Cambridge Health Alliance
Cambridge Health Alliance
News Article | April 17, 2017
The Department of Biomedical Informatics at Harvard Medical School has named Bill Geary to its advisory council. Geary joins a group of distinguished individuals and thought leaders charged with advising department chair Isaac Kohane as he scales up the research and education activities at Harvard Medical School’s newest academic department. The Department of Biomedical Informatics was established in 2015 to propel a radical transformation in scientific discovery, clinical medicine and population health by harnessing the power of computation to generate new insights. The department seeks to develop the methods, tools and infrastructure required for a new generation of research investigators and health care providers to move biomedicine forward by taking full advantage of existing and emerging data resources. Geary is a general partner and cofounder of Flare Capital Partners, a healthcare technology and digital health venture capital firm. Prior to that, Geary was with North Bridge Venture Partners since inception, a partner at Hambro International Equity Partners, and the chief financial officer of MathSoft, a science and engineering applications software start-up. Geary holds an undergraduate degree from the Carroll School of Management at Boston College and served as chair of the university’s Board of Trustees. Geary is a member of the Massachusetts General Hospital Institute of Health Professions Board of Trustees. He was previously appointed by the Massachusetts governor to the oversight council of the Center for Health Information and Analysis. Additionally, Geary represents Flare Capital Partners on the Boards of Directors as an investor in numerous healthcare technology and digital health companies. Harvard Medical School Harvard Medical School (http://hms.harvard.edu) has more than 11,000 faculty working in 10 academic departments located at the School’s Boston campus or in hospital-based clinical departments at 15 Harvard-affiliated teaching hospitals and research institutes: Beth Israel Deaconess Medical Center, Boston Children’s Hospital, Brigham and Women’s Hospital, Cambridge Health Alliance, Dana-Farber Cancer Institute, Harvard Pilgrim Health Care Institute, Hebrew SeniorLife, Joslin Diabetes Center, Judge Baker Children’s Center, Massachusetts Eye and Ear/Schepens Eye Research Institute, Massachusetts General Hospital, McLean Hospital, Mount Auburn Hospital, Spaulding Rehabilitation Network and VA Boston Healthcare System.
News Article | May 8, 2017
New research from Boston Children's Hospital and Beth Israel Deaconess Medical Center (BIDMC) shows that chronic sleep loss increases pain sensitivity. It suggests that chronic pain sufferers can get relief by getting more sleep, or, short of that, taking medications to promote wakefulness such as caffeine. Both approaches performed better than standard analgesics in a rigorous study in mice, described in the May 8, 2017 issue of Nature Medicine. Pain physiologist Alban Latremoliere, PhD, of Boston Children's and sleep physiologist Chloe Alexandre, PhD, of BIDMC precisely measured the effects of acute or chronic sleep loss on sleepiness and sensitivity to both painful and non-painful stimuli. They then tested standard pain medications, like ibuprofen and morphine, as well as wakefulness-promoting agents like caffeine and modafinil. Their findings reveal an unexpected role for alertness in setting pain sensitivity. The team started by measuring normal sleep cycles, using tiny headsets that took electroencephalography (EEG) and electromyography (EMG) readings. "For each mouse, we have exact baseline data on how much they sleep and what their sensory sensitivity is," says Latremoliere, who works in the lab of Clifford Woolf, PhD, in the F.M. Kirby Neurobiology Center at Boston Children's. Next, unlike other sleep studies that force mice to stay awake walking treadmills or falling from platforms, Alexandre, Latremoliere and colleagues deprived mice of sleep in a way that mimics what happens with people: They entertained them. "We developed a protocol to chronically sleep-deprive mice in a non-stressful manner, by providing them with toys and activities at the time they were supposed to go to sleep, thereby extending the wake period," says Alexandre, who works in the lab of Thomas Scammell, MD, at BIDMC. "This is similar to what most of us do when we stay awake a little bit too much watching late-night TV each weekday." To keep the mice awake, researchers kept vigil, providing the mice with custom-made toys as interest flagged while being careful not to overstimulate them. "Mice love nesting, so when they started to get sleepy (as seen by their EEG/EMG pattern) we would give them nesting materials like a wipe or cotton ball," says Latremoliere. "Rodents also like chewing, so we introduced a lot of activities based around chewing, for example, having to chew through something to get to a cotton ball." In this way, they kept groups of six to 12 mice awake for as long as 12 hours in one session, or six hours for five consecutive days, monitoring sleepiness and stress hormones (to make sure they weren't stressed) and testing for pain along the way. Pain sensitivity was measured in a blinded fashion by exposing mice to controlled amounts of heat, cold, pressure or capsaicin (the agent in hot chili peppers) and then measuring how long it took the animal to move away (or lick away the discomfort caused by capsaicin). The researchers also tested responses to non-painful stimuli, such as jumping when startled by a sudden loud sound. "We found that five consecutive days of moderate sleep deprivation can significantly exacerbate pain sensitivity over time in otherwise healthy mice," says Alexandre. "The response was specific to pain, and was not due to a state of general hyperexcitability to any stimuli." Surprisingly, common analgesics like ibuprofen did not block sleep-loss-induced pain hypersensitivity. Even morphine lost most of its efficacy in sleep-deprived mice. These observations suggest that patients using these drugs for pain relief might have to increase their dose to compensate for lost efficacy due to sleep loss, thereby increasing their risk for side effects. In contrast, both caffeine and modafinil, drugs used to promote wakefulness, successfully blocked the pain hypersensitivity caused by both acute and chronic sleep loss. Interestingly, in non-sleep-deprived mice, these compounds had no analgesic properties. "This represents a new kind of analgesic that hadn't been considered before, one that depends on the biological state of the animal," says Woolf, director of the Kirby Center at Boston Children's. "Such drugs could help disrupt the chronic pain cycle, in which pain disrupts sleep, which then promotes pain, which further disrupts sleep." The researchers conclude that rather than just taking painkillers, patients with chronic pain might benefit from better sleep habits or sleep-promoting medications at night, coupled with daytime alertness-promoting agents to try to break the pain cycle. Some painkillers already include caffeine as an ingredient, although its mechanism of action isn't yet known. Both caffeine and modafinil boost dopamine circuits in the brain, so that may provide a clue. "This work was supported by a novel NIH program that required a pain scientist to join a non-pain scientist to tackle a completely new area of research," notes Scammel, professor of neurology at BIDMC. "This cross-disciplinary collaboration enabled our labs to discover unsuspected links between sleep and pain with actionable clinical implications for improving pain management." "Many patients with chronic pain suffer from poor sleep and daytime fatigue, and some pain medications themselves can contribute to these co-morbidities," notes Kiran Maski, MD, a specialist in sleep disorders at Boston Children's. "This study suggests a novel approach to pain management that would be relatively easy to implement in clinical care. Clinical research is needed to understand what sleep duration is required and to test the efficacy of wake-promoting medications in chronic pain patients." Alexandre (BIDMC) and Latremoliere (Boston Children's) were co-first authors on the paper. Woolf (Boston Children's) and Scammell (BIDMC) were co-senior authors. Ashley Ferreira and Giulia Miracca of Boston Children's and Mihoko Yamamoto of BIDMC were coauthors. This work was supported by grants from the NIH (R01DE022912, R01NS038253). The Neurodevelopmental Behavior and Pharmacokinetics Cores at Boston Children's Hospital, the metabolic Physiology Core at BIDMC (P30DK057521) and P01HL09491 also supported this study. Boston Children's Hospital is home to the world's largest research enterprise based at a pediatric medical center, where its discoveries have benefited both children and adults since 1869. More than 1,100 scientists, including seven members of the National Academy of Sciences, 11 members of the Institute of Medicine and 10 members of the Howard Hughes Medical Institute comprise Boston Children's research community. Founded as a 20-bed hospital for children, Boston Children's today is a 404-bed comprehensive center for pediatric and adolescent health care. Boston Children's is also the primary pediatric teaching affiliate of Harvard Medical School. For more, visit our Vector and Thriving blogs and follow us on our social media channels @BostonChildrens, @BCH_Innovation, Facebook and YouTube. Beth Israel Deaconess Medical Center is a patient care, teaching and research affiliate of Harvard Medical School and consistently ranks as a national leader among independent hospitals in National Institutes of Health funding. BIDMC is in the community with Beth Israel Deaconess Hospital-Milton, Beth Israel Deaconess Hospital-Needham, Beth Israel Deaconess Hospital-Plymouth, Anna Jaques Hospital, Cambridge Health Alliance, Lawrence General Hospital, MetroWest Medical Center, Signature Healthcare, Beth Israel Deaconess HealthCare, Community Care Alliance and Atrius Health. BIDMC is also clinically affiliated with the Joslin Diabetes Center and Hebrew Rehabilitation Center and is a research partner of Dana-Farber/Harvard Cancer Center and the Jackson Laboratory. BIDMC is the official hospital of the Boston Red Sox. For more information, visit http://www. .
News Article | May 4, 2017
Already extolled for their health benefits as a food compound, omega-3 fatty acids now appear to also play a critical role in preserving the integrity of the blood-brain barrier, which protects the central nervous system from blood-borne bacteria, toxins and other pathogens, according to new research from Harvard Medical School. Reporting in the May 3 issue of Neuron, a team led by Chenghua Gu, associate professor of neurobiology at Harvard Medical School, describes the first molecular explanation for how the barrier remains closed by suppressing transcytosis--a process for transporting molecules across cells in vesicles, or small bubbles. They found that the formation of these vesicles is inhibited by the lipid composition of blood vessel cells in the central nervous system, which involves a balance between omega-3 fatty acids and other lipids maintained by the lipid transport protein Mfsd2a. While the blood-brain barrier is a critical evolutionary mechanism that protects the central nervous system from harm, it also represents a major hurdle for delivering therapeutic compounds into the brain. Blocking the activity of Mfsd2a may be a strategy for getting drugs across the barrier and into the brain to treat a range of disorders such as brain cancer, stroke and Alzheimer's. "This study presents the first clear molecular mechanism for how low rates of transcytosis are achieved in central nervous system blood vessels to ensure the impermeable nature of the blood-brain barrier," Gu said. "There is still a lot we do not know about how the barrier is regulated. A better understanding of the mechanisms will allow us to begin to manipulate it, with the goal of getting therapeutics into the brain safely and effectively." The blood-brain barrier is composed of a network of endothelial cells that line blood vessels in the central nervous system. These cells are connected by tight junctions that prevent most molecules from passing between them, including many drugs that target brain diseases. In a 2014 study published in Nature, Gu and colleagues discovered that a gene and the protein it encodes, Mfsd2a, inhibits transcytosis and is critical for maintaining the blood-brain barrier. Mice that lacked Mfsd2a, which is found only in endothelial cells in the central nervous system, had higher rates of vesicle formation and leaky barriers, despite having normal tight junctions. In the current study, Gu, Benjamin Andreone, a neurology student at Harvard Medical School, and their colleagues examined how Mfsd2a maintains the blood-brain barrier. Mfsd2a is a transporter protein that moves lipids containing DHA, an omega-3 fatty acid found in fish oil and nuts, into the cell membrane. To test the importance of this function to the barrier, the team created mice with a mutated form of Mfsd2a, in which a single amino acid substitution shut down its ability to transport DHA. They injected these mice with a fluorescent dye and observed leaky blood-brain barriers and higher rates of vesicle formation and transcytosis--mirroring mice that completely lacked Mfsd2a. A comparison of the lipid composition of endothelial cells in brain capillaries against those in lung capillaries--which do not have barrier properties and do not express Mfsd2a--revealed that brain endothelial cells had around two- to five-fold higher levels of DHA-containing lipids. Additional experiments revealed that Mfsd2a suppresses transcytosis by inhibiting the formation of caveolae--a type of vesicle that forms when a small segment of the cell membrane pinches in on itself. As expected, mice with normal Cav-1, a protein required for caveolae formation, and that lacked Mfsd2a exhibited higher transcytosis and leaky barriers. Mice that lacked both Mfsd2a and Cav-1, however, had low transcytosis and impermeable blood-brain barriers. "We think that by incorporating DHA into the membrane, Mfsd2a is fundamentally changing the composition of the membrane and making it unfavorable for the formation of these specific type of caveolae," Andreone said. "Even though we observed low rates of vesicle formation and transcytosis in blood-brain barrier cells decades ago, this is the first time that a cellular mechanism can explain this phenomenon." By revealing the role of Mfsd2a and how it controls transcytosis in the central nervous system, Gu and her colleagues hope to shed light on new strategies to open the barrier and allow drugs to enter and remain in the brain. They are currently testing the efficacy of an antibody that potentially can temporarily block the function of Msfd2a, and whether caveolae-mediated transcytosis can be leveraged to shuttle therapeutics across the barrier. "Many of the drugs that could be effective against diseases of the brain have a hard time crossing the blood-brain barrier," Gu said. "Suppressing Mfsd2a may be an additional strategy that allows us to increase transcytosis, and deliver cargo such as antibodies against beta-amyloid or compounds that selectively attack tumor cells. If we can find a way across the barrier, the impact would be enormous." This work was supported by The National Institutes of Health (grants F31NS090669, NS092473), the Mahoney postdoctoral fellowship, the Howard Hughes Medical Institute, the Kaneb Fellowship, Fidelity Biosciences Research Initiative and the Harvard Blavatnik Biomedical Accelerator. Harvard Medical School has more than 11,000 faculty working in 10 academic departments located at the School's Boston campus or in hospital-based clinical departments at 15 Harvard-affiliated teaching hospitals and research institutes: Beth Israel Deaconess Medical Center, Boston Children's Hospital, Brigham and Women's Hospital, Cambridge Health Alliance, Dana-Farber Cancer Institute, Harvard Pilgrim Health Care Institute, Hebrew SeniorLife, Joslin Diabetes Center, Judge Baker Children's Center, Massachusetts Eye and Ear/Schepens Eye Research Institute, Massachusetts General Hospital, McLean Hospital, Mount Auburn Hospital, Spaulding Rehabilitation Network and VA Boston Healthcare System.
News Article | May 17, 2017
Patients treated by older hospital-based internists known as hospitalists are somewhat more likely to die within a month of admission than those treated by younger physicians, according to the results of a study led by researchers at Harvard Medical School and Harvard T.H. Chan School of Public Health. The findings, published May 16 in BMJ, reveal the largest gap in patient mortality--1.3 percentage points--between hospitalists 40 and younger and those 60 and older. The researchers note that the absolute difference in death rates was modest yet clinically meaningful--10.8 percent among patients treated by physicians 40 and younger, compared with 12.1 percent among those treated by physicians 60 and older. That difference translates into one additional patient death for every 77patients treated by physicians 60 and older, compared with those treated by doctors 40 and younger. "This difference is not merely statistically significant, but clinically important--it is comparable to the difference in death rates observed between patients at high risk for heart disease who are treated with proper heart medications and those who receive none," said study senior investigator Anupam Jena, the Ruth L. Newhouse associate professor of Health Care Policy at Harvard Medical School and an internal medicine physician at Massachusetts General Hospital. Importantly, the researchers note, physician age made no difference in mortality outcomes for doctors who managed large numbers of patients. That finding, the research team said, suggests that treating more patients may have a protective effect on maintaining clinical skills. "Residency training sharpens the clinical skills of newly minted physicians because it exposes them to a great number of cases, but as physicians get farther away from residency their clinical skill may begin to decline somewhat," said study first author Yusuke Tsugawa, a researcher in the Department of Health Policy and Management at Harvard T.H. Chan School of Public Health. "Our observation that physicians' age is inconsequential so long as they treat a high volume of patients supports that notion." The differences in patient mortality rates between physicians in their 40s and 50s were far less pronounced--11.1 percent and 11.3 percent, respectively. However, patient death rates crept up at a regular pace as physicians got older. The difference in death risk persisted even when investigators accounted for patients' age and the severity of their conditions. Patient readmission rates were not affected by physician age, but cost of care was slightly higher among older physicians. The researchers caution that their study is strictly observational, showing only a link, rather than cause and effect, between physician age and patient outcomes. Additionally, the analysis focused on one subspecialty--hospitalists--and the findings may not apply to other specialists. However, the team added, the results warrant a more in-depth analysis to tease out precisely what factors may be contributing to the higher mortality seen among patients treated by older physicians. "Older physicians bring invaluable richness of knowledge and depth of experience, yet their clinical skills may begin to lag behind over time," Jena said. "The results of our study suggest the critical importance of continuing medical education throughout a doctor's entire career, regardless of age and experience." The link between clinical performance and physician age has long fascinated doctors, health care policy researchers and social scientists alike. Although older physicians' depth of experience can boost clinical performance, there has been a lingering concern that rapidly emerging scientific evidence, new technologies and changing clinical guidelines may prove challenging to keep up with and incorporate into practice. The study findings, the authors said, point to the importance of physicians participating in continuing medical education courses throughout the entire span of their professional lives. They also suggest that direct measurement of patient outcomes--rather than reliance on surrogate measures such as test scores--may be a more meaningful gauge of how physicians' skills evolve over time. To tease out the interplay between physician age and patient mortality risk, investigators analyzed more than 730,000 hospital admission records of Medicare patients, ages 65 and older, treated between 2011 and 2014 by more than 18,800 hospitalists. To further define physician characteristics and the hospital environment in which they practice, researchers linked patient admission records to data obtained from Doximity, an online professional network for practicing physicians, as well as to data from the American Hospital Association's annual survey, which collects and analyzes hospital infrastructure, staffing, demographics, organizational structure and service lines, among other factors. Co-authors included Joseph Newhouse and Alan Zaslavsky, of Harvard Medical School, and Daniel Blumenthal, of Massachusetts General Hospital. Yusuke Tsugawa was supported in part by the Abe Fellowship (Social Science Research Council and the Japan Foundation Center for Global Partnership). Anupam Jena was supported by the Office of the Director, National Institutes of Health (NIH Early Independence Award, under grant 1DP5OD017897-01). Harvard Medical School has more than 11,000 faculty working in 10 academic departments located at the School's Boston campus or in hospital-based clinical departments at 15 Harvard-affiliated teaching hospitals and research institutes: Beth Israel Deaconess Medical Center, Boston Children's Hospital, Brigham and Women's Hospital, Cambridge Health Alliance, Dana-Farber Cancer Institute, Harvard Pilgrim Health Care Institute, Hebrew SeniorLife, Joslin Diabetes Center, Judge Baker Children's Center, Massachusetts Eye and Ear/Schepens Eye Research Institute, Massachusetts General Hospital, McLean Hospital, Mount Auburn Hospital, Spaulding Rehabilitation Network and VA Boston Healthcare System.
News Article | May 25, 2017
New England College of Business (NECB) announced today that it is hosting a webinar entitled, “Living WELL, Working WISE Webinar – Mindfulness, What is it and What Can it Bring to the Workplace?” The webinar is free of cost and will feature Jody Daniels, Workplace Mindfulness Project Manager at the Center for Mindfulness and Compassion. With more than two decades of experience in human resources and six years of experience as a mindfulness practitioner, Daniels regularly provides top-notch mindfulness training programs and workshops for businesses and community organizations. Daniels will begin by introducing participants to the concept of mindfulness and walking them through the foundations of the practice. She will then delve into the specifics of mindfulness in the workplace, and detail the different ways in which organizations can incorporate mindfulness training into their culture. Daniels will also discuss the positive effects mindfulness can have on employees, and, as a result, their employers. There are several common myths about mindfulness, which, one by one, she will debunk. Finally, participants will be led through the process of getting started practicing mindfulness. The webinar will take place on Wednesday, June 28 at 11 a.m. EST. The Webinar ID is 507-566-227. RSVP for this online event here. About New England College of Business Founded in 1909, New England College of Business (NECB) is a leading higher education institution offering quality education and online degrees at the undergraduate and graduate levels. Serving students across the United States, NECB is an online college accredited by the New England Association of Schools and Colleges (NEASC) and is licensed by the Massachusetts Department of Higher Education. For information on NECB, visit https://www.necb.edu/, follow NECB on Twitter or connect with the school on Facebook. About the Center for Mindfulness and Compassion (CMC) Founded in 2014, CMC is a vibrant center integrating evidence-based mindfulness and compassion practice to foster an inclusive, caring and multi-cultural community that allows individuals to thrive. CMC is located within Cambridge Health Alliance and is affiliated with the Department of Psychiatry at Harvard Medical School. CMC’s mission is to integrate evidence-based mindfulness and compassion through five main channels: scientific research, patient care, workplace well-being, programming for the local community, and professional training and education. Jody is the Workplace Mindfulness Project Manager and an instructor in Mindfulness-Based Stress Reduction (MBSR) at the Center for Mindfulness and Compassion at Cambridge Health Alliance. She is also an adjunct professor in the graduate healthcare management program at the University of Massachusetts, Lowell. Formerly a senior V.P. with over 20 years’ experience in human resources with a mid-size healthcare organization, Jody also has over eight years’ clinical experience as a psychiatric social worker at various academic medical centers. She has trained at the Center for Mindfulness in Medicine, Health Care and Society at UMass Medical School in Worcester, MA and has been a mindfulness practitioner for the past six years.
News Article | May 24, 2017
Cancer -- the second leading cause of death in the United States -- claims more than 600,000 lives each year. Beyond the devastating human toll on individuals and families, the disease can drain a person's financial resources and strain the healthcare system as a whole. Since its passing in 2010, the Affordable Care Act -- commonly known as Obamacare -- has helped assuage some of the most devastating medical and financial burdens associated with cancer by improving insurance coverage and access to critical services. These are some of the findings in a series of newly published studies in a special May-June edition of The Cancer Journal documenting the effects of the law on cancer care in America. As the White House moves forward with its efforts to repeal Obamacare, it should strive to preserve -- and further boost -- these important advances, according to an introduction penned by Harvard Medical School professor health care policy expert Nancy Keating, who served as guest editor for the issue. "The ACA has improved access to and affordability of cancer-related care for millions of Americans," Keating said. "But some critical gaps remain and more needs to be done to ensure that all Americans with cancer have access to affordable cancer care of high quality. Efforts to repeal and replace the ACA must not lose sight of that goal." Each year more than 1.6 million Americans are diagnosed with cancer, a number projected to increase to 2.6 million by 2050. The ACA has provided access to health insurance for more than 20 million previously uninsured Americans. The act made it illegal for insurers to deny coverage based on current or previous cancer diagnosis and removed the limits on lifetime insurance coverage that a person can receive. The evidence so far suggests that key provisions of the ACA have improved access to screening and led to earlier diagnoses, particularly among people with lower education and income. By expanding eligibility for coverage under Medicaid -- the joint federal-state health insurance program for low-income people, women, children and those with disabilities -- the ACA has also ensured access to cancer treatments for more people and broadened access to clinical trials, Keating added. The Obamacare provision that made it possible for young adults to remain on their parents' insurance until age 26 has also led to higher rates of HPV vaccination--a critical preventive measure for cervical cancer--and greater use of effective treatments for women diagnosed with the disease, the research shows. In 2010, total spending on oncology care was $124 billion, and that number continues to rise. As more and more Americans live into older age, the number of cancer diagnoses will rise in coming years, Keating said. Coupled with ballooning spending on cancer care fueled by newer, more expensive treatments, this is bound to create financial turmoil for both individuals and the health care system as a whole. Out-of-pocket costs for individuals with cancer can lead to "financial toxicity," which experts now recognize as a side effect of cancer. The consequences of this financial burden, which are well-documented, include high rates of bankruptcy and delays in receiving cancer care and treatment. Higher costs bring devastating financial consequences. Cancer patients are more than twice as likely to experience bankruptcy than people without cancer, which can in turn lead to higher mortality rates. In light of this troubling trend, Keating said, it is ever more critical to preserve and enhance ACA provisions that can help curb the spending growth and reduce out-of-pocket expenses for cancer patients. Harvard Medical School has more than 11,000 faculty working in 10 academic departments located at the School's Boston campus or in hospital-based clinical departments at 15 Harvard-affiliated teaching hospitals and research institutes: Beth Israel Deaconess Medical Center, Boston Children's Hospital, Brigham and Women's Hospital, Cambridge Health Alliance, Dana-Farber Cancer Institute, Harvard Pilgrim Health Care Institute, Hebrew SeniorLife, Joslin Diabetes Center, Judge Baker Children's Center, Massachusetts Eye and Ear/Schepens Eye Research Institute, Massachusetts General Hospital, McLean Hospital, Mount Auburn Hospital, Spaulding Rehabilitation Network and VA Boston Healthcare System.