of the melanoma risk genes, and discussed approaches that are being taken to identify other markers of the melanoma predisposition.
Dr. Fisher noted that statistics reflect that melanoma cases are rising, yet treatment and prevention strategies are lacking. Inadequate treatments reflect the intrinsic survival properties of melanoma cells.
He said that examination of the skin’s response to ultraviolet radiation has revealed a molecular pathway integrally involved in control of pigmentation, and potentially exploitable for skin-cancer prevention.
June 12 , 2007: Leading researchers discuss personalized medicine
Janina Longtine, MD, BWH, HMS
Carolyn Mountford, D.Phil, BWH, HMS
Researchers are moving steadily forward in understanding cancer and other diseases, but more research is required before “personalized medicine” becomes widely used.
Presenters at the June 12 Forum at Simches Research Center at Massachusetts General Hospital were Janina Longtine, MD, chief of molecular diagnostics, Department of Pathology, Brigham and Women’s Hospital, associate professor of pathology at Harvard Medical School and program director of the Harvard Medical School Molecular Genetic Pathology Training Program; and Carolyn Mountford, D.Phil, director of spectroscopy, Department of Radiology, Brigham and Women’s Hospital, and visiting professor in radiology, Harvard Medical School.
Dr. Longtine spoke on the subject of “Molecular Diagnostics in Personalized Cancer Care: Opportunities and Challenges.”
She said the rapid progress in identifying the genetic basis of disease, combined with technological advancement, has transformed diagnostic medicine. In cancer care, molecular diagnostics provides more precise classification of disease based on genetic mutations and/or altered gene expression, which in turn, provides predictive information, identification of tumors that are candidates for targeted drug therapy, and sensitive monitoring of therapeutic response.
Dr. Longtine said that such diagnostics are helpful in “providing the right therapy for the right patient at the right time,” but that cost can be a factor in the expansion of such a practice.
She said a drug such as Gleevec can be useful, but at $30,000 per year for treatment, it is used primarily in wealthy countries. Practitioners in poorer nations still use more mature methods, such as the bone-marrow transplant which is less expensive.
Dr. Longtine said that some research is slowed by the fact one private company might own the intellectual property rights to a promising therapy, and is uncomfortable with sharing the research with academics or researchers from other organizations.
Dr. Mountford spoke on the topic of “Magnetic Resonance Spectroscopy in Personalized Medicine.”
She discussed how well-characterized chemical and molecular biomarkers can be used to detect, diagnose and image cancer and other disease states, potentially non-invasively and in-vivo.
June 5 , 2007: Doctors discuss mitral valve care
Judy Hung, MD; MGH, HMS
Michael Davidson, MD; BWH
Chances are improving for achieving better outcomes in treating mitral regurgitation, two cardiac specials said at the CIMIT Forum Tuesday, June 5, at Simches Research Center at Massachusetts General Hospital.
Judy Hung, MD, assistant physician at Massachusetts General Hospital and assistant professor of medicine at Harvard Medical School, spoke about potential improvements in care as a result of three-dimensional echocardiography.
The topic of her address was “Mechanism of Mitral Regurgitation: Insights from 3D Echo Toward Improving Repair.”
She discussed current surgical repair and percutaneous approaches, and how therapy might be improved based on these mechanistic insights.
About 500,000 patients suffer from mitral regurgitation, a common valve disorder. Though progress has been made in recent years, some patients are underserved, experts say.
Michael Davidson, MD, associate surgeon in the Division of Cardiac Surgery, Brigham and Women’s Hospital, spoke on the topic, “From the Scalpel to the Catheter: Percutaneous Approaches to Mitral Valve Repair.”
He said the advent of newer imaging and device technologies have enabled the development of catheter-based mitral valve repair, which might benefit these populations.
Dr. Davidson reviewed the state-of-the-art approaches to fixing mitral regurgitation, including the lessons surgery can offer to disruptive technologies. He also discussed the CIMIT-sponsored research using transcatheter methods to enable chordal replacement.
Dr. Davidson utilized a CIMIT study grant to learn more about cardiology, and the most effective methods in dealing with heart problems.
May 29, 2007: The future of optical medicine
Irving Bagio, PhD; BU
Sergio Fantini, PhD; Tufts
Guillermo Tearney, MD, PhD; MGH
David Benaron, MD; Stanford; CEO, Spectros Corp.
Satish Singh, MD; BU
Optical medicine has a future as a new diagnostic tool but will have to pass both regulatory and commercial tests if it is to come into common use in medical centers. It will have to prove to be accurate, user friendly and reimbursable by the health-insurance system, a panel of experts said.
The well-attended CIMIT Forum on May 29, hosted at the Boston University Photonics Center, was focused on “The Future of Optical Medicine.”
Irving Bigio, Ph.D., Boston University professor in the departments of biomedical engineering, electrical and computer engineering and physics, said that much research is being done in various areas of spectrometry (the observation and measurement of wavelengths of light and other electromagnetic radiation).
He indicated that it could take a decade before it can go from promising scientific application to a tool that will be embraced by commercial interests and used by medical centers.
“You’re not going to get rid of pathologists” any time soon, said Dr. Bigio.
Sergio Fantini, PhD, professor of biomedical engineering and associate dean of graduate students at Tufts University School of Engineering, said that optical imaging is one of a number of optical techniques that are showing potential for clinical use.
The technique might someday be used clinically in areas such as optical mammography and functional brain imaging.
David Benaron, MD, chief executive officer of Spectros Corp. and associate professor, Intensive Care, Stanford School of Medicine, said that researchers must remember to keep the needs of hospitals in mind when they are carrying out research that they hope will be used in health care some day.
He said that researchers must show that their new device or system can save the hospital money, or is so much better that what’s currently being used that they can’t afford to avoid it.
“Commercial interests and the hospitals themselves are looking for efficiency, and they also want something that is reimbursable,” said Dr. Benaron.
Guillermo “Gary” Tearney, MD, PhD, agreed, saying that hospitals want tools and systems that are smaller, less expensive and cost effective.
Satish Singh, MD, assistant professor of Medicine at Boston University School of Medicine, and staff gastroenterologist at the VA Boston Healthcare System, noted that research alone won’t pave the way for the advance of optical medicine.
He said that if this new technology were to suddenly flourish, the medical centers would need “thousands” of new technologists to process the data generated by testing of patients.
May 22, 2007: Doctors discuss challenges of traumatic brain injury
Lee Schwamm, MD; MGH, HMS, MIT
Marc de Moya, MD; MGH, HMS
Mel Glenn, MD; Spaulding Rehabilitation Hospital
Traumatic brain injury is becoming a greater concern in the U.S. medical community and more must be done to help patients, specialists in the field said at the May 22 Forum at Simches Research Center.
The well-attended session was titled, “Acute and Chronic Consequences of Traumatic Brain Injury: How Can We Better Treat Patients?”
Lee Schwamm, MD, director of acute stroke services and vice chair, Department of Neurology at Massachusetts General Hospital, said therapies for TBI have not improved significantly in the past decade.
Yet about 500,000 Americans suffer from TBI, according to Marc de Moya, MD, a trauma surgeon at MGH. More cases are being discovered monthly from soldiers returning from Iraq.
He said that effective methods of treating early-stage TBI are largely unknown. He and a team at MGH are studying ways to understand the mechanism of primary brain injury extension and determine how to mitigate the extension.
His team is also interested in using the learning/memory model in large animals such as swine to study the long-term effects of severe TBI.
Mel Glenn, MD, director of outpatient and community brain injury rehabilitation at Spaulding Rehabilitation Hospital, said that football players and boxers who receive repeated blows to the head often suffer in later years. But there is little effective therapy available to them.
Dr. Glenn cited the case of Ted Johnson, a former linebacker for the New England Patriots football team. Johnson has told reporters that he suffers from severe headaches. He says he is often depressed. He blames his condition on collisions he received on the field. Patients like Johnson would benefit from more research and better therapies, said Dr. Glenn.
Dr. Glenn mentioned that research shows boxers frequently manifest head injury either during their careers or after retirement. However, he said that studies thus far show that soccer players are not damaged by heading the ball during their games and practices.
Dr. de Moya said that greater efforts are being made to study traumatic brain injury, aided by funding from the Department of Defense which is reacting to the number of head injuries sustained overseas.
Dr. de Moya said that one positive aspect of the Iraq War could be greater funding for TBI, and better diagnosis and therapies for those injured either in battle or civilian mishaps.
May 15, 2007: Enabling medical systems to interact
Julian Goldman, MD; MGH
Stephen Grimes, FACCE FHIMSS; President, American College of Clinical Engineering
Operating rooms are becoming increasingly sophisticated as they receive more effective equipment, but new components must be compatible to make the OR of the Future function as well as patients and doctors are expecting.
Julian Goldman, MD, spoke at the May 15 CIMIT Forum at Simches Research Center at Massachusetts General Hospital, on the topic of “Medical Device Interoperability.”
Dr. Goldman is principal anesthesiologist at MGH’s Operating Room of the Future; Director, CIMIT Program of Interoperability; founder, Medical Device “Plug-and-Play” Interoperability Program; Physician Advisor, Partners HealthCare Biomedical Engineering; Vice-Chair, U.S. National Standards Committee on Anesthetic and Respiratory Equipment.
The subject of Dr. Goldman’s presentation was “Device Interoperability for Improving Patient Safety: A Grand Challenge.”
Also speaking was Stephen Grimes, FACCE FHIMSS, vice president, enterprise resource planning, Technology in Medicine Inc.; and president, American College of Clinical Engineering. His topic was “Convergence of Biomedical and Information Technologies: Opportunities and Challenges.”
Dr. Goldman is leading a national initiative to improve the safety and efficiency of operating rooms.
His MD PnP program (dubbed “Plug ‘n Play”) is focused on using modern networking technology to prove the safety of medical diagnosis and therapy. Its mission is to lead the evaluation and adoption of standards and technology that allows networking medical devices to improve patient safety and healthcare efficiency.
The project spun out of the Operating Room of the Future project at MGH, with funding from CIMIT and the Department of Defense. A key focus is to improve safety in the OR by coordinating data and enabling systems to talk to each other.
Example: If monitoring devices aren’t linked, medical personnel might not be aware of a breakdown in the system, such as a respirator standing inert rather than operating during a life-or-death procedure.
“There have been quite a few examples of injury and even death when devices did not function properly and yet anyone knew it,” said Dr. Goldman. “We are working with many organizations to develop standards that work for everyone, and we look forward to the day when patients fully benefit from this type of safety consideration.”
Collaborations have been carried out with institutions including Draper Laboratory, Mitre Corp., Partners HealthCare, Inc.; Kaiser Permanente, LiveData Inc., the University of Pennsylvania and numerous medical societies.
But before machines can “talk to each other” and computers can share data, common standards must be crafted. To that end, Dr. Goldman is taking a leadership role shaping national standards that would be acceptable to both medical authorities and participating device manufacturers.
An international MD PnP standard is being drafted and vetted.
“To make this work, we need cooperation of institutions, device makers, medical professionals and more,” said Dr. Goldman. “It’s a large task but an important one.”
Dr. Grimes focused on the situation that in recent years there has been a growing integration and interconnection between disparate medical and information technology.
The convergence has the potential to improve the quality and safety of patient care, but it can leave providers vulnerable to major failures that can compromise their ability to deliver that care. Procedures to avoid such risks were discussed.
Moderating the program of Dr. Goldman was John Hedley-Whyte, MD, the David S. Sheridan Professor of Anesthesia and Respiratory Therapy at Harvard University.
Moderating the Dr. Grimes program was Jeffrey Cooper, PhD, director, Biomedical Engineering, Partners HealthCare System, Inc.; associate professor of anesthesia, Harvard Medical School, and MGH; and director, Center for Medical Simulation.
May 8, 2007: Researchers discuss advances in battlefield medicine
Col. Geoffrey Ling, MD, PhD; DARPA, Walter Reed, Johns Hopkins Hospital
Michael Callahan, MD, BTN&H, MSPH; DARPA, CIMIT/MGH
One of CIMIT’s priorities is responding to medical needs on the battlefield, and the May 8 Forum at the Simches Research Center at Massachusetts General Hospital featured two impassioned practitioners who provided an overview of developments in technology to aid soldiers.
Speaking were Col. Geoffrey Ling, M.D., Ph.D., program manager for the Defense Advanced Research Projects Agency (DARPA), and an attending physician at Walter Reed Medical Center and Johns Hopkins University; and Michael Callahan, M.D., DTN&H, M.S.P.H., program manager for DARPA Defense Sciences Office; and Command Physician 77, Biological Threat Defense and Mass Casualty Care, CIMIT/Massachusetts General Hospital.
One project DARPA is developing is the “trauma pod,” a project to improve battlefield casualty care by developing mobile surgical capabilities through the integration of tele-robotic and robotic medical systems.
The initial phase has successfully automated functions typically performed by the scrub nurse and circulating nurse, officials say. These functions are now performed by semi-autonomous robots working in coordination with the tele-robotic surgeon.
The program plans to incorporate a portable CT scanning capability to enable pre- and post- surgical diagnosis and assessment. The final phase of the program will miniaturize the entire robotic surgery and scanning system, and integrate it onto a tactical platform. The project is under development.
On the topic of delivering medical care, Col. Ling said that military medics have the highest casualty rate in the Iraq theater.
He also stated that close to 80 percent of casualties are civilian Iraqis, which American medical teams are committed to help. The number of casualties the military must assist is high, he said.
DARPA researchers also are investigating manufacturing pharmaceuticals on demand so that more medicines are near the region of fighting. And researchers are investigating the nature of “blast brain injury.”
Dr. Callahan said that there is a need to improve current vaccine manufacturing systems in the face of large-scale biological threats.
In addition, he said DARPA is doing research on preparing soldiers for extreme environments.
He said that research at Stanford University shows that new techniques in dealing with physical stress can improve the biochemical etiology (causation) of muscle fatigue.
His group also is researching the creation of Accelerated Manufacture of Pharmaceuticals (AMP) which seeks to create a system of producing 3 million doses of any vaccine or therapeutic in 12 weeks, and perhaps at pennies per dose.
Moderating the session of Dr. Ling was Lee Schwamm, M.D., vice chair of the Department of Neurology at MGH and associate program director, MIT General Clinical Research Center.
Moderating the session of Dr. Callahan was Murray Hamlet, DVM, former director of the Cold Research Division, U.S. Army Research Institute of Environmental Medicine, in Natick.
May 1, 2007: The challenge of educating physicians
George Velmahos, MD, PhD; MGH
John Abele, founding chairman; Boston Scientific
James Gordon, MD, PhD; MGH
Jay Schnitzer, MD, PhD; MGH
Jo Shapiro, MD; BWH
Debra Weinstein, MD; MGH
"The Challenge of Educating Physicians" was the topic at the May 1 CIMIT Forum. We discussed how we teach and how we learn. We focused on the use of simulation for procedural skills and the complexity of teaching and learning cognitive skills as the amount of medical knowledge becomes wider and deeper.
If old silos are developing sub-silos, how do we integrate and synthesize?
George Velmahos, MD, PhD, chief, trauma, surgery and critical care, MGH, and program leader of CIMIT's trauma and casualty care program and John Abele, founding chairman of Boston Scientific Corp., moderated the sessions.
Panelists included James Gordon, MD, PhD, director of the Gilbert Program in Medical Simulation at Harvard Medical School, and who practices and teaches as a member of the faculty in the Department of Emergency Medicine at Massachusetts General Hospital; Jay Schnitzer, MD, PhD, a surgeon and CIMIT site miner at MGH; Jo Shapiro, MD, chief of the Division of Otolaryngology at Brigham and Women's Hospital; and Debra Weinstein, MD, director, graduate medical eduation, at MGH.
In theory, simulation tools are valuable, but in complex practice seem to fall short of expectations. Data for early simulation training is compelling, including pre and post operative instruction. Physical simulations for team training in behavioral and cognitive education demonstrate solid results. High fidelity virtual reality simulators for complex surgery are still visions. Such tools are wanted, but are they what is needed?
The specifics regarding simulation raised questions such as what does it take to become competent? What does it take to become expert? What techniques work? What learning improves patient outcomes?
The dialogue didn't shy away from discussing the political and hierarchical aspects of medicine and the difficulties of introducing change in that environment. It is notable that patient demand has been a driver for change as well as regulatory requirements.
We concluded that in addition to assisting learning, utilizing simulation, emergent media and gaming tools can provide us with data to assess user competency and expertise as well as assessing the education process itself.
Questions raised included the following: Does the simulation system have memory and feedback? Can the simulator learn? Can the simulator become an operative assistant? Can we tap into education R & D in this arena? What platforms can we adopt or develop?
By Lynn Osborn, Director of Education, CIMIT
April 24, 2007: Experts discuss Mass Casualty Incident response
Sandy Bogucki, MD, PhD; Yale University School of Medicine; US Department of Health and Human Services
Technology challenges relating to mass casualty disaster was the topic of the CIMIT Forum held April 24 at the Beth Israel Deaconess Medical Center.
Sandy Bogucki, M.D., Ph.D., an associate professor at Yale University and a senior medical advisor to the United States Department of Health and Human Services, outlined broad needs that communities must respond to when a mass casualty incident (MCI) occurs.
She defined an MCI as an event that involves six to 12 severely injured patients, and up to several dozen less critical victims.
Dr. Bogucki said that challenges range from adjusting preconceived MCI planning scenarios to the organizational and IT obstacles inherent in multi-jurisdictional responses, the dilemma of triage, the treatment and transport of victims despite inadequate local resources.
She suggested that medical and community leaders must examine their capabilities and attempt to improve their ability to react to unexpected disasters.
Also presenting were a half-dozen students from Harvey Mudd College of Claremont, Calif.
They discussed “design and development of a real-time mass-casualty accountability system.”
Noting that many victims of Hurricane Katrina were unable to receive care, they discussed a plan they conceived to provide a portable, non-invasive system to monitor heart rate, body temperatures and location of vulnerable people within a given area.
That data would be wirelessly transmitted to a centralized data processing unit for use by professionals knowledgeable about mass casualty situations.
Moderator was William Weismann, M.D., CEO of BioSTAR Group.
April 17, 2007: Lester Wolfe Workshop draws experts on breast cancer
Barbara L, Smith, MD, PhD; MGH, HMS
Maryann Fitzmaurice, MD, PhD; Case Western Reserve University
Arjun Yodh, PhD; University of Pennsylvania
Stephen Boppart, MD, PhD; University of Illinois, Mills Breast Cancer Institute
The Lester Wolfe Workshop in Laser Biomedicine was held April 17 as part of the CIMIT Forum series, and four prominent speakers addressed optical methods in breast-cancer diagnosis.
Lester Wolfe was a Boston inventor with an interest in optics and photography. He died in 1983, and his will provided funds "for fellowships for studies in molecular biology and for research using optical methods in the investigation of the structure and properties of matter."
The well-attended workshop, held at Simches Research Center of Massachusetts General Hospital, addressed new approaches to diagnosing breast cancer.
Providing a clinical overview of new approaches to unique research was Barbara L. Smith, MD, PhD, director of the Breast Program of the Cancer Center, and co-director of the Women's Cancers Program, at Massachusetts General Hospital.
"As yet, there are no clinical applications of optical imaging for breast cancer - all are still experimental," said Dr. Smith.
"While there has been steady progress in diagnostic approaches for breast cancer, many challenges remain. Current imaging techniques are imprecise in outlining the extent of the tumor, so that up to 50 percent of women need multiple surgical procedures for complete removal of their tumor. Optical techniques have the potential to identify involved margins intraoperatively and on pathology specifimens. This would be a major step forward for patients and surgeons."
Maryann Fitzmaurice, MD, PhD, an associate professor of pathology and oncology at Case Western Reserve University, spoke on "Shedding Light on Breast Cancer: Advances in Optical Spectroscopy Diagnosis of Breast Cancer."
She said optical spectroscopy holds promise for both improving the accuracy of breast cancer diagnosis and enabling breast cancer diagnosis to be made in a less invasive and more timely fashion.
Arjun Yodh, PhD, a professor of science at the University of Pennsylvania, spoke on the topic of "Breast Imaging and Characterization with Diffuse Optics."
He discussed diffuse optical tomography (DOT), and discussed the next generation of medical instruments in the field.
Stephen Boppart, MD, PhD, discussed "Intra-operative Optical Biopsy of Breast Cancer." He is a professor of medicine at the University of Illinois at Urbana-Champaign, and director of the Mills Breast Cancer Institute in that community.
He raised the possibility of utilizing optical coherence tomography (OCT) to enable real-time intra-operative visualization of tissue architecture at cellular resolution, with the potential to perform volumetric microscopy and computer-automated classification over large regions.
Moderator was Michael Hamblin, PhD, associate professor of dermatology at Harvard Medical School, and associate chemist at the Wellman Center for Photomedicine, Massachusetts General Hospital.
April 10, 2007: Telemedicine is making a healthy difference
Joseph Ternullo, CPA, JD;
Partners Telemedicine
John Clark, MD;
HMS, MGH, BWH, Metro West Medical Center
Paul Heinzelmann, MD;
Partners HealthCare
David Spinale, MBA;
MGH
Lee Schwamm, MD;
MGH, HMS, MIT
Hassan Sharif, MD;
WorldCare
Kathy Duckett, RN, BSN, PHN;
Partners Home Care
Leaders in telemedicine were featured at the CIMIT Forum on April 10 at the Simches Research Center of Massachusetts General Hospital, and panelists reported that the need for such services is driving significant growth.
Panelists defined telemedicine as the transfer of electronic medical data (including images, live video and patient records) from one location to another.
One successful innovator has been Lee Schwamm, MD, a MGH clinician who heads a not-for-profit institution that focuses on the field of "telestroke." Dr. Schwamm has organized an enterprise in which high-trained clinicians check digitally sent images, and make recommendations even if they are 100 miles away.
If the images are interpreted correctly, stroke victims don't have to be transported to distant medical centers. Dr. Schwamm's team can make many decisions by observing images and analyzing medical records. Their recommendations are passed on to attending physicians, who may not have been trained in sophisticated techniques.
"The project works well, especially in distant locations like Nantucket or Martha's Vineyard," said Dr. Schwamm. "If you can recommend treatment based on images, and not have to transport a patient all the way into Boston, that means less time in big hospitals and a convenience for the patient."
Dr. Schwamm said his organization has signed about 15 medical centers in New England for the service.
Kathy Duckett, RN, BSN, PHN, director of clinical programs for Partners Home Care, said that the brand of telemedicine that she is supervising also is successful.
Her organization monitors home-bound chronic patients with technology ranging from digital scales to Web-connected blood-pressure systems.
She said that if patients actively cooperate with this "remote" system, it can result in 40 percent fewer visits from nurses and 25 percent fewer rehospitalizations.
"Remote monitoring is working," she said, by saving medical centers money and limiting the hospitalizations.
"But there are at least two elements involved in a successful situation: patient involvement, and the assurance that home-bound patients won't lose their nurse. They want to know there is a personal connection."
Paul Heinzelmann, MD, project leader of Operation of Village Health, discussed his program that extends the reach of Harvard-affiliated physicians to remote villages in countries like Cambodia through an email-based telemedicine platform.
Hassan Sharif, MD, a founding member and chief medical officer of WorldCare Telemedicine Global Services, said his organization has expanded into numerous countries in Europe and the Middle East as it offers patient access to remote "second opinions" for a variety of diseases.
April 3, 2007: Optimism about microfabrication, tissue-engineered heart valves
Ali Khademhosseini, PhD; BWH, HMS
John Mayer Jr., MD; HMS, CHB
Two distinguished medical professionals discussed the future of microfabrication and valve replacement devices at the April 3 CIMIT Forum at Simches Research Center at Massachusetts General Hospital.
Presenting were John Mayer Jr., MD, professor of surgery, Harvard Medical School; and senior associate in cardiovascular surgery, Children's Hospital Boston; and Ali Khademhosseini, PhD, associate bioengineer at Brigham and Women's Hospital; and assistant professor, Division of Health Sciences and Technology, Harvard Medical School.
Dr. Mayer discussed, "Current Progress Toward a Tissue Engineered Heart Valve."
He said the idea of his valve research developed during a conversation with Joseph Vacanti, MD, a doctor-researcher at Massachusetts General Hospital who at the time was with Children's Hospital. A research interest of Dr. Vacanti, who has been supported by CIMIT, is tissue engineering and the development of body parts.
Dr. Mayer noted that valve replacement devices in pediatric patients have major limitation, including the reality that a growing child needs heart valves that will expand.
His presentation reviewed studies of efforts to help children with congenital heart defects, including using progenitor cells that can be obtained by minimally invasive met