TREDS partners with San Diego-based employers in launching a campaign to end distracted driving
Expanding their efforts to keep citizens safe on San Diego roadways, UC San Diego’s Training, Research and Education for Driving Safety (TREDS) program announced today that they are launching a new distracted driving education project called Just Drive - Take Action Against Distraction, a one hour class free of charge offered to businesses in San Diego. The decision followed a recent survey by the research team, which found that 83 percent of adults who participated reported texting, talking or using a smartphone application while driving.
“Research has shown that talking on the phone while driving increases the risk of collision four-fold, with equal risk attached to hands free and hand held devices. This is the same as driving with a blood alcohol content (BAC) of .08. Texting increases this risk eight to 16 times,” said Linda Hill, MD, MPH, professor in the Department of Family and Preventive Medicine at UC San Diego School of Medicine and TREDS program director.
TREDS, with funding provided by a grant from the California Office of Traffic Safety (OTS), through the National Highway Traffic Safety Administration (NHTSA), will partner with the California Highway Patrol (CHP) to offer San Diego businesses and organizations distracted driving education for their employees as part of safety and wellness programs. Classes include the latest research from national safety experts, information on cell phone laws, real-life examples of individuals affected by cell phone use while driving and resources to help drivers change distracted driving behaviors.
“The flawed expectation today is that we need to be instantly responsive at all times. We need to change that expectation, especially when we are driving,” said Hill. “We need strategies to fend off the temptation to answer every call and text immediately, especially when engaged in activities where multitasking is unsafe. Both employers and employees benefit from a safer workforce.”
In 2011, 3,331 people in the United States were killed in crashes involving a distracted driver and an additional 387,000 people were injured in motor vehicle crashes involving a distracted driver.
For the seventh consecutive year, the Training, Research and Education for Driving Safety (TREDS) program at the University of California, San Diego School of Medicine has been awarded a grant from the California Office of Traffic Safety (OTS) that will help keep our roadways and senior drivers safe through professional training.
TREDS works with health care providers and law enforcement to identify and assist older drivers with health issues that may put them and other drivers at risk. Driving abilities decrease with age due to physical impairments such as vision, cognition, frailty and the use of medications. Prescription and over-the-counter medications can significantly impair necessary driving skills, including eye sight, reaction time, judgment, hearing, simultaneous task processing and motor skills. Additionally, when drugs are mixed with alcohol, the results can be devastating. According to studies, a 10 mg of Valium has been found to be equivalent to a blood alcohol content (BAC) of 0.10 in its ability to impair driving.
“Physicians have a responsibility to their patients and to the public to help minimize driving risks through appropriate prescribing practices and patient counseling,” said Linda Hill, MD, MPH, professor of Family and Preventive Medicine, UC San Diego School of Medicine and TREDS program director. “It is estimated that 78 percent of drivers 55-years-old and older are using at least one prescription medication with the potential to impair driving, yet only 28 percent of senior drivers are aware that their medications have this potential effect. Patients over 65-years-old make up 12 percent of the population, yet they consume 31 percent of prescribed drugs.”
Antidepressants are an example where both the medication and the disease being treated can affect driving safety. Depression increases the crash risk two to three times, and equally worrisome is that antidepressant medications have been associated with more than double the crash risk in the elderly. Muscle relaxers, anti-anxiety and anti-insomnia medications also adversely affect the safety of senior drivers.
Diabetes drugs, chemotherapy and narcotics can also result in impaired judgment, confusion, drowsiness, nausea and dehydration, all likely to impair driving safety.
“The frailness associated with cancer and chemotherapy alone reduces driving skills and increases crash risks,” said Hill. “Individuals should understand the medications they are taking and how they can impair their driving abilities.”
UC San Diego Study Suggests Racial Inequality Leads to Higher Mortality
Researchers at the University of California, San Diego School of Medicine say metastatic colorectal cancer patients of African-American descent are less likely to be seen by cancer specialists or receive cancer treatments. This difference in treatment explains a large part of the 15 percent higher mortality experienced by African-American patients than non-Hispanic white patients.
The study, published online in the Journal of the National Cancer Institute, noted there was no difference in risk of death when black patients received the same treatments, such as chemotherapy and surgery, as non-Hispanic white patients.
“Other studies have looked at racial disparities in treatment and still others have focused on racial differences in survival rates of cancer patients, but our research attempted to go further by demonstrating the impact of race-based inequalities in cancer treatment on survival rates of black colorectal cancer patients,” said James D. Murphy, MD, MS, assistant professor and chief of the Radiation Oncology Gastrointestinal Tumor Service at UC San Diego Moores Cancer Center.
The researchers analyzed data from 11,216 patients over the age of 66 with stage IV colorectal cancer from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. The analysis compared patient consultation rates with cancer specialists as well as treatment with surgery, chemotherapy and radiation therapy for white and black patients.
Despite screening efforts and improvements in treatment, colorectal cancer is the third leading cause of cancer death in the United States, according to the American Cancer Society, with approximately 50,000 deaths annually. This disease disproportionally affects black patients, with higher incidence rates, more advanced stage at diagnosis and decreased survival rates compared to other ethnic groups.
The study concluded that black patients were 10 percent less likely to have primary tumor surgery, 17 percent less likely to receive chemotherapy and 30 percent less likely to receive radiotherapy. Among patients who received chemotherapy, white patients were more likely to receive more than one chemotherapy agent. The researchers noted that black patients typically received chemotherapy four days later than white patients. Chemotherapy was associated with a 66 percent decreased risk of death.
“Of note, our analysis found that 47 percent of the relative survival difference between black and white patients was attributable to treatment differences and, after accounting for these treatment differences, the race-based survival difference completely disappeared,” wrote the study authors.
The study did not ascribe a specific cause for the racial disparities but offered six possible explanations: conscious or unconscious provider biases; patient mistrust; health literacy; patient-physician communication breakdown; healthcare access barriers; and/or race-based differences in disease biology.
“Further studies may answer the important question of why there are racial disparities in consults with cancer specialists and treatment among this population. The answers may lead to areas we can improve upon to close these gaps,” said Murphy. “I suspect that this pattern of disparity could be present in other underserved minority groups as well.”
A study led by researchers at the University of California, San Diego School of Medicine shines a new light on molecular tools our cells use to govern regulated gene expression. The study will be published online in advance of print November 10 in the journal Nature Structural and Molecular Biology.
“We uncovered a novel mechanism that allows proteins that direct pre-mRNA splicing – RNA-binding proteins – to induce a regulatory effect from greater distances than was thought possible,” said first author Michael T. Lovci, a biomedical sciences graduate student working in the Department of Cellular and Molecular Medicine, the Stem Cell Research Program and Institute for Genomic Medicine at UC San Diego.
Researchers from California, Oregon, Singapore and Brazil made this finding while working toward an understanding of the most basic signals that direct cell function. According to Lovci, the work broadens the scope that future studies on the topic must consider. More importantly, it expands potential targets of rationally designed therapies which could correct molecular defects through antisense RNA oligonucleotides – small pieces of DNA or RNA that can bind to specific RNA targets to either block interactions with RNA-binding proteins and/or initiate degradation of the target RNA.
“This study provides answers for a decade-old question in biology,” explained principal investigator Gene W. Yeo, PhD, assistant professor of Cellular and Molecular Medicine, member of the Stem Cell Research Program and Institute for Genomic Medicine at UC San Diego, as well as with National University of Singapore. “When the sequence of the human genome just over a decade ago, we learned that less than 3 percent of the entire genome contains information that encodes for proteins. This posed a difficult problem for genome scientists – what is the other 97 percent doing?”
The role of the rest of the genome was largely a mystery and was thus referred to as “junk DNA.” Since then sequencing of other, non-human, genomes has allowed scientists to delineate the sequences in the genome that are remarkably preserved across hundreds of millions of years of evolution. It is widely accepted that this evidence of evolutionary constraint implies that, even without coding for protein, certain segments of the genome are vital for life and development.
Using this evolutionary conservation as a benchmark, scientists have described varied ways cells use these non-protein-coding regions. For instance, some exist to serve as DNA docking sites for proteins which activate or repress RNA transcription. Others, which were the focus of this study, regulate alternative mRNA splicing.
Eukaryotic cells use alternative pre-mRNA splicing to generate protein diversity in development and in response to the environment. By selectively including or excluding regions of pre-mRNAs, cells make on average ten versions of each of the more than 20,000 genes in the genome. RNA-binding proteins are the class of proteins most closely linked to these decisions, but very little is known about how they actually perform their roles in cells.
“For most genes, protein-coding space is distributed in segments on the scale of islands in an ocean,” said John G. Conboy, PhD, of the Lawrence Berkeley National Laboratory, co-lead investigator on the study. “RNA processing machinery, including RNA-binding proteins, must pick out these small portions and accurately splice them together to make functional proteins. Our work shows that not only is the sequence space nearby these ‘islands’ important for gene regulation, but that evolutionarily conserved sequences very far away from these islands are important for coordinating splicing decisions.”
Since this premise defies existing models for alternative splicing regulation, whereby regulation is enacted very close to protein-coding segments, the authors sought to define the mechanism by which long-range splicing regulation can occur. They identified RNA structures – RNA that is folded and base-paired upon itself – that exist between regulatory sites and far-away protein-coding “islands.” Dubbing these types of interactions “RNA-bridges” for their capacity to link distant regulators to their targets, the authors show that this is likely a common and under-appreciated mechanism for regulation of alternative splicing.
These findings have foreseeable implications in the study of biomedicine, the researchers said, as the RNA-binding proteins on which they focused – RBFOX1 and RBFOX2 – show strong associations with neurodevelopmental disorders such as autism and also certain cancers. Since these two proteins act upstream of a cascade of effects, understanding how they guide alternative splicing decisions may lead to advancements in targeted therapies which correct the inappropriate splicing decisions that underlie many diseases.
Published ahead of print in last week’s online edition of the journal PNAS, the study establishes using segments of genetic material called antisense oligonucleotides – ASOs – to block the buildup and selectively degrade the toxic RNA that contributes to the most common form of ALS, without affecting the normal RNA produced from the same gene.
The new approach may also have the potential to treat frontotemporal degeneration or frontotemporal dementia (FTD), a brain disorder characterized by changes in behavior and personality, language and motor skills that also causes degeneration of regions of the brain.
In 2011, scientists found that a specific gene known as C9orf72 is the most common genetic cause of ALS. It is a very specific type of mutation which, instead of changing the protein, involves a large expansion, or repeated sequence of a set of nucleotides – the basic component of RNA.
A normal C9orf72 gene contains fewer than 30 of the nucleotide repeat unit, GGGGCC. The mutant gene may contain hundreds of repeats of this unit, which generate a repeat containing RNA that the researchers show aggregate into foci.
“Remarkably, we found two distinct sets of RNA foci, one containing RNAs transcribed in the sense direction and the other containing anti-sense RNAs,” said first author Clotilde Lagier-Tourenne, MD, PhD, UC San Diego Department of Neurosciences and Ludwig Institute for Cancer Research.
University of California, San Diego School of Medicine researchers Joseph G. Gleeson, MD, Howard Hughes Medical Institute investigator and professor of neurosciences and pediatrics, and Richard D. Kolodner, PhD, professor of medicine and Ludwig Cancer Research scientist, have been named new members of the Institute of Medicine (IOM), considered among the highest honors in the fields of health and medicine.
Gleeson and Kolodner were among 70 new members and 10 foreign associates announces today at the IOM’s annual meeting, bringing total IOM membership to 1,966 worldwide. Forty-six UC San Diego faculty members, current and emeritus, are IOM members.
Increased vitamin D levels may prevent a wide range of diseases, according to recent studies. However, some previous studies led to a concern that vitamin D supplementation could increase an individual’s risk of developing kidney stones.
However, a study of 2,012 participants – published in the American Journal of Public Health –found no statistically relevant association between 25-hydroxyvitamin D (25 (OH)D) serum level in the range of 20 to 100 ng/mL and the incidence of kidney stones.
This study – led by Cedric F. Garland, DrPH, adjunct professor in the Division of Epidemiology, Department of Family and Preventive Medicine at the University of California, San Diego School of Medicine – used data from the nonprofit public health promotion organization GrassrootsHealth to follow more than 2,000 men and women of all ages for 19 months.
Only 13 individuals self-reported a kidney stone diagnosis during the study.
“Mounting evidence indicates that a Vitamin D serum level in the therapeutic range of 40 to 50 ng/mL is needed for substantial reduction in risk of many diseases, including breast and colorectal cancer,” said Garland, adding that this serum level is generally only achieved by taking vitamin supplements. “Our results may lessen concerns by individuals about taking vitamin D supplements, as no link was shown between such supplementation and an increased risk for kidney stones.”
The study did show that older age, male gender and higher body mass index (BMI) were all risk factors for developing kidney stones. According to the researchers, individuals with high BMI need higher vitamin D intake than their leaner counterparts to achieve the same 25 (OH)D serum level.
Thomas Kipps One of Four Recipients of Leukemia & Lymphoma Society Award
The Leukemia & Lymphoma Society has awarded Thomas J. Kipps, MD, PhD, Distinguished Professor of Medicine at the University of California, San Diego School of Medicine, with a 5-year, $6.25 million Specialized Center of Research program grant to support research on chronic lymphocytic leukemia (CLL), the most common adult leukemia in the United States.
Kipps, the Evelyn and Edwin Tasch Chair in Cancer Research and UC San Diego Moores Cancer Center deputy director for research, is a recipient of The Leukemia & Lymphoma Society’s grant for the “Specific Targets for Therapy of Patients with Chronic Lymphocytic Leukemia,” a four-part project. After nearly three decades of investigating and treating CLL, Kipps is considered among the nation’s leading experts in the disease. According to the National Cancer Institute, 1 in 192 people will be diagnosed with CLL during their lifetime.
“Although the research proposal is directed toward improving therapy for patients with CLL, the research may impact other leukemias, lymphomas and cancers in general,” said Kipps. “The Leukemia & Lymphoma Society’s Specialized Center of Research grant plays an important part in moving this research forward.”
CLL is a cancer of the blood and bone marrow, characterized by the growth of abnormal white blood cells that ultimately crowd out healthy cells. Treating this slow-growing cancer is challenging because malignant cells are resistant to drugs used to treat other leukemias. Past research has been unable to uncover a common mutation; instead, alterations in CLL occur through different survival pathways.
A research team, headed by Theodore Friedmann, MD, professor of pediatrics at the University of California, San Diego School of Medicine, says a gene mutation that causes a rare but devastating neurological disorder known as Lesch-Nyhan syndrome appears to offer clues to the developmental and neuronal defects found in other, diverse neurological disorders like Alzheimer’s, Parkinson’s and Huntington’s diseases.
The findings, published in the October 9, 2013 issue of the journal PLOS ONE, provide the first experimental picture of how gene expression errors impair the ability of stem cells to produce normal neurons, resulting instead in neurological disease. More broadly, they indicate that at least some distinctly different neurodevelopmental and neurodegenerative disorders share basic, causative defects.
The scientists say that understanding defects in Lesch-Nyhan could help identify errant processes in other, more common neurological disorders, perhaps pointing the way to new kinds of therapies.
Lesch-Nyhan syndrome is caused by defects in the HPRT1 gene (short for hypoxanthine guanine phosphoribosyltransferace, the enzyme it encodes), a gene that is well-known for its essential “housekeeping duties,” among them helping generate purine nucleotides – the building blocks of DNA and RNA.
Mutations in the gene result in deficiencies in the HPRT enzyme, leading to defective expression of the neurotransmitter dopamine and subsequent abnormal neuron function. HPRT mutation is known to be the specific cause of Lesch-Nyhan, an inherited neurodevelopmental disorder characterized by uncontrollable repetitive body movements, cognitive defects and compulsive self-mutilating behaviors. The disorder was first described in 1964 by medical student Michael Lesch and his mentor, William Nyhan, MD, professor emeritus at UC San Diego School of Medicine.
Surgeons at UC San Diego Health System have performed the region’s first robotic gastrectomy, a potentially lifesaving procedure to remove a section of the stomach after a diagnosis of gastric cancer. Aided by a da Vinci robot, surgeons remove the diseased tissue, perform a delicate reconstruction and remove local lymph nodes for further testing.
“To treat the gastric cancer, we remove part or all of the stomach with five small incisions,” said Kaitlyn Kelly, MD, surgical oncologist at UC San Diego Health System. “The goal of the robotic approach is to remove the cancer and carefully extract nearby lymph nodes in a highly precise way to achieve a more accurate cancer staging.”
Kelly’s patient, a woman of Korean descent, was diagnosed with stomach cancer after reporting upper abdominal pain to her physician. Korean men and women are five to seven times more likely than Caucasians to develop gastric cancer, which is the fourth most common cancer worldwide.
Also known as an adenocarcinoma, stomach cancer arises from the mucus-producing cells of the stomach lining. Early detection and accurate staging are essential to the patient’s long-term survival. Staging describes the extent or severity of a person’s cancer. Patients with a diagnosis of gastric cancer typically complain of upper stomach pain, persistent and severe heartburn or stomach fullness shortly after eating.
“What is special about the robotic approach is the ability to carefully remove the lymph nodes around large blood vessels without causing damage to the nodes or vessels. This robotic approach can potentially offer a better specimen for pathologists to evaluate,” said Santiago Horgan, MD, chief of minimally invasive surgery at UC San Diego Health System and director of the Center for the Future of Surgery at UC San Diego School of Medicine.
UC San Diego Moores Cancer Center researcher says breast cancer in women of Mexican descent occurs despite seemingly protective factors
Scientific data suggest that a woman reduces her risk of breast cancer by breastfeeding, having multiple children and giving birth at a younger age. A study led by the University of California, San Diego School of Medicine and recently published online by Cancer Epidemiology, Biomarkers & Prevention, indicates that women of Mexican descent may not fit that profile. In fact, results suggest that women of Mexican descent with more children and those who breastfeed are more likely to be diagnosed with an aggressive form of breast cancer.
During the four-year Ella Binational Breast Cancer Study, scientists assessed the association between reproductive factors and tumors subtypes in 1,041 Mexican and Mexican-American female cancer patients.
The study looked at the occurrence of three tumor subtypes: luminal A, HER2 and triple negative. The luminal tumor starts in the inner cell lining of the mammary ducts and is most common. The HER2 tumor is so-named because it is positive for human epidermal growth factor receptor 2 (or HER2) – a protein shown to play a role in aggressive breast cancer. Triple negative breast cancer does not have targeted treatment options, making it difficult to treat and giving it the worst prognosis.
“We found that breastfeeding in women of Mexican descent is associated with triple negative breast cancer,” said María Elena Martínez, MPH, PhD, UC San Diego Moores Cancer Center Sam M. Walton Endowed Chair for Cancer Research and co-director of the Reducing Cancer Disparities research program and lead author of the study. “This was quite surprising. No other study has seen this correlation before. Most studies show health benefits of breastfeeding.”
The average age when women in the Ella study gave birth to a first child was 23 years old. These women had an average of two to three children and were likely to breastfeed for long periods of time. Based on existing research, primarily based on non-Hispanic white women, this reproductive pattern would be classified as low risk. Yet all of the women in the study developed breast cancer, says Martínez.
The Ella study enrolled breast cancer patients, 18 years old and older, at the University of Arizona Cancer Center, the University of Texas M.D. Anderson Cancer Center and three sites in Mexico – the Universidad de Sonora, the Instituto Tecnológico de Sonora and the Universidad de Guadalajara.
The study showed that patients of Mexican descent who breastfed for 12 months or more were more than twice as likely to have triple negative breast cancer. They were younger at diagnosis and younger during their first full-term pregnancy. Patients who had three or more children were also more likely to have triple negative breast cancer. Martinez said that it is important to note that prior studies, mainly in non-Hispanic white women, have shown that these reproductive characteristics reduce the risk of breast cancer overall, possibly due to effects on the more common, better prognosis, of luminal A cancers.
“Our results are both puzzling and disconcerting because we do not want to give the wrong message about breastfeeding,” said Martínez. “If you treat breast cancer as one disease, breastfeeding is beneficial to both mother and baby. That should not be dismissed.”
Martínez said the most important takeaway from this report is that the scientific community needs to do further research into populations with unique risk-factor patterns that might benefit from different screening or prevention approaches. She added that the observations made in the Ella study need to be replicated in populations with similar reproductive profiles to determine if the results are due to common biologic factors or specific genetic or environmental factors of the women in the Ella study.