Nisha Pradhan was seven when she began to suspect she was missing out on something. Her sister seemed to have an uncanny knack for predicting what their mother was making for dinner. Pradhan, meanwhile, never had a clue.
“I would just stare at her,” Pradhan says. “She’s younger than me—how does she know more than I do?”
Now 21, Pradhan knows she has a limited ability to detect odour—including the smell of dinner cooking. Her situation is not unique: The sense of smell is often taken for granted, until it malfunctions.
As a patient in a clinical trial being conducted at Rockefeller University, Pradhan is helping scientists develop new smell tests, which promise to help improve diagnosis because they can be used reliably for anyone, anywhere. Because smell disorders can be linked to a variety of health conditions—interfering with appetite, as well as social interaction and sometimes leading to isolation, anxiety, and depression.
“People have their vision and hearing tested throughout their lives, but smell testing is exceedingly rare,” says neuroscientist Leslie Vosshall.
The new tests, developed by Vosshall along with Julien Hsieh, a Rockefeller clinical scholar, and their colleagues could even aid the early detection of neurological disorders that have been linked to problems with olfaction.
People suffer from smell loss for various reasons—a head trauma or sinus infection, for example, or even a common cold—and the cause can be as hard to pinpoint as the condition itself. In Pradhan’s case, she believes she lost much of her sense of smell as a young child, although she’s not sure how. She brought the issue up with her paediatrician, but never received any testing or guidance.
Both the medical community and the people affected by smell loss can be prone to overlook it. “Olfies,” says Pradhan, referring to people with a normal sense of smell, “think not having a sense of smell just affects our ability to detect gas leaks, smoke, and bad body odour. But it deprives us of so much more, including emotions and memories that are so intimate and integral to the human experience.”
A handful of tests already exist for diagnosing people like her. One problem with these tests is that they rely on a patient’s ability to detect and identify single types of odour molecules, such as rose-scented phenylethyl alcohol. However, the ability to detect odours and to recognize them can vary greatly between people. So, someone with an otherwise normal sense of smell may not be able to detect the rose molecule. Meanwhile, another person who can smell roses but is from an area where these flowers are scarce may struggle to put a name to the scent. In either case, there is the potential for misdiagnosis, particularly when testing across different populations and countries.
Hsieh and colleagues set out to eliminate these potential biases with the help of “white smells,” made by mixing many odours together to produce something unfamiliar. Just as a combination of wavelengths of light produces white light, and many frequencies of sound make up white noise, the team generated white smells from assortments of 30 different odour molecules. Their two new tests ask patients to distinguish white smells with overlapping ingredients and to detect white smells at increasingly lower concentrations.
If a person is unable to detect a single component of the test scent, this has little effect on the outcome, and test takers don’t need to identify the odour at all. “We’re really excited about these new tests,” says Vosshall, who is Robin Chemers Neustein Professor and a Howard Hughes Medical Institute investigator. “They focus on the problem of smell itself, because they don’t force people to match smells to words.”
Clinical trials conducted at The Rockefeller University Hospital and Taichung Veterans General Hospital in Taiwan showed that the new tests detected smell loss more reliably than conventional options. The results open up the possibility of a new means to detect smell loss worldwide. It could be used for detection of Alzheimer’s and Parkinson’s diseases, says Hsieh, now a resident at the Geneva University Hospitals in Switzerland.
“The goal is to use changes in the sense of smell, along with other biomarkers, to identify underlying causes of these neurological disorders very early, and so potentially improve treatment,” he says.

Rockefeller University www.rockefeller.edu/news/20624-new-smell-test-aid-early-detection-alzheimers-parkinsons/

Braunschweig Municipal Hospital and Siemens Healthineers are breaking new ground through an innovative medical technology partnership. Together, they have entered into a long-term Asset Management Services (AMS) contract. Braunschweig Municipal Hospital is one of the largest hospitals in northern Germany, with 1,499 beds and 38 clinics and institutes. Siemens Healthineers will assume responsibility for supplying and maintaining all initial and replacement equipment in the areas of radiology, radiotherapy and nuclear medicine. The partnership also includes strategic and operational consulting services to drive continuous improvement initiatives over time. On October 23, in Braunschweig, the parties signed a ten-year contract with a five-year extension option.
“The primary goal of this technology partnership is to assure high-quality and cost-effective medical care for our patients through first-class diagnostic radiological, surgical and radiotherapy services”, explains Ulrich Markurth, mayor of Braunschweig and chairman of the hospital’s supervisory board.
“We are very pleased to be able to contribute as a technology partner in the coming years to further improve the quality of patient care at the Braunschweig Municipal Hospital and its performance capability,” says Dr. Stefan Schaller, head of Siemens Healthineers in Germany. “In addition to the provision of innovative medical technology systems, we support the Braunschweig Municipal Hospital in planning new buildings and optimizing workflows in radiology, cardiology and the emergency department as well as in all steps towards the digitization of healthcare. This holistic package provides the hospital with security of planning, budget certainty and future reliability over the entire duration of the project.”
Matthias Platsch, President of Siemens Healthineers Services adds: “We are delighted to have been chosen as a technology partner for the Braunschweig Municipal Hospital and we are both proud and humbled by the vote of confidence that this important healthcare provider has placed in our new services portfolio. In this, Siemens Healthineers’ first asset management services partnership in Germany, we will combine the strength of our innovative product portfolio with the forward-looking business approach of our enterprise services to help deliver best-value clinical outcomes for patients. Together with the Braunschweig Municipal Hospital, we will transform healthcare delivery by leveraging our combined expertise in established and new care models. With a fresh look at the design and operation of the facility we will significantly improve the patient experience, and the new technologies we will deploy will enable more efficient and more precise clinical diagnosis. We are very excited to play such a role in the future of healthcare in Braunschweig.”
Hospital CEO Dr. Andreas Goepfert explains that the award of the contract for this technology partnership, including the vendor-neutral procurement and management of around 50 new systems (ranging from magnetic resonance and computed tomography, to angiography, X-ray, nuclear medicine and radiotherapy machines) is the result of a Europe-wide call for tenders via an initial selection process and a competitive dialogue. The fundamental premise is that this innovative, end-to-end partnership model – for procurement and management, in particular – will generate savings for the hospital compared to a series of individual, reactive calls for tender.
As a consequence, Siemens Healthineers will be responsible for procurement, installation, maintenance, servicing, an innovation guarantee (through updates and upgrades), and an availability guarantee for all devices. The long-term technology roadmap takes into consideration the hospital’s strategic orientation, especially its current plan to concentrate the hospital at two locations. A Syngo.via Enterprise solution will also give the hospital access to all Siemens Healthineers’ software applications, enabling it to stay at the forefront of digital innovation.
 “The technology partnership in the area of radiology will bring together the heterogeneous imaging device landscape and IT in our radiology department at Braunschweig Municipal Hospital,” forecasts its medical director, Dr. Thomas Bartkiewicz. “That ensures we always stay at the forefront of innovation in diagnostic imaging and imaging-based treatment, while ensuring radiation exposure for patients and employees is kept to a minimum.” Complex interfaces will be removed and the clinical staff will find their day-to-day work routines become noticeably simpler. Nursing director Ulrich Heller adds: “Different operating processes from various device manufacturers will be reduced to a single standardized system.” This will speed up workflows and improve quality of care at the same time. In addition, maintenance plans and contracts that were not previously coordinated will be combined as part of an optimized programme in the future. The result will be a sustainable reduction in maintenance costs.
The ‘Braunschweig Model’ for a technology partnership enables the hospital to respond flexibly to changing requirements and future device needs due to a separate ‘innovation budget’. This includes possible changes in both the scope and the timing of procurement throughout the entire term of the partnership. The fixed quarterly payment fee also provides the hospital with budgetary certainty for the contract duration.
“The technology partnership guarantees predictability of costs whilst providing security of investments in the fields of radiology, radiotherapy and nuclear medicine,” says hospital CEO Goepfert. The long-term technology partnership will enable the hospital to benefit from future technological advances in radiology, including innovative algorithms to improve image reading and computer-assisted diagnostic modules. This will ensure high-quality and cost-effective patient care for the long term.
The AMS also encompasses a number of flagship projects in which the two partners will work closely together in the future. For example, Siemens Healthineers will contribute the know-how in the area of molecular diagnostics built up by its company NEO New Oncology GmbH. Thanks to genome analyses of tumour tissue performed by NEO New Oncology, Braunschweig Municipal Hospital will be able to create customized, targeted treatment recommendations that will facilitate highly promising precision medical treatment for cancer patients. www.siemens.com/healthineers

Using a combination of DNA sequencing and computer science techniques, a team of researchers has developed a new method for monitoring the health of organ transplant patients – one that promises to provide life-saving clues to diagnose organ rejection at an early stage.
More than 180,000 people live with organ transplants in the U.S., and many undergo costly and risky biopsies to determine if their body is accepting or rejecting an organ. An alternate method demonstrated by Iwijn De Vlaminck, who is also a senior author of the current study, found that cell-free DNA (cfDNA), essentially fragments of dead cells derived from an organ, can be detected in a patient’s bloodstream and used as a proxy for the organ’s health. The more cfDNA that is discovered, the greater the likelihood the organ is failing. But without knowing the donor’s DNA – which is often the case – doctors have no reference to identify the cfDNA.
But now a research team from Cornell and Stanford University has demonstrated a method for identifying cfDNA without the donor. To address the issue, Eilon Sharon, postdoctoral researcher with Jonathan Pritchard, and colleagues worked to develop a computer algorithm that estimates the donor-derived cfDNA and can predict heart and lung rejection with an accuracy similar to that in cases where donor information is available. Their work also details a refined algorithm to address closely related recipients and donors, a scenario that is common in bone marrow and kidney transplantations.
The algorithm uses publicly available genotypes and techniques of relationship inference to model which cfDNA fragments are most likely from the organ. "Specifically, the model infers the donor’s most probable ancestral population and accounts for close relationship by detecting DNA segments that are identical due to close descent," said Sharon, adding that the phenomenon is known as "identity by descent."
The findings alleviate a major barrier to using cfDNA detection – also known as genome transplant dynamics – instead of biopsies, and researchers hope the computer science-based method will help save lives. Accurate monitoring of organ health is essential to a patient’s long-term survival; currently, the median life expectancy for a heart transplant patient is around 11 years, and only 5.3 years for recipients of lungs.

EurekAlert
www.eurekalert.org/pub_releases/2017-08/p-nmf072717.php

Nearly a third of all antibiotics prescribed for hospitalized children globally were intended to prevent potential infections rather than to treat disease, according to the results of a worldwide survey.  A large proportion of these preventive, or prophylactic, prescriptions also were for broad-spectrum antibiotics or combinations of antibiotics, or were for prolonged periods, which can hasten the development of antibiotic-resistant bacteria and drug-resistant infections.
“This pattern and high rate of prophylactic prescribing indicates a clear overuse of antibiotics,” said study author Markus Hufnagel, of the University of Freiburg in Germany. “Hopefully, our study results will help to raise awareness among health professionals about appropriate prescribing of antibiotics in children,” Dr. Hufnagel said.
The study provides a snapshot of antibiotic prescriptions for 6,818 children who were inpatients at 226 paediatric hospitals in 41 countries, including four hospitals in the United States, during one day in 2012. There were 11,899 total prescriptions for antibiotics, and 28.6 percent of these were for prophylactic use, researchers found. Among hospitalized children who received at least one antibiotic prescription, 32.9 percent (2,242 children) were prescribed an antibiotic to prevent a potential infection rather than to treat a current one.
Of the antibiotics prescribed for prophylactic use, 26.6 percent were to prevent potential infections associated with an upcoming surgery, and the vast majority of these antibiotics were given for more than one day. The remaining 73.4 percent of the prophylactic prescriptions were intended to potentially prevent other types of infections. Approximately half (51.8 percent) of all preventive antibiotic prescriptions were for broad-spectrum antibiotics. In 36.7 percent of cases, two or more systemic antibiotics were prescribed at the same time.
These patterns contradict current recommendations for appropriate prophylactic antibiotic use. Guidelines often call for using narrow-spectrum antibiotics for shorter periods, in an effort to limit the development of antibiotic resistance. The study findings suggest clear targets for improving antibiotic prescribing in paediatric patients, according to the authors. These include reducing prolonged, preventive antibiotic use before surgery, limiting the use of broad-spectrum and combinations of antibiotics, and reducing antibiotic use, overall, for prophylactic rather than therapeutic use.
Additional education for clinicians and improved implementation of current guidelines for antibiotic use to prevent surgical infections are needed, Dr. Hufnagel said. More in-depth guidelines that address the use of prophylactic antibiotics for a broader range of medical conditions than current guidelines do are also needed, as well as efforts to communicate these guidelines to health care providers and to analyze how the recommendations are used.
Pediatric Infectious Diseases Societywww.pids.org/news/611-antibiotics-often-inappropriately-prescribed-for-hospitalized-kids-global-study-suggests.html

A study by researchers at the University of Birmingham has found that people whose heart rhythm returns to normal continue to be at high risk of stroke and should continue to be treated
Patients with an abnormal heart rhythm that can leave them at a higher risk of suffering from stroke still need treatment even after their heart rhythm seems to have returned to normal, say researchers at the University of Birmingham.
Atrial fibrillation is the most common heart rhythm disturbance, affecting around 1.6 million people in the UK. Those with atrial fibrillation may be aware of noticeable heart palpitations, where their heart feels like it’s pounding, fluttering or beating irregularly. Sometimes atrial fibrillation does not cause any symptoms and a person who has it is completely unaware that their heart rate is irregular.
People with atrial fibrillation are much more likely to develop blood clots and suffer from strokes. To avoid strokes it is important for them to take drugs to prevent blood clotting. Sometimes atrial fibrillation seems to go away and the heart goes back to its normal rhythm –the condition may then be deemed to have ‘resolved’. Up until now it has been unclear as to whether the clot-prevention drugs can be safely stopped when the condition is ‘resolved’.
Now a study by researchers at the University of Birmingham has found that people whose heart rhythm returns to normal continue to be at high risk of stroke and should continue to be treated.
Researchers looked at patient records from 640 general practices throughout the UK and compared the frequency of strokes in three groups of people: those with ongoing atrial fibrillation; those whose records said that atrial fibrillation had resolved; and those who never had atrial fibrillation.
Dr Nicola Adderley, of the University of Birmingham’s Institute of Applied Health Research, said: “What we found was that strokes were least common in people who never had atrial fibrillation, and much more common in people whose records said their atrial fibrillation had been resolved.
“Significantly, in recent years we found that strokes were nearly as common in people whose atrial fibrillation had resolved as in those with ongoing atrial fibrillation.
“Therefore, we can conclude that people with resolved atrial fibrillation continue to be at high risk of stroke.”
The researchers also looked at patient treatment. What they found was that, while most people deemed to have atrial fibrillation as an ongoing condition continue to get the clot-prevention drugs they need, the vast majority of those whose atrial fibrillation had ‘resolved’ do not.
Dr Krish Nirantharakumar, of the University of Birmingham’s Institute of Applied Health Research, added: “Our research demonstrates that although people with resolved atrial fibrillation continue to be at high risk of stroke, they are not getting their prevention drugs.
“Worryingly, we found that the problem seems to be becoming more common, with our research showing an increasing number of people are recorded as having atrial fibrillation as resolved and are highly unlikely to be given medication to prevent stroke.”

University of Birminghamwww.birmingham.ac.uk/news/latest/2018/05/irregular-heart-beat-research.aspx