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Staff Reports



Stressing About Finances is Harmful to Baby’s Health

Becoming a parent can be stressful. It is even more so when you consider the cost of raising a child – an estimated $250,000 on average through age 18. Keep in mind, the average household income in the U.S. is $55,775 a year.

But all that fretting about finances during pregnancy could be bad for your baby.

Researchers at the Institute for Behavioral Medicine Research at The Ohio State University Wexner Medical Center found that financial concerns about the arrival and care of a newborn could contribute to a higher likelihood of a low birth weight.

According to the study, which was recently published in the Archives of Women’s Mental Health, the biggest worries were centered around pregnancy-specific distress, such as concern about the costs of medical care, changing relationships, labor and delivery, as well as infant health.

Digital Pathology Could Improve Accuracy, Timeliness of Cancer Diagnosis

Ohio State among first to implement a system-wide digital pathology service for cancer diagnostics, including primary diagnosis and second opinions

COLUMBUS – An accurate, timely diagnosis is the critical first step in every cancer patient’s treatment. Traditional pathology services, however – where tumor cells are placed on glass slides for examination under a microscope – make it more difficult to share the cases for second review and rely on more subjective methods of grading and quantitating cancer.

In April 2017, the U.S. Food and Drug Administration (FDA) approved digital pathology for use in primary cancer diagnosis, opening the door for clinical pathology services to undergo important changes that will make it easier to share cases for expert review and utilize sophisticated quantitative algorithms to accurately stage and grade cancer. This will enable patients to start potentially life-saving therapies sooner.

Also known as “whole-slide imaging,” digital pathology is the process of scanning conventional glass slides and then digitally knitting consecutive digital images into a single, whole image that replicates the information on the glass slide. This virtual image is paired with associated clinical information to give pathologists an integrated picture of the person’s unique cancer. Pathologists can then perform additional diagnostics, including image analysis tests that are not possible on traditional glass slides.

Unlike conventional glass slides, these enhanced images can be viewed, manipulated and interpreted on a computer with the combined benefit of the pathologist’s trained eye and predictive algorithms.

“These algorithms can separate certain features above and beyond what the human eye can see because the important features may actually be a combination of characteristics that indicates a specific diagnosis,” says Anil Parwani, MD, PhD, director of digital pathology and vice chair/director of anatomic pathology at The Ohio State University College of Medicine Department of Pathology. “Taken together, these features act almost like an image signature to help us make a prediction about a patient’s cancer. We can also use algorithms to do risk assessment.”

The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James) is implementing a long-term digital pathology workflow solution for the cancer program as well as the overall health system. All new patient pathology slides will be digitized along with the past five years of pathology slides processed at the Columbus, Ohio-based hospital.

“Cancer pathologic diagnosis is needed at all hours of the day and in every community across the globe. This technology will allow us to take that subspecialized consultation and diagnosis to patients – regardless of where they live,” adds Parwani.

In addition to improving pathology workflow and patient care implications, the OSUCCC – James effort will create a robust digital archive of pathology cases with associated clinical data for future research based on subsets of cancer. Funds raised by Pelotonia, a grassroots cycling event that supports cancer research initiatives at the OSUCCC-James, will be used to help create this research archive and make it available to all cancer investigators.

“Leveraging this type of de-identified big data for research collaboration is critical as we move forward in an era of predictive precision cancer medicine – finding ways to match the right patient with the right drug at the right time is absolutely critical, and this is taking another step toward that goal,” adds Michael Caligiuri, MD, director of the Ohio State University Comprehensive Cancer Center and CEO of The James Cancer Hospital and Solove Research Institute.

Ohio State selected to help lead international study on children

Center for Human Resource Research will develop, manage survey

COLUMBUS – The Ohio State University’s Center for Human Resource Research (CHRR) has been selected by the Organization for Economic Cooperation and Development (OECD) to help lead a multinational study on social and emotional skills in children.

The Study on Social and Emotional Skills will survey 10- and 15-year-olds in 10 to 12 cities around the world to identify the conditions and practices that foster or hinder the development of those critical skills.

The study will be led by Elizabeth Cooksey, professor of sociology at Ohio State and director of CHRR, and Randall Olsen, professor emeritus of economics and former CHRR director, in conjunction with OECD staff.

“There’s growing recognition that children’s success depends on more than just intelligence and how they perform academically,” Cooksey said.

“Whether it is at work, in their relationships, or with their families, social and emotional skills are as crucial as cognitive skills in determining how well people do in life. This study aims to explore those issues.”

The OECD is the best organization to lead a study like this, Cooksey said. It is an intergovernmental organization with 35 member countries, including the United States, which promotes policies that will improve the economic and social well-being of people around the world.

CHRR will design the study, which will survey 3,000 10-year-olds and 3,000 15-year-olds in each city, as well as their parents and teachers.

“We want to end up with an improved understanding of how social and emotional skills contribute to children’s development. The ultimate goal is to be able to recommend policies and practices that will support the development of those skills,” Cooksey said.

Cities around the world have been asked to apply to participate in the study. Cities are expected to have made the decision to participate by next April.

The CHRR staff will spend this year and early next year developing the survey instruments, and working with partners to have them translated into all the languages necessary.

The surveys will be field tested in 2018. The study will be administered in 2019, with CHRR researchers conducting an analysis of the data in 2019 and 2020. The public release of the findings by the OECD is expected in late 2020.

The CHRR, which recently celebrated its 50th anniversary, was selected to manage the study because of its experience running large, complex social science surveys, Cooksey said. Most notable are the National Longitudinal Surveys, a related group of seven surveys (three ongoing) that have interviewed more than 54,000 Americans over the past 50 years.

Others at Ohio State involved in the new project include Stanley Lemeshow, professor of public health; Dawn Anderson-Butcher, professor of social work; and Paul De Boeck, professor of psychology.

Key outside partners include Padmini Iyer from Oxford University, Fritz Drasgow of the Drasgow Consulting Group, Research Support Services and cApStAn, a Belgium firm that will provide translations of the survey instruments.

Bill Puts Treatment at Residential Pediatric Recovery Facilities in Reach for Families

WASHINGTON, D.C. – U.S. Sens. Sherrod Brown (D-OH), Rob Portman (R-OH), Shelley Moore Capito (R-WV), and Angus King (I-ME) reintroduced bipartisan legislation that would help newborns suffering from addiction recover in the best care setting and provide support for their families.

“With the right care, newborns suffering from addiction have every shot of growing up and leading a healthy life. But treating these babies in the hospital is expensive and can be overwhelming for families,” said Brown. “We must ensure that Ohio moms and babies have access to residential treatment facilities that specialize in giving them the specific kind of care they need and at a lower cost to taxpayers.”

“The Ohio Department of Health estimates that about 84 infants are being treated for drug withdrawal in Ohio hospitals every day,” said Portman. “We must ensure women who are pregnant don’t have access to care and treatment for a substance use disorder. My Comprehensive Addiction and Recovery Act (CARA) enacted important changes in the law to ensure that hospitals followed a plan to safe care when babies were born dependent on opioids or other substances. I am also excited about a pilot under CARA that will fund residential treatment for women that allows babies to stay in a safe environment with their mother, instead of being removed from the home. The CRIB Act will provide another opportunity to ensure babies are given the care they need to thrive and I am pleased to cosponsor this bill.”

“Every 25 minutes, a baby is born already suffering from opioid withdrawal, and in West Virginia, that rate is approximately three times the national average,” Capito said. “It is vitally important that we make sure infants experiencing this pain have access to specialized care and a range of treatment options. Lily’s Place in West Virginia is already doing a remarkable job of providing that kind of care, and the CRIB Act will make it easier for other states and communities to do the same.”

“The consequences of the opioid epidemic are tragic and far-reaching, hurting even the youngest and most innocent members of our society,” King said. “In Maine today, an estimated one in 12 babies is born with drugs in their system. It’s heartbreaking, but there are steps we can take to help them overcome this tragic struggle – one of which is providing easier access to the type of specialized care that will help put mothers and their children on the road to a healthy and successful life. This bipartisan bill will help make the services provided by residential pediatric care facilities more attainable for families, which will make our children healthier, our families stronger and our communities safer.”

Neonatal abstinence syndrome (NAS) is a withdrawal condition often caused by use of opioids and other addictive substances in pregnant women. Babies with NAS are usually treated in the neonatal intensive care unit (NICU), and treatment costs are more than five times the cost of treating other newborns. With the bright lights and loud noises, the NICU is not always the best place for newborns suffering from withdrawal. Residential pediatric recovery facilities, an alternative setting to a NICU, offer specialized care and an environment conducive to treating newborns with NAS, as well as counseling for mothers and families that emphasizes family bonding.

The Caring Recovery for Infants and Babies (CRIB) Act would recognize residential pediatric recovery facilities as providers under Medicaid, allowing Medicaid to cover these services in residential pediatric recovery facilities in addition to hospitals. The bill does not cost tax payers any additional money, but allows babies to receive quality care in the best setting. Dayton, Ohio is home to Brigid’s Path, a residential treatment facility for babies with NAS. U.S. Reps. Katherine Clark (D-MA), Evan Jenkins (R-WV), Tim Ryan (D-OH), and Michael Turner (R-OH) introduced a companion bill in the House.

Studies show that cases of NAS have tripled over the past decade. In Ohio, NAS increased six-fold between 2004-2011, from 14 cases per 10,000 live births in 2004 to 88 cases per 10,000 live births in 2011. In 2015, the Ohio Department of Health released data that there had been 2,174 hospital admissions for NAS, and reported that an average of 84 infants were being treated for drug withdrawal by Ohio hospitals every day. Because newborns with NAS require specialized care, caring for these babies can result in longer hospital stays and increased costs. The Ohio Department of Health reported that treating newborns with NAS in 2015 alone was associated with more than $133 million in health-system costs.

Rise in Lung Adenocarcinoma Linked to ‘Light’ Cigarette Use

A new study shows that so-called “light” cigarettes have no health benefits to smokers and have likely contributed to the rise of a certain form of lung cancer that occurs deep in the lungs.

For this new study, researchers at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James) and five other universities/cancer centers examined why the most common type of lung cancer, called adenocarcinoma, has increased over the last 50 years, rather than decreasing as smokers have been able to quit. Other types of lung cancer have been decreasing in relationship to fewer people smoking, but not lung adenocarcinoma. Because of this, lung adenocarcinoma is now the most common type of lung cancer.

Results confirm what tobacco-control researchers have suspected for years: There is no health benefit to high-ventilation (light) cigarettes – long marketed by the tobacco industry as a “healthier” option – and these cigarettes have actually caused more harm. Holes in cigarette filters were introduced 50 years ago and were critical to claims for low-tar cigarettes

“This was done to fool smokers and the public health community into thinking that they actually were safer,” says Peter Shields, MD, deputy director of the OSUCCC – James and a lung medical oncologist. “Our data suggests a clear relationship between the addition of ventilation holes to cigarettes and increasing rates of lung adenocarcinoma seen over the past 20 years. What is especially concerning is that these holes are still added to virtually all cigarettes that are smoked today.”

The U.S. Food and Drug Administration (FDA) was given the authority to regulate the manufacture, distribution and marketing of tobacco products through the Family Smoking Prevention and Tobacco Control Act in 2009. Current regulations ban tobacco companies from labeling and marketing cigarettes as “low tar” or “light.” Study authors, however, say that given this new data, the FDA should take immediate action to regulate the use of the ventilation holes, up to and including a complete ban of the holes.

“The FDA has a public health obligation to take immediate regulatory action to eliminate the use of ventilation holes on cigarettes,” adds Shields. “It is a somewhat complicated process to enact such regulations, but there is more than enough data to start the process. We believe that such an action would drive down the use and toxicity of conventional cigarettes, and drive smokers to either quit or use less harmful products. There are some open questions about unintended consequences for enacting a ban, which provides for an important research agenda.”

Study Design and Methods

A team made up of lung oncology, public health and tobacco regulation researchers conducted a comprehensive, multi-faceted analysis of existing literature that included chemistry and toxicology studies, human clinical trials and epidemiological studies of both smoking behavior and cancer risk. They studied scientific publications in the peer-reviewed literature and internal tobacco company documents.

Researchers hypothesized that the higher incidence rates of lung adenocarcinoma were attributable to the filter ventilation holes, which allow smokers to inhale more smoke that also has higher levels of carcinogens, mutagens and other toxins.

“The filter ventilation holes change how the tobacco is burned, producing more carcinogens, which then also allows the smoke to reach the deeper parts of the lung where adenocarcinomas more frequently occur,” explains Shields.

To date, all the scientific evidence involves the adverse impact of adding ventilation, but not removing it. Additional research is needed to confirm that the addictiveness of the cigarette or toxic exposures from cigarettes would not increase with elimination of the ventilation holes. The OSUCCC – James and researchers at the University of Minnesota, Roswell Park Cancer Institute, Virginia Tech, Harvard University and Medical University of South Carolina are conducting additional research to reconcile human biomarkers studies and smoke distribution/exposure in the lung.

Funding for this research comes from the National Cancer Institute and Food and Drug Administration Center for Tobacco Products. Coauthors include OSUCCC – James researchers Min-Ae Song, PhD, Micah Berman, JD, Theodore Brasky, PhD, and Casper Woroszylo, PhD; Neal Benowitz, MD, University of California-San Francisco; Michael Cummings, PhD, Medical University of South Carolina; Dorothy Hatsukami, PhD, University of Minnesota; Vaughan Rees, PhD, Harvard University; Richard O’Connor, PhD, Roswell Park Cancer Institute; and Catalin Marian, PhD, of Victor Babes University of Medicine and Pharmacy (Romania).

About the OSUCCC – James

The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute strives to create a cancer-free world by integrating scientific research with excellence in education and patient-centered care, a strategy that leads to better methods of prevention, detection and treatment. Ohio State is one of 47 National Cancer Institute (NCI)-designated Comprehensive Cancer Centers and one of only a few centers funded by the NCI to conduct both phase I and phase II clinical trials on novel anticancer drugs sponsored by the NCI. As the cancer program’s 308-bed adult patient-care component, The James is one of the top cancer hospitals in the nation as ranked by U.S. News & World Report and has achieved Magnet designation, the highest honor an organization can receive for quality patient care and professional nursing practice. With 21 floors and more than 1.1 million square feet, The James is a transformational facility that fosters collaboration and integration of cancer research and clinical cancer care. Learn more at cancer.osu.edu.

OHIO STATE STUDY SHOWS ROBOTIC ARM BRACE HELPS STROKE PATIENTS

COLUMBUS – A study by stroke rehabilitation researchers at The Ohio State University Wexner Medical Center shows that wearing a novel robotic brace that is triggered by just a hint of muscle activity can allow patients to move quickly and independently and to perform activities independently.

The findings are published in the journal Archives of Physical Medicine and Rehabilitation.

“This approach has been around since the 1950s, and is commonly used with injured soldiers returning home from war. However, this is one of the first studies examining the utility of using a myoelectric neuroprosthesis to produce an instantaneous effect on movement,” said Stephen Page, lead author of the study and associate professor of Health and Rehabilitation Sciences in Ohio State’s College of Medicine.

Every year, more than 795,000 people in the United States have a stroke, according to the Centers for Disease Control and Prevention. May is Stroke Awareness Month.

Stroke remains one of the leading causes of disability, with most patients experiencing moderate to severe impairment in their ability to use their arms, Page said.

“The people we studied had moderate to severe arm impairment. We found that when these patients were wearing the device, their performance of movements was significantly better. Patients were able to do things wearing the robotic brace that they would not be able to do under normal circumstances after having a stroke.”

The MyoPro Motion-G is a noninvasive, lightweight, wearable system that uses surface electromyographic signals, the electrical activity produced by skeletal muscles. The device uses these signals from affected muscle groups to control a powered orthosis, providing powered assistance for elbow flexion and extension and gross grasp motions via motors attached to the exterior of the brace. It functions by continuously monitoring the surface electromyographic signals of the user’s bicep and triceps muscles for elbow motion and the forearm flexor and extensor muscle groups for grasp motion. These signals are filtered and processed to provide a desired joint movement proportional to the exerted effort of the user.

The device can be adjusted for each individual based on their level of impairment through a custom software interface.

Study participants exhibited increased quality in performing all functional tasks while wearing the device, including significant increases in their ability to grasp objects while feeding and drinking. Additionally, patients showed significant decreases in time taken to grasp a cup, and increased gross manual dexterity while wearing the device.

Page said he was pleasantly surprised by the results, but added that more research is needed before this device will be available to stroke patients through their health providers. Page is leading a multicenter trial enrolling additional patients to test out the robotic brace “Usually it takes multiple attempts and considerable amounts of practice to restore function to someone whose arm has been impaired by a stroke,” Page said. “This was one of the first times in my 16-year career that I have seen an approach positively affect independence so quickly and comprehensively.”

Funding for this study was provided by Myomo, Inc. Page discloses that he received payment from Myomo as a per diem therapist last year.

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Staff Reports

Information for this story was provided by The Ohio State University Wexner Medical Center.

Information for this story was provided by The Ohio State University Wexner Medical Center.