Colonoscopy? How About a Blood Test?

Paul Tullis wrote . . . . . . .

Nobody likes getting a colonoscopy. For the people who catch colon cancer early thanks to that bowel camera, the standard screening—every 5 to 10 years from age 50 to 75—proves invaluable. For the 993 people in 1,000 who don’t test positive following a colonoscopy, the pain (and for the uninsured, the expense) can be enough to make them skip the next one. People who’ve shirked their exams often number among the 50,000 Americans who die from colon cancer each year. “More non-​invasive ways of screening are needed,” says Matthew Kalady, co-director of the colorectal cancer program at the Cleveland Clinic. “If you could pick up colon cancer early and noninvasively with a simple blood test, that would be just fantastic.”

An Israeli health-tech company is trying to use machine learning software to do just that. ColonFlag is the first product from Medial EarlySign, and while poorly named, the software predicts colon cancer twice as well as the fecal exam that’s the industry-standard colonoscopy alternative, according to a 2016 study published in the Journal of the American Medical Informatics Association. ColonFlag compares new blood tests against a patient’s previous diagnostics, as well as Medial’s proprietary database of 20 million anony-​mized tests spanning three decades and three continents, to evaluate the patient’s likelihood of harboring cancer. Israel’s second-largest health maintenance organization is already using the software, and Medial (a mashup of “medical” and “algorithms”) is working with Kaiser Permanente and two leading U.S. hospitals to develop other uses for its database and analysis tools.

“Our algorithms can automatically scan all the patient parameters and detect subtle changes over time to find correlative patterns for outcomes we want to predict,” Nir Kalkstein, Medial’s co-founder and chief technology officer, says, characteristically clinical. The database allows his team “to find similar events in the past and then identify from the data correlations that can predict these events.”

“To see in many dimensions at the same time is very difficult. With machine learning, it becomes easy”

Other companies are building massive databases with an eye toward predictive medicine, including heavy hitters such as DeepMind Technologies, owned by Google parent Alphabet Inc. In Boulder, Colo., startup SomaLogic Inc. is predicting heart attacks based on combinations of certain proteins in cardiac patients. In Salt Lake City, Myriad Genetics Inc. assesses hereditary cancer risks based on DNA profiles. DeepMind’s public U.K. tests have largely focused on managing understaffed wards; Myriad’s tests cost thousands of dollars; and most of the other companies have had trouble delivering actionable results. With 45 employees, Medial has the first test that’s becoming an unobtrusive, critical part of doctors’ rounds by using the cheap, easy blood tests they routinely conduct.

Kalkstein has some experience with both bureaucracy and big data sets. He served his mandatory years in the Israel Defense Forces (IDF) with an elite cybersecurity research unit, then started a company called Final (short for “financial algorithms”) on the day of his discharge, in 2001. Despite knowing nothing about finance, he proved adept at writing code that could predict stock market activity based on past market reactions to similar events. “We only looked at the data and the story it told us, without the use of any economic models,” Kalkstein says.

Final made Kalkstein a billionaire, according to the Jerusalem Post, but left him unsatisfied. By 2009, he says, he decided to “invest my time and resources only in things that will make a positive impact on people’s lives.” With some pals from college and the IDF, he started Medial out of a garage near his house in the Tel Aviv suburbs, recruiting tech executive Ori Geva as chief executive officer and consultant Ofer Ariely as chairman.

The team lacked health-care know-how, but learned quickly. In 2011, Medial held an informal contest with intensive-care-unit doctors at Rabin Medical Center, Israel’s largest hospital, to predict which ICU patients would survive. The data scientists trounced the MDs. “To see in many dimensions at the same time is very difficult,” says Varda Shalev, a primary-care physician who also runs the research and development arm of Maccabi Healthcare Services, which now uses ColonFlag. “With machine learning, it becomes easy.”

50,000: The number of Americans who die from colon cancer each year

Shalev helped lead Kalkstein’s team to use colon cancer as a proving ground in 2011, a couple of years after she lost a patient a little too young for the screening. “You always blame yourself,” she says. Maccabi’s 2 million electronic patient records, stripped of identifying information, were among the first to feed Medial’s database, and Maccabi was the first to build ColonFlag into its alerts system. The software consistently identified patients at 10 times the normal risk of harboring cancer and flagged tumors six months to a year ahead of doctors’ diagnoses, while the cases were still beatable, according to a Kaiser study published last year in the journal Digestive Diseases and Sciences. All told, studies by Medial, Kaiser, and Oxford University identified 100 Maccabi patients with cancer and another 100 with potentially precancerous adenomas. The HMO now uses ColonFlag on any blood test from an older patient who’s refused a colonoscopy or the chemical test.

The Israeli company will have to tread carefully to avoid the public outcry faced by companies, including DeepMind, that are building large-scale databases from patient records. “It’s critical that de-identification be done in a rigorous and responsible way,” says Deven McGraw, former deputy director for health information privacy at the U.S. Department of Health and Human Services. Some doctors are skeptical because Medial’s studies have looked at the blood tests of patients known to have later acquired colon cancer. (A blind study is under way.) And a computer’s prediction about the usefulness of a colonoscopy might never be as reliable as, well, getting a colonoscopy. Even Medial executives acknowledge that the success of Kalkstein’s past enterprises hardly guarantees success in this new field. “What Final is doing is much easier,” says Ariely, Medial’s chairman. “Their data is clean, and if they’re wrong, no one dies.”

For now, Kalkstein’s team is focusing mainly on R&D. Medial has raised $40 million from investors led by Hong Kong billionaire Li Ka-shing’s Horizon Ventures, and the company says its next product, due in the second quarter, will predict the onset of diabetes. Further away: a wearable device that seeks to predict seizures in epileptics, giving them precious seconds to pull over their cars or clamber out of their bathtubs. It’s also working on analytics to predict conditions including heart failure, acute kidney injury, and sepsis. There’s always more work to be done, Kalkstein says. “No other sector has such a huge potential of being a force multiplier for the type of resources, algorithmic and financial, which I can invest.”

Source : Bloomberg

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Risotto with Ham and Spinach

Ingredients

5 cups fresh young spinach leaves
4 oz cooked ham
4 cups chicken stock
1 tbsp olive oil
3 tbsp butter
1 small onion, finely chopped
generous 1-3/8 cups risotto rice
2/3 cup dry white wine
1/4 cup light cream
3/4 cup freshly grated Parmesan or Grana Padano cheese
salt and pepper

Method

  1. Wash the spinach well and slice into thin shreds. Cut the ham into thin strips.
  2. Bring the stock to a boil in a pan, then reduce the heat and keep simmering gently over low heat while you are cooking the risotto.
  3. Heat the oil with 2 tablespoons of the butter in a deep pan over medium heat until the butter has melted. Add the onion and cook, stirring occasionally, for 5 minutes, or until soft and starting to turn golden. Do not brown.
  4. Reduce the heat, add the rice, and mix to coat in oil and butter. Cook, stirring constantly, for 2-3 minutes, or until the grains are translucent.
  5. Add the wine and cook, stirring constantly, for 1 minute until reduced.
  6. Gradually add the hot stock, a ladleful at a time. Stir constantly and add more liquid as the rice absorbs each addition. Increase the heat to medium so that the liquid bubbles. Cook for 20 minutes, or until all the liquid is absorbed and the rice is creamy.
  7. Add the spinach and ham with the last ladleful of stock.
  8. Remove the risotto from the heat and add the remaining butter and the cream. Mix well, then stir in the Parmesan until it melts. Season to taste and serve at once.

Makes 4 servings.

Source: Risotto

Italian Chefs in the U.S. Rated Different Types of Pasta

Lee Breslouer wrote . . . . . . .

We asked Italian chefs in America from coast to coast about the type of pasta they thought was overrated and underrated. These chefs will tell you why you should avoid certain noodles and start ordering ones you might never have considered in the first place. These are the most overrated and underrated pastas.

Fabio Viviani, chef/restaurateur at Siena Tavern, Chicago, Illinois

Overrated: Fusilli

“They’re impossible to do by hand, so there’s no artistry behind it. People [still] love fusilli though!”

Underrated: Spaghetti chitarra

“It’s underrated because not many people know about it. You need a special wooden machine to make them, but it comes out as perfect square spaghettis.”

* * * * * *

Salvatore Marcello, chef at Mamo, New York, New York

Overrated: Orzo

“Orzo is often used in pasta salad, but it overcooks easily and lacks texture and true pasta flavor. It also has a slimy mouthfeel. When you eat it, you don’t feel the comfort of a plate of pasta, which is a huge loss!”

Underrated: Paccheri

“This very Neapolitan [pasta] shape is a classic in my home. It has a nice bite, and the large rings hold the sauce well, giving each bite texture and flavor. They go well with many types of sauces (ragù, Genovese, seafood), which is why I usually serve it as a special — I don’t want to limit its versatility by having it on the menu in just one style.”

Silvia Barban, executive chef/co-owner at LaRina, Brooklyn, New York

Overrated: Black ink linguine

“Everyone goes crazy for the color and the shape, but I don’t think it gives much of a different flavor, especially if the sauce is already really good. I think it’s just something about the look and aesthetic, so people want to order it and see it on their plate. It’s funny, too — in Italy, people are scared about that color of pasta as it’s not very traditional, but here in NYC everyone goes crazy for it!”

Underrated: Strozzapreti/strangolapreti

“Strozzapreti or strangolapreti (aka “choke the priest”) is a type of pasta that a lot of people don’t know about, or get too scared to try it. The pasta is originally from Emilia Romagna, and is very good with every sauce — even with fish. It has a great texture, stays al dente, and has a linguine thickness to it but is shorter. You can also use it with ragù or vegetable sauces. I love it! In my restaurant, my business partner’s mother comes from Italy, and she always makes it for us to eat personally, as well as for the customers. It makes everyone happy.”

* * * * * *

Bart Retolatto, chef de cuisine at Gran Morsi, New York, New York

Overrated: Penne

“Penne is overrated because it’s everyone’s default pasta. It’s on almost every Italian menu and unlike fusilli col buco or strozzapreti, it doesn’t work well with sauces. It’s a short shaped pasta, which is overused.”

Underrated: Fusilli col buco

“Not many restaurants use it, but a lot of Italian-Americans and families grew up using fusilli col buco. It’s a fun, playful shape that sauce adheres really well to.”

Matthew Prokopchek, chef/owner at Trattoria Roma, Columbus, Ohio

Overrated: Gomito (aka elbow)

“It’s usually been oversaturated with cheese or Hamburger Helper. Although it is a good pasta for children to eat.”

Underrated: Cavatelli

“It can be a stand-alone pasta with light sauce, a side, or as an alternative to gnocchi. What’s great about cavatelli is the variety of uses. Ricotta adds a smooth texture, and is lighter than fettuccine. Other starches can be used in the dough, such as purple potatoes or leftover polenta. If you overcook them, they can still be eaten. For a home cook, it’s a way to [prepare] something other than a dried pasta and add some diversity to their meal.”

* * * * * *

Jeff Michaud, head chef and culinary director at Osteria, Philadelphia, Pennsylvania

Overrated: Penne

“Penne reminds me of all the Italian-American dishes like penne alla vodka and penne alfredo. Although there’s nothing wrong with those dishes, I am somewhat of a traditionalist and feel that if you’re going to take time to make a nice pasta dish — use rigatoni and make cacio e pepe or all’amatriciana. The classic Italian dishes are always the simplest and stand the length of time.”

Underrated: Any pasta made with squid ink

“People tend to shy away because of the color. When squid ink is used in the dough, it adds a little fish flavor and saltiness from the sea, which can really shine through in the dish.”

[ . . . . . . . ]

Read more at Thrillist . . . . .

Study: Weight Loss Plans Promising Fast Pounds Off May Not be the Best Choice

Janet Lee wrote . . . . . . .

Is losing weight one of your resolutions for the New Year? The secret to your success may be to avoid extreme diet and exercise plans and instead stick with more measured, steadier regimens.

A study released last August from researchers at Drexel University in Philadelphia found that dieters were more successful if they adhered to a program where pounds came off in a consistent way in those first weeks of dieting.

The Drexel team found that people who dropped about the same amount of weight week after week at the beginning of a new regimen were more likely keep the weight off over the long term, compared with those whose weight loss varied weekly.

The study, published in the journal Obesity, involved 183 overweight or obese men and women who were following different weight-loss plans. The researchers looked at the number of pounds the participants lost from week to week during the first 12 weeks of their various programs. Then they compared the pattern of weight loss to the participants’ weights after 12 months and again at 24 months.

“No matter which program they were on, those who were able to lose roughly the same amount of weight each week early on did better long-term than those whose weight loss fluctuated during those initial weeks,” says study co-author Michael Lowe, Ph.D., a clinical psychologist and professor in the department of psychology at Drexel University in Philadelphia.

For example, if two dieters each lost 20 pounds in 12 weeks, the one who did it by steadily dropping a pound or two a week stands a better chance of maintaining that loss (and possibly losing more) than the person who dropped 4 pounds in one week, and then gained a pound the next, lost 3 the week after, and so on.

“This is the first time this kind of relationship has been shown,” Lowe says. “We’ve always known that people take off weight in their own way. Some seem to lose roughly the same amount each week, while others bounce around more. We’ve never known if that variability impacts long-term success. This research says it does have something to do with it.”

It’s not clear why weight-loss fluctuation would affect the long-term outcome, Lowe says. The researchers investigated whether emotional eating and food cravings might explain the variability in weekly weight loss but were not able to find a connection.

“We have done two other studies with people who are in a healthy weight range [they’re not trying to drop pounds] where we’ve shown that those whose weights vary more week to week tend to gain more weight in the long term,” Lowe says.

It’s possible that changes in hormones that affect appetite or metabolism may be to blame, but more research is needed.

How to Be a Good Loser

“This study seems to show that slow and steady wins the race,” says William H. Dietz, M.D., Ph.D., director of the Sumner M. Redstone Global Center for Prevention and Wellness at George Washington University.

Dropping as little as a half-pound each week may not seem encouraging when some diet plans promise much bigger and faster weight loss. But, Drexel University’s Lowe explains, it’s unlikely that you could continue to lose a large amount of weight week after week.

“It’s far better to lose less weight and do it consistently over time,” Lowe says. “Weight loss, to really be helpful, has to be maintained.”

The secret to success on the scale? It sounds simple, but you have to find a healthy way of eating that you can stick with, Lowe says.

“It’s better to approach it as, ‘What can I realistically achieve not only this week but every week?’” he says.

So that means, for example, avoiding those diets that severely restrict calories, require you go very low-carb, or cut out entire food groups. Such approaches, he explains, are just difficult to sustain.

Keeping your eating habits similar from day to day may also be important.

“Maybe you eat in the same situations, at roughly the same time, and you eat a narrower range of foods and it becomes routine,” Lowe says.

In contrast, tactics such as having a “cheat day” or following your plan during the week and eating what you want on the weekends, for instance, may give you too much food flexibility.

“We know that the more variety you’re exposed to, the likelier you are to consume more calories,” Dietz says.

Being prepared will help you stay on the path to weight loss, too. Perhaps you bring a lunch to work daily or prep meals every Sunday night so that you know what you’ll be eating most days.

“The more you plan ahead, the less susceptible you are to momentary influences that might get the better of you,” Lowe says.

He also recommends weighing yourself every few days, so you can quickly make changes if you start to see the number on the scale creeping up instead of going down.

Source: Consumer Report

A More Complete Mediterranean Diet May Protect Against Aggressive Prostate Cancer

In a new study published in The Journal of Urology®, researchers determined that men who followed a Mediterranean diet, rich in fish, boiled potatoes, whole fruits, vegetables, legumes, and olive oil, and low consumption of juices had lower risk of aggressive prostate cancer (PC) than those who followed other dietary patterns like Prudent or Western diets.

Although PC is the most common type of cancer in men and can have a high mortality rate, evidence linking PC to specific environmental, occupational, or dietary exposures has been limited. Recent studies have investigated whether certain dietary patterns impact cancer risks, but the results have been inconsistent.

“This study adds important evidence to the scarce information regarding the association of diet with PC, and highlights the relevance of focusing on global dietary patterns,” explained lead investigator Beatriz Perez-Gomez, PhD, Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Instituto de Salud Carlos III (Madrid). “Our results show that a diet oriented towards the prevention of aggressive tumors in the prostate should probably include important elements of the Mediterranean diet such as fish, legumes, and olive oil, and suggest that a high intake of fruits, vegetables, and whole grains might not be enough.”

The authors explored the relationship between the risk of having PC and dietary patterns as part of the MCC-Spain study, a Spanish case-control study that involved 733 patients with histologically confirmed PC and 1,229 healthy men with a mean age of 66 years from seven Spanish regions. Anthropometric, epidemiologic, and dietary data were collected.

Adherence to the three dietary patterns of Western, Prudent, and Mediterranean, which characterize the dietary habits of the Spanish population, was evaluated, The Western pattern includes consumption of large amounts of fatty dairy products, refined grains, processed meat, caloric beverages, sweets, fast food, and sauces. The Prudent pattern involves consumption of low-fat dairy products, whole grains, fruits, vegetables, and juices. Finally, the Mediterranean pattern consists of high consumption of fish, boiled potatoes, fruits, vegetables, legumes, and olive oil, and low consumption of juices. The diets were graded according to the degree of adherence to each pattern and assigned to four quartiles from lower to higher adherence within each pattern.

Only a high adherence to Mediterranean dietary pattern appeared to be associated with a lower risk of aggressive PC. Prudent and Mediterranean dietary patterns showed different effects in low and high grade tumors.

PC was assessed using Gleason scores of tumor aggressiveness (6) and clinical stage (cT1b to cT4). A Gleason score of 6 and stages cT2b to cT4), only high adherence to the Mediterranean diet showed a statistically significant protective effect. All other dietary patterns and tumor characteristics showed little or no correlation and did not achieve statistical significance.

Emphasizing the findings that the degree of adherence to a particular diet can affect the risk for PC, co-author Adela Castelló. PhD, Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Instituto de Salud Carlos III (Madrid), commented, “There is a striking contrast between the relevance of prostate cancer in terms of public health and the evidence regarding its primary prevention. If other researchers confirm these results, the promotion of the Mediterranean dietary pattern might be an efficient way of reducing the risk of developing advanced PC, in addition to lowering the risk of other prevalent health problems in men such as cardiovascular disease. Dietary recommendations should take into account whole patterns instead of focusing on individual foods.”

Source: Science Daily


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