DOE/Oak Ridge National Laboratory: Revolutionary green technology bus has DOE roots

	Fisher Coachworks' lightweight hybrid bus, which achieves twice the fuel economy of current hybrid buses, has some Oak Ridge National Laboratory roots.

Insight from Oak Ridge National Laboratory, commitment from two Michigan companies and funding from the Department of Energy have led to the commercialization of a lightweight urban transit bus with double the fuel efficiency of conventional hybrid buses.

This new green technology 40-foot bus features a high-strength stainless steel body and chassis and a hybrid power system that drives the bus primarily with stored electrical energy. This approach reverses the paradigm of conventional parallel hybrid designs that use electric energy only to supplement the acceleration and torque requirements of a diesel engine.

At the heart of the bus is a chassis made of Nitronic 30, a nitrogen-strengthened stainless steel that is stronger and stiffer than conventional steel. These attributes translate into less material required for a chassis, resulting in reduced weight.

"Nitronic stainless steel is incredibly durable and enables our chassis designs to have significantly longer service life vs. ordinary steel vehicles," said Bruce Emmons, president of Autokinetics (http://www.autokinetics.com/) of Rochester, Mich., which developed the bus. "The fact that stainless is also 100 percent recyclable and more environmentally friendly to produce than aluminum makes this an ideal green raw material for vehicle structures."

Additional advantages of Nitronic 30 include excellent mechanical properties at sub-zero and elevated temperatures along with low-temperature impact resistance and superb resistance to high-temperature oxidation. While this material is more costly than conventional steel, Emmons noted that the additional cost is offset by design innovation, parts consolidation and streamlined manufacturing processes.

"The benefits of improved strength-to-weight performance quickly compound to all other vehicles systems such as smaller tires, lighter brakes, batteries, motors and so on," Emmons said. "By optimizing the total vehicle we have been able to cut the weight almost in half, which has led to performance improvements, most notably fuel economy gains."

In addition to its reduced weight and hybrid power system, the bus will incorporate a number of advanced design features and advantages, said Gregory Fisher, chief executive officer of Fisher Coachworks (http://www.fishercoachworks.com/), which licensed the technology, has produced a prototype and plans full commercialization. The bus made its debut today and deliveries of the bus are expected to begin in 2009.

Some of the advantages are improved vehicle safety for passengers, lower cost, reduced noise and improved ride dynamics. The major advantage, though, will be in cost to operate, according to Fisher.

Specific contributions from ORNL included computer crash studies and infrared thermal imaging to evaluate the quality of some of the initial laser welds in the structure. Early tests showed some problems with the laser welding technique, so Autokinetics chose to use resistance spot welding in most places and tungsten inert gas welding for the remainder of the joining needs.

But even before its technical contributions, Emmons said ORNL had a huge impact.

"ORNL was the first to suggest the possibility of applying Autokinetics' light-weighting ideas and technologies to the bus field," Emmons said. "Without that insight, this program would never have happened."

Phil Sklad of ORNL's Materials Science and Technology Division served as the program manager and technical monitor and noted that DOE's $2.5 million investment in this project is being rewarded with a revolutionary bus.

"This is a perfect example of how the Department of Energy, a national laboratory and the private sector can collaborate to produce something that is potentially of great value to society," Sklad said.

Fisher Coachworks, located in Troy, Mich., is planning to use this patented technology for transit buses and other commercial vehicle market segments that would benefit from vastly improved fuel economy in urban stop and start applications. Fisher Coachworks was formed in 2007 to focus on production of advanced hybrids using an ultra-lightweight stainless steel unibody construction.

Funding for this project was provided by DOE's Office of FreedomCAR and Vehicle Technologies Program. UT-Battelle manages Oak Ridge National Laboratory for the Department of Energy.

Johns Hopkins University Bloomberg School of Public Health Study Suggests 86 Percent of Americans Could be Overweight or Obese by 2030

Most adults in the U.S. will be overweight or obese by 2030, with related health care spending projected to be as much as $956.9 billion, according to researchers at the Johns Hopkins Bloomberg School of Public Health, the Agency for Healthcare Research and Quality and the University of Pennsylvania School of Medicine. Their results are published in the July 2008 online issue of Obesity.

“National survey data show that the prevalence of overweight and obese adults in the U.S. has increased steadily over the past three decades,” said Youfa Wang, MD, PhD, lead author of the study and associate professor with the Bloomberg School’s Center for Human Nutrition. “If these trends continue, more than 86 percent of adults will be overweight or obese by 2030 with approximately 96 percent of non-Hispanic black women and 91 percent of Mexican-American men affected. This would result in 1 of every 6 health care dollars spent in total direct health care costs paying for overweight and obesity-related costs.”

The researchers conducted projection analyses based on data collected over the past three decades from nationally representative surveys. Their projections illustrate the potential burden of the U.S. obesity epidemic if current trends continue.

“Our analysis also shows that over time heavy Americans become heavier,” says May A. Beydoun, a former postdoctoral research fellow at the Johns Hopkins Bloomberg School of Public Health.

“The health care costs attributable to obesity and overweight are expected to more than double every decade. This would account for 15 to 17 percent of total health care costs spent,” Wang says. “Due to the assumptions we made and the limitations of the available data, these figures are likely an underestimation of the true financial impact.”

Current standards define adults with a body mass index (BMI) between 25 and 29.9 as overweight and adults with a BMI of 30 or higher as obese. Both the overweight and obese are at an increased risk for developing a number of health conditions, including hypertension, type 2 diabetes, heart disease and stroke. Researchers estimate that children and young adults may have a shorter life expectancy than their parents if the obesity epidemic is left unaddressed.

The authors warned that obesity has become a public health crisis in the U.S. Timely, dramatic and effective development and implementation of corrective programs and policies are needed to avoid the otherwise inevitable health and societal consequences implied by their projections. If current trends continue, the researchers say that the U.S. Department of Health and Human Services will not meet its Healthy People 2010 initiative to increase the proportion of adults who are at a healthy weight and to reduce the proportion of adults who are obese.

Lan Liang, PhD; Benjamin Caballero, MD, PhD and Shiriki Kumanyika, PhD, MPH, co-authored the study “Will All Americans Become Overweight or Obese? Estimating the Progression and Cost of the U.S. Obesity Epidemic.”

The U.S. Department of Agriculture and the National Institutes of Health provided partial funding for the research.

Public Affairs media contact: Natalie Wood-Wright at 410-614-6029 or nwoodwri@jhsph.edu.

Public Library of Science : Sensitive testing reveals drug-resistant HIV with possible consequences for treatment

Drug-resistant HIV at levels too low to be detected by standard tests is not unusual and may contribute to treatment failure, according to research published in PLoS Medicine.

Mutations in the AIDS virus commonly occur during treatment, especially if HIV drugs are not taken consistently, and may cause treatments to fail. HIV treatment in developed countries normally includes testing for these mutations, both to select first-line drugs for a given patient and to choose second-line drugs if the virus rebounds from initial treatment. However, tests used by clinical laboratories cannot reliably detect mutant viruses that make up less than about 20% of the virus in a patient's blood.

To investigate the role of resistant virus present at lower levels, Jeffrey Johnson of the Division of HIV/AIDS Prevention Laboratory in the National Center for HIV, STD, and TB Prevention at the US Centers for Disease Control and Prevention and colleagues studied HIV from more than 500 recently infected patients in Canada and the US. Although these individuals had not received anti-HIV drugs, a highly sensitive test developed by the researchers showed that more than 10% carried HIV with common drug-resistance mutations that were not detected using usual tests.

The researchers then studied 316 samples from a separate study of about 1400 patients who were started on their first HIV treatment, which included the drug efavirenz. Before starting treatment, none of these patients had resistance to efavirenz according to standard tests. However, highly sensitive testing showed that 7 of the 95 patients who experienced treatment failure had low levels of HIV with resistance mutations to efavirenz prior to treatment. Of 211 patients whose treatment did not fail, only 2 showed low level resistance prior to treatment.

These data suggest that sensitive testing for resistance could avert failures in HIV treatment. However, given the small number of cases in this initial study, larger studies are needed to confirm the results.

In an accompanying Perspective, Steven Deeks of the University of California San Francisco, who was uninvolved with the research, discusses "whether assays for the detection of low level variants can or even should be developed for patient management." He notes that although "a sizable proportion of treatment naïve HIV infected individuals harbor a minority population of drug-resistant HIV," many patients with positive results on highly sensitive resistance testing might not go on to experience treatment failure.

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Citation: Johnson JA, Li J-F, Wei X, Lipscomb J, Irlbeck D, et al. (2008) Minority HIV-1 drug resistance mutations are present in antiretroviral treatment-naïve populations and associate with reduced treatment efficacy. PLoS Med 5(7): e158. doi:10.1371/journal.pmed.0050158

University of Alabama at Birmingham: Anti-HIV Therapy Boosts Life Expectancy

• Improvements due to modern antiretroviral cocktails

• Study underscores HIV testing, treatment needs

BIRMINGHAM, Ala. - The life expectancy for patients with human immunodeficiency virus (HIV) has increased by more than 13 years since the late 1990s thanks to advancements in antiretroviral therapy, according to researchers at the University of Alabama at Birmingham (UAB) and Simon Fraser University in Vancouver, British Columbia.

Improved survival has led to a nearly 40 percent drop in AIDS deaths among 43,355 HIV-positive study participants in Europe and North America, bolstering the call for improved anti-HIV efforts worldwide, the study authors said.

The study is published in the British medical journal The Lancet. It was compiled by The Antiretroviral Therapy Cohort Collaboration, which includes UAB, Simon Fraser University and more than a dozen other research sites around the world.

COCKTAIL OF DRUGS

The authors looked at changes in life expectancy and mortality among the 43,355 HIV patients taking a cocktail of drugs called combination antiretroviral therapy (cART). Data was compiled from a total of 14 studies in Europe and North America.

"Since their introduction in 1996 cART regimens have become more effective, better tolerated and easier to follow," said Michael Mugavero, M.D., an assistant professor in UAB's Division of Infectious Diseases and a co-author on the study.

"We are now seeing the benefits of years of research, hard work and efforts to make these medications widely available. This has led to dramatic improvements in life expectancy, but patients who start cART with more advanced HIV infection do not have the same level of benefit," Mugavero said.

The new Lancet study found cART yielded a 13.8-year life-expectancy increase - from 36.1 years in study participants who began therapy during the 1996-1999 period to 49.9 years in participants who began therapy during the 2003-2005 period.

Despite the good results, the study found life expectancy for HIV patients is far lower on average than the general population, which includes all those with other chronic illnesses. For example, an HIV-positive patient starting cART at age 20 will live to 63, about 20 years shorter than the average life span of non-infected adults.

With nearly half of all patients diagnosed with advanced HIV infection, the life expectancy benefits of cART are not fully realized, said Mugavero and lead study author Robert Hogg, Ph.D., of Simon Fraser University. Improved AIDS testing and increased access to care is needed.

Funding from the study came from the UK Research Council and from GlaxoSmithKline.

Media Contact

Troy Goodman

(205) 934-8938

tdgoodman@uab.edu

Wake Forest University Baptist Medical Center Researchers disprove long-standing belief about HIV treatment

Researchers at Wake Forest University Baptist Medical Center have disproved a long-standing clinical belief that the hepatitis C virus slows or stunts the immune system's ability to restore itself after HIV patients are treated with a combination of drugs known as the "cocktail."

Hepatitis C (HCV) infection is more serious in HIV-infected people, leading to rapid liver damage, according to the Centers for Disease Control. Intravenous drug use is a main method of contraction for both HIV and HCV and 50 to 90 percent of HIV-infected drug users are also infected with HCV.

The Wake Forest Baptist study looked at whether having HCV co-infection impairs immune restoration in patients receiving highly active anti-retroviral therapy (HAART) to suppress their HIV infection. The results appear in the July issue of AIDS Research and Human Retroviruses.

The research focused on levels of CD4 cells, the specific type of immune cell that is attacked by the HIV virus, and their ability to rebuild after HIV is suppressed.

"We've been observing that in some patients that are co-infected with hepatitis C, we were treating their HIV with HAART but didn't always get very good restoration of CD4," said Marina Nunez, M.D., lead researcher and an assistant professor of infectious diseases. "Some studies suggested it was because of the hepatitis C. This study says it's not the presence of active hepatitis C replication."

Thus, said Nunez, genetic factors involved in the immune system regulation, confounding factors associated with HCV acquisition, or other unknown factors might explain the blunted immune restoration observed in some co-infected patients. "Research efforts should pursue the role of those other factors in the immune restoration," she said.

"From a clinical standpoint, although these findings will not alter the clinical management of HIV-HCV-co-infected patients, they make clear that even after successful treatment of the HCV infection, some patients may still not get an adequate CD4 recovery under HIV treatment."

For the retrospective study, researchers examined existing medical records of 322 patients from two separate databases – one from Madrid, Spain, and the other from Wake Forest University Baptist Medical Center. Patients were separated into two groups – those co-infected with hepatitis C and HIV and those infected only with HIV. Researchers reviewed CD4 levels at baseline (before beginning HIV suppression) and every year after for up to three years, while the patients continuously received HAART, an HIV treatment consisting of three different types of medicines used by many patients, and formerly referred to as the HIV "cocktail."

Years of clinical experience have shown that, with HAART treatment suppressing the HIV, CD4 levels are typically able to restore themselves, Nunez said.

However, in some patients, it has been observed that the immune restoration is poorer after HAART. Therefore, Nunez said, it has been a common practice for doctors to attribute less than desirable CD4 restoration after HAART in co-infected patients to the hepatitis C virus.

Studies to date have found evidence both in support of and against this belief, Nunez said. But a limitation in previous studies has been that co-infected patients have been identified by the presence of HIV and the hepatitis C antibody. Since many patients with hepatitis C clear the active virus but continue to carry the antibody, there hasn't been a pure sample of patients truly co-infected with both active viruses to analyze. In this study, only patients with HIV and active hepatitis C cell replication, therefore active virus, were classified as "co-infected."

The study found that there is no difference in the CD4 restoration of co-infected patients and mono-infected patients. However, it did show some differences that seem to be associated with age, gender or past intravenous drug use.

"The purpose of this study was to find out if hepatitis C was impeding the CD4 restoration in co-infected patients," Nunez said. "And it does not. There are other factors doing it. This study says that you can look into those other factors, but we cannot blame the hepatitis C anymore."

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Media Relations Contacts: Jessica Guenzel, jguenzel@wfubmc.edu, (336) 716-3487; Bonnie Davis, bdavis@wfubmc.edu or Shannon Koontz, shkoontz@wfubmc.edu, (336) 716-4587

Wake Forest University Baptist Medical Center (www.wfubmc.edu) is an academic health system comprised of North Carolina Baptist Hospital, Brenner Children's Hospital, Wake Forest University Physicians, and Wake Forest University Health Sciences, which operates the university's School of Medicine and Piedmont Triad Research Park. The system comprises 1,154 acute care, rehabilitation and long-term care beds and has been ranked as one of "America's Best Hospitals" by U.S. News & World Report since 1993. Wake Forest Baptist is ranked 32nd in the nation by America's Top Doctors for the number of its doctors considered best by their peers. The institution ranks in the top third in funding by the National Institutes of Health and fourth in the Southeast in revenues from its licensed intellectual property.

New York- Presbyterian Hospital/Columbia University Medical Center research into robotic surgery for kidney cancer

New research helps optimize benefits of robotic approach

NEW YORK (July 28, 2008) -- Clinical research at NewYork-Presbyterian Hospital/Columbia University Medical Center is helping bring the advantages of robotic surgery, including reduced pain and quicker recovery, to kidney cancer patients.

Using the latest-generation da Vinci® S Surgical System by Intuitive Surgical, surgeons operate through several small incisions in the abdomen. Surgeons then remove only the cancerous tissue from the kidney, and repair the remaining normal kidney tissue, all using robotic arms guided by video taken by a camera controlled by a separate robotic arm.

The stereoscopic view provides enhanced visibility, and the nimble robotic mechanism makes for easy cutting and suturing, according to Drs. Ketan Badani and Jaime Landman, who make up the robotic kidney surgery team at NewYork-Presbyterian/Columbia.

"With robotics, there is a much greater opportunity for complex reconstruction of the kidney than can typically be achieved with a standard laparoscopic approach," notes Dr. Badani, director of robotic urologic surgery at NewYork-Presbyterian Hospital/Columbia University Medical Center and assistant professor of urology at Columbia University College of Physicians and Surgeons.

"This means that, hopefully, we will have an opportunity not only to reduce the need for kidney cancer patients to require a kidney transplant, but also reduce their need for dialysis later in life," adds Dr. Landman, director of minimally invasive urologic surgery at NewYork-Presbyterian Hospital/Columbia University Medical Center and associate professor of urology at Columbia University College of Physicians and Surgeons.

In a recent issue of the Journal of Endourology, Dr. Badani described a new technique for port placement -- the location of the small incision through which the robot operates -- that maximizes range of motion for the robot's camera arm and working arm. The approach was shown to be successful in more than 50 cases, and has been adopted for use by medical centers worldwide.

Robotic surgery, most widely used for prostate cancer surgery, is beginning to be more widely available for other conditions. In addition to kidney cancer, Dr. Badani and Dr. Mitchell Benson (George F. Cahill Professor and Chairman of the Department of Urology at Columbia University College of Physicians and Surgeons and urologist-in-chief at NewYork-Presbyterian Hospital/Columbia University Medical Center), have established robotic surgery for bladder cancer, and they cite work being undertaken in pelvic floor reconstruction and repair of vaginal wall prolapse.

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Columbia University Medical Center

Columbia University Medical Center provides international leadership in basic, pre-clinical and clinical research, in medical and health sciences education, and in patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the College of Physicians & Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Established in 1767, Columbia's College of Physicians & Surgeons was the first institution in the country to grant the M.D. degree and is now among the most selective medical schools in the country. Columbia University Medical Center is home to the largest medical research enterprise in New York City and state and one of the largest in the United States. For more information, please visit www.cumc.columbia.edu.

NewYork-Presbyterian Hospital

NewYork-Presbyterian Hospital, based in New York City, is the nation's largest not-for-profit, non-sectarian hospital, with 2,242 beds. The Hospital has nearly 2 million patient visits in a year, including more than 230,000 visits to its emergency departments -- more than any other area hospital. NewYork-Presbyterian provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine at five major centers: NewYork-Presbyterian Hospital/Weill Cornell Medical Center, NewYork-Presbyterian Hospital/Columbia University Medical Center, Morgan Stanley Children's Hospital of NewYork-Presbyterian, NewYork-Presbyterian Hospital/Allen Pavilion and NewYork-Presbyterian Hospital/Westchester Division. One of the largest and most comprehensive health-care institutions in the world, the Hospital is committed to excellence in patient care, research, education and community service. It ranks sixth in U.S.News & World Report's guide to "America's Best Hospitals," ranks first on New York magazine's "Best Hospitals" survey, has the greatest number of physicians listed in New York magazine's "Best Doctors" issue, and is included among Solucient's top 15 major teaching hospitals. The Hospital's mortality rates are among the lowest for heart attack and heart failure in the country, according to a 2007 U.S. Department of Health and Human Services (HHS) report card. The Hospital has academic affiliations with two of the nation's leading medical colleges: Weill Cornell Medical College and Columbia University College of Physicians and Surgeons. For more information, visit www.nyp.org.

Blackwell Publishing : Prostate Cancer Patients Undergoing Hormone Therapy May Experience Cognitive Effects

A recent review of the literature has found that hormone deprivation therapy, a commonly used treatment for prostate cancer, may have subtle adverse effects on cognition in patients--such as in the ability to recall and concentrate. Published in the September 1, 2008 issue of CANCER, a peer-reviewed journal of the American Cancer Society, the study indicates that clinicians and patients should be aware of these potential effects and watch closely for their appearance.

For years, hormone deprivation therapy, also known as androgen depletion therapy, has been used as an effective treatment for prostate cancer because hormones such as testosterone drive the growth of prostate cancer cells. The most common way to achieve androgen depletion is through chemical castration with drugs such as leuprolide and goserelin. Androgen depletion therapy has traditionally been reserved for advanced cases of prostate cancer, but increasing numbers of men with earlier stages of the disease are also undergoing the treatment.

Prostate cancer patients who are prescribed these drugs often stay on them for the duration of their life, and researchers have been documenting the potential adverse effects associated with their use. Men may experience hot flashes, osteoporosis, anemia, fatigue, loss of libido, erectile dysfunction, risk of diabetes, risk of cardiovascular disease, emotional distress and other effects. Research also indicates that androgen depletion may impact cognitive functioning, which can affect a patient’s decision-making skills and quality of life.

Unfortunately, only a handful of relatively small studies have investigated the impact of androgen depletion on cognitive functioning, and some of these studies have reported contradictory results. Dr. Christian Nelson, a psychologist at Memorial Sloan-Kettering Cancer Center in New York City and his colleagues recently conducted the first review of these studies and summarized their overall results.

After performing a systematic literature search of studies in animals and humans, Dr. Nelson’s team found that testosterone and its derivatives may impact cognition via several mechanisms in the brain. For example, testosterone can modulate brain chemicals called neurotransmitters and stimulate the connections between neurons. Also, studies that have examined the impact of androgen depletion therapy in prostate cancer patients indicate that between 47 percent and 69 percent of men being treated decline in at least one cognitive area, most commonly in processes dependent on spatial ability and in high-order capacities such as the ability to multi-task.

The findings indicate that larger, more thorough studies that include brain imaging techniques are needed to better understand the nature and extent of the cognitive effects of androgen depletion.

In addition, researchers are exploring the effectiveness of using androgen depletion therapy in men with rising levels of prostate specific antigen, a potential precursor to prostate cancer. The authors concluded that “as the use of androgen depletion therapy increases, clinicians should become aware of this relationship [with cognitive decline], and inform and monitor patients for this possible side effect of treatment.”

Article: “The cognitive effects of hormone therapy in men with prostate cancer: a review.” Christian J. Nelson, Jennifer S. Lee, Maria C. Gamboa, and Andrew J. Roth. CANCER; Published Online: July 28, 2008 (DOI: 10.1002/cncr.23658); Print Issue Date: September 1, 2008.

Contact: Esther Napolitano, Media Relations Manager at Memorial Sloan-Kettering Cancer Center’s Department of Public Affairs. 212-639-3573, napolite@mskcc.org.