Risky Behavior in Adolescents May Signal Mature Brain

A new study using brain imaging to study teen behavior indicates that adolescents who engage in dangerous activities have frontal white matter tracts that are more adult in form than their more conservative peers.

The brain goes through a course of maturation during adolescence and does not reach its adult form until the mid-twenties. A long-standing theory of adolescent behavior has assumed that this delayed brain maturation is the cause of impulsive and dangerous decisions in adolescence. The new study, using a new form of brain imaging, calls into question this theory.

In order to better understand the relationship between high risk-taking and the brain’s development, Emory University and Emory School of Medicine neuroscientists used a form of magnetic resonance imaging (MRI) called diffusion tensor imaging (DTI) to measure structural changes in white matter in the brain. The study’s findings are published in the Aug. 26, 2009 PLoS ONE.

“In the past, studies have focused on the pattern of gray matter density from childhood to early adulthood, says Gregory Berns, MD, PhD, principal investigator and professor of Psychiatry and Neuroeconomics at Emory University and director of the Center for Neuropolicy. “With new technology, we were able to develop the first study looking at how development of white matter relates to activities in the real world.”

Gray matter is the part of the brain made up of neurons, while white matter connects neurons to each other. As the brain matures, white matter becomes denser and more organized. Gray matter and white matter follow different trajectories. Both are important for understanding brain function.

The study enrolled 91adolescents ages 12 through 18 over a three-year period. Levels of engagement in dangerous behaviors were measured by a survey that included questions about the teens’ thrill seeking behaviors, reckless behaviors, rebellious behaviors and antisocial behaviors. DTI was used to measure corresponding structural changes in white matter.

“We were surprised to discover that risk-taking was associated with more highly-developed white matter – a more mature brain,” says Berns. “We were also surprised to learn that except for slightly higher scores in risk-taking, there was no significant difference in the maturity of the white matter between males and females.”

Berns suggests that doing adult-like activities requires sophisticated skills.

“Society is a lot different now than it was 100 years ago when teens were expected to go to work and raise a family,” says Berns. “Now, adolescents aren’t expected to act like adults until they are in their twenties, when they have finished their education and found a career.

“You could make the case that in this country, biological capacity shows up long before the wisdom that comes with time is fully developed,” notes Berns.

Berns says more studies need to be done to determine if early brain development predisposes someone to engage in risky behaviors, or if the risky behavior drives the maturation of the brain.

The CDC reports that, 27,000 people between the ages of 10 and 24 die from bad decisions in the United States per year. Additionally, it has been shown that the period of mid-adolescence (ages 15 through 19) is the time when teens are more likely to begin high-risk behaviors such as drinking, abusing drugs or driving recklessly.

Other researchers who contributed to this study include, Sara Moore, BS, Department of Psychiatry and Behavioral Sciences at Emory University School of Medicine and C. Monica Capra, PhD, the Department of Economics and the Center for Neuropolicy, Emory University.

This study was funded by grants from the National Institute on Drug Abuse.

“Adolescent Engagement in Dangerous Behaviors Is Associated with Increased White Matter Maturing of Frontal Cortex”, PLoS ONE, 8/26/09, 10.1371
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MHA Director McIlwain Prepared for the Challenges of the Health Care System

As health care remains on the front burner of political debate, the Master of Health Administration (MHA) program at Clayton State University is prepared to continue its mission of developing well-rounded competent individuals for administrative positions in varying types of health care organizations. The new director of the MHA program, Dr. Thomas F. McIlwain, is prepared for the challenges in a changing health care system.

“Change is inevitable, and the health care system is no exception,” he says. “In my 25 or so years of working and teaching in health services administration, I have seen the problems, issues, health policies, and health policy outcomes debated. Each new policy change is a tweak of the existing system, but each has been designed to make it better. I have no doubt of the outcome of the current debate. The system will get a little better.”

McIlwain comes to Clayton State with a wealth of prior industry and teaching experience. In the 80s, he served as an administrative associate at University Hospitals of Alabama while teaching in the MSHA program at the University of Alabama at Birmingham, where he received his Ph.D. in Health Services Administration. His administrative residency was with a for-profit system, American Medical International, which eventually merged with National Medical Enterprises to form what is now know as Tenet Health Care.

His immediate teaching position after UAB was at Appalachian State University in the Walker College of Business’ Department of Management. He served as director of the undergraduate health care management program for eight of the 10 years he was in Boone, N.C. He then moved to Mount Pleasant, S.C., where he served as MHA program director for three of the 10 years he was on faculty at the Medical University of South Carolina.

For the past four years he was associate professor of Public Health and vice-chair in the Department of Community Health Sciences in the College of Health at the University of Southern Mississippi in Hattiesburg. While there, he developed the graduate emphasis in health administration in the CEPH-accredited Master of Public Health program. He was also involved in the development of the cohort-based Executive Master of Public Health in Health Services Administration program.

McIlwain has consulted with health care organizations in the area of strategic planning including medical group practices, nursing homes, and hospitals. His research interests are in health care marketing, including direct-to-the-consumer pharmaceutical advertising, and health care strategic management.

“The main goal of the MHA program at Clayton State is to become CAHME (the Commission on Accreditation of Health Management Education) accredited. CAHME is dedicated to promoting, evaluating, and improving graduate healthcare management education. I was responsible for the re-accreditation of the MHA program at MUSC where the program received the highest awarded number for seven years,” McIlwain says. “My goal is to move this program to that level of quality education. This process will involve making sure that we have quality admissions, support, and outcomes in teaching, service, and research. We are moving the program to competency based outcome measurement also.

“I was attracted to Clayton State because of its proximity to the health care industrial complex of the Metro Atlanta area. This program is poised to become a premier provider of graduate health care management education in the Atlanta and Georgia region. My experience with accreditation and program management provides me with a perspective of what this University can accomplish in this type of program”McIlwain is looking forward to accomplishing many goals within MHA program.

“The goals of the program are to prepare students for positions of increased responsibility within healthcare organizations. It also provides individuals with clinical backgrounds the management skills needed to assume leadership positions,” he says. “We are also interested in attracting individuals who have experience in other industries but want to begin careers in health care management.

“Of course the goal of all health administration programs is to improve the quality of care and resource use in health organizations by graduating individuals with the skills and competencies to achieve this goal.”
McIlwain is married to Margaret, a family nurse practitioner, and is the father of two sons.

A unit of the University System of Georgia, Clayton State University is an outstanding comprehensive metropolitan university located 15 miles southeast of downtown Atlanta.
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Dental Hygiene Holds Second Annual White Coat Ceremony

The Clayton State University Department of Dental Hygiene held its second annual “White Coat” ceremony on Aug. 17 in the Harry S. Downs Center. A total of 55 junior and senior students took the dental hygiene oath.

“The Dental Hygiene program’s White Coat Ceremony is a great day of recognition for our current students. The day welcomes the junior students into the program and introduces them to the responsibilities associated with patient care while in the dental hygiene program. The ceremony also reminds the senior students of their responsibilities associated with patient care in the program and also promotes the principles of professionalism they will need to embrace in their future practice of dental hygiene,” says Dr. Susan Duley, head of the Department of Dental Hygiene.

Dr. Karl Haden, founder and president of the Academy for Academic Leadership, was the keynote speaker at the ceremony. Tianddria Walton (Newnan), president of the Student American Dental Hygienists’ Association at Clayton State, led in reciting the oath along with her fellow classmates.

Haden was also guest speaker for the first White Coat ceremony at Clayton State in fall 2008. For more than 15 years, Haden has consulted with colleges and associations in academic healthcare. Haden’s areas of expertise include leadership development, organizational change, ethics, team building, negotiation and conflict management, strategic planning, curriculum development, and the scholarship of teaching and learning.

A unit of the University System of Georgia, Clayton State University is an outstanding comprehensive metropolitan university located 15 miles southeast of downtown Atlanta.
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Emory Begins Vaccinating Volunteers Today in First H1N1 Clinical Trial

Today Emory University researchers began vaccinating volunteer participants in the first of several planned clinical trials of a new H1N1 vaccine. The clinical trials are being conducted by the eight Vaccine and Treatment Evaluation Units (VTEUs), supported by the National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health (NIH).

Emory began signing up several hundred interested volunteers about two weeks ago and has been screening the volunteers to make sure they fit certain criteria. Volunteers will receive their first vaccinations over the first week of the trial and will return several times over the course of nine weeks to receive additional vaccinations and blood tests.

The Emory clinical trial will evaluate the safety and immune response to an H1N1 vaccine and also help determine how the pandemic flu shot should be given along with the seasonal flu shot to make it most effective. Participants will receive two H1N1 vaccinations concurrent with, before, or after, the seasonal flu shot.

The trials are being conducted in a compressed timeframe because of the possible fall resurgence of pandemic H1N1 flu infections that may coincide with the circulation of seasonal flu strains in the Northern Hemisphere.

The trials are expected to gather critical information that will allow the NIH to quickly evaluate the new vaccines to determine whether they are safe and effective in inducing protective immune responses. The results will help determine how to begin a fall 2009 pandemic flu vaccination program.

The U. S. government declared the H1N1 outbreak a public health emergency in April and two months later, the World Health Organization classified the outbreak a pandemic, reflecting its widespread nature.

“We have had a tremendous response from volunteers wanting to participate in the clinical trials,” says Mark Mulligan, MD, principal investigator of the Emory VTEU and executive director of the Hope Clinic of the Emory Vaccine Center. “Hopefully this will make it much easier to have a vaccine available for the fall flu season. We are very appreciative of the efforts of our volunteers.”

This first adult clinical trial as well as subsequent pandemic vaccine clinical trials will be conducted at the Emory Vaccine Center’s Hope Clinic in nearby Decatur. Pediatric clinical trials will be initiated one week after the first adult trial and will be conducted at the Emory-Children’s Center on Emory University’s campus. Harry Keyserling, MD, and Paul Spearman, MD, co-directors of the Emory VTEU, lead the pediatric studies at Emory-Children’s Center.

The VTEUs were established in 1962 as a vital research component of the NIAID. The units conduct clinical trials for all infectious diseases other than HIV/AIDS. They have conducted hundreds of clinical studies over the past four decades. Emory was designated a VTEU site in 2007 and received a seven-year contract of approximately $23.7 million.

An important strength of the VTEUs is their ability to rapidly enroll large numbers of volunteers into trials and to immunize the volunteers in a safe, effective and efficient manner. This rapid-response capability is especially important for testing vaccines designed to combat pandemic influenza. Results are expected to be available weeks after the trials begin.

In addition to Emory, VTEU sites are Baylor College of Medicine, Houston; Children’s Hospital Medical Center, Cincinnati; Group Health Cooperative, Seattle; Saint Louis University, St. Louis; University of Iowa, Iowa City; University of Maryland School of Medicine, Baltimore; and Vanderbilt University, Nashville. They will be joined for these studies by Children’s Mercy Hospital in Kansas City and Duke University Medical Center.

For more information about the Emory flu clinical trials, call 877-424-HOPE (4673) for the adult and senior studies, or 404-727-4044 for the pediatric studies, or vaccine@emory.edu for further information about the upcoming trials.
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Glucose Challenge Test is Accurate and Economical for Diabetes and Prediabetes Screening

A test commonly used to help identify women with diabetes during pregnancy may be an accurate, convenient and inexpensive way to screen the general population for unrecognized diabetes and prediabetes, according to Emory University researchers.

The results of the study, "Glucose challenge test screening for prediabetes and undiagnosed diabetes" will be published online and in print in the journal Diabetologia.

"Widespread use of the glucose challenge test (GCT) to screen Americans for prediabetes and diabetes could provide a major opportunity to improve the health of more than 40 million people," said lead study author Lawrence S. Phillips, MD, Emory University School of Medicine Professor of Medicine, Division of Endocrinology.

The study screened 1,573 volunteer participants who had never been diagnosed with diabetes. At a first visit, at different times of the day and without restriction of meals, participants were given a 50-gram glucose drink. Glucose was measured both before the drink (random glucose) and an hour after the drink (GCT glucose).

At a follow-up visit held in the morning after an overnight fast, participants had measurement of hemoglobin A1c (a standard test used to monitor diabetes), and a 75-gram oral glucose tolerance test (OGTT). The OGTT is the "gold standard" for diagnosing diabetes and prediabetes.

After screening, researchers found that 4.6 percent of the participants had previously unrecognized diabetes, and 18.7 percent had prediabetes.

The GCT was the most accurate screening test for these problems, significantly better than the random glucose or A1c tests. Since the good performance of the GCT was unaffected by the time of day, or times after meals, the GCT could be performed during a routine office visit. If a patient's GCT glucose level is low, he/she wouldn't need to be screened again for another two or three years, but if the GCT glucose level is high, patients would need a confirmatory oral glucose tolerance test.

This approach is similar to screening women for diabetes during pregnancy. GCT screening is almost universal for women in their sixth month of pregnancy.

The GCT provided consistent results for a diverse group of patients – old and young, normal weight and overweight, men and women, with and without a family history of diabetes, etc. The GCT also appeared to be less expensive than other screening strategies.

Early diagnosis is a benefit both for people who have diabetes or prediabetes, and for their health care teams. Regular glucose challenge test screening (GCT first, then a follow-up OGTT if the GCT glucose is high) would be a way to assure early diagnosis, according to Phillips and team.

"Glucose challenge test screening could help improve disease management by permitting early initiation of therapy aimed at preventing or delaying the development of diabetes and its complications," says Phillips.

Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life.

According to the American Diabetes Association, 23.6 million U.S. children and adults, or 7.8 percent of the population, have diabetes. While an estimated 17.9 million have been diagnosed with diabetes, 5.7 million people are unaware that they have the disease.

Pre-diabetes is a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. There are 57 million Americans who have pre-diabetes, in addition to the 23.6 million with diabetes.

In addition to Phillips, study authors were: David Koch, PhD, K.M. Venkat Narayan, MD, MSc, MBA, Mary Rhee, MD, Viola Vaccarino, MD, PhD, and David Ziemer, MD, of Emory University; Ranee Chatterjee, MD, of the Johns Hopkins University School of Medicine; and P. Kolm and W.S. Weintraub, of the Christiana Care Health System in Newark, Del.

The research was supported in part by the National Institutes of Health and the National Center for Research Resources, and by the Veterans' Administration. The work was presented in part at the June 2008 national meeting of the American Diabetes Association.

Emory and HBO Host Alzheimer's Disease Documentary Screening May 2

The Emory University Alzheimer's Disease Research Center in partnership with HBO and the Alzheimer's Association of Georgia will premiere the HBO documentary film, "MOMENTUM IN SCIENCE" on Saturday, May 2, for a gathering of medical professionals and families who have loved ones living with Alzheimer's disease.

"MOMENTUM IN SCIENCE," is part of an HBO Films' Documentary series called THE ALZHEIMER'S PROJECT.

The ALZHEIMER'S PROJECT, executive produced by Maria Shriver, is a multi-part, multi-platform series that brings new understanding and hope for millions of people affected by Alzheimer's disease.

The screening will be held from 9 a.m. to1 p.m. at the Emory Conference
Center located at 1615 Clifton Rd. in Atlanta. It will be followed by a panel
discussion and Q & A with leading Alzheimer's disease researchers, including:
*Allan Levey, MD, PhD – Professor and Chair, Department of Neurology, Emory
University
*James Lah, MD, PhD – Associate Professor and Vice Chair, Department of
Neurology, Emory University
*Felicia Goldstein, PhD – Director of Neuropsychology, Emory University
*Larry Tune, MD – Professor of Psychiatry and Neurology, Emory University
*Angela Ashley, MD – Assistant Professor of Neurology, Emory University
*Ginny Helms – Vice President of Programs and Services, Alzheimer's Association of Georgia
*Monica W. Parker, MD – Assistant Professor of Medicine, Emory University
*Kenneth Hepburn, PhD – Professor and Associate Dean for Research, Nell
Hodgson Woodruff School of Nursing, Emory University
*Carolyn Clevenger, DNP – Assistant Professor of Nursing, Nell Hodgson
Woodruff School of Nursing, Emory University
*Suzette Binford, Executive Director, Alzheimer's Association of Georgia

THE ALZHEIMER'S PROJECT is a presentation of HBO Documentary Films and the National Institute on Aging of the National Institutes of Health in association with the Alzheimer's Association®, Fidelity® Charitable Gift Fund and Geoffrey Beene Gives Back® Alzheimer's Initiative. The series of four films will debut on HBO on May 10, 11 and 12.
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