Now, researchers from the 91探花 Department of Electrical Engineering, 91探花Department of Neurological Surgery and 91探花Department of Philosophy have teamed up with medical device manufacturer to use the Activa庐 PC+S Deep Brain Stimulation (DBS) system with people who have essential tremor. The system is not yet approved by the Food and Drug Administration for commercial use in the United States.

One drawback with existing DBS devices is that batteries only last three to five years, depending upon how frequently stimulation occurs. By increasing battery life, the 91探花researchers hope to lengthen the time between surgeries 鈥� which carry risks of coma, bleeding and seizures 鈥� that patients must undergo to replace the device.

鈥淭he technology we鈥檝e created using the Activa PC+S is unique in that it will selectively determine when and how stimulation should occur,鈥� said Jeffrey Herron, a 91探花doctoral student in electrical engineering. 鈥淚n doing so, we hope to increase battery life and reduce side effects.鈥�

The technology also aims to alleviate potential side effects from DBS therapy, which can include worsening of motor symptoms and speech and language impairments, by adjusting stimulation parameters.

This type of device, along with externally-worn equipment, is known as a system, because it encompasses the complete path followed by an electrical signal. In this case, the system will use either externally-worn sensors or recorded neural signals in the brain to modify stimulation within limits that are established by a clinician.

In addition, researchers are also exploring the use of voluntary neural commands by the patient to modify the therapeutic stimulation. 鈥淭his will let the patient decide when to adjust their stimulation, to reduce side effects,鈥� said Howard Chizeck, 91探花professor of electrical engineering. 鈥淭he negative effects of stimulation on speaking could be reduced voluntarily for a while, at the cost of more tremor,鈥� Chizeck said.

Activa PC+S has been made available to a select number of research institutions worldwide for physician-sponsored research. This collaboration stems from work at the (CSNE), which is based at the 91探花and is one of 17 Engineering Research Centers funded by the National Science Foundation. Medtronic is an industry member in the CSNE.

The 91探花team received US Food and Drug Administration approval for an investigational device exemption in November 2014 and, subsequently, Institutional Review Board permission to conduct this research with human subjects. 91探花Medicine鈥檚 Dr. Andrew Ko and his team have started to recruit patients.

鈥淥ne part of my job that gets me particularly excited is when an operation has the potential to significantly improve a patient鈥檚 function and quality of life,鈥� said Ko, whose research expertise lies in DBS and epilepsy. 鈥淭he patients whom I treat are complex and require multidisciplinary care. This collaboration that teams up neurological surgery, electrical engineering and philosophy really gets at the multidisciplinary approach at the 91探花and allows us to explore DBS therapy in a truly innovative manner.鈥�

Timothy Brown, 91探花doctoral student in philosophy, is working with researchers on the neuroethics of DBS device design and use. Brown will help shape the research study by exploring how people who have voluntary control over DBS therapy might come to think of themselves (and their abilities) differently than people without that same control.

In conjunction with the Activa PC+S device, scientists will use Medtronic鈥檚 Nexus-D system, which performs real-time command and control of the implanted device.

Research being conducted with the DBS system may one day unlock the mechanism of action for DBS therapy鈥攃urrently, clinicians do not understand how it works, despite its efficacy鈥攁nd lead to future advances in treatment. To date, more than 125,000 patients worldwide have received Medtronic DBS therapy.

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For more, contact Chizeck at chizeck@uw.edu or 206-221-3591 and Susan Gregg with 91探花Medicine at sghanson@uw.edu or 206-616-6730.

Researchers from Washington state and California found that over a ten-year period, from 1997 to 2007, patients are starting dialysis approximately five months earlier on average.聽 The study, “Trends in timing of initiation of chronic dialysis in the United States,鈥� is published in the .聽 Changes in timing are not explained by changes in measured patient characteristics and most likely reflect a shift in dialysis initiation practices over this time period, researchers said.

Dialysis is an intensive, time-consuming and expensive procedure for patients, said OHare.聽 “Its a substantial commitment, taking place three times a week, for three or four hours per treatment, and costing several hundred dollars per treatment. When you look at the overall chronic dialysis population, our findings are significant.鈥�

The research team estimated that the difference in timing translates into 63 additional hemodialysis treatments, 189 or more hours of treatment and approximately $14,490 in additional payments for dialysis for each patient, or more than $1.5 billion if extrapolated to patients in the study who initiated dialysis in 2007.

Researchers used two different data sources for the study:聽 the , a national registry of end-stage renal disease and a detailed renal database from the Group Health Research Institute. The national registry contains details on the level of kidney function for patients starting dialysis.聽 The Group Health data contain information on the rate of loss of kidney function prior to dialysis initiation not available in registry data.

OHare said the findings are also important in light of other recent research that found starting dialysis earlier did not improve a range of health outcomes.聽 “Patients are starting chronic dialysis significantly earlier, but there is no real evidence that it is beneficial,鈥� she said.

Researchers said the findings call for more careful evaluation of current dialysis initiation practices in the U.S.聽 “We really need to take a good critical look at what were doing,鈥� said OHare.聽 “Our study did not reveal the rationale for initiating chronic dialysis sooner, nor did it provide details on circumstances, signs and symptoms that might have prompted dialysis initiation .聽 Its an open question as to why this is happening, but these findings provide a rationale for more detailed study to better understand practices and whats driving this trend.鈥�

In addition to OHare, researchers involved in the study include Drs. Ilan Zawadzki, Walter Clinton and Eric B. Larson of Group Health Cooperative and the Group Health Research Institute; Drs. Andy Choi and John Boscardin of the ; Dr. Paul Hebert of the 91探花 and the ; Dr. Leslie Taylor of the VA Puget Sound Healthcare System and Dr. Manjula Tamura of Stanford University and the VA Palo Alto Healthcare System.聽 The study was funded by a Beeson Career Development award from the National Institute on Aging, U.S. National Institutes of Health, to Dr. OHare.

The study is dedicated to the memory of , who made generous and important contributions to this work.聽 Choi died unexpectedly during the final stages of manuscript preparation, leaving behind a wife and two young daughters.聽 OHare described him as a “rising star鈥� in his field.

“This study has been 10 years in the making,鈥� Nghiem explained, “since it is much more difficult to genetically target this protein enzyme specifically. But what it suggests is that caffeines protective effect against ultraviolet damage, which weve documented in other studies, is likely due to ATR inhibition.鈥�

That means this guarding most likely works at the pre-cancerous stage, Nghiem said, before UV-induced skin cancers fully develop.

“In past studies, weve been able to show that caffeine decreases the incidence of skin cancer development,鈥� Nghiem said. “In this study, we set out to determine how that works and how the body protects itself from skin cancer. We were able to show that caffeine manipulates the pathway of this protein in a live mouse by suppressing ATRs function.鈥�

With more than a million new cases in the United States each year, non-melanoma skin cancer is the most common form of cancer in humans. The researchers suggest that topical application of caffeine could be useful in preventing such cancers, with the added benefit that it directly absorbs UV light, thus acting as a sunscreen.

A new study from researchers at the 91探花 (UW) concludes that adolescent alcohol use corrupts decision-making later in life. It does so by changing the perception of risk but not how rewards are valued. The findings provide insight into the specific consequences of adolescent alcohol use on decision making, according to researchers. The study, “Risk preference following adolescent alcohol use is associated with corrupted encoding of costs but not rewards by mesolimbic dopamine,” is published March 14 in the Proceedings of the National Academy of Science (PNAS).

Researchers from 91探花departments of psychology, psychiatry and behavioral sciences and pharmacology studied decision-making in adult rats that were provided with continuous access to alcohol during adolescence. Consider a choice between two options – a reward of $50 with 100 percent probability or either $100 or zero dollars with a 50-50 probability.聽 “When you offer these options to people, they tend to take the safe bet,” said Jeremy J. Clark, 91探花acting assistant professor of psychiatry and behavioral sciences. “They’ll take the $50,” That is just what the control rats did in this study.

However, the alcohol-treated animals consistently choose the riskier option.

One way to produce such risk-taking behavior is to alter the value an individual places on rewards. Alternatively, risk-taking could also result from changing how someone judges risks. Clark said he and his colleagues measured changes in the neurotransmitter dopamine during the presentation of rewards alone and in response to cues predicting risky or certain outcomes to test these possibilities.聽 “Dopamine is central to the way we process and evaluate rewards and is the primary target in the brain for virtually all abused drugs,” said Clark. The researchers found that alcohol use during adolescence increased dopamine signaling to risky options but did not affect responses to rewards. “Alcohol is corrupting the ability to make a good decision by altering the perception of risk,” said Clark. “It doesn’t appear to be about the reward.”

“There could be something about the risk itself,” said Clark, who described this as akin to a “gambling buzz.” On the other hand, it could be that the alcohol-exposed rats are not capable of judging probabilities very well.

Clark said researchers now plan to conduct additional experiments to evaluate these possibilities and determine what the implications are for individuals with substance abuse histories. Study findings may also help inform clinical treatments directed at mindfulness now currently being explored in substance abuse treatment programs.

Funding for the study was supported by a grant from the National Institutes of Health and by the Alcohol and Drug Abuse Institute.

91探花Medical Center (UWMC) was the only hospital in the United States to be awarded two medals of honor in the silver category from HRSA/HHS for superb performance with liver and kidney transplant programs. Only 10 silver medals and one gold medal were awarded across the entire country. UWMC also received a bronze medal for its kidney/pancreas program.

“This is a great honor,” said Dr. Jorge Reyes, 91探花professor of surgery, Division of Transplant Surgery. “No other medical system in the nation has accomplished this level of excellence and we’re proud to bring these awards home to all the patients and families we’ve worked with and touched through our care. I applaud all of our transplant teams, who share in this award.” Reyes is chief of the division of transplant surgery. Transplant team members include surgeons, residents, physician assistants, nurses, social workers, pharmacists, dietitians and coordinators.

The awards program recognizes high-performing transplant programs across the country. HRSA officials assess post-transplant survival rates, transplant rates and mortality rates for patients after being placed on the wait list. Structured in a way akin to the Olympic games, medal categories include gold, silver and bronze. Transplant programs under consideration include kidney, pancreas, liver, heart and lung.

91探花Medical Center performs 90 to 110 kidney transplants per year, with 35 to 40 kidneys coming from live donors. Transplant teams also perform from 70 to 100 liver transplants each year.

91探花Medical Center (UWMC) was the only transplant hospital in the United States to be awarded two medals of honor in the silver category from HRSA/HHS for superb performance with. Only 10 silver medals and one gold medal were awarded across the entire country. UWMC also received a bronze medal for its kidney/pancreas program.

“This is a great honor,” said , 91探花 professor of surgery, division of transplant surgery. “No other medical system in the nation has accomplished this level of excellence and we’re proud to bring these awards home to all the patients and families we’ve worked with and touched through our care. I applaud all of our transplant teams, who share in this award.” Reyes is chief of the division of transplant surgery. Transplant team members include surgeons, residents, physician assistants, nurses, social workers, pharmacists, dietitians and coordinators.

The awards program recognizes high-performing transplant programs across the country. HRSA officials assess post-transplant survival rates, transplant rates and mortality rates for patients after being placed on the wait list. Structured in a way akin to the Olympic games, medal categories include gold, silver and bronze. Transplant programs under consideration include kidney, pancreas, liver, heart and lung.

91探花Medical Center performs 90 to 110 kidney transplants per year, with 35 to 40 kidneys coming from live donors. Transplant teams also perform from 70 to 100 liver transplants each year.

The 91探花Medicine clinicians who developed the implantable device hope that success in a 10-person surgical trial of Meniere’s patients will lead to exploration of its usefulness against other common balance disorders that torment millions of people worldwide.

The device being tested — a cochlear implant and processor with re-engineered software and electrode arrays — represents four-plus years of work by Drs. Jay T. Rubinstein and James O. Phillips of UW’s Department of Otolaryngology-Head and Neck Surgery. They worked with Drs. Steven Bierer, Albert Fuchs, Chris Kaneko, Leo Ling and Kaibao Nie, 91探花specialists in signal processing, brainstem physiology and vestibular neural coding. Rubinstein is also a聽 91探花professor of bioengineering.

“What we’re proposing here is a potentially safer and more effective therapy than exists now,” said Rubinstein, an ear surgeon and auditory scientist who has earned a doctoral degree in bioengineering and who holds multiple U.S. patents.

In the United States, Meniere’s affects less than 1 percent of the population. The disease occurs mostly in people between ages 30 and 50, but can strike anyone. Patients more often experience the condition in one ear; about 30 percent of cases are bilateral.

The disease affects hearing and balance with varying intensity and frequency but can be extremely debilitating. Its episodic attacks are thought to stem from the rupture of an inner-ear membrane. Endolymphatic fluid leaks out of the vestibular system, causing havoc to the brain’s perception of balance.

Many patients respond to first-line treatments of medication and changes to diet and activity. When those therapies fail to reduce the rate of attacks, surgery is often an effective option but it typically is ablative (destructive) in nature. In essence, the patient sacrifices function in the affected ear to halt the vertigo — akin to a pilot who shuts down an erratic engine during flight. Forever after, the person’s balance and, often, hearing are based on one ear’s function.

With their device, Phillips and Rubinstein aim to restore the patient’s balance during attacks while leaving natural hearing and residual balance function intact.

A patient wears a processor behind the affected ear and activates it as an attack starts. The processor wirelessly signals the device, which is implanted almost directly underneath in a small well created in the temporal bone. The device in turn transmits electrical impulses through three electrodes inserted into the canals of the inner ear’s bony labyrinth.

“It’s an override,” Phillips said. “It doesn’t change what’s happening in the ear, but it eliminates the symptoms while replacing the function of that ear until it recovers.”

The specific placement of the electrodes in the bony labyrinth is determined by neuronal signal testing at the time of implant. The superior semicircular canal, lateral semicircular canal and posterior semicircular canal each receive one electrode array.

A National Institutes of Health grant funded the development of the device and its initial testing at the Washington National Primate Research Center. The promising results from those tests led the U.S. Food and Drug Administration, in June, to approve the device and the proposed surgical implantation procedure. Shortly thereafter, the limited surgical trial in humans won approval from the Western Institutional Review Board, an independent body charged with protecting the safety of research subjects.

“If you started from scratch, in a circumstance like this where no one has ever treated a vestibular disorder with a device, it probably would take 10 years to develop such a device,” Rubinstein said.

The device epitomizes the translational advancements pursued at UW’s academic medical centers, he said. He credited the team’s skills and its access to the primate center, whose labs facilitated the quick turnaround of results that helped win the FDA’s support.

A successful human trial could lead the implant to become the first-choice surgical intervention for Meniere’s patients, Phillips said, and spark collaboration with other researchers who are studying more widespread balance disorders.

The first patient will be a 56-year-old man from Yakima, Wash. He has unilateral Meniere’s disease and has been a patient of Rubinstein’s for about two years.

Cochlear Ltd. of Lane Cove, Australia, will manufacture the device. Cochlear is a medical equipment company and longtime maker of devices for hearing-impaired people.