Dr. Michael Schlitt, Neurosurgery

Ebola Hits the US

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Dr. Michael Schlitt ebola

A group of workers in West Africa dealing with an Ebola victim.

There has been a lot of talk about the spread of Ebola in West Africa, but most of this seems to have been restricted to Africa.  That is, until now.  The first case of Ebola has just been diagnosed by a person in the US, who had traveled between Liberia and Dallas, TX.  Although this patient didn’t display any symptoms upon leaving West Africa, symptoms revealed themselves 4 days after landing in Texas.  On September 26, two days after falling ill, the patient visited Texas Health Presbyterian Hospital.  Because of the patient’s recent trip to Liberia and symptoms, the Center for Disease Control and Prevention (CDC) recommended that they be isolated and tested for Ebola.

Thankfully, the CDC does know how to stop the further spread of Ebola, so there shouldn’t be too much to worry about.  Close contacts of the patients are currently under daily monitoring for 21 days following exposure.  Yesterday, Congressman Dr. Michael C Burgess of the North Texas Congressional district issued a statement that “the inevitable” had occurred.  While Ebola is pretty scary to think about, the US is significantly better equipped for disease control than West Africa, and therefore experts don’t believe that Ebola in the US won’t be on nearly the same scale that it was across the ocean.  Of course, it’s not impossible that there could be additional cases associated with the Texan patient, but the CDC is confident that they can contain this infection.

The Ebola virus is spread through direct contact with the bodily fluids of an infected person, and can’t be spread through casual contact or through the air.  Therefore, the CDC recommends that exposed people should be monitored for symptoms for 3 weeks.  Experts had previously concluded that Ebola would eventually make its way to the US, but experts insist that the US’ capacity to test and treat Ebola patients is excellent, and they don’t expect any “real transmission” in the US.  According to the CDC, the American public health and medical systems had previously been successful at containing similar outbreaks, pointing to five imported cases of viral hemorrhagic fever diseases similar to Ebola over the past 10 years that the US had contained without any transmission.

 

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Dr. Michael Schlitt, Neurosurgeon, Neurosurgery, Seattle

Rise in Depression

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According to data gathered by San Diego State University Dr. Michael Schlitt depressionprofessor Jean Twenge from 6.9 million adolescents and adults, Americans are now more depressed than they’d previously been in decades.  Twenge discovered that Americans now report more psychosomatic symptoms of depression, such as trouble with sleeping or concentrating, than people did back in the 1980s.  Previously, studies found that more people have been treated for depression in recent years, although it wasn’t clear if this was due to a rise in depression or just increased awareness and less stigma.  However, Twenge claims that this study shows an increase in symptoms that most people don’t even know are connected with depression, suggesting that adolescents and adults are actually suffering a lot more.

In comparison to people from the 1980s, teens in the 2010 are 38 percent more likely to have trouble remembering, 74 percent more likely to have trouble sleeping and twice as likely to have seen a professional for issues with mental health.  College students in the survey were 50 percent more likely to say that they felt overwhelmed, and adults were more likely to say that their sleep was restless, they had little appetite and everything was an effort.  These are all typical psychosomatic symptoms of depression.  In spite of all these symptoms, people are no more likely to say that they’re depressed when asked the question directly.  Twenge says this suggests that this rise in depression isn’t based on people being more willing to admit depression.

This study also found that the suicide rates among teens have decreased, even though this decline was at best insignificant when compared to the increase in symptoms of depression.  Due to the use of anti-depressant medications doubling over this time period, Twenge believes that while medication has helped those with the most severe depression problems, it hasn’t reduced the increases in other symptoms that can still cause significant issues.

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Dr. Michael Schlitt, Neurosurgeon, Neurosurgery, Seattle

Studying Ebola

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An international research team has rapidly sequenced 99 Ebola virus genomes collected in the 2014 outbreak.  The team, which includes members from the Broad Institute, Harvard University and the Sierra Leone Ministry of Health and Sanitation, holds out hope that the findings will help multidisciplinary, international efforts to understand and contain the epidemic that is currently exploding in West Africa.  Before their research was published, five of the team members died of Ebola.  The 99 genomes that they studied came from a total of 78 patients diagnosed with Ebola in Sierra Leone during the first 24 days of the outbreak.  Since some patients gave more than one sample, the team was able to see how the virus changed over the course of a single infection.

Through deep sequencing techniques, the team increased the amount of data available on the Ebola by four-fold.  The results revealed that the 2014 Ebola virus genomes contain over 300 mutations that distinguish them from previous outbreaks.  They also found clues that suggest that the 2014 outbreak started from a single introduction into humans before spreading among them over many months.  Fruit bats are thought to be the natural host of Ebola, which first appeared among humans in the 1970s.  The 2014 outbreak is unprecedented in both its size and the fact that it emerged in highly populated parts of West Africa, as opposed to sparsely populated areas in Central Africa as before.  Previously, the largest outbreak was in 1976 and reported 318 cases.  The current outbreak, however, has reported over 2,000 cases and over 1,000 deaths.  According to the World Health Organization (WHO), the current outbreak has infected more than 240 health care workers in West Africa, more than half of whom have died.

Dr. Michael Schlitt ebola

The Ebola virus as seen under a microscope.

According to the study, the 2014 Ebola strains most likely have a common ancestor back in the 1976 outbreak, and suggests that the strains in the current West African outbreak separated from the Central African version in the past 10 years.  The mutations in the 2014 Ebola strains are mostly in genes that code for proteins, which is important for researchers looking to keep track of how the virus is changing.  With this is in mind, the researchers released the genome sequences to the international scientific community before finally publishing their study.  By making the data immediately available to the community, the researchers hope to accelerate response efforts.  The study presents a catalog of 395 mutations, over 340 of which distinguish the current outbreak from previous ones, and over 50 of which have exclusively occurred during the current outbreak.

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Dr. Michael Schlitt, Neurosurgeon, Neurosurgery, Seattle

Virtual Reality and Surgery

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August saw the first ever “virtual reality (VR) operation” being conducted as part of research into how the Oculus Rift headset could benefit surgical training.  I recently came across an article that discusses the merging of surgery and gaming technology.  This March, Facebook acquired the startup Oculus VR, the developers of the Oculus Rift virtual reality headset, for $2 billion.  The gaming world had mixed feelings about this purchase, as they were suspicious as to what a tech giant like Facebook was planning on doing with what many people consider to be the next major evolution in gaming.

Dr. Michael Schlitt Oculus Rift

The Rift, shown here, could be used to train surgeons.

Immediately after the takeover was announced, Markus Persson, known for creating Minecraft, cancelled a deal that would have brought Minecraft to the Rift.  With Mark Zuckerberg acquiring the Rift, it seemed like the focus of the device was no longer going to be gaming, as Zuckerberg planned on using for other purposes.  However, those who were angry that the Rift was being used for purposes other than gaming didn’t realize that such a device could be used for a variety of purposes, possibly even health care.  Groups have already started experimenting with the technology in the medical field.  Last month, scientists, videographers and surgeons collaborated on the first “Oculus Rift operation”.  The project was originally conceived by French engineer and VR enthusiast Rémi Rousseau.  Rousseau partnered with the medical research fundraising body MOVEO Foundation to demonstrate what role the Oculus Rift could play as a training aid for surgeons.

According to Rousseau, using VR for training purposes is nothing new, as the military has been using virtual reality-simulated environments in training for over 35 years.  The advantages that come from being able to train novice personnel in a low-to-no-risk simulated environment is undeniable.  The technology has yet to catch on due to money, but with such tech giants as Apple, Android, Windows and Linux backing it, VR could soon be available to consumers.  The Rift, however, wouldn’t be a medical device, but if it’s widely adopted, it could be a valuable tool for physicians.  In Rousseau’s experiment, two synchronized GoPro cameras were mounted onto the head of surgeon Dr. Thomas Gregory as he was performing a total hip replacement.  The idea here was to capture hi-res 3D footage of the operation from the perspective of the surgeon.  When this was viewed back through the headset of the Rift, the viewer has the feeling of being in the surgeon’s body, watching the procedure through their eyes.

When you’re a training surgeon, you always have a task to do during the surgery, and therefore it becomes difficult to see what the main surgeon is actually doing.  Being able to witness a surgery through the perspective of the surgeon is extremely useful, and the Rift would allow the user to replay the surgery in detail, pause, fast forward or rewind.  It can also be a great way to share and learn new technologies among surgeons.  Since the current iteration of the Rift costs $350, while radiology screens cost over $15,000, Rousseau suggests that if the resolution of the Rift is improved, then it could even be a viable radiological interpretation tool.

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Dr. Michael Schlitt, Neurosurgeon, Neurosurgery, Seattle

Glasses Obsolete?

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There’s a joke by the comedian Brian Regan about people who only wear glasses when they’re driving.  “Why don’t you just get a car window with lenses in it?”, he says.  While this sounds goofy, something like it may soon become reality.  Scientists at UC Berkeley are currently developing computer algorithms that compensate for an individual’s visual impairment, creating vision-correcting displays that allow users to see text and images clearly on a computer screen without the need of eyeglasses or contact lenses.  This technology could help hundred of millions of people who currently need glasses to use their smartphones, tablets and computers.  For example, one common problem is presbyopia, a type of farsightedness in which the ability to focus on nearby objects is gradually diminished as the aging eyes’ lenses lose elasticity.

Glasses

Glasses like these may soon become obsolete

More importantly, these displays being developed could eventually aid people with more complex visual problems, known as high order aberrations, which cannot be corrected by eyeglasses.  In a world where screens such as computers and smartphones are a daily fact of life, many of us could take for granted the ability to use such devices without any sort of visual aid.  A lot of people with high order aberrations have irregularities in the shape of the cornea, which makes it very difficult to have a contact lens that will fit them.  In some instances, this can be a barrier to holding certain jobs or functioning in society, since many workers need to look at a screen as part of their work.  Such research, if successful, could transform the lives of such people.

UC Berkeley researchers teamed up with Gordon Wetzstein and Ramesh Raskar, colleagues at MIT, to develop their latest prototype of this vision-correcting display.  The setup adds a printed pinhole screen sandwiched between two layers of clear plastic to an iPod display to enhance image sharpness.  The research team will present this computational light field display in August at the International Conference and Exhibition on Computer Graphics and Interactive Techniques (SIGGRAPH) in Vancouver.  According to the study’s lead author, Fu-Chung Huang, this project is so significant because, instead of relying on optics to correct vision, this is one of the first attempts at using computation.  It’s a very different, non-intrusive, class of correction.  The algorithm works by adjusting the intensity of each direction of light that emanates from a single pixel in an image based on a user’s specific visual impairment.  In a process known as deconvolution, the light then passes through the pinhole array in such a way that the user will perceive a sharp image.

In the experiment, researchers displayed images that appeared blurred to a camera, which was set to simulate a farsighted person.  When using the new prototype display, the blurred images appeared sharp through the camera lens.  This latest approach improves upon earlier versions of vision-correcting displays that resulted in low-contrast images.  This new display combines light field display optics with a new algorithm.  This research prototype could easily be developed into a thin screen protector, and continued improvements in eye-tracking technology would help make it easier for the displays to adapt to the position of the user’s head position.

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Dr. Michael Schlitt, Neurosurgery

Brains Respond to Ads

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For quite some time now, media and marketing experts have long sought a reliable method of getting responses from the general population to future products and messages.  According to a recent study done by the City College of New York, (CCNY) in partnership with Georgia Tech, it looks like the brain responses of just a few individuals are a remarkably strong predictor.  By analyzing the brainwaves of 16 individuals as they watched mainstream TV content, researchers were able to accurately guess the preferences of large TV audiences, up to 90 percent in the case of Super Bowl commercials.  These findings appear in a paper entitled “Audience Preferences Are Predicted by Temporal Reliability of Neural Processing”, which was recently published in the latest edition of Nature Communications.

Mean Joe Coke

Now, measuring brainwaves allows people to determine how good commercials are.

Alternative methods such as self-reports are characterized by problems such as people conforming their responses to their own values and expectations.  However, brain signals measured through electroencephalography (EEG) can, in principle, alleviate this shortcoming by providing immediate physiological responses immune to such self-biasing.  According to Lucas Parra, the senior author of the report, explained that when two people watch a video, their brains respond similarly, but only if the video is engaging.  Popular shows and commercials draw our attention and make our brainwaves very reliable.

In the study, participants watched scenes from the TV show The Walking Dead, and then several commercials from the 2012 and 2013 Super Bowls.  EEG electrodes were then placed on their heads to capture brain activity.  The reliability of the recorded neural activity was then compared to audience reactions in the general population using publicly available social media data provided by the Harmony Institute and ratings from USA Today’s Super Bowl Ad Meter.  Brain activity among participants watching The Walking Dead predicted 40 percent of the associated Twitter traffic.  When brainwaves were in agreement, the number of tweets went up as well.  Brainwaves were also able to predict 60 percent of the Nielsen ratings that measure the size of a TV audience.

The study was even more accurate when comparing preferences for Super Bowl ads.  For instance, researchers saw very similar brainwaves from their participants as they watched a 2012 Budweiser commercial that featured a beer-fetching dog.  The general public voted the ad as their second favorite that year.  The study then found little agreement in the brain activity among participants when watching a GoDaddy commercial with a kissing couple, which was among the worst-rated Super Bowl ads in 2012.  The CCNY researchers collaborated with Matthew Bezdek and Eric Schumacher from Georgia Tech to identify which brain regions are involved and explain the mechanisms.  With functional magnetic resonance imaging (fMRI), they found evidence that brainwaves for engaging ads could be driven by activity in visual, auditory and attention brain areas.

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Dr. Michael Schlitt, Neurosurgeon, Neurosurgery, Seattle

Weight Loss Pill

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I recently came across an article about a new pill, Gelesis100, which is apparently supposed to be both a safe and effective weight loss aid.  However, this isn’t a new treatment; the pill, by manufacturer Gelesis, was previously known as Attiva, and was piquing the media’s interest back in 2010 after passing a clinical trial of 95 people.  Reportedly in development for 15 years, Attiva was a new way of thinking about weight loss treatment.  The capsule contains a “hydrogel”, which is comprised of two food ingredients that have a unique reaction when cross-linked with each other.

Gelesis

Gelesis, the company who created Gelesis100.

While the hydrogel is only around the size of a sugar grain, when it’s consumed with water, it expands into gel-form in the stomach, which stretches the stomach walls.  The stomach’s nerve fibers are then stimulated, which tells the brain that the stomach is full and unable to receive more food.  Attiva was found to be safe and well-tolerated, and with few side effects, mostly focused around nausea, constipation or diarrhea.  After this pill was created, Gelesis neded to demonstrate to the FDA that their pill can help people lose weight over a year-long period.  However, after that, there wasn’t a whole lot heard about Attiva.

At ICE/ENDO 2014, Gelesis revealed their new “proof of concept” trial on Attiva, which they rebranded as Gelesis100.  A group of 43 people were randomly assigned to receive 2.25g of Gelesis100 before lunch and dinner, a group of 42 received 3.75g and a control group of 43 received a placebo that contained cellulose.  All participants were then instructed to eat 600 fewer calories a day.  Participants were weighed at the start and end of the 12-week study.  The people in the 2.25g group had lost 6.1% of their body weight after treatment, the 3.75g group lost 4.5% and the placebo group lost 4.1%.  The researchers believe that the higher dose group lost less weight due to “lower tolerability” to the hydrogel.

In the 2.25g group, subjects with initial high-fasting blood sugar lost more weight than other participants in the group, with an average reduction in body weight of 8.2%.  However, the people who lost the most weight were prediabetic subjects, who lost on average 10.9% of their body weight.  Once again, the trial found only minor side effects from hydrogel, mostly bloating, flatulence, abdominal pain and diarrhea, which occurred significantly less in the smaller dose group.  If Gelesis100 is approved by the FDA, then Gelesis will be regulated as a medical device.

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