U.S. Falls to 27th in World Social Progress
Cuts in social services and chronic poverty in U.S. cities and rural areas during the ’90s have caused the U.S. to lag behind nearly all of Europe and several other countries in terms of overall social progress, according to the 2004 Report Card on World Social Progress by Dr. Richard Estes, professor of social work.
“The U.S. has gone from 18th in the world to 27th. We’re now on the same level as Poland and Slovenia,” said Dr. Estes, who has researched world social development for 30 years and is president of the International Society for Life Quality Studies.
“Chronic poverty is the greatest threat to social progress in the United States,” Dr. Estes said. “Today, more than 36 million Americans—almost 13 million of them children—are poor.”
Dr. Estes argues that, unless the U.S. starts to adopt enhanced education and health systems and employers begin offering living rather than minimum wages, the U.S. will continue to lose ground.
Denmark, Sweden, Norway, Finland, Luxembourg, Germany, Austria, Iceland, Italy and Belgium are the top 10 countries, according to the Report Card. The bottom 10 in the report are Afghanistan, Eritrea, Ethiopia, Sierra Leone, Angola, Liberia, Niger, Guinea, Chad and the Democratic Republic of Congo.
Using data provided primarily by national governments to the United Nations and the World Bank, the Report Card on World Social Progress measures the ability of nations to meet the needs of their residents for health, education, human rights, political participation, population growth, improved women’s status, cultural diversity and freedom from social chaos.
“The overall picture for social progress in the world is grim, with 21 African and Asian countries nearing social collapse due to concentrated poverty, weak political institutions, repeated economic failure, disease and cultural isolation,” Dr. Estes said.
The most rapid social development improvements are taking place in South Central and Western Asia. Dr. Estes associated this with the emergence of democratic institutions in the region’s newly independent countries as well as the region’s vast oil wealth and other natural resources. Also contributing to the improvement in Asia were significant reductions in military spending, which allowed higher investments in education and health and advancements of the economic status of women.
Nature and Prevalence of Errors in Patient Care
A Penn School of Nursing study provides the first detailed description of the nature and prevalence of errors by hospital staff nurses. During a 28-day period, 393 registered nurses kept a detailed journal of their errors and prevented errors, referred to as near-errors. Thirty percent of the nurses reported at least one error during the 28-day period, and 33 percent reported a near-error. Although the majority of errors and near-errors were medication-related, the nurses also reported a number of procedural, transcription and charting errors. The findings were presented in the November issue of the journal Applied Nursing Research and are derived from a previous study that examined staff nurse fatigue and patient safety.
Approximately 33 percent of actual medication errors were because of late administration of drugs to patients, which in some cases was due to inadequate numbers of nurses on duty. In one example, a nurse reported a 90-minute delay in giving medications to one patient and a 40-minute delay to another because she could not leave the bedside of a third unstable patient. As hospitalized patients become more ill, with complex care requirements, and the nursing shortage intensifies, such situations may become more common.
Other errors can be attributed to workplace distractions. According to the participants in the study, frequent interruptions from staff, students or even the telephone made administering medications and carrying out other patient-care activities challenging.
Procedural errors, such as omitting a routine task or making charting and transcription errors often arise from garbled communication within the immediate work area. While it might be impossible to avoid all distractions, the use of technology such as bar code medication administration systems and paperless charting systems have been shown to reduce errors. But such technologies are not widely used and are not user-friendly, according to Dr. Ann E. Rogers, associate professor of nursing.
Resistin Integral Part of the Inflammatory Response
Chronic inflammation is being implicated in diseases as widespread as cancer, heart disease, Alzheimer’s disease, and most recently, diabetes and obesity. The role of the hormone resistin in people with these diseases has been questioned because it is primarily secreted by immune cells called macrophages in humans rather than fat cells, as in mice. Nevertheless, resistin is elevated in some people with diabetes and obesity. Higher levels of resistin are associated with insulin resistance. But what is the connection among inflammation, insulin resistance, and obesity?
Insulin resistance, which occurs when muscle, fat, and liver cells fail to use insulin effectively to regulate blood sugar, usually precedes type-2 diabetes and is part of metabolic syndrome. A new study from the laboratory of Dr. Mitch Lazar, chief of the division of endocrinology, diabetes and metabolism at the School of Medicine, has found that by simulating inflammation in human macrophages and patients, levels of resistin substantially increase. In people, the resistin level in blood increases by about 400 percent. “This suggests that resistin is part of the inflammatory process,” says Dr. Lazar. “This leads us to hypothesize that human resistin also contributes to insulin resistance.” He and colleagues published their findings in the November 30 issue of PloS, Medicine.
Since several inflammatory molecules called cytokines are increased in the blood of people with obesity, the human body seems to react in the same way to wounds and infections as it does to obesity. Obesity in humans may cause immune cells like macrophages to overproduce resistin in reaction to the cytokines, promoting diabetes through insulin resistance.
Dr. Lazar’s team also treated human macrophages with endotoxin, a product of bacteria that stimulates inflammation. Resistin levels increased forty-fold in cell cultures of these immune cells. Cytokines were required for the increase in resistin in the presence of endotoxin. The cytokines are probably coming from fat cells, as well as from macrophages, he speculates. Earlier in 2004, other research groups found more macrophages in the fat tissue of obese people compared to non-obese.
These studies demonstrate that blood levels of resistin are a marker for inflammatory disease, and suggest a potential causative role for resistin in the insulin resistance that is seen in patients with serious bacterial infections known as sepsis. Earlier studies from other laboratories have shown that such patients benefit from insulin treatment. Research is ongoing to address whether treatments that lower resistin levels would be similarly beneficial.
Heritability of Non-Genomic Information
It’s one of the defining tenets of modern biology: the characteristics of a living organism are coded into the organism’s DNA, and only information in the DNA can be passed to the organism’s offspring.
A new study by scientists at the Wistar Institute suggests that this is not the full story. Instructions that control gene activity and are recorded solely in the molecular packaging of the DNA can also be passed to an organism’s progeny, according to the new data. This heritable information is distinct from the genetic information coded in the DNA and is referred to by scientists as being “epigenetic” in nature. A report on the study appears in the November 1 issue of Genes & Development.
In their experiments with fruit flies, Dr. Jumin Zhou, an assistant professor in the gene expression and regulation program at Wistar and senior author on the new study, and his colleagues investigated certain regulatory elements involved in controlling the homeotic gene complex, a large and complex gene region responsible for the proper development of the basic body plan. These vital genes have been highly conserved in evolution, appearing in species as divergent as fruit flies, mice, and humans. Large genes often employ highly sophisticated regulatory mechanisms: a mandatory promoter that activates transcription of the gene, enhancers that send instructions to the promoter, and specialized regulatory DNA elements such as insulators that can block or augment communication between enhancers and the promoter.
Dr. Zhou’s team studied a regulatory element called the Promoter Targeting Sequence, or PTS. They showed that the PTS overcomes an insulator to facilitate, but also restrict, the activity of distant enhancers of a single promoter. They also found that while the PTS required the insulator to target its designated promoter, the insulator could then be removed from the system without effect: with the PTS alone, no activity was seen. With the PTS and the insulator, the PTS effectively targeted its promoter. Then, with the insulator removed, PTS continued to target its promoter.
The notion that epigenetic alterations can be passed from generation to generation complicates the standard model of genetics. Scientists have long held the view that acquired changes in the regulatory molecules associated with DNA are removed in the germ line cells, reset to a baseline state. Based on the current study, as well as other research conducted over the last few years, this does not appear to be entirely true.
These observations recall the theories of 19th century scientist Jean-Baptiste Lamarck, who postulated that traits acquired by parents during their lives could be passed on to their offspring. His ideas about evolutionary process were overtaken in subsequent years by those of naturalist Charles Darwin and, later, the monk Gregor Mendel. Recent advances in epigenetics suggest that Lamarck may have been at least partly correct, for reasons and in ways that he could never have anticipated.
Ethical Challenges Ahead for Neuroscience and Society
Are we ready for a future where brain scans invade our private thoughts? Will we have to alter our brains chemically to keep competitive at our jobs? Could science determine that “souls” do not exist, and, if so, what does that mean for how we think of ourselves as human beings?
The cover story in the December edition of the journal Trends in Cognitive Sciences, tackles these questions about the growing influence of neuroscience on 21st-century life. Penn researcher Dr. Martha Farah, professor of psychology and director of Penn’s Center for Cognitive Neuroscience, outlines advances in knowledge about the brain and how new technology enables us to monitor and manipulate it.
Breakthroughs in functional neuroimaging have enabled researchers to study cognitive and emotional processes as they unfold in a person’s brain. This is a potential boon for psychologists and neuroscientists, but is also being used in the service of corporate profits. In “neuromarketing,” researchers use functional MRI to gauge a person’s desire for particular products and the effectiveness of advertising campaigns. Brain imaging is also being explored as a substitute for lie detectors, which could be used to screen employees and travelers or even to assess the truthfulness of legal testimony. Other ethically problematic applications of brain imaging are more immanent.
Advances in neurochemistry are also leading to neuroethical challenges. Healthy people are increasingly using psychiatric drugs for the purpose of enhancing their brain function, to perform better on the job or eradicate twinges of depression. In a world that now sees athletes enhancing their muscles for competition, what happens when pharmaceuticals or even electronic brain enhancements become the necessary edge for students and workers?
Perhaps the trickiest ethical issues surrounding neuroscience are those that confront some of our best-held assumptions of our own nature.
“Neuroscience is showing that not only perception and motor control but also character, consciousness and a sense of spirituality are all physical functions of the brain,” Dr. Farah said. Support for this research was provided through grants from the NIH and the NSF.
Major Commercial Weight Loss Programs Evaluated
Obesity continues to plague an ever-growing number of Americans, dramatically increasing not only their girth, but also their chances of developing Type 2 diabetes, heart disease and other debilitating illnesses. The situation is further complicated when those seeking to lose weight generally have only glossy advertisements or testimonials to guide them to an appropriate source of help. To address this problem, researchers at the School of Medicine have evaluated major commercial diets and self-help weight loss programs, providing physicians and their overweight patients with the first comprehensive review of these resources. The article appeared in the January 3, 2005 issue of the Annals of Internal Medicine.
Dr. Adam Gilden Tsai, instructor of medicine with the University’s Weight and Eating Disorders Program, and Dr. Thomas A. Wadden, director of Penn’s Weight and Eating Disorders Program, examined four types of programs: non medical, medically supervised, Internet-based, and organized self-help (e.g. Overeaters Anonymous). For each of the largest nationally based programs in these categories, the authors described the principal treatment components, staff qualifications, and costs (as determined from company websites and discussions with program representatives). The average weight loss for each program was determined by reviewing scientifically acceptable studies. The review examined only programs that required regular in-person or on-line contact.
Among non-medical commercial programs, the authors found that Weight Watchers was the most thoroughly tested. Participants in two studies lost approximately 5 percent of their initial weight (about 10 pounds) in three to six months. Attending Weight Watchers group meetings weekly for three months was estimated to cost $167. The costs for Jenny Craig and LA Weight Loss were substantially higher, and no scientifically acceptable evaluations of weight loss have been published.
Medically supervised plans, including Health Management Resources (HMR) and OPTIFAST, produced average losses of 15-25 percent of initial weight (about 30-50 pounds) in three to six months. These plans, which include the use of a liquid diet to replace all or most foods eaten, were estimated to cost $1,700-$2,200 for the first three months. (This covered all medical care, group lifestyle counseling, and the liquid diet.)
The review revealed minimal scientific evidence to support the use of a new generation of Internet-based weight loss plans. Similarly there has been little evaluation of self-help programs, that charge minimal or no fees.
The authors stated that all of the programs reviewed had undoubtedly been of help to some individuals. They hope their review will encourage health care providers and their patients to start talking about excess weight, even if commercial or self-help programs are not an option.
Effects Between Vioxx and Celebrex Studied
In the first epidemiological study designed and executed specifically to determine the heart-attack risk associated with COX-2 inhibitors rofecoxib (Vioxx) and celecoxib (Celebrex), researchers at the School of Medicine found a greater risk of heart attack associated with Vioxx than Celebrex, although neither of the two drugs showed a statistically significant elevated risk of heart attack relative to people who did not use the drugs. In addition, the researchers found discrete clinical differences between the two COX-2 inhibitors—which suggest that the effect of the drugs on the cardiovascular system should be viewed separately rather than as a single class of drugs. This study will be published in the February 1, 2005 print issue of the Annals of Internal Medicine.
The study, which also compared the heart-attack risk between COX-2 inhibitors and older nonsteroidal anti-inflammatory drugs (NSAIDs), found a lower risk with NSAIDs rather than COX-2 inhibitors. The NSAIDs studied included aspirin, ibuprofen (Advil and Motrin), and naxproxen (Aleve).
Use of rofecoxib was associated with 2.72-higher odds of heart attack than was the use of celecoxib. That difference, Dr. Stephen E. Kimmel, associate professor of medicine and lead author of the study, suggests, may be due to a number of factors, including differences in selectivity for the COX-2 isoenzyme, blood pressure, endothelial function, and oxidative stress. Rofecoxib was also associated with a higher odds of heart attack compared with older NSAIDs.
The study also demonstrated a lower risk of heart attacks among people using Celebrex relative to people who did not use other NSAIDs, but Dr. Kimmel notes that “this could be just a fluke.” Regardless, there was no evidence for an increased risk from Celebrex, again suggesting differences within the class of COX-2 inhibitors.
As part of their case-control study, the research team solicited relevant data from 36 hospitals in a five-county area about patients who had been discharged following hospitalization for a nonfatal myocardial infarction (MI), or heart attack, between May 1998 and December 2002. The researchers then queried those patients (within four months of their hospitalization for MI) about their use of COX-2 inhibitors or NSAIDs immediately prior to their heart attack.
Despite the careful planning of the study, definitive conclusions about the risk of heart attacks from rofecoxib or celebrex relative to people who did not use the drugs cannot be made from this nonrandomized study. However, the comparison between the drugs is much more likely to be accurate.
Tiwanaku Project to Collect Detailed Subsurface Data
Penn Museum archaeologists working at the renowned ancient site of Tiwanaku in Bolivia—a site sometimes called the “American Stonehenge”—have joined forces with a team of engineers, mathematicians, computer scientists and anthropologists from Penn’s Department of Computer and Information Science, School of Engineering, the Center for Advanced Spatial Technologies, University of Arkansas, and the Department of Anthropology, University of Denver, to begin a large-scale, subsurface surveying project using equipment and techniques that may one day serve as a model for future archaeological efforts worldwide.
Their three-year, collaborative pilot project, made possible through a $1.05 million grant from the NSF, is called “Computing and Retrieving 3D Archaeological Structures from Subsurface Surveying.” It seeks to collect detailed, three-dimensional archaeological structural data from approximately 60 subterranean acres of Tiwanaku—without benefit of the archaeologist’s trowel.
In the last 10 years, teams of archaeologists from the Penn Museum and elsewhere have made progress understanding this enigmatic site, and more is being uncovered every year. Archaeologists have concluded that the ancient city was occupied between A.D. 500-1,000, then abandoned hundreds of years before the arrival of the Inka in the 15th century. The loss of surface data, and the large size of the site, estimated at about four square miles, have made it especially difficult for archaeologists to deepen their understanding of the spatial organization of this complex site. Work funded by the NSF grant will begin in June of 2005, and continue for six weeks every summer through 2008.
Principal investigators on the project are, Dr. Vranich, American Section research associate at the Penn Museum, a co-principal investigator of the grant and field director, and Dr. Daniilidis, leading principal investigator and associate professor, CIS, Dr. George Biros, assistant professor, departments of mechanical engineering & applied mechanics and CIS; Dr. Jianbo Shi, assistant professor, CIS; Dr. Lawrence Conyers, associate professor of anthropology, University of Denver; and Dr. W. Fredrick Limp, director for the Center for Advanced Spatial Technologies and professor, departments of anthropology, geoscience and environmental dynamics, University of Arkansas.
Almanac, Vol. 51, No. 17, January 18, 2005
January 18, 2005
Volume 51 Number 17