Archive for June, 2009

In the United States, back pain continues to be a leading cause of disability and one of the most common reasons to see a physician for evaluation. Among various treatment options is spinal fusion surgery, which may use a biological agent known as bone-morphogenetic protein (BMP).

Researchers at Brigham and Women’s Hospital (BWH) found that BMP is used in 25 percent of spinal fusion surgeries and is associated with a higher rate of complications in certain types of fusions, as well as greater hospital charges, compared with fusions that do not use BMP. The research appears in the June 30 issue of the Journal of the American Medical Association.

Researchers looked at the outcomes of more than 300,000 patients who underwent spinal fusion surgery. “The use of BMP in these surgeries jumped from less than 1 percent in 2002 to 25 percent in 2006,” said Kevin Cahill of the Neurosurgery Department at BWH, a clinical fellow in surgery, and lead author of the study. “With the use of BMP on the rise, this study illustrates the need to determine the cost-effectiveness of the product in different procedures.”

The researchers found that immediate postoperative, in-hospital rates of complications among patients undergoing spinal fusion by BMP were no higher for lumbar, thoracic, or posterior cervical procedures.

However, the use of BMP in anterior cervical (front of the neck) fusion procedures was associated with a higher rate of complications, with the primary increases seen in wound-related concerns, difficulty in swallowing, or hoarseness.

BMP use was associated with a longer length of stay in the hospital and greater inpatient hospital charges across all categories of fusion, with an 11 percent to 41 percent increase in total hospital charges.

“This study has highlighted the need to continue to develop refined guidelines for BMP usage and to further study its long-term risks and benefits,” Cahill said. Other investigators on the study include John H. Chi, Arthur Day, and Elizabeth B. Claus, all of the Neurosurgery Department at BWH.

The Brain Science Foundation funded the study.

$100,000 in grants go to community projects

Artists and others in Allston and Brighton get first round of Harvard funding

By Corydon Ireland

Harvard News Office

Over the next five years, Harvard will award grants to nonprofit groups serving North Allston/North Brighton.

The first round of funding from the Harvard Allston Partnership Fund totals $100,000. Recipients were announced last Friday (June 26) in a public gathering at the Harvard Allston Education Portal on North Harvard Street.

An advisory committee made up of neighborhood residents chose the grant recipients after a detailed review process.

Six organizations share in the inaugural funding, with grants that range from $5,000 to $20,000. The money will go toward new projects, including an arts workshop, health education classes, and a poetry program for schoolchildren.

Harvard President Drew Faust – acknowledging “the hard times, the challenging times we all find ourselves in” – called the grants an example of the University’s sustained commitment to surrounding communities.

“We stand pledged to support that neighborhood connection,” she said, “to be your good neighbor, and to work together as partners in bringing some of these hopes and dreams to fruition.”

Joining Faust was Boston Mayor Thomas M. Menino, who praised Harvard and its neighborhood partners.

“You judge a city by its neighborhoods,” he said. “If your neighborhoods are strong, your city is strong.”

John Palmieri, director of the Boston Redevelopment Authority – which assisted the awards committee – pointed to a durable town-gown collaboration. “There is no better model,” he said, “than the Harvard-Allston model.”

Karen Smith, one of seven committee members, said the grants process was “an opportunity for true collaboration” that included voices from the neighborhoods, the city, and the Harvard Allston Task Force.

She called the grants process “joyful and easy.”

That was also true because of the quality of the applicants – many of whom already do great good with “modest dollars,” said Smith.

“They were all thoughtful; they were worthy,” she said of the applicants. “So many people are stepping up, often very quietly.”

John Hoffman is one. He’s executive director of The Fishing Academy, which received a grant this year.

For five years, his nonprofit public charity has sponsored river and ocean boat trips for urban youngsters. “It changes lives,” he said afterward.

Of the grant recipients, “We wish you every success,” said Smith. “We know you will inspire others to apply.”

Committee deliberations begin in September for the 2010-11 round of funding for Harvard Allston Partnership Fund grants.

The partnership fund is part of a cooperation agreement between Harvard and the city of Boston that has introduced new programs and neighborhood improvements in North Allston/North Brighton.

One such improvement already in place is the Harvard Allston Education Portal. More than 80 Allston-Brighton children are mentored by Harvard students there in science, math, and writing.

Forthcoming is Library Park, a one-acre public green space behind the Honan-Allston Library at 300 N. Harvard St. It’s currently in design and scheduled to be finished in 2011.

A closer look at the winners of this year’s Harvard Allston Partnership Fund grants:

■ The Allston Brighton Arts Bridge – an arts project created for local teenagers by a filmmaker, director, and actress – will sponsor 18 weeks of workshops and culminate in a public screening.

■ The Charles River Watershed Association will convert a barren paved lot alongside the German International School Boston on Holton Street into a lush, green, sustainable landscape.

■ The Fishing Academy will increase scholarships to help local children attend a recreational fishing camp this summer.

■ The Joseph M. Smith Community Health Center will offer health workshops and one-on-one patient education for at-risk populations.

■ The Massachusetts Poetry Outreach Project will host a poets-in-residence program for fourth- and fifth-grade writing classes at Gardner Pilot Academy, readings at the Honan-Allston Library, and a letterpress studio.

■ St. Luke’s and St. Margaret’s Episcopal Church will offset the costs of diapers for 90 families that use the church’s free diaper service every month at the Allston-Brighton Baby Diaper Pantry.

‘Water guy’ John Briscoe stays in motion

Brought to Harvard with joint appointment at SEAS, HSPH

By Michael Patrick Rutter

SEAS Communications

For someone who deep-sixed his BlackBerry (instant e-mail was taking over his life) and traded the local newspaper for a good book (“What do I need to know about Celtics’ scores?”), John Briscoe ’76 is as worldly a person as you are ever likely to meet.

An expert on water and economic development who most recently served as the World Bank’s senior water adviser and the country director for Brazil, Briscoe has lived in his native South Africa as well as Bangladesh, Mozambique, India, and Brazil.

Briscoe’s cultural comfort has been his guide amid what he calls the “changing economic geography” of the world. However painful and disorienting the current financial crisis, he insists that the true mover and shaker of the planet has never been the markets. It is instead the ebb and flow of the oceans.

“Water touches everything,” Briscoe explains. “It is about religion, culture, history, biology, government. It is everything.”

To make that point, the August 2008 Scientific American cover featured an image of the world as a sponge being wrung dry. The article’s author, Peter Rogers, Gordon McKay Professor of Environmental Engineering at Harvard’s School of Engineering and Applied Sciences (SEAS), concluded that if unchecked, “by midcentury as much as three-quarters of the Earth’s population could face scarcities of freshwater.”

Rich or poor, powerful or weak, water’s fate is our fate.

From ‘the Bank’ to ‘the Big H’

Briscoe arrived in January as the Gordon McKay Professor of the Practice of Environmental Engineering, a joint appointment between SEAS and the Harvard School of Public Health (HSPH). Having loved his roles as the “water guy” and the “Brazil guy” at “the Bank,” he did not make the change lightly.

His decision to come to Cambridge was influenced by the tug of ties both old and new. Two former deans, Venkatesh “Venky” Narayanamurti (of SEAS) and Barry Bloom (of HSPH), urged him to create a water program for the 21st century, highlighting how Harvard was embracing integrative, global-minded science and engineering.

Only half a term in, he has discovered the promised openness and enthusiasm of the research community. Colleagues have filled up his schedule, asking Briscoe to give talks on behalf of the South Asia and Middle East Initiatives, present a lecture during Latin American Week, and meet with a group of visiting Chinese executives.

“Harvard is one of the few places where you can do this — and I feel like an absolute fish in water,” Briscoe says. Moreover, he has not had to give up his international connections. “The big ‘H’ counts for a lot. Everyone wants to partner with Harvard.”

At the same time, Briscoe was pulled in by past history, remembering fondly the achievements of his faculty advisers. From the late 1950s to the early ’60s, Harold A. Thomas Jr. (1913-2002) guided what became the famed Harvard Water Program. In tandem, Roger Revelle (1909-91), the man who inspired Al Gore about an inconvenient truth, focused on the link between population and natural resources as he created the Center for Population Studies at Harvard.

Both thinkers answered a call by John F. Kennedy, who was intent on offering a nonmilitary incentive to then-Pakistani President Muhammad Ayub Khan. As Pakistan was facing an agricultural crisis due to waterlogging (saturation) and salinization, Kennedy offered academic expertise. Thomas and Revelle’s diagnosis — more, not less, irrigation by supplementing canal water with the extensive use of groundwater — changed the history of the country and the region.

“By doing good science, [offering] good policy, and engaging politicians, they left a mark that is still revered by Pakistanis today,” says Briscoe.

Likewise, his goal is to craft a program that brings together politicians with policies and science. “The science part standing alone, is interesting, important, and obviously necessary, but not sufficient,” he says. “At the same time, even the best technocratic policies can be a bit blue-eyed and pie in the sky. Proposals will only work when they make political sense, too.”

Already, with no influence from Washington, 10 of the governors of Brazil’s 27 states — Briscoe knows them all — have said they are ready to work with Harvard on issues like sustainable development in the Amazon. On campus, students have pitched thesis topics, and policymakers have offered collaborations.

To best direct such enthusiasm, Briscoe advises those interested in the water development business to first overcome a common “moral hazard.” As many have never lived without water, “they come up with a whole set of prescriptions about an imagined solution that has nothing to do with people’s actual situation,” he says.

Put another way, water is deeply personal. “If you want to understand it in your heart, live in Mozambique or India or turn the taps or electricity off for a week.”

At Harvard, Briscoe’s vision is to create an environment where students, faculty, and politicians can come “in and out of the fray” and gain “a sense of what the battles are really about and find enough distance to see the science and what’s essential in it.”

He pictures a series of “horizontal partnerships” in which faculty and students pair with their peers in Brazil (to start) and then those within Australia and Pakistan. “The old model of ‘send your best and brightest to Harvard’ must,” says Briscoe, “be replaced by new types of partnerships that reflect the changed global economic geography.”

Part of his plan includes training a new generation of “integrators” — the kind of individuals a future world leader might call in a crunch. With a Harvard degree, he says, “you are equipped to be adventurous, and that’s a fantastic gift” — and essential, he has found, for tackling a moving target like the water problem.

Briscoe offers a sense of optimism rather than dire Malthusian predictions about a coming drought. That “water has no respite” inspires him. Even the pessimistic poet Philip Larkin saw beauty in the Earth’s most elusive element: “And I should raise in the east/A glass of water/Where any-angled light/Would congregate endlessly.”

Regional bounty graces Allston market

With tempting produce and artisan bread come lessons in sustainable living

By Corydon Ireland

Harvard News Office

A surprise visitor put in an appearance at the corner of Harvard Street and Western Avenue last Friday (June 26): the sun.

Welcome solar rays scrubbed clouds out of the sky and shone down on the Harvard Allston Farmers’ Market.

Now in its second year, the market is open every Friday from 3 p.m. to 7 p.m., through October. Bring big bags, and your appetite.

On Friday, in a wide parking lot outside the Harvard Allston Education Portal, white-topped tents shaded the vendors. For sale were a medley of regional goods, including artisan chocolates, exotic breads, and fresh-picked bounty from local farms.

Boston Mayor Thomas M. Menino stopped by to chat with Allston resident Theresa Magee, the market’s new manager, and Theresa McCulla ’04, administrator of the Food Literacy Project at Harvard University Dining Services.

Among the shoppers was Harvard President Drew Faust. She bought strawberries, a head of Romaine lettuce, and a cauliflower.

“My husband’s the cook,” she said, “and he’s going to go crazy with all this.”

Faust paused at the table for Big Sky Bakery, laden with scones, strudels, and – a specialty – dark rye Russian breads. Eyeing a tray of macaroons, she said, “One will do it.”

The clerk had no problem contradicting a president. “There’s going to be a fight,” he said. “You’ve got to get two.”

Faust gave in, then made her way across the pavement to a display showing how to make compost “tea” – a nutrient-rich liquid brewed from compost. In two vats, pumps sang merrily, roiling the darkening tea.

The display was one of several set up for a one-time sustainability fair. It diverted market shoppers with demonstrations on recycling, energy-efficient lighting, the environmental advantages of tap water, and composting.

Compost teas are a fixed part of landscaping at Harvard now, eliminating the need for artificial fertilizers and pesticides in many places.

Roots can get deeper into healthier, tea-augmented soils. Lawns in Harvard Yard have a heartiness that Faust herself has noticed.

“The landscaping looks beautiful,” she told former Loeb Fellow Eric T. Fleisher, who set up the guidelines for greening Harvard’s public space. “It’s working.”

Fleisher – a regular visitor to Harvard – is director of horticulture at Battery Park City Parks Conservancy, New York City’s only fully organic public landscape.

The art of compost tea, he said, involves coaxing beneficial organisms out of good quality compost and into a liquid form. Teas are brewed to be predominantly bacterial (for grasses, annuals, and vegetables) or fungal (for trees and shrubs).

In a separate display nearby, a shallow bin of compost – formerly banana peels, coffee grounds, and other organic waste – teemed with friendly microbes and wriggled with earthworms and millipedes.

Compost – the conversion of bulky waste into friable rich soil – is a one-stop environmental lesson, said Robert M. “Rob” Gogan Jr., associate manager for recycling and waste at Harvard. “It does everything good.”

At another table, Zachary Arnold ’10, who works for Harvard’s Office for Sustainability (OFS), watched over a blind taste test: Is it bottled water or tap water?

Most of us can’t tell the difference, he said, but the taste test starts a conversation on tap water – and how drinking it circumvents the waste (and wasted energy) of bottled water.

Environmental lessons come naturally at a farmers’ market, said OFS director Heather Henriksen. For one, she said, very fresh food means less transportation pollution was required to get it from farm to farm stand.

“Food is a gateway issue” to creating a sustainable lifestyle, said Henriksen. “Everyone eats.”

Across the way, at the stand from Dragonfly Farms in Pepperell, Mass., there were garlic scapes for sale. The stalky flowering vegetable is one of the first items ready to be picked at New England farms.

Nearby, Bee Vue and his family – Hmong from the uplands of Laos – offered early-season greens and herbs, like bok choy, cilantro, and lettuces, from 70-acre Flats Mentor Farm in Lancaster, Mass., an hour away. The big seller on Friday was pea tendrils, tender and lacy – best sautéed with garlic in olive oil.

Rob Fitzhenry, chef and proprietor of Baked Orchard in Chelsea, Mass., had his own big sellers Friday: scones, chocolate chip cookies, and flourless tea cakes.

He uses local fruit, artisan chocolate from Taza in Somerville, Mass., and homemade preserves.

Said Fitzhenry, “I try to utilize as many local products as I can.”

Harvard researchers at Brigham and Women’s Hospital (BWH) found that diabetics hospitalized for noncritical illnesses who develop hypoglycemia (low blood sugar) during hospitalization have an increased likelihood of remaining hospitalized longer and a greater risk of mortality both during and after hospitalization. This research appears in the July 2009 issue of Diabetes Care.

Previous research showed an increased risk of mortality, seizures, and coma in patients who, while admitted to the intensive care unit (ICU), developed hypoglycemia. “Ours is the first study to examine mortality risks for hospitalized diabetes patients outside of a critical care setting,” said Alexander Turchin of the Endocrinology Department at BWH. “This is crucial because a majority of hospitalized diabetics are treated on the general ward rather than the ICU.”

Preventing hypoglycemia: Tips from the National Institutes of Health

Researchers examined the medical records of more than 2,500 diabetics admitted to the general ward of a teaching hospital. They studied the association between the number and severity of hypoglycemic episodes with inpatient mortality, length of hospital stay, and mortality within one year of discharge. 

This study found that for each hospital day with at least one hypoglycemic episode, there was an 85.3 percent increased risk of dying as an inpatient and a 65.8 percent increased risk of dying within one year of discharge. The odds of inpatient death also tripled for every 10 mg/dl decrease in the lowest blood glucose during hospitalization. Additionally, a patient’s length of stay increased by 2.5 days for each day spent in the hospital with a hypoglycemic episode.

“Hypoglycemia is common among diabetics admitted to the general ward,” said Turchin. “These findings provide support for considering increased monitoring, more aggressive treatment of infections, and transitioning to a more intensive care setting for diabetic patients who have developed hypoglycemia in the general ward.”

The study was funded by grants from the Diabetes Action Research and Education Foundation and the National Library of Medicine.