Medical imaging may detect unrelated diseases in research participants

  Public release date: 27-Sep-2010

JAMA and Archives Journals

In about 40 percent of research participants undergoing medical imaging, radiologists may detect a tumor or infection unrelated to the study but that may be meaningful to the individual's health, according to a report in the September 27 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
"An incidental finding in human subjects research is defined in a major consensus project as an observation 'concerning an individual research participant that has potential clinical importance and is discovered in the course of conducting research, but is beyond the aims of the study,'" the authors write as background information in the article. "Numerous reports have detailed how the detection of an incidental finding can result in the early beneficial diagnosis of an unsuspected malignant neoplasm or aneurysm. However, others describe harm and excessive cost resulting from treatment of radiographically suspicious incidental findings. Moreover, clinical experience dictates that many incidental findings are of indeterminate clinical significance and generate uncertainty among both research participants and their physicians."
Nicholas M. Orme, M.D., of Mayo Clinic, Rochester, Minn., and colleagues evaluated the medical records of 1,426 research participants who underwent an imaging procedure related to a study conducted in 2004. Each image was interpreted by a radiologist the day it was performed, and an expert panel reviewed all incidental findings that resulted in a clinical action during a three-year follow-up period.
Of the 1,426 research imaging examinations, an incidental finding occurred in 567 (39.8 percent). The risk of an incidental finding increased with age. More incidental findings were generated in patients undergoing computed tomography (CT) scans of the abdomen and pelvic area than in any other imaging procedure, followed by CT of the chest and magnetic resonance imaging (MRI) of the head.
Clinical action was taken for 35 (6.2 percent) of the individuals with an incidental finding; in most cases (26 of 567, or 4.6 percent) the medical benefit or burden of these actions was unclear. However, action resulted in clear medical benefit for six of the 567 patients (1.1 percent) and clear medical burden in three patients (0.5 percent).
"This study demonstrates that research imaging incidental findings are common in certain types of imaging examinations, potentially offering an early opportunity to diagnose asymptomatic life-threatening disease, as well as a potential invitation to invasive, costly and ultimately unnecessary interventions for benign processes," the authors write. "The majority of incidental findings seem to be of unclear significance. These instances represent a dilemma for researchers."
The findings should help researchers identify imaging studies at high risk for generating incidental findings and develop a plan for managing them, the authors conclude. "Timely, routine evaluation of research images by radiologists can result in identification of incidental findings in a substantial number of cases that can result in significant medical benefit to a small number of patients," they write.
(Arch Intern Med. 2010;170[17]:1525-1532. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Editorial: Researchers Must Plan for Incidental Findings "In clinical research, investigators may learn information about a participant that is not pertinent to the research question but that may have important clinical implications for the participant," writes Bernard Lo, M.D., of the University of California, San Francisco, in an accompanying editorial. "Such incidental findings present ethical dilemmas. Although they may offer the possibility of substantial personal benefit to the participant, more commonly they are false-positive findings that lead to a cascade of testing that presents additional risks and burdens."
"When planning a study, researchers need to develop a comprehensive plan for how they will respond to incidental findings, including what findings they will offer to disclose to participants," Dr. Lo continues. "The possibility of incidental findings, and their ramifications, should be part of the informed consent process. The work by Orme et al helps us to start to quantify their impact."
(Arch Intern Med. 2010;170[17]:1522-1524.

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Scientists release first cultivated ohelo berry for Hawaii

  What the US Department of Agriculture and its university affiliates did may be duplicated else where in other countries.

The first cultivar of 'ōhelo berry, a popular native Hawaiian fruit, has been released by U.S. Department of Agriculture (USDA) scientists and their university and industry cooperators.

'Ōhelo (Vaccinium reticulatum Smith) is a small, native Hawaiian shrub in the cranberry family, commonly found at high elevations on the islands of Maui and Hawaii. As people scour the landscape to harvest this delectable berry for use in jam, jelly and pie filling, they unfortunately disrupt the fragile habitats where this plant grows.

In an effort to reduce damage to the environment and meet consumer demands, horticulturist Francis T.P. Zee, with the USDA Agricultural Research Service (ARS) Pacific Basin Agricultural Research Center (PBARC) in Hilo, Hawaii, is evaluating 'ōhelo for small farm production and ornamental use. Zee collaborated with fellow ARS scientists and cooperators at the University of Hawaii at Manoa, Big Island Candies and the Big Island Association of Nurserymen. ARS is the principal intramural scientific research agency of USDA.

Zee and his team selected the offspring of seed-grown plants to create the new cultivar "Kilauea" for berry production. They found 'ōhelo's tiny seeds readily germinated under 20-30 percent shade in well-watered and well-drained potting mixture. Plant hardiness and vigor improved with age, and some seedlings flowered just 10 months after germination, much sooner than the 5 years reported in previous studies. The 16-month-old plants Zee successfully transplanted from the greenhouse to the field produced berries a year later.

Zee also used cuttings and tissue culture to propagate selected 'ōhelo of high ornamental potential. With proper care, young, growing shoots of 'ōhelo can be groomed into vibrant, colorful ornamental potted plants. Since the plant is not seasonal, its readiness for market can be scheduled by trimming and fertilizing. Older potted 'ōhelo plants can be trained into a bonsai and can readily adapt to the office environment.

Zee and PBARC scientists are currently examining the disease and insect problems associated with growing potted 'ōhelo. Full descriptions of Zee's 'ōhelo studies can be found on the University of Hawaii's College of Tropical Agriculture and Human Resources' (CTAHR) website.

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Scientists release first cultivated ohelo berry for    Hawaii

What US Department of Agriculture and its university affiliates did may be followed  universally by similar departments elsewhere in any country. Many wild berries and fruits rich in vitamins and other nutrients have become extinct.

The first cultivar of 'ōhelo berry, a popular native Hawaiian fruit, has been released by U.S. Department of Agriculture (USDA) scientists and their university and industry cooperators.

'Ōhelo (Vaccinium reticulatum Smith) is a small, native Hawaiian shrub in the cranberry family, commonly found at high elevations on the islands of Maui and Hawaii. As people scour the landscape to harvest this delectable berry for use in jam, jelly and pie filling, they unfortunately disrupt the fragile habitats where this plant grows.

In an effort to reduce damage to the environment and meet consumer demands, horticulturist Francis T.P. Zee, with the USDA Agricultural Research Service (ARS) Pacific Basin Agricultural Research Center (PBARC) in Hilo, Hawaii, is evaluating 'ōhelo for small farm production and ornamental use. Zee collaborated with fellow ARS scientists and cooperators at the University of Hawaii at Manoa, Big Island Candies and the Big Island Association of Nurserymen. ARS is the principal intramural scientific research agency of USDA.

Zee and his team selected the offspring of seed-grown plants to create the new cultivar "Kilauea" for berry production. They found 'ōhelo's tiny seeds readily germinated under 20-30 percent shade in well-watered and well-drained potting mixture. Plant hardiness and vigor improved with age, and some seedlings flowered just 10 months after germination, much sooner than the 5 years reported in previous studies. The 16-month-old plants Zee successfully transplanted from the greenhouse to the field produced berries a year later.

Zee also used cuttings and tissue culture to propagate selected 'ōhelo of high ornamental potential. With proper care, young, growing shoots of 'ōhelo can be groomed into vibrant, colorful ornamental potted plants. Since the plant is not seasonal, its readiness for market can be scheduled by trimming and fertilizing. Older potted 'ōhelo plants can be trained into a bonsai and can readily adapt to the office environment.

Zee and PBARC scientists are currently examining the disease and insect problems associated with growing potted 'ōhelo. Full descriptions of Zee's 'ōhelo studies can be found on the University of Hawaii's College of Tropical Agriculture and Human Resources' (CTAHR) website.

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'Dry water' could make a big splash commercially

		IMAGE: Powdered material called "dry water " could provide a new way to store carbon dioxide in an effort to fight global warming. Click here for more information.

An unusual substance known as "dry water," which resembles powdered sugar, could provide a new way to absorb and store carbon dioxide, the major greenhouse gas that contributes to global warming, scientists reported at the 240th National Meeting of the American Chemical Society. The powder shows bright promise for a number of other uses:

*It may, for instance, be a greener, more energy-efficient way of jump-starting the chemical reactions used to make hundreds of consumer products.

*Dry water also could provide a safer way to store and transport potentially harmful industrial materials.

Carter explained that the substance became known as "dry water" because it consists of 95 percent water and yet is a dry powder. Dry water was discovered in 1968 and got attention for its potential use in cosmetics. Scientists at the University of Hull, U.K. rediscovered it in 2006 in order to study its structure, and Cooper's group at the University of Liverpool has since expanded its range of potential applications. One of the most recent involves using dry water as a storage material for gases, including carbon dioxide. In laboratory-scale research, Cooper and co-workers found that dry water absorbed over three times as much carbon dioxide as ordinary, uncombined water and silica in the same space of time.

In another potential new application, the scientists also showed that dry water is a promising means to speed up catalyzed reactions between hydrogen gas and maleic acid to produce succinic acid, a feedstock or raw material widely used to make drugs, food ingredients, and other consumer products. "There's nothing else quite like it," said Ben Carter, Ph.D., researcher for study leader Professor Andrew Cooper. "Hopefully, we may see 'dry water' making waves in the future."