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Flu Season Has Exposed Life-Threatening Flaws in Medical Supply Chains

Flu season in the U.S. typically peaks in February, but this year’s outbreak is already one of the worst on record. As of Jan. 6, 20 children have died from the flu, and overall mortality caused by the flu is already double that of last year’s.

One reason the flu is so severe this season is that the dominant strain is H3N2, which has an impressive ability to mutate and is particularly aggressive against Americans over 50.

Making the threat worse is the fact that most of the IV saline bags used in common medical treatments and procedures – including severe cases of the flu – are made in Puerto Rico, which is still reeling from Hurricane Maria. Hospitals in some areas around the country that are operating at or above capacity because of the flu are quickly running low on saline, resorting to time-consuming and potentially dangerous treatments of patients.

The IV saline shortage is unlikely to cause a life-threatening breakdown of medical treatments. But the shortage does expose a dangerous flaw in the medical supply chains that everyone relies on to counter disease outbreaks or bioterrorism. Many different types of important medical equipment and medicines either come from abroad or rely on a single producer.

Global Supply Chains

Globalization has changed the way we produce, transport and store almost anything, including medicines and medical supplies. Now that it’s inexpensive to transport goods, many can be easily produced abroad at substantially lower costs. In nearly all cases, that benefits producers and consumers alike.

For the medical industry, approximately 80 percent of all pharmaceuticals used by Americans are produced overseas. The majority of this production takes place in China and India.

Forty-three percent of saline in the U.S. comes from Puerto Rico. The U.S. was already running below optimal levels of saline when Hurricane Maria hit.

Rapid transportation of goods also allows most industries to rely on “just in time” deliveries. That means goods arrive only shortly before they are needed, rather than arriving in large shipments.

In most situations, and for most goods, that causes few issues. However, when there’s an insufficient stockpile, delivery delays can be life-threatening. Many of our hospitals receive shipments of critical pharmaceuticals three times a day.

Unhappy Coincidences

As researchers studying how countries can prepare for disease and disasters, it’s clear to us that the IV saline shortage is just the tip of a gigantic iceberg.

There are two ways the “just in time” system can be disrupted: an unexpected surge in demand or a delay in delivery. In this case, both occurred simultaneously. The U.S. is dealing with an unusually potent strain of the flu, while Hurricane Maria brought production in Puerto Rico to a grinding halt. If only one of the two had occurred, it’s unlikely the U.S. would have experienced a shortage.

Now, hospitals overrun with flu patients have to turn to alternatives to IV saline. One is an IV push procedure, in which medications are manually “pushed” into the IV line. This can be deadly if not done correctly.

In the case of IV saline, the simultaneous occurrence of both demand and delay was accidental. Unfortunately, it’s not only possible that such confluence will occur in the future – it’s likely. In the case of pandemics or biological warfare, there will likely be both a surge in demand for important goods and a simultaneous disruption of production and delivery.

If a pandemic disease severely affected China or India, where large shares of medicines come from, production could be knocked out or slowed. That would leave the rest of the world vulnerable to the disease’s spread, because there would be no supply of crucial medicines to combat it. The 1918 influenza pandemic caused disruptions that prevented coal from being delivered to the northeastern U.S. That left some without heat in the height of winter, causing people to freeze to death and compounding the deadly pandemic.

Today, such a breakdown could leave hospitals and other crucial infrastructure without electricity. If the spread of the disease is intentional, as in cases of bioterrorism or bio-warfare, adversaries could target global supplies of crucial treatments.

Preparing for Problems

The destruction in Puerto Rico and the impact it has had on the supply of small IV saline bags in American hospitals is a warning. This time, it’s IV saline. Next time, it might be electricity to run intensive care units or critical antibiotics to treat infections.

Global supply chains are a massive puzzle, but public health and emergency preparedness officials need to, at a minimum, understand every link in the chain of critical goods. Without a thorough understanding of the supply chain, it’s difficult to preempt problems that could arise in times of emergency. Hospitals and other crucial infrastructure, such as power plants and the transportation industry, may want to diversify their suppliers of critical goods and encourage those suppliers to not focus production in a single area, especially not to an area prone to natural disaster. A final, but far more costly, option is to ensure we can produce most of these goods domestically in times of emergency.

In our view, the solution depends on a partnership between government and industry. Federal, state and local governments have to alter procedures, but private companies involved in the production and delivery of critical goods have to plan ahead for emergencies.

If these weaknesses in our global supply chains are not addressed, especially as they relates to medical supplies, pharmaceuticals and other critical goods, we are headed for disaster.

This article was originally published on The Conversation. Read the original article.

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Health

The Aftermath of Michael Jackson’s Antigravity Lean

The infamous lean.

In Michael Jackson’s 1987 music video “Smooth Criminal,” the legendary performer leans forward 45 degrees from a straight-up position — and comes back. It’s a feat that seemingly defies both physics and physiology, and the move has become another element of MJ’s aura of mystery.

Some type of cinematic or mechanical trick must be responsible, since most people can manage only a 20-degree forward tilt before toppling headlong. Yet Jackson performed the move live on tours around the world for years.

Lean In

In a study published this week in the Journal of Neurosurgery, three scientists examine the so-called Antigravity Lean, not from a physics but from a physiological perspective. The three neurosurgeons, all at the Postgraduate Institute of Medical Education and Research in Chandigarh, India, combine in the article their knowledge of Jackson with data on spine biomechanics.

It’s been known for years how Jackson defied gravity. His shoes had a slot that slid onto a bolt in the floor, allowing him to perform the dramatic lean.

Bending forward is limited by the erector spinae muscles, which act like cables to support forward bends up to 20 degrees, though some dancers can achieve 30 degrees, the paper says. When near the max of a bend, you can feel the strain on the Achilles’ heel as the ankles become the fulcrum for balance. People soon return to vertical or catch themselves from falling headlong.

Though Jackson’s 45-degree bend is not physically possible without trickery, the King of Pop still needed incredible core strength and leg muscles to pull it off, the authors write. Not just anyone can lock their shoes into the floor and become Michael Jackson, it seems.

“Several MJ fans, including the authors, have tried to copy this move and failed, often injuring themselves in their endeavors,” the researchers write.

Figure A shows the Antigravity Tilt (a 45-degree forward bend) and the normal limit that most people can bend forward. Jackson used shoes with a slot that slid onto a bolt in the floor. Figure B shows the shift when the body’s fulcrum is the hip and when it’s the Achilles’ tendon. (Illustration courtesy of Manjul Tripathi)

Figure A shows the Antigravity Tilt (a 45-degree forward bend) and the normal limit that most people can bend forward. Jackson used shoes with a slot that slid onto a bolt in the floor. Figure B shows the shift when the body’s fulcrum is the hip and when it’s the Achilles’ tendon. (Illustration courtesy of Manjul Tripathi)

Tough Act to Follow

Jackson’s sleight of foot inspired generations of dancers who push the limits physically. This has resulted in spinal stresses not previously seen by neurosurgeons.

This is not to point the finger at Jackson. But it does suggest the reality that injuries can occur that might require implant spinal surgery, the article says, something potentially devastating to a dancer.

But it’s not all bad news — neurosurgeons have gained a lot of new information on how to treat spinal cord injuries in recent years, something that could be in part thanks to MJ’s envelope-pushing dance moves.

“The King of Pop has not only been an inspiration but a challenge to the medical fraternity,” Tripathi says.

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Your Emergency Contact Does More Than You Think

(Credit: Shutterstock)

You know when you’re filling out your medical paperwork and it asks for your emergency contact? Sure, the process might be annoying, but that emergency contact could actually be put to good use by researchers.

Since many of us use a family member, those contacts can help scientists create family trees. And they can also be used for genetics and disease research, according to a study released Thursday in Cell. Discovering what diseases are inheritable can be a laborious and expensive process — patients must be recruited and researchers must clearly determine patients’ phenotypes (physical traits that include eye color, height, and overall health and are often influenced by your genes).

To make that process easier researchers from three major New York medical centers generated family trees from millions of electronic medical records to create a database.This is the first time electronic health records have been used to trace ancestry and it’s the largest study of heritability using such records.

The More You Know

The researchers identified 7.4 million relatives with an algorithm that matched names, addresses and phone numbers from three medical centers. They found 500 inheritable phenotypes in the data just by looking at test results and observations in health records. The traits included diseases affecting skin, blood and mental health.

The data can help determine the heritability level of many common diseases. For example, researchers found that having an increase of HDL (good) cholesterol is 50 percent heritable, while LDL (bad) cholesterol is only 25 percent heritable. The study’s findings were consistent across the participating medical centers and published studies.

Previous heritability research primarily documented Caucasians of northern European descent, according to the study’s first author Fernanda Polubriaginof, but this research is much broader.

“This dataset will allow us for the first time to compute whether there are differences in other races and ethnicities,” said Polubriaginof in a news release.

Future studies could look at medical records for the hereditary contribution of any trait. Due to privacy issues, patient identifiers were removed for the data, which can only be used for research at the moment. Though, with patient consent, emergency contacts could be put to important use in the future.

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Mosquito Bites Leave A Lasting Impression On Our Immune System

(Credit: Kokhanchikov/Shutterstock)

Mosquito bites are like a gross form of French kissing — the insects swap your blood with their saliva, and leave a trail of salivary secretions behind like mosquito cooties. Some of those compounds prevent clotting as the insects slurp up your blood. Now researchers find mosquito spit aggravates your immune system for days afterward. The findings could help scientists develop vaccines for mosquito-born diseases like Zika.

Rebecca Rico-Hesse, a virologist at Baylor College of Medicine in Houston, Texas, wanted to know how mosquitoes exploit our immune systems with their drool. So, she and her team exposed mice with human-like immune systems to live mosquitoes. Then, they sized up the mice’s immune response as it reacted to the mosquito spittle.

The bug’s saliva toyed with their immune systems in both bone marrow and skin cells with effects that lasted up to seven days after biting, the team reports today in PLoS: Neglected Tropical Diseases. The researchers say their discovery could explain how these tissues might act as virus incubators and help spread disease.

Master Manipulators

In 2012, Rico-Hesse was looking to untangle how Dengue virus causes Dengue hemorrhagic fever — an illness that affects 400 million people each year and can lead to death — when she came across a strange occurrence. Mice infected with the virus from mosquito bites fared far worse than mice that had received an injection of the virus but hadn’t been served as a mosquito meal. The result made Rico-Hesse take a step back.

It seems that mosquito bites caused the immune system to behave differently, and in ways that could potentially give infectious diseases a leg up.

To find out, Rico-Hesse and her team set starving Aedes aegypti mosquitoes on mice that had received a dose of human stem cells to make their immune systems look more like a human’s. Each mouse endured eight mosquito bites total. Then the team checked out different parts of the immune system — blood, bone marrow, spleen, and skin cells — six and 24 hours after biting, as well as seven days later. By then, the immune system should have returned to normal.

Sneaky Viruses

Instead, the team discovered immune cells that had disappeared from the skin at least six hours post-bite came back seven days later after maturing in bone marrow, something that shouldn’t have happened. If those cells harbored a virus, they could then pass it on to new mosquitoes, who could infect others.

The research is pointing out new ways in which mosquito bites affect our immune systems, and it goes beyond simple itching and scratching.

“Mosquito saliva has evolved to modify our immune system,” Rico-Hesse said. And as their new research shows, viruses and parasites could be hijacking that activity to get to the cells they reproduce in, like bone marrow cells, faster, according to her.

Essentially, viruses might be taking advantage of the immune system’s response to travel from their point of entry — the skin — to a place they can multiply in that’s away from attacks by the immune system.

“It’s mind-blowing,” Rico-Hesse said. “No one has ever seen this before.”

Ultimately, the work could lead to infection-blocking vaccines, said Duane Gubler, an international health expert who was not involved in the research.

That’s what Rico-Hesse hopes, too. “If we can make a vaccine that would protect us against the effects of the [mosquito] saliva, or blocking our immune reaction … then we could stop global vector-born diseases,” she said.

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