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Ga. researchers may have found effective weapon against dry mouth

Georgia Regents University researchers Stephen Hsu (left) and Scott DeRossi say a clinical trial showed their lozenge containing green tea antioxidants produced a fourfold increase in saliva.

Researchers Stephen Hsu (left) and Scott DeRossi say a clinical trial showed their lozenge containing green tea antioxidants produced a fourfold increase in saliva.

Millions of patients suffer from dry mouth, a condition generally caused by a decrease in saliva.

Everyone’s mouth occasionally feels dry, and for many it’s simply a matter of being thirsty. For a long time, there was little public awareness of dry mouth as a chronic health problem. But that has changed in recent years.

Dry mouth is frequently a side effect of medication and cancer therapy. It can range from being simply a nuisance to having a major impact on general health and the health of teeth, as well as appetite and enjoyment of food, according to the Mayo Clinic.

A product developed by researchers at Georgia Regents University in Augusta may help dry mouth sufferers.

The GRU researchers say a clinical trial showed their lozenge containing green tea antioxidants produced a fourfold increase in saliva.

 

Looking at the data

 

Dr. Scott DeRossi, chairman of oral health and diagnostic sciences in the College of Dental Medicine, says the formula “increases a patient’s salivary flow statistically and clinically to a significant level without any adverse side effects.”

DeRossi and Dr. Stephen Hsu, professor of oral biology in the College of Dental Medicine, co-authors of the study, presented their findings in April at an international gathering of oral medicine professionals in Orlando.

Researchers asked 60 patients with dry mouth symptoms to consume one lozenge every four hours. Half received lozenges containing the patented MighTeaFlow formula, and the other half received a placebo.

After eight weeks, the group receiving the active lozenges experienced a 419 percent increase in “unstimulated” saliva production, such as while resting or sleeping. The same group also experienced a 218 percent increase in “stimulated” saliva production, such as while chewing.

The group receiving the placebo experienced no significant change in saliva production.

 

Marketing has begun

 

The products, which include chewing gum, rinse, oral spray, and the lozenges used in the study, are already on the market as over-the-counter items available at such websites as www.camellix.com and www.amazon.com.

The researchers plan larger-scale clinical trials next, along with possibilities of developing new prescription drugs based on the formula.

Hsu and DeRossi are encountering more patients with dry mouth symptoms, and say the increase in public awareness has been gradual.

“People are living longer with more chronic diseases and more medicines, resulting in more patients with dry mouth complaints and complications,” DeRossi said. “Ongoing education is needed to increase awareness of the problem.”

The dry mouth products were developed and patented at the GRU Life Sciences Business Development Center in the Office of Innovation Commercialization, which takes research from the laboratory to the marketplace.

Emory’s EMTs combine learning, lifesaving and community outreach

Emory EMT student Elizabeth Rodgers learns to use all of her  senses during a simulation exercise.

Emory EMT student Elizabeth Rodgers learns to use all of her senses during a simulation exercise. Photos by Rachel Barnhard.

 

The normal sounds of classes at Emory University are occasionally interrupted by something even more important — emergency tones erupting from a radio clipped to the shirt of a student EMT.

“We really try to minimize distractions by sitting near the exit and turning the radios down low so that we don’t disrupt the room when we need to leave,” said Alison Yarp, who volunteered as an EMT for three out of her four years at Emory. “It can be difficult sometimes to jump back and forth between being a student and being an EMT, but it’s so worth it.”

According to the National Collegiate Emergency Medical Services Foundation, there are more than 250 colleges and universities in the United States with accredited collegiate EMS programs. But Emory is the only school in Georgia with a fully functioning collegiate EMS program.

Emory Emergency Medical Services, or EEMS, is an entirely volunteer-based organization staffed by students trained through the program to become Georgia-licensed advanced emergency medical technicians (AEMTs).

Student AEMTs respond to calls not only on campus but also in the surrounding community in east metro Atlanta. The EEMS response area is extremely diverse, including the CDC Roybal campus, Wesley Woods Geriatric Hospital, several schools and shopping centers and the entire university campus.

Whether it is a cardiac arrest or a car accident, the Emory AEMTs may be on the scene 5 to 10 minutes before other local medical responders arrive, according to Rachel Barnhard, full-time director for EEMS.

In their white Ford SUV with “Emory EMS” emblazoned across the side, EEMS can respond to a scene with lights, sirens, and a full trunk of medical equipment.

“Our student volunteers provide invasive medical care in a very stressful environment alongside local EMS and public safety workers in the area,” Barnhard said. “Their goal is to help people, but they are truly making a difference in someone’s life.”

The course consists of two four-hour training sessions each week plus two eight-hour Saturday sessions each month. Each student must complete more than 100 hours of clinical rotations in different hospital emergency departments and time as a “third rider” in an ambulance with two preceptors. Clinical rotations cannot take place during regular Emory class hours, so the students have to find time to do them outside class.

“For the students in the course, it’s like a yearlong job interview,” Barnhard said. “The students go through a ton of pathophysiology and clinical skills training. The curriculum is very in-depth and we take this course really seriously.”

Upon completion of each portion of the course (EMT & AEMT, respectively), students are eligible to sit for the National Registry of EMTs exam, divided into a written portion and a hands-on psychomotor portion.

 

A yearlong commitment

 

Since EEMS is staffed solely by graduates of the course, students are asked to volunteer a minimum of one year of their time upon completion of the program requirements and earning their AEMT certification.

During her time as an AEMT, Yarp earned the rank of supervisor. Like most EEMS students, she delicately balanced her clinical hours with other commitments — in her case, organic chemistry exams and playing the viola in the Emory orchestra.

Gabe Gan, as a student in EMT class, learns about being "backboarded" during an exercise.

Gabe Gan, as a student in EMT class, learns about being “backboarded” during an exercise.

All in all, Yarp worked 1,500 hours of EMS shift time as an undergrad, which is an impressive figure to include on her medical school applications. (She is currently taking a “gap year” to work and apply to medical schools.)

Her EEMS experience is far more than a number of hours, however. The aspiring pediatric emergency medicine physician said her time with the program not only confirmed her career goals, but expanded them as well.

“I’ve always had an interest in emergency medicine, but getting to be one of the first patient care providers on scene showed me that I did enjoy that environment,” she said. “However, I didn’t know I’d be so interested in emergency preparedness until I got indirectly exposed to it through EEMS, so that’s a newer interest of mine.”

Gabe Gan, a rising junior, came to Emory with extensive EMS experience after working as an EMT during high school in his home state of Maryland. Gan, who was recently appointed assistant chief of operations for EEMS, was especially attracted to Emory for the EMS program. He enjoys learning on the job, and he likes how it supplements his major in human health.

“Through interacting with patients, I am able to see the effects of chronic disease that I learned in my nutrition and chronic disease class or understand better how the mental health problem I learned about in class actually presents.” Gan said.

He has completed about 600 hours of EMS shift time at Emory so far.

John Harper is a sergeant with the Emory Police Department. During his four years on the force, he has worked extensively with the EEMS students while they pull their overnight shifts from midnight to 8 a.m. During these shifts, the students work out of a special EEMS squad room in the police department building.

“They provide patients with a really high level of care in such a timely manner,” Harper said. “One really big advantage to having them on campus is that they are extremely familiar with the area. They know the names of buildings and locations that non-campus personnel may not know.”

From the scene of an emergency, EEMS can provide specific directions over the radio for emergency responders coming from outside the Emory campus.

Harper noted that EEMS had a presence at Emory’s graduation ceremony May 12. Some families felt unsure about the Atlanta heat and its impact on elderly guests at the ceremony, and the EMTs set up a medical tent.

“At the request of families and friends, the EMTs will take the blood pressure or vital signs to ensure that guests are safe and healthy before the ceremony begins,” Harper said. “They have a great attitude about it and they are extremely professional. Their presence gives guests peace of mind.”

Detective Anthony ReFour is another member of the Emory Police Department who has spent time working with the EEMS students.

“The EEMS unit provides rapid medical attention that may otherwise be delayed in such a large, busy county,” he said. “Being an all-volunteer unit, they do this selflessly and with astonishing attention to detail. I feel as though their work ethic and desire to be of service to their community espouse the values that Emory University was built on. In short, the altruistic nature of the program is a beacon of strength in the community.”

 

Camaraderie and dedication

 

Outside of responding to calls, the EEMS has always put priority on outreach and engagement with the community. In February 2014, it hosted its first-ever regional EMS for Children conference on the Emory campus, and drew more than 100 health care providers from across the state.

While Emory EMS requires a significant commitment of time, students still make room in their schedules to pursue interests outside the program.

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“It is amazing to see and learn about all that our volunteers do outside of EEMS, from performing in Emory’s music, dance, and theater ensembles to playing on club sports teams,” Gan said. “Not all of our members are pre-med or science majors. One of our members is actually a professor in the Goizueta Business School.”

After going through so much training and moving up through the ranks together, EEMS students have become a tight-knit group. They call themselves “the Unit,” Yarp said, adding that as diverse as they may be in other ways, they are united in their love for EMS work.

“We’re just all brought together by our interest and passion and dedication to pre-hospital care. It’s a special field and it takes certain people to do it. That interest and dedication is probably the most common thread that runs through all of us.”

Whether students go on to enroll in medical school or become paramedics in their hometowns, many continue providing care and spreading knowledge long after their four years are over.

“We’ve had international students who are interested in going back to their country and establishing EMS programs there,” Barnhard said. “Maybe a student is working to be an emergency room physician, but because of EEMS, they’re going to understand the process that led up to a patient arriving in their care.”

 

Natalie Duggan, a GHN intern, is a recent graduate of Emory University, where she majored in journalism and anthropology with an emphasis in health writing. She has previously interned at the CDC, the CNN Medical Unit, and was a summer 2013 ORISE research fellow at the National Institute of Allergy & Infectious Diseases.

 

 

Life-or-death debate: Proposal could hurt Georgia on liver transplants

A transplant operation at Piedmont Atlanta Hospital

A transplant operation at Piedmont Atlanta Hospital

 

Susan Honea didn’t expect to live beyond her 30s.

She was diagnosed at age 29 with primary biliary cirrhosis, a chronic disease that slowly destroys the medium-sized bile ducts in the liver.

Honea, a Hiram resident, was put on a liver transplant list last year, and she got the transplant at Piedmont Atlanta Hospital in March. “You don’t realize how bad you were until you get one,’’ she said. “I didn’t think I would make it to my 40th birthday.’’

Susan Honea

Susan Honea

Though she got an opportunity for a normal life, Honea fears that some other Georgians won’t. She believes a proposed federal change to liver transplant distribution policies, if it had already been in effect, could have prevented her from getting the lifesaving operation.

The United Network for Organ Sharing (UNOS), the organization that manages the nation’s organ transplant system under contract with the federal government, is considering changes to the liver transplant districts in the country.

The nation is currently divided into 11 transplant regions that have wide variations in patients and available organs. Livers generally are allocated within each locality or region.

Putting Georgia into a new district would change the calculus of whether a patient here gets a transplant.

 

Don’t meddle with a good thing?

 

Right now, the region that includes Georgia works efficiently in terms of organ donations and distribution, Emory and Piedmont transplant chiefs contend.

“Organ donation is working quite well in Georgia,’’ said Dr. Stuart Knechtle, director of liver transplantation at Emory University Hospital, and chief of transplant services at Children’s Healthcare of Atlanta.

Dr. Mark Johnson, program director of Piedmont Transplant Institute, said other regions have donor rates that are not as strong as Georgia’s.

But a remapping could put Georgia in a region of Northeastern states.

A bipartisan group of 11 Georgia congressmen signed an April letter to the Health Resources and Services Administration saying the idea of remapping the regional set-up for liver transplant allocation would hurt the state. Redistricting, the congressmen argued, “would reduce the number of liver transplants performed in Georgia by 25 percent, reducing access to this lifesaving procedure for Georgians.”

It would also disproportionately harm minorities and poorer patients in Georgia and the Southeast, the congressmen said.

The letter asked Mary Wakefield, the HRSA administrator, to put a hold on the process by UNOS.

Rep. Lynn Westmoreland (R-Ga.) told GHN in a statement, “Including Georgia among Northeastern states proposes not only a higher health risk to patients, but the survival time for the liver. In order to keep costs, health risks, and travel time low for Georgia and the surrounding regions, remapping needs to be considered with the needs of the patients as a priority.”

 

Determining the greater need

 

The current transplantation process is based largely on severity of disease. Because the number of people waiting for new livers far exceeds the number of livers available, a transplant is reserved for a critically ill patient. Thousands of people nationally are waiting for a liver transplant at any given time, and each year hundreds die before receiving one.

The purpose of remapping would be to level out the geographic disparities and equalize the MELD scores, a measure of severity of liver disease. That system is a numerical scale used for adult liver transplant candidates. The range is from 6 (less ill) to 40 (gravely ill).

The organs generally go to the sickest (by MELD score) within a region.

The Associated Press reported last year that UNOS figures show that in three regions stretching from Michigan and Ohio down to Florida (including Georgia), adults receiving new livers over the past two years had median MELD scores of 22 to 23.

But in the region that includes California, recipients were far sicker, with a median score of 33, AP reported. Almost as high were regions that include New York, the Dakotas and Illinois.

Current liver transplant districts

Current liver transplant districts

 

(Last year, UNOS made one change to the way livers are allocated. The policy change, called Share 35, offers livers broadly to people on the wait list with MELD scores of 35 or higher.)

Dr. David C. Mulligan, chairman of the UNOS Liver and Intestinal Organ Transplantation Committee, noted in April that there are significant geographic disparities in the current system.

“Our committee is reviewing alternate distribution methods to both increase the number of lives saved through liver transplantation, and decrease overall variation in [MELD] scores at which candidates receive a transplant opportunity,” Mulligan said. “Statistical modeling strongly suggests these optimized maps would result in more lives saved overall and reduced variation in the [MELD] scores at transplant.’’

A UNOS spokeswoman said the earliest time an actual proposal for a change would go out for public comment would be spring 2015.

 

Demographics and geography

 

More than 300 Georgians are currently waiting for a liver transplant. Emory and Piedmont, along with Children’s Healthcare of Atlanta, perform a total of more than 250 a year.

Under the current set-up, the wait time in Georgia for a liver transplant is less than six months, Piedmont’s Johnson said. And he added that Georgia is now a net exporter of livers, sending 10 to 12 to other states each year.

“Using wait-list mortality as sole metric for reallocating a scarce gift is not maximizing the value of that gift to society, nor is always transplanting to the sickest first,” Johnson added. “Some patients are too sick to survive even one year after transplantation, and that takes away from the donor’s wishes of giving the gift of life.”

markjohnson

Dr. Mark Johnson

The proposed remapping is “too shortsighted and simplistic a fix to the inequities across the country,’’ Johnson said.

Emory’s Knechtle pointed out that Georgia has a higher disease burden than other states. “We have a poor population and poor access to health care,’’ he said.

A high percentage of donated livers in Georgia are from African-Americans, Knechtle says. With a remapping, “you’re going to take from a poor, African-American population and send to a wealthier, whiter population. I’d have a hard time with that.”

Travel times for a donated organ is also a factor, he said. If transported, “the liver will be older by the time it gets there. Ideally, it should be transplanted less than eight hours’’ after the donation, Knechtle said.

Home cooking: Schools put new emphasis on locally grown lunches

Chef Josh Aaron (far left) and Debbie Morris (far right) prepare the salad with food service manager Debra Patton.

Josh Aaron  and Debra Morris (far right) prepare salad with food service manager Debra Patton.

Fresh, locally grown fruits, vegetables and meats are the emerging stars of school menus across Georgia.

“Farm to school [programs] and bringing local foods into the school has been increasingly popular over the last couple of years,” said Nancy Rice, state director of the Department of Education’s school nutrition division.

Some schools purchase produce from nearby farms while school is in session, Rice said, while a few contract with local farmers who freeze summer produce that can be used during the school year.

The Jackson County School System is doing more: Chef Josh Aaron is building special menus around Georgia-grown food. Aaron owns The Savory Spoon restaurant in Jefferson, where diners feast upon fresh and locally sourced ingredients.

On a chilly day in mid-April, all 12 schools in the district served a “Spring Salad with Chicken and Local Lettuces,” featuring Georgia-grown Bibb and Romaine lettuce and fresh chicken. Other ingredients included strawberries from North Florida, apples, Parmesan cheese and Italian dressing.

The chef himself strolled among the lunch tables at North Jackson Elementary School, an imposing but friendly presence.

“I’m there to talk to the kids about local produce and get them interested,” Aaron said. He wants the kids to know more about the food whether they actually like eating it or not.

 

Push from first lady

 

Meanwhile, healthy school lunches made national headlines this week, as first lady Michelle Obama vowed to fight industry efforts at rolling back federal standards.

A House bill up for consideration this week by the Appropriations Committee would allow schools to apply for waivers from the federally mandated standards if the school’s food program has recorded a financial loss for six months in a row, the Washington Post reported.

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Mrs. Obama urged health activists to fight agribusiness’s lobbying efforts to allow schools to opt out of the mandates to reduce sodium, increase whole grains, and increase servings of fresh fruits and vegetables in lunches.

In Jackson County, though, Chef Aaron wants to expose children to as many kinds of fruits, vegetables and fresh, unprocessed meats as possible.  If kids broaden their tastes while they’re young, their “number one, go-to” food is less likely to be fried chicken fingers or nuggets, he said.

This is the second Georgia-centered meal the chef has created for local schools. The first featured slow-cooked pulled pork, braised collard greens, and carrots marinated in a citrus vinaigrette. The carrots and the collard greens were harvested in Georgia, and the meal was served to all 12 schools in the Jackson County school system in March.

The goal is for students to know and care where their food comes from and to appreciate “good, wholesome, non-processed foods,” said Debra Morris, nutrition director for the Jackson County School System.

If a child is asked to imagine a carrot, Morris wants them to visualize root vegetables that grow in soil and vary in size and color – not a plastic bag of uniform “baby” carrots milled by machines.

Similar efforts are under way throughout Georgia.

 

‘Feed My School’

 

The Georgia Department of Agriculture (GDA) sponsors a program called “Feed My School for a Week,” and schools vie to take part.

Recently announced 2014 participants are Annie Bell Clark Elementary in Tifton, Cave Springs Elementary in Rome, Claxton Elementary in Claxton, Commerce Primary School in Commerce and Mossy Creek Elementary in Cleveland.

For a week next spring, these schools will serve meals made mostly from Georgia-grown ingredients. GDA will help the schools create recipes and get local food. The schools will host guest speakers who will teach students about food and agriculture, and run contests and taste tests.

This 3-year-old program aims to improve the health of Georgia students by changing cafeteria menus and bringing farms and lunchrooms closer by helping schools with Farm to School initiatives.

Farm to School is a nationwide initiative that emphasizes not only buying food from local growers, but also teaching children to raise their own vegetables in school gardens. The Georgia effort is led by Georgia Organics, a nonprofit organization that promotes Georgia farms and locally grown food.

Georgia’s Farm to School program “was a little slow for the first two years back around 2007, but the demand is higher than ever,” said state director Erin Croom.

Only a few schools signed up at first, but when the U.S. Department of Agriculture conducted a national Farm to School census in 2011-2012, more than half of Georgia’s school districts  (52 percent) were on board. Another 19 percent said they might join in the future.

Nationwide, just 43 percent of schools had Farm to School activities during the 2012-2013 school year, and only 13 percent were considering such programs.

Although Georgia’s programs look successful by comparison, they have room to grow. During the 2011–2012 school year, respondents spent close to $10 million on locally grown food, but their overall spending on food was close to $155 million. However, more than half of the schools (66 percent) said they plan to supply their cafeterias with more local food in the future.

Josh Aaron answers questions from students

Josh Aaron answers questions from students at North Jackson Elementary

In Jackson County, chef Aaron’s initiative is gathering momentum. Commerce City Schools have served his two local food menus to their students, and the Jefferson City School System may join next year.

The chef says there is much more work to do, and he doesn’t see his partnership with the schools ending any time soon. His plans include creating more and better menus for kids and a hub where local, certified naturally grown and organic farmers can send their produce for school distribution. Aaron has already spoken with farmers who are interested in supplying the schools, even if they just break even.

“We have a large group of local business [owners] who have a vested interest in these kids’ health and want to do whatever it takes to make them more energetic and successful in the classroom,” Aaron said in an email.

Putting fresh, locally grown food on the menu was just Aaron’s vision a year ago. Now that it’s become reality, he wants to see more fresh food coming down the cafeteria line. “We’re right on the first stepping stones of this work, “ Aaron said. “Now [we’ve] got the next steps to take.”

 

Hyacinth Empinado is a freelance science writer. She is currently a first-year graduate student in the health and medical journalism program at the University of Georgia.

Autism and eye contact: Baby research yields surprise, hope

Baby

How long a baby looks into people’s eyes provides an early sign of whether the child will probably develop autism, research has shown.

Infants who later developed autism began spending less time gazing into people’s eyes between 2 and 6 months of age, according to a study by the Marcus Autism Center in Atlanta.

But building off this research, a new Marcus Center analysis found that some babies with declining eye fixation undergo a “course correction” at 18 months. They show an increase in gazing — and don’t develop autism.

This phenomenon, the authors say, could mean there’s a “window of opportunity” for early treatment and intervention, and it may be a feasible goal to foster such “course corrections” in a larger number of children at greater genetic risk for autism.

Their findings were presented at the world’s largest autism research conference, the International Meeting For Autism Research (IMFAR), taking place in Atlanta this week.

More than 1,700 researchers, delegates, autism specialists and students are gathering to exchange the latest scientific findings and stimulate research into the nature, causes and treatments for autism.

One in 68 U.S. children has an autism spectrum disorder (ASD), a 30 percent increase from 1 in 88 two years ago, according to a March report by the CDC. Georgia has a slightly higher autism rate than the national average, which may reflect the better services and awareness in the state.

The disorder is characterized by difficulties with social interaction, verbal and nonverbal communication and repetitive behaviors.

Warren Jones

Warren Jones

There is no known cure for autism. But Autism Speaks, a national autism science and advocacy organization, says nearly half of autistic children who receive early intervention with applied behavioral therapy will recover “typical function” and another 40 percent will improve significantly.

Warren Jones, director of research at the Marcus Autism Center, and lead author of the new study, told GHN on Thursday that the children that showed a “course correction’’ actually began that change at 9 months old.

“Those infants found a way to learn about the social world,” making the change without treatment, Jones said.

But treatment could help babies who show greater vulnerability of developing autism, he said.

The average age of autism diagnosis is 4.5 to 5 years old. Jones said at some specialty clinics, diagnoses can be achieved at 18 to 24 months.

The Marcus Center, where more than 5,700 children received diagnostic and treatment services in 2013, currently has a treatment study of children 12 months old who have had early vulnerabilities identified.

“There has been an enormous increase in autism research,” Jones said. “We still have enormous amounts to learn.”

 

Do parents’ jobs matter?

 

A second study that garnered some interest at the conference is one that tracked the occupations of parents who have children with autism.

A researcher at the University of Texas Health Science Center at Houston discovered that certain jobs may be linked to a higher rate of children placed on the autism spectrum.

Aisha Dickerson of the Houston center used data from two previous studies with 273 children ages 7 to 18 years.

In these cases, fathers of the children were six times more likely to work in health care and four times more likely to work in finance, after adjustment for demographic variables, the analysis found.

Dickerson said Thursday that she divided the occupations into technical (not people-oriented) and non-technical (jobs that are people-oriented, such as teaching). She said she accounted for socioeconomic status in the analysis.

These parents of children with autism, she said, “may have characteristic symptoms or behaviors similar to autism.”

David Mandell, associate director of the Center for Autism Research at the Children’s Hospital of Philadelphia, when asked to comment about the research, expressed reservations about it. He said that among other things, the occupation categories appeared too broad.

Dickerson told GHN she began the analysis after learning that many scientists and engineers had children with autism.

But she emphasized that she does not want to imply in her study “that people in technical occupations will have an autistic child.”

“It’s an exploratory analysis,’’ Dickerson said.

 

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