amudu

Tuesday, May 10, 2011

Maternal monitoring: A device designed by the West Wireless Health Institute measures fetal heart rate via an ultrasound monitor (lower belt) and maternal contractions via another sensor (higher belt), and then transmits the data via Bluetooth to a tablet (left).
Credit: West Wireless Health Institute

BIOMEDICINE

A Cheap, Portable Way to Monitor Unborn Babies

A nonprofit creates a new heart monitoring machine employing wireless technology.

An inexpensive portable device could make it easy to monitor fetal health in remote locations, and it might also provide an alternative to more expensive machines currently used in doctors' offices in the developed world.

The device, a cardiotocography machine dubbed Sense4Baby, was designed by engineers at the nonprofit West Wireless Health Institute, a medical research organization whose mission is to use wireless technology to reduce the cost of health care.

"We designed Sense4Baby from the ground up to be low-cost," says Joe Smith, West Wireless's chief medical officer. "It takes every advantage of consumer-scale microelectronics and ubiquitous low-cost communication infrastructure." The institute is now planning field tests of the device in Mexico and is in talks to organize tests at major health-care systems in the United States. The device has not yet been approved by the U.S. Food and Drug Administration.

Cardiotocography machines are currently used by obstetricians, typically during the third trimester and in high-risk pregnancies, to measure fetal heart rate and uterine contractions as an indicator of fetal distress. The heart rate of a healthy fetus drops during a contraction and then rapidly comes back to normal. "If the doctor sees a lack of change or early or late changes in heart rate, it could be a sign of trouble," says Steven Garverick, an engineer at West Wireless who has been leading the project.

Sense4Baby uses the same basic sensors as existing devices: Doppler ultrasound to measure fetal heart rate and a pressure sensor called a tocodynamometer (or toco) to measure the force of the contraction via the tension of the maternal abdominal wall. But it eliminates the large bedside machine used to process these measurements in standard cardiotocography, replacing it with a Bluetooth transmitter and a smart phone or tablet running custom software.We took a fresh look at problem, designing a tiny device that could combine traditional measurements with a Bluetooth transmitter so that data can be sent wirelessly to a cell phone or computer," says Garverick. "The data is transmitted via a cell phone to the Internet, where it can be analyzed in a semi-automated way and used to make treatment and monitoring decisions."

The initial prototype, which incorporated an off-the-shelf handheld ultrasound device, performed just as well as a standard cardiotocography machine, and was able to detect a range of 50 to 240 heartbeats per minute. The team is now working on a second-generation device whose novel circuit design should help further reduce the size and cost. It also has additional features, such as the ability to track multiple babies at once. Garverick says it's difficult to estimate the cost of the new device in production, but he predicts it will be in line with the cost—about $100—of consumer ultrasound monitors that perform much more limited functions.

Sense4Baby is part of a larger trend toward using consumer electronics and wireless technology to develop more portable and easier-to-use medical devices, such as cell-phone-based ultrasound. "The baby monitor is a great example of taking a device and making it more efficient," says David Zar, a computer scientist at Washington University in St. Louis and chief technology officer at Mobisante, a startup that has developed one such system. "There is no new medical technology being developed, but rather, they are taking existing technology and packaging it in a way that becomes less expensive and more convenient for everyone." Zar is not involved with West Wireless.

For the first field tests of the device, in Mexico, researchers hope to use it to monitor women in rural areas who are unable to travel regularly to a clinic. Unicef estimates that 80 percent of maternal deaths could be prevented with access to essential obstetric and other health-care services, including monitoring technology. "If we can keep the cost down, hopefully it can be used in all pregnancies and done at home, so the mother doesn't have to make three trips to the hospital," says Garverick. He adds that there is significant interest in the United States as well. "We have had interest from major health institutes to employ these in studies," he says.

Brain Images Reveal the Secret to Higher IQ

Pixilated brain: At the bottom, an MRI image shows a slice of the human brain. At the top is shown a magnified portion of this section, created using diffusion imaging. To create the image, scientists measured the direction of the water diffusion in brain tissue. The "flower petals" at each point show the directions of fastest diffusion. These are aligned along the neural pathways of the brain, because water diffuses directionally along the well-insulated neural wires that carry electrical signals. The different directions of diffusion are color-coded red, green, and blue. In this example, the bright red areas reveal the thick fiber tract, called the corpus callosum, which transfers information between the left and right sides of the brain.

Credit: David Shattuck, Arthur Toga, Paul Thompson/UCLA

BIOMEDICINE

Brain Images Reveal the Secret to Higher IQ

The integrity of neural wiring is a big factor in determining intelligence. It's also inheritable.

New research suggests that the layer of insulation coating neural wiring in the brain plays a critical role in determining intelligence. In addition, the quality of this insulation appears to be largely genetically determined, providing further support for the idea that IQ is partly inherited.

The findings, which result from a detailed study of twins' brains, hint at how ever-improving brain-imaging technology could shed light on some of our most basic characteristics.

"The study answers some very fundamental questions about how the brain expresses intelligence," saysPhilip Shaw, a child psychiatrist at the National Institute of Mental Health, in Bethesda, MD, who was not involved in the research.

The neural wires that transmit electrical messages from cell to cell in the brain are coated with a fatty layer called myelin. Much like the insulation on an electrical wire, myelin stops current from leaking out of the wire and boosts the speed with which messages travel through the brain--the higher quality the myelin, the faster the messages travel. These myelin-coated tracts make up the brain's white matter, while the bodies of neural cells are called grey matter.

White matter is invisible on most brain scans, but a recently developed variation of magnetic resonance imaging, called diffusion-tensor imaging (DTI), allows scientists to map the complex neural wiring in our brains by measuring the diffusion of water molecules through tissue. Thanks to the fatty myelin coating, water diffuses along the length of neural wires, while in other types of brain tissue it moves in all different directions. Researchers can calculate the direction of fastest diffusion at each point in the brain and then construct a picture of the brain's fiber tracts. A well-organized brain has well-functioning myelin, in which water can be seen clearly moving along specific paths. "Diffusion imaging gives a picture of how intact your brain connections are," says Paul Thompson, a neuroscientist at the University of California, Los Angeles, who lead the study.

Thompson and his colleagues took DTI scans of 92 pairs of fraternal and identical twins. They found a strong correlation between the integrity of the white matter and performance on a standard IQ test. "Going forward, we are certainly going to think of white matter structure as an important contributor of intelligence," says Van Wedeen, a neuroscientist at Massachusetts General Hospital in Boston, who was also not involved in the research. "It also changes how you think about what IQ is measuring," says Wedeen. The research was published last month in the Journal of Neuroscience.

BY EMILY SINGER

IQ inheritance: By comparing the brain scans of twins, scientists discovered that the quality of the fatty tissue that insulates neural wires is largely inherited. The parietal lobe, which is involved in logic and mathematics, is 85 percent genetically determined, whereas the visual cortex is about 76 percent, and the temporal lobe, which is involved in learning and memory, is only 45 percent genetically determined.

Credit: David Shattuck, Arthur Toga, Paul Thompson/UCLA

If white matter is linked to both processing speed and IQ, this raises the question: is intelligence merely a function of how fast your brain works? Previous research has linked processing speed to IQ, but the tests used in the study are measures of general intelligence, including verbal skills, math, and logic. "Processing speed plays a big part in how intelligent you are, but it's not the only factor," says Shaw.

The new study is among the first to link a specific neural architecture to IQ in healthy individuals. "Most people have focused on grey matter," says Shaw. "This is good evidence we should be looking at white matter as well." Previous studies using DTI have linked white matter damage to Alzheimer's disease, chronic alcoholism, and traumatic brain injury.

The UCLA researchers took the study a step further by comparing the white matter architecture of identical twins, who share almost all their DNA, and fraternal twins, who share only half. Results showed that the quality of the white matter is highly genetically determined, although the influence of genetics varies by brain area. According to the findings, about 85 percent of the variation in white matter in the parietal lobe, which is involved in mathematics, logic, and visual-spatial skills, can be attributed to genetics. But only about 45 percent of the variation in the temporal lobe, which plays a central role in learning and memory, appears to be inherited.

Thompson and his collaborators also analyzed the twins' DNA, and they are now looking for specific genetic variations that are linked to the quality of the brain's white matter. The researchers have already found a candidate--the gene for a protein called BDNF, which promotes cell growth. "People with one variation have more intact fibers," says Thompson.

But the debate may be moot since, as Wedeen points out, it is unlikely that an individual brain scan could predict a person's IQ. "The report described aggregate data over number of individuals," he says. "That's not the same as saying we can do a scan and determine a person's intelligence. That may be in the offing, but we don't know that yet."The search for the genetic and neuroanatomical basis of intelligence has been controversial, largely because opponents fear it will spawn a deterministic view of abilities and education. "People worry that if something is genetic, they have no power to influence it," says Thompson. "But that's not true at all." For example, both an average runner and a genetically gifted one can benefit from training.

Mapping the Brain on a Massive Scale

Charting the brain: Scientists will use both structural and functional brain imaging to create detailed maps of 1,200 human brains. In the top image, areas in yellow and red are structurally connected to the area indicated by the blue spot. In the bottom image, areas in yellow and red are those that are functionally connected to the blue spot.
Credit: David Van Essen, Washington University

BIOMEDICINE

Mapping the Brain on a Massive Scale

Scanning 1,200 brains could help researchers chart the organ's fine structure and better understand neurological disorders.

A massive new project to scan the brains of 1,200 volunteers could finally give scientists a picture of the neural architecture of the human brain and help them understand the causes of certain neurological and psychological diseases.

The National Institutes of Health announced $40 million in funding this month for the five-year effort, dubbed the Human Connectome Project. Scientists will use new imaging technologies, some still under development, to create both structural and functional maps of the human brain.

The project is novel in its size; most brain-imaging studies have looked at tens to hundreds of brains. Scanning so many people will shed light on the normal variability within the brain structure of healthy adults, which will in turn provide a basis for examining how neural "wiring" differs in such disorders as autism and schizophrenia.

The researchers also plan to collect genetic and behavioral data, testing participants' sensory and motor skills, memory, and other cognitive functions, and deposit this information along with brain scans in a public database (although the patients' personal information will be stripped out). Scientists around the world can then use the database to search for the genetic and environmental factors that influence the structure of the brain.

"We want to learn as much as we can, not only about the typical patterns of brain connectivity, but also about the differences in wiring that make each of us a unique individual," says David Van Essen, a neuroscientist at Washington University in St. Louis, who is one of the project leaders. "If you're good at math, and I'm better at certain types of memory, can we identify some of the wiring characteristics that account for those differences?"

The most detailed studies to date of the neural circuits that connect one brain cell to another have focused on animal brains, because scientists can examine the animals' living tissue cells and their networks under a microscope. "We don't know how our species specifically is wired up," says Michael Huerta, associate director of the Division of Neuroscience and Basic Behavioral Science at the National Institute of Mental Health, and director of the Connectome project. "There is an entire class of data that is missing from neuroscience that is fundamentally important for how the brain works and how it breaks down in different disorders." And because researchers will be scanning only identical and fraternal twins and their siblings, the scientists can get a sense of the role that genetics and environment play in shaping brain structure. Structures of the brain that are highly dictated by genes will be more similar in identical twins than in fraternal twins, for example.Most human brain imaging studies have employed magnetic resonance imaging (MRI) to examine the gross anatomy of the brain or functional MRI to detect which regions are active during specific tasks. But advances in brain imaging technologies in recent years, as well as growing computing power, have made it possible to look at the fine wiring connecting brain regions. "If we want to understand the brain, we need to know what individual areas are doing and how they talk to each other," says Russell Poldrack, director of the Imaging Research Center at the University of Texas at Austin. "Moving from examining how 120 brain areas operate on their own to determining how those 120 areas interact with each other increases the complexity by an order of magnitude, and the scale you need to address the problem also goes up."

Van Essen and his collaborators plan to scan participants using two relatively recent variations on MRI. Diffusion imaging, which detects the flow of water molecules down insulated neural wires, indirectly measures the location and direction of the fibers that connect one part of the brain to another. Functional connectivity, in contrast, examines whether activity in different parts of the brain fluctuates in synchrony. The regions that are highly correlated are most likely to be connected, either directly or indirectly. Combining both approaches will give scientists a clearer picture. Collaborators at the University of Minnesota and Massachusetts General Hospital are optimizing existing scanners with new magnets and custom analysis programs so that they are better suited to detecting these circuits.

"This will be a landmark study," says Robert Williams, a neuroscientist at the University of Tennessee, in Memphis. "I think it will have the same kind of impact on neuroscience that the Human Genome Project had on human genetics, providing a strong foundation for other work."

The Human Body, Searchable in 3-D

BIOMEDICINE

The Human Body, Searchable in 3-D

A new tool lets people see the inside of the body up close and in great detail.

The online 3-D interactive search tool of the human body was released . It allows a user to view and navigate the human anatomy, male or female, down to the finest detail—from the muscles and deep muscles to the nerves, arteries, vessels, and bones. This new tool, called BodyMaps, was developed by Healthline Networks, a company that provides medical information to consumers online, and GE Healthyimagination, a Web-based platform that shares and promotes projects that focus on consumer health, such as apps or healthy how-to videos.

BodyMaps is a consumer tool developed to educate the user on health conditions or medical ailments. At the center of the BodyMaps page is a 3-D image of the body; at left is textual information about the body section being shown. As a user mouses over the text, the section of the body in the image is highlighted, and vice versa if a user mouses over the image. At the bottom is a scrubber that lets the user rotate the body 360 degrees. The page also features videos, tips on staying healthy, information on symptoms and conditions, and a definition of the section in view.

The user can select a body region to explore by clicking the text or image, or by using the search tool. Selecting shoulders generated a crisp, high-definition 3-D image of the shoulder section, starting at the skin level, with the option to click through to see the muscles, nerves and vessels, and bone. Choosing the deltoid muscle, a definition popped up and the remaining muscles were shaded out. An option to read more provided a lengthy definition and description of the muscle, including common injuries and their causes and symptoms.

There is also an anatomy list for each body section the user chooses to view—the heart even has a cross-section view and a diagram of blood flow while the knee shows each layer of connective tissues.

Body Maps is a flash application and can be viewed in any browser; it does not require the user to download any software or special programs to run. "This is not a science experiment," says West Shell, chairman and CEO of Healthline Networks. "We have built this as a search product for consumer education," he says. Google is working on a similar project called Google Body, which is part of Google Labs. Unlike BodyMaps, it requires a Web 3-D standard called WebGL and can only be used in a Chrome browser. Google Body also lacks the level of detail both in its imagery and information that is available in BodyMaps.

BodyMaps was built using Healthline's taxonomy, a database of health and medical information the company spent 10 years building. It relates the different attributes and facets of a disease or condition to relevant symptoms and treatments, types of doctors, and even insurance billing codes. When a user conducts a search, all the relevant information is displayed. To create the 3-D graphics, Healthline and GE Healthyimagination used over 25 medical illustrators to first make the drawings. They then partnered with Visible Productions to do the 3-D modeling and applied the existing taxonomy and search and navigation technology to the models.

Shell says the most viewed information on Healthline.com is visual data such as images, videos, and animations. "We are enhancing the visual learning experience by making the 3-D body the platform for navigation," he says.

The next phase of development for the new 3-D tool is to make it available on mobile devices and tablets. To do so, Healthline is building the application in HTML 5, a programming language that is supported by most devices. Shell expects Body Maps to be on mobile platforms in the next six months to a year.

The system, while the first of its kind, still needs some work. Some queries, like "large intestine," produce no results, and certain "read more" sections, such as in the knee region, do not have any additional information. Also, choosing to "read more" about the muscle "biceps brachii," displayed in the shoulder region, makes the user go back to the arm section.

The company expects to introduce additional capabilities by June that will let users explore in 3-D graphics the progression of a disease, how a drug works in the body, a medical procedure, or even an injury. At least 20 different scenarios will be launched initially, and new ones will continue to be released. Further planned improvements will let users upload his or her medical imagery into the system and compare it with the information in BodyMaps.

Shell says Healthline is conducting a pilot study with GE, integrating the imagery from the company's electronic medical record system with BodyMaps. This application will not be available to users "for a while," but should be implemented widely across GE for testing later this year, he says.