February 24, 2012
NIH Podcast Episode #0153
Balintfy: Welcome to episode 153 of NIH Research Radio. NIH Research Radio bringing you news and information about the ongoing medical research at the National Institutes of Health – NIH . . . Turning Discovery Into Health®. I'm your host Joe Balintfy, and coming up in this episode, a safe and effective way for paramedics to treat prolonged seizures, how steroids can boost survival of pre-term infants and details on a free e-book that give insight on an NIH icon. But first, this news update. Here’s Craig Fritz.
Fritz: Patterns of brain development in the first two years of life are distinct in children who are later diagnosed with autism spectrum disorders, according to researchers funded by NIH. The study results show differences in brain structure at 6 months of age, the earliest such structural changes have been recorded in autism spectrum disorders. Scientists say the difference in the brain development between children later diagnosed with an autism spectrum disorder and children that were unaffected was dramatic between 6 and 24 months. Behavioral studies have suggested that this is the time period when symptoms of autism are first appearing. Researchers scanned the brains of 92 infants that had a sibling diagnosed with an autism spectrum disorder. They tracked 15 points of brain development at 6, 12 and 24 months of age and found at 6 months, the intensity of these points of development was greatest in the group that later developed an autism spectrum disorder. However, by 24 months, points of development in the children with an autism spectrum disorder had failed to keep pace with those of the children who did not develop a disorder. Autism spectrum disorders involve communication and social difficulties as well as repetitive behavior and restricted interests. Many early behavioral signs are not apparent until the first year of age. Typically, autism spectrum disorders are diagnosed at age 3 or older, and affect 1 of 110 children in the United States, according to the CDC.
NIH has unveiled a new, easy-to-read website on drug abuse designed for adults with a low literacy level. The site, which provides information on neuroscience, drug abuse prevention and treatment, is also a resource for adult literacy educators. It has a simple design with a large text size, animated videos and other features that make it easy to read and understand the science of addiction and how drugs affect the brain. Scientists note that drug abuse and addiction affect people of all reading levels, yet there are no websites with drug abuse information created specifically for adults with limited literacy. They hope the site will inform a large segment of our population who may not have otherwise received potentially life-saving information. To learn more, visit www.easyread.drugabuse.gov.
For this NIH news update, I’m Craig Fritz.
Balintfy: News updates are compiled from information at www.nih.gov/news. Coming up, improving survival of pre-term infants, the inside story of an NIH icon and treating seizures with an autoinjector. That’s next on NIH Research Radio.
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Autoinjectors offer way to treat prolonged seizures
Balintfy: Seizures are symptoms of a brain problem. They happen because of sudden, abnormal electrical activity in the brain. Most seizures last from 30 seconds to 2 minutes and do not cause lasting harm. But some seizures can last longer than 5 minutes or a person may have many seizures and not wake up between them.
Koroshetz: Status epilepticus is basically seizures that are just not stopping.
Balintfy: Dr. Walter Koroshetz is deputy director at the NIH institute researching the brain and nervous system.
Koroshetz: It's an extremely dangerous condition. Unfortunately, some people will go on and may seize for months at a time and the best chance of stopping it is right at the beginning.
Balintfy: Status epilepticus is a potentially life-threatening emergency that causes 55,000 deaths each year. Standard treatment has been anticonvulsant drugs, including lorazepam, which are typically given intravenously, through an IV.
Koroshetz: Now, you can imagine if you've seen somebody who is seizing that they are moving sometimes violently and it's really hard to start an IV.
Balintfy: Dr. Koroshetz explains that a new study is looking at using the drug midazolam as a first line treatment.
Koroshetz: It's been known for a long time that midazolam is effective at controlling seizures. It's easier to give. So people in the emergency setting have been using midazolam intramuscularly.
Balintfy: Midazolam is given directly into a muscle with an autoinjector, much like the EpiPen used to treat serious allergic reactions.
Koroshetz: The problem was there was no evidence before to indicate that the dose was right, that it was equivalent to what had previously been defined as the standard of care, which was the lorazepam dose.
Balintfy: Dr. Koroshetz says this new study, which is a pragmatic comparative effectiveness trial, compared the midazolam treatment with the standard of care.
Koroshetz: This study shows that using an autoinjector that just injects right into the muscle is as effective as the previous standard which was starting the IV and giving the meds.
Balintfy: The investigators add that more research is required to see if autoinjectors might someday be available for use by patients with epilepsy, a brain disorder that causes people to have recurring seizures. Midazolam has a strong sedative effect which requires on-site medical supervision of patients. Dr. Koroshetz also points out that another purpose of this study was to find ways to stop seizures in the event of a chemical accident or attack by nerve agents, many of which cause seizures.
Koroshetz: Should there ever be an emergency where hundreds of people are exposed to a nerve agent that causes seizures, the people who respond to take care of those affected individuals are never going to be able to start a hundred IV lines in the timeframe necessary, but they could come in with hundreds of these autoinjectors and just go around and just inject into the muscle of people who are seizing.
Balintfy: He adds that this treatment could be put into a stockpile of countermeasures that the government holds in case of chemical accident or attack. Partners in the study include the NIH Countermeasures Against Chemical Threats, the Biomedical Advanced Research and Development Authority and the Department of Defense.
Koroshetz: But also, it's a huge effort that was taken part around the country by almost 4,000 emergency responders who go out on ambulances and respond to people who have seizures.
Balintfy: The trial involved an NIH-run network of emergency physicians in 79 different hospitals working with ambulance crews that treated 893 patents. Findings are published in the New England Journal of Medicine. For more information on the study, visit www.ninds.nih.gov.
Steroids boost survival, reduce brain injury for infants born at 23 weeks
Balintfy: Prenatal steroids—given to pregnant women at risk for giving birth prematurely—appear to improve survival and limit brain injury among infants born as early at the 23rd week of pregnancy. Wally Akinso brings us this report.
Akinso: A full term pregnancy is 40 weeks. Infants born pre-term, in the 22nd through the 25th week of pregnancy are the smallest, most frail category of newborns. Many die soon after birth, despite the best attempts to save them, including the most sophisticated newborn intensive care available. Some survive, and reach adulthood relatively unaffected. The rest experience some degree of lifelong disability, including minor hearing loss, cerebral palsy, and intellectual disability.
Higgins: In 1995 the NIH published a statement on antenatal steroids for mothers with threaten preterm delivery.
Akinso: Dr. Rosemary Higgins is a board-certified neonatologist at the NIH.
Higgins: Prior studies have showed that steroids improved the baby's lung maturation. They reduce new problems such as respiratory distress syndrome.
Akinso: Increased lung development improves the chances for survival and may decrease the risk of brain injury. A recent study has been conduct by researchers participating in the NIH's Neonatal Research Network. Before this present study, little information was available to guide practitioners in use of prenatal steroids for infants before the 24th week.
Higgins: NIH consensus statement recommended steroids for 24-34 weeks. There's much practice variability. Based on those recommendations some physicians would follow them very rigidly and not offer steroids at less than 24 weeks which would be well within the practice guideline. However some physicians felt that if there could potentially be a benefit they would give steroids.
Akinso: To conduct the study, researchers analyzed medical records from network hospitals for about 10,500 infants born preterm from 1993 to 2009. The researchers also performed neurological examinations on the 4,924 surviving infants who were born between 1993 and 2008. The examinations were conducted 18-22 months after the infants' original due dates. Dr. Higgins sums up what was found when the mothers were given the steroids.
Higgins: When the physicians admitted the steroids to the mothers before the baby was born, overall in the whole group study from 22 to 25 weeks, there was an improved survival rate as well as the neurodevelopmental outcome at 18 to 22 months.
Akinso: Dr. Higgins says these findings provide strong evidence that prenatal steroids can benefit infants born as early as the 23rd week of pregnancy. For more information, visit www.nichd.nih.gov. For NIH Radio this is Wally Akinso.
Balintfy: Coming up, details on Dr. Ruth Kirschstein and a book about her lasting impact on NIH.
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Always There: The Remarkable Life of Ruth Lillian Kirschstein, M.D.
Balintfy: Welcome back to NIH Research Radio. She’s been called an NIH icon: Medical scientist. Classical pianist. Physician. Art lover. Humanitarian. Research administrator. She was Dr. Ruth Kirschstein.
Davis: She was a lot of things to a lot of people, but above all, I would say, if you had to come up with an adjective to describe Ruth Kirschstein, it was humble.
Balintfy: That’s NIH science writer, Alison Davis. She is the author of the new book Always There: The Remarkable Life of Ruth Lillian Kirschstein, M.D.
Davis: She wouldn’t have wanted a book written about her, but so many people want her story to be told. And I know that her family, who I work with very closely in this book, believe that her story could and should be told and would be very inspiring to all sorts of people from young scientists to midlevel scientists, people working at the NIH, citizens to see how a woman's compassion and yearning for social justice could make such a difference here at the NIH and really throughout the country.
Balintfy: Dr. Ruth Kirschstein, who died in October 2009, will be remembered not only for the many roles she played throughout her life, but also for the many lives she touched in the course of her 83 years.
Porter: To us on the hill, she was the embodiment of NIH.
Morella: She became a trusted mentor to whom I often turned for advice and counsel and support.
Stokes: She was indeed an inspiration to all who knew her.
Balintfy: That was former congressman John Edward Porter, former congresswoman Connie Morella and former congressman Lewis Stokes. They and many others spoke at a symposium commemorating Dr. Kirschstein’s life and accomplishments. Again, author Davis:
Davis: Ruth was an NIH icon, but she was also a person. She was a mother. She was a wife. She was a friend. So I tried to write this book for a variety of different types of people, but I tried to capture her story in a way that transcends the scientific details and spares the agency politics although those wanting some agency politics are sure to find some.
Balintfy: The book walks readers through Dr. Kirschstein’s life, as she grows from a talented, curious child into a courageous, confident woman who overcomes obstacles and illness — personally and professionally. Congressman Porter recalled her challenge of getting into medical school.
Porter: Can you imagine a Jewish woman from Brooklyn applying for admission and graduating from a medical school in New Orleans? Sure you can today. But Ruth Kirschstein did that in 1948 when women were expected only to marry, to have babies and to stay home. She was a ground breaker and her entire life worked to bring women into careers and medical research and encourage and smooth their paths.
Balintfy: Davis says what's important about telling Dr. Kirschstein story is to understand the many facets of her career progression and how it has influenced others.
Davis: She helped inner city school kids get excited about science. She helped female scientists climb the ladder when the ladder was shaky. She helped hundreds of friends in need just because she wanted to be there for them.
Balintfy: One of many who Dr. Kirschstein mentored is Wendy Wertheimer, a senior advisor in the NIH Office of AIDS Research. She also spoke at the symposium.
Wertheimer: Over these years she was more than just a mentor to me and to a huge number of other women on this campus. Not just scientists. Everyone from institute directors to technicians. There are so many of us whose lives and careers she profoundly affected. And each of us has our own unique story of Ruth that we carry with us. When Ruth took you under her protective wing she infused herself into your life. She got to know and always remembered everything about you and your family. You learned she had strong opinions, a strong will, strong likes and dislikes. She loathed materialism, hypocrisy, injustice, laziness, bad writing, comma errors, prima donnas and drama queens. She loved politics, classical music modern art, especially the Nevelson outside the Clinical Center, movies, New York City, McNeil/Lehrer, silk scarves, tote bags, good chocolate and good gossip. But I believe the greatest of her many achievements was her amazing marriage.
Balintfy: Dr. Kirschstein’s widower is Dr. Alan Rabson, deputy director at the National Cancer Institute here at NIH.
Davis: So Ruth and her dear husband, Al, they were an inseparable couple and really a love story for the ages. They were both very passionate about the arts. Here's a couple that were staunch civil servants for a half a century, never took a vacation, but every single weekend went to the Kennedy Center, to the symphony and would enjoy a short period of time where they were immersed in the arts. That was incredibly important to her and to them. So even though she was a driven professional woman, she appreciated the beauty in life especially that that comes to us through art and music. I think that's a side of Ruth that many may not have seen.
Balintfy: Davis also points out that Dr. Kirschstein was honest and hardworking.
Davis: One thing that I learned that I think is particularly gratifying in a sense that Ruth was not an angel. She did not love everyone. She could be stubborn. She could be difficult. She loved to gossip and she did it a lot. She hated to exercise. But yet if you talk to anybody that knew all of those things, they would say, “Well, her energy was always focused on getting the job done and whatever she needed to do.” So even though she wasn’t perfect herself and she had flaws, she knew how to channel energy into work with people to get things done. That's something that in today's society isn’t always rewarded. We're more apt to give awards and honors and things that you can hang on a wall, but the people that are behind-the-scenes just getting stuff done are the ones that really make change in this world, and I say she was definitely one of those.
Balintfy: While many awards and honorary degrees that Dr. Kirschstein received ended up in a paper bag, an award bearing her name is helping continue her commitment to research training and building the next generation of research scientist.
Davis: There have been tens of thousands of trainees now that have received Kirschstein NRSA awards and are carrying on her legacy.
Balintfy: In a taped statement at the symposium, Senator Tom Harkin explained the National Research Service Award that is named after her.
Harkin: Ruth accomplished so much in her life, both in terms of research she conducted and the vision she demonstrated in her many leadership roles at NIH. But her greatest accomplishment her living legacy is the people she inspired and continues to inspire to follow in her footsteps. Who knows how far science will advance for decades to come
because of the bright young minds who earned the Ruth L. Kirschstein National Research Service Awards.
Balintfy: Senator Harkin continued that it was an honor more for him to know Dr. Kirschstein for more than 20 years.
Harkin: Ruth epitomized the qualities I respected in our world class scientists at NIH: Dedication to public service, a passion for research, discovery, and relieving human suffering.
Balintfy: Covering her work at NIH with the polio vaccine, to bringing science to children in inner-city classrooms, Always There is an inspirational story showing the many ways a scientist can share her talents. And the symposium was a way for many to share their feelings about Dr. Kirschstein. Again Wendy Wertheimer, Senator Harkin, Congresswoman Morella and Congressman Stokes:
Wertheimer: She blazed the trail and set the example. Now it is our job and our obligation to live up to her high expectations for us and follow in her footsteps.
Harkin: You all stand not in Ruth's shadow but in her light.
Morella: Shakespeare could have had her in mind when he said those about her from her shall read the perfect ways of honor.
Stokes: She was a great lady.
Davis: I hope that non-scientists young and old will enjoy learning about the NIH through this book because it tells the story of an agency that's prominent in all of our lives through the lens of a dedicated public servant.
This woman was a champion for people that needed a champion whether it was in science, whether it was in opportunity -- any number of things. She was there for people who needed a push to help them get to where they wanted to be.
Balintfy: That’s NIH science writer Alison Davis, who is author of Always There: The Remarkable Life of Ruth Lillian Kirschstein, M.D. Always There is available as an e-book. You can download it for free at www.nih.gov/about/kirschstein. The book can be downloaded in pdf form, for the Kindle or Nook and iPad. Again that’s www.nih.gov/about/kirschstein. The full video of the symposium is also available there.
Balintfy: And that’s it for this episode of NIH Research Radio. Please join us again on Friday, March 9 when our next edition will be available. In that episode:
“This allows us to get a very detailed and high resolution picture of the activity in the brain in a way that’s not currently possible with existing technology.”
That and more in two weeks. In the mean time, if you have any questions or comments about this program, or have story suggestions of your own for a future episode, please let me know. Send an email to NIHRadio@mail.nih.gov. Also, please consider following NIH Radio via Twitter @NIHRadio, or on Facebook. Until next time, I'm your host, Joe Balintfy. Thanks for listening.
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