The American Society for Microbiology (ASM) will hold its 110th General Meeting May 23-27, 2010 in San Diego, California. The meeting will feature approximately 3,000 individual scientific presentations spanning the breadth of microbiology and has an expected attendance of 10,000.

Microbiologists study living organisms and infectious agents, and their work is critical to human and animal health, agriculture, the environment and biotechnology. Many accomplishments in the microbiological sciences have significantly affected our lives, such as the development of treatments for infectious diseases, the prevention of food spoilage, the use of microorganisms to clean up pollutants and basic knowledge of the nature of all living things.

Among the topics to be presented are:
The role of microbes in extinction events

The persistence of foodborne pathogens in the food supply from farm to fork

Issues in the testing and diagnosis of sexually transmitted diseases in adolescent and pediatric patients.

The impact of humans and the changing environment on the spread of infectious disease

Microbiology and ecology of wine, beer and cheese

H1N1 Influenza Pandemic: What worked, what didn’t, and what have we learned

More detailed information, including program, abstracts, and online media registration can be found online at tinyurl/asm2010.

Source:
Garth Hogan

American Society for Microbiology

Biotechnology Industry Organization (BIO) Executive Vice President for Food and Agriculture Sharon Bomer Lauritsen issued the following statement on the newly launched tracking program for animal clones:

“Today, the leading animal cloning companies introduced an animal clone registry program that will track livestock produced through cloning. With this new registry program in place, BIO encourages a timely release by the U. S. Food and Drug Administration (FDA) of the final risk assessment on the safety of foods from animal cloning. Our industry believes the tracking program will help to identify animal clones and address market concerns when the voluntary moratorium on the use of cloning for commercial food production is lifted.”

“The biotechnology industry has a long history of promoting stewardship and responsible use of its technology. The animal clone registry program demonstrates the technology providers’ commitment to facilitating future market needs. While companies have thus far voluntarily taken steps to keep animal clones and their offspring from entering the marketplace, BIO believes that when cloning technology is available for commercial food production, this tracking system will help promote a wider variety of choices in the world’s food supply and support smooth trade transactions in the agricultural community.”

“BIO applauds its members, leading cloning companies and program developers ViaGen and Trans Ova, for their efforts and believes this system of animal food product management will provide farmers and ranchers with access to the full range of assisted reproductive technologies, while still meeting food retailer demands.”

“Livestock cloning is the newest assisted reproductive technology that allows farmers and ranchers to use the best genetics to produce healthy animals, and therefore provide consumers with consistent, healthful and safe food products. Using the tools of biotechnology to produce desirable and healthier farm animals is not a new practice. For decades, livestock producers have used genomics to improve the health and efficiency of animals that provide healthy and nutritious meat and milk. In December 2006, FDA published a draft risk assessment that determined the milk and meat products from animal clones and their offspring are as safe as products from conventionally-bred animals.”

BIO represents more than 1,100 biotechnology companies, academic institutions, state biotechnology centers and related organizations across the United States and 31 other nations. BIO members are involved in the research and development of healthcare, agricultural, industrial and environmental biotechnology products.

Biotechnology Industry Organization

A study of a drug that reduces the pain of fibromyalgia and improves sleep is being published by a University of Kentucky physician in the peer-reviewed journal, Arthritis & Rheumatism.

The lead author of the study was Dr. Leslie Crofford, professor, UK College of Medicine, chief, Division of Rheumatology, and the Gloria W. Singletary Chair and Director of the Center for the Advancement of Women’s Health

“Fibromyalgia is a debilitating condition affecting as many as six million Americans, yet there is no approved treatment that relieves its core symptoms,” said Crofford. “This is the first prospective study suggesting that Lyrica may be effective in improving the pain of fibromyalgia and some of its other symptoms such as sleep problems and fatigue.”

Pfizer Inc’s Lyrica (pregabalin) significantly reduced the pain of fibromyalgia and improved sleep, fatigue and other patient-reported conditions such as bodily pain and vitality, according to a study published in Arthritis & Rheumatism.

Fibromyalgia is characterized by widespread musculoskeletal pain, fatigue and sleep problems. Fibromyalgia is difficult to treat, with most patients continuing to have persistent symptoms even after pain management interventions. The cause of fibromyalgia is unknown. In the study, patients treated with Lyrica experienced a greater reduction in pain compared to those who received placebo.

The benefit with Lyrica was demonstrated as early as the first week of treatment. In addition, a significantly greater proportion of patients receiving Lyrica versus placebo (48 percent versus 27 percent) experienced a clinically meaningful reduction of pain, as defined by a 30 percent or greater improvement in pain. Additionally, significantly more patients taking Lyrica (450 mg per day) experienced a 50 percent or greater reduction in pain at the end of the study compared with placebo (29 percent versus 13 percent, respectively).

Patients taking Lyrica reported significant improvement in the quality of sleep compared to those who received placebo, as assessed by daily sleep diaries and a sleep scale measurement. Additionally, patients taking Lyrica reported reduced fatigue on a scale of severity, distress, degree of interference in activities of daily living, and timing.

Study Background

In this eight-week double-blind trial, 529 patients with fibromyalgia were randomized to receive one of three daily doses of Lyrica (150 mg, 300 mg, or 450 mg) or placebo. The primary objective was reduction in the severity of pain. Pain scores were recorded in daily diaries. On average, patients in the study were women in their late 40s who had a long history of fibromyalgia, with average duration nine years, and had experienced moderate to severe pain and diminished quality of life. Prior to the trial, study participants discontinued all medications for pain and sleep disorders except for acetaminophen, aspirin or symptomatic migraine treatment.

The two most common side effects reported by Lyrica-treated patients were mild-to-moderate dizziness and sleepiness, and tended to be dose-related. Few patients discontinued the trial due to these side effects. About 80 percent of patients from all treatment groups entered the open-label extension.

LYRICA Background

The U.S. Food and Drug Administration (FDA) approved Lyrica in December 2004 for the management of two of the most common forms of neuropathic (nerve) pain, diabetic peripheral neuropathy and post herpetic neuralgia. Lyrica will be available in pharmacies in the future. Lyrica is currently under review by the FDA for the adjunctive treatment of partial seizures in adults.

Pfizer’s Lyrica is currently available in various European Union member states for the treatment of peripheral neuropathic pain and as adjunctive therapy for partial seizures, and in Mexico for the treatment of neuropathic pain and as adjunctive therapy for partial seizures.

Contact: Amanda W. Nelson
agwhit0emaily.edu
859-323-6363
University of Kentucky
uky.edu

View drug information on Lyrica.

Increasingly severe sleep-related breathing disorders in older men appear to be associated with a greater risk of abnormal heart rhythms (arrhythmias), according to a report in the June 22 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. In addition, different types of breathing problems appear more closely associated with different categories of arrhythmia.

Sleep-disordered breathing is a common condition, according to background information in the article. It causes a number of physiologic events that could be stressful to the cardiovascular system, including inadequate blood oxygen levels at night and activation of the sympathetic nervous system (associated with the body’s fight-or-flight response).

Reena Mehra, M.D., M.S., of Case Western Reserve University School of Medicine, Cleveland, and colleagues studied 2,911 men who underwent sleep testing by polysomnography between 2003 and 2005. The number of times they experienced apnea (brief pauses in breathing) or hypopnea (shallow breathing) during sleep was recorded, as were any periods of time in which the oxygen level of blood in their arteries dipped below 90 percent (hypoxia).

Having more episodes of paused or shallow breathing was associated with increased odds of two types of arrhythmias-one involving the heart’s upper chambers (atria) and one involving the heart’s lower chambers (ventricles). Obstructive sleep apnea-the most common type, involving a partial or complete blockage of the airways-was associated with irregular heartbeats caused by a problem with the lower chambers or ventricles. Lower blood oxygen levels also appeared to be associated with this type of arrhythmia. However, central sleep apnea, involving a malfunction in brain signals controlling breathing muscles, was more strongly associated with arrhythmias in the atria or upper chambers.

More severe cases of sleep-disordered breathing were associated with higher odds of arrhythmia; in addition, “there also seems to be a threshold effect such that moderate-to-severe sleep-disordered breathing confers the greatest increased odds of clinically significant arrhythmias independent of self-reported heart failure and cardiovascular disease,” the authors write.

“This line of investigation also identified hypoxia as the possible culprit pathophysiologic characteristic of sleep-disordered breathing that may serve as the trigger of ventricular cardiac arrhythmia development in older men. The strong associations between central sleep apnea and atrial fibrillation [arrhythmia originating in the heart's upper chambers] suggest that central sleep apnea may be a sensitive marker of underlying abnormalities in autonomic or cardiac dysfunction associated with atrial fibrillation,” they conclude. “Further prospective and intervention studies are needed to better determine causality and the impact of aggressive sleep-disordered breathing interventions on cardiac outcomes.”

Arch Intern Med. 2009;169[12]:1147-1155.

Source
Archives of Internal Medicine

A new study by the University of Michigan Medical School and VA Ann Arbor Health System challenges the medical thinking that the lower the cholesterol, the better.

Tailoring treatment to a patient’s overall heart attack risk, by considering all their risk factors, such as age, family history, and smoking status, was more effective, and used fewer high-dose statins, than current strategies to drive down cholesterol to a certain target, according to the U-M study.

While study authors support the use of cholesterol-lowering statins, they conclude that patients and their doctors should consider all the factors that put them at risk for heart attack and strokes.

The findings will be released online Monday ahead of print in the Annals of Internal Medicine.

“We’ve been worrying too much about people’s cholesterol level and not enough about their overall risk of heart disease,” says Rodney A. Hayward, M.D., director of the Veterans Affairs Center for Health Services Research and Development and a professor of internal medicine at the University of Michigan Medical School.

The National Cholesterol Education Program recommends harmful LDL cholesterol levels should be less than 130 for most people. High risk patients should be pushed even lower — to less than 70.

The U-M study took a different approach, called tailored treatment, which uses a person’s risk factors and mathematical models to calculate the expected benefit of treatment, by considering:

•A person’s risk of a heart attack or stroke without treatment;
•How much a statin decreases the risk; and
•Potential harms from the treatment

“These are the three factors that determine the net benefit of a treatment. Our fixation on just one factor, LDL cholesterol, is leading us to often treat the wrong people,” Hayward says.

In the recent study, U-M physicians who worked with Yale University School of Medicine used data from statin trials that included Americans ages 30-75 with no history of heart attack.

Study authors evaluated the benefit of five years of treatment that was tailored, on coronary artery disease risk factors such as age, family history, diabetes, high blood pressure, smoking status, and recently CRP, C-reactive protein.

The tailored approach was more efficient (more benefit per person treated) and prevented substantially more heart attacks, strokes and cardiovascular deaths than the currently recommended treat-to-target approaches.

The tailored strategy treated fewer individuals with high-dose statins and saved 500,000 more quality-adjusted life years.

“The bottom line message – knowing your overall heart attack risk is more important than knowing your cholesterol level,” Hayward says. “If your overall risk is elevated, you should probably be on a statin regardless of what your cholesterol is and if your risk is very high, should probably be on a high dose of statin,” the U-M physician says.

“However, if your LDL cholesterol is high, but your overall cardiac risk is low, taking a statin does not make sense for you,” Hayward says. “If your cholesterol is your only risk factor and you’re younger, you should work on diet and exercise.”

Research has increasingly emerged questioning the value of cholesterol targets and which of statins mechanisms is most important to preventing cardiac events. Cholesterol-lowering drugs work by blocking a key enzyme linked with LDL cholesterol production, but they initiate other changes in the body.

“Statins also affect inflammation on the inside of our blood vessels which is often what causes heart attacks and strokes – it’s not just a matter of cholesterol alone,” he says.

Additional authors: Harlan M. Krumholz, M.D., Yale University School of Medicine, and Donna M. Zulman, M.D., Justin W. Timbie, Ph.D., and Sandeep Vijan, M.D, all of the VA Center for Health Services Research and Development, VA Ann Arbor Health Care System.

Funding: VA Health Services Research and Development Service’s Quality Enhancement Research Initiative and the Measurement Core of the Michigan Diabetes Research & Training Center of the National Institutes of Health.

Source
University of Michigan Health System

Byproducts from the electronics, fuel, chemical and defense industries can be far from benign. Toxic heavy metals like cadmium and lead can seep into our food chain and cause cancer. And if found in the soil, these dangerous materials can render parks off-limits and real estate worthless.

For environmental, health and financial reasons, new solutions are needed to help clean industrial chemicals from America’s soil.

Now, an innovative Tel Aviv University soil-cleaning technique, which turns a cement truck into a giant mixer, may change things for industry and environmental specialists. Prof. Amos Ullmann and Prof. Neima Brauner of TAU’s Faculty of Engineering and Prof. Eliora Ron of the Faculty of Life Sciences, in cooperation with Israeli researcher Dr. Zvi Ludmer, are working on a new cleaning agent that binds to and whisks dangerous materials away from the soil, leaving desirable minerals intact.

“My colleagues have developed a system that literally washes the soil,” says Dr. Michael Gozin of TAU’s School of Chemistry. Their top-secret formulation, now in the early stages of research and development, will make it possible for truckloads of contaminated earth to be cleaned in a cement mixer. The compound not only leaves life-sustaining nutrients in the soil, but it’s also biodegradable and environmentally safe.

More than Soap and Water

“Heavy metals can’t be removed from the soil with just soap and water,” says Dr. Gozin. “Chemically-speaking, a cleaning agent of this nature is very difficult to develop.” With the new technique, once a commercial partner is found, however, the product could be ready in as little as 3 years. It can also be customized to remove specific dangerous chemicals, which can then be transferred to suitable confinement facilities.

Soil, says Dr. Gozin, is a very complex material. “When we’re designing chemicals of the future, we have to keep in mind the delicate balance in our environment. Micro-organisms, for example, are important to keep in the soil. We don’t want to kill them or remove the beneficial minerals and metals. Our advanced solution keeps all these factors in mind,” he says.

The special compound developed by the Tel Aviv University team relies on advanced chemical architecture: they’ve created molecular compounds with complex and highly specific functions. As well as being able to recognize and bind to certain metals such as cadmium, the compounds are also non-toxic and biodegradable.

Current solutions for cleaning the soil are very time-consuming, expensive and not completely effective. They strip the soil of all its basic compounds, leaving behind dead and useless sand. They also leave behind their own toxic byproducts and do not biodegrade. “These solutions solve one problem, but create others,” says Dr. Gozin, who also works on research projects for the U.S. Department of Defense, and the U.S. Air Force.

Other Applications

The new Tel Aviv University solution will give polluted soil a new lease on life and may affect business as well. Properties close to industrial parks are especially at risk and the value of that real estate remains low.

Technically-speaking, the solution could also be applied in the mining industry, to help mineralogists pull certain desired chemicals from the soil, like gold or the rare metals used in the high-tech industry.

The Tel Aviv University research is funded by the Israeli Science Foundation.

Source:
George Hunka

American Friends of Tel Aviv University

The Genetics Policy Institute (GPI) has submitted an amicus curiae (“friend of the court”) brief in the United States District Court for the District of Columbia, supporting federal funding for embryonic stem cell research.

The plaintiffs in the Sherley suit are trying to stop the government from funding such research, and as a result to hinder a field of research that offers the possibility of revolutionizing medicine. The plaintiffs claim that federal funding is prohibited by a statute known as the Dickey-Wicker Amendment.

GPI’s brief shows that the plaintiffs are misinterpreting the Amendment. It analyzes the language of Dickey-Wicker in detail and shows that the statute is most naturally read to permit federal funding of stem cell research, as long as the funding is not used to pay for the actual derivation of stem cells.

Bernard Siegel, GPI’s executive director, said, “GPI’s brief presents an extensive analysis of the Dickey-Wicker Amendment’s text and makes arguments that were not before the court when it issued a preliminary injunction last month. We think that those arguments make it very clear that the opponents of embryonic stem cell research funding are misreading the statute.”

Under the court’s procedures, the brief was submitted along with a motion asking the court to accept the amicus filing. The parties to the lawsuit have said they do not oppose GPI’s request to participate in the case as an amicus and a ruling on GPI’s motion is expected shortly.

Siegel also said, “We are very grateful to our counsel, Neal Goldfarb of the law firm of Butzel Long Tighe Patton, PLLC in Washington, D.C. for his efforts in writing the brief.” The memorandum will be available at the GPI web site.

GPI’s mission is to promote and defend stem cell research and its application in medicine to develop therapeutics and cures for many otherwise intractable diseases and disorders. GPI pursues this mission through production of its flagship annual World Stem Cell Summit, publication of the World Stem Cell Report, special projects, speaking engagements, teaching initiatives and strategic collaborations.

The 2010 World Stem Cell Summit takes place October 4-6, at the Detroit Marriott Renaissance Center and is co-organized by the University of Michigan, Michigan State University, Wayne State University and the State of Michigan.

Source:

Genetics Policy Institute

Contact: Eve Harris
415-885-7277
JAMA and Archives Journals Website (USA)
(JAMA = Journal of the American Medical Association)

CHICAGO (USA) – A review of previous studies suggests a possible benefit of statin drugs for reducing the risk of bone fracture in older women, although further research is needed to examine this question, according to an article in the January 26 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

According to the article, statins are widely used to treat high cholesterol, but little information is available about the effects of statins on bone.

Some retrospective studies have found that statin use is associated with a reduced risk for fracture, and other studies suggest that bone mass is higher in people taking statin medications.

Douglas C. Bauer, M.D., from the University of California, San Francisco, and colleagues investigated whether statin use is associated with a reduced risk for bone fracture.

The researchers analyzed combined data on statin use and fracture rates from four large prospective studies of older women (the Study of Osteoporotic Fractures, the Fracture Intervention Trial, the Heart and Estrogen/Progestin Replacement Study, and the Rotterdam Study).

They also summarized the results of eight observational studies and two clinical trials (found by searching English-language medical literature through January 2002) that reported statin use and documented fractures.

Statin use ranged from less than 1 percent of participants in the Rotterdam Study, to greater than 26 percent in the Heart and Estrogen/Progestin Replacement Study.

After the researchers adjusted data to take into account age, body mass index, and estrogen use, they found that there was a trend towards fewer hip fractures (38 percent to 81 percent lower risk) and to a lesser extent, nonspine fractures (5 percent to 51 percent lower risk) among statin users in each of the four large studies.

The researchers’ analysis of the observational studies was consistent with these findings, with an estimated 57 percent reduction in hip fracture, and an estimated 31 percent reduction in nonspine fracture among statin users.

Analysis of the clinical trials did not support a protective effect with statin use for hip or nonspine fracture.

The researchers conclude: ‘We found that use of [statins] was associated with a consistent and clinically meaningful but nonsignificant reduction in hip and vertebral fracture for prospective observational studies of older women.’

‘These findings build on the recent reports that statins increase bone formation in rodents and suggest that statins may be useful agents for osteoporosis. Clinical trials are needed to test the ability of potent statins to prevent fracture,’ write the authors.

(Arch Intern Med. 2004;164:146-152. Available post-embargo at archinternmed)

Editor’s Note: This study was supported by grants from the Public Health Service. The Study of Osteoporotic Fractures was supported by grants from the National Institutes of Health, Bethesda, Md. The Fracture Intervention Trial was supported by Merck and Co. The Heart and Estrogen/Progestin Replacement Study was supported by Wyeth. The Rotterdam Study was supported by the Research Institute for Diseases in the Elderly, funded by the Ministry of Education and Science and the Ministry of Health, Welfare and Sports, through the Netherlands Organization for Scientific Research.

To contact Douglas C. Bauer, M.D., call Eve Harris at 415-885-7277.
For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail mediarelationsjama-archives

“A technique that was popular in the past to treat chronic total occlusions of infrapopliteal arteries has been shown to still be a valuable technique in case of failure to recanalize the occlusion from antegrade,” Andrej Schmidt, MD of the Park hospital and Heart Center (Leipzig, Germany) told attendees at the 37th annual VEITHsymposium™ held at the Hilton Hotel (New York, NY).

Dr. Schmitdt went on to explain that access can be attempted to the anterior tibial artery or dorsalis pedis artery at any level, to the posterior tibial artery at the level of the malleolus and even to the peroneal artery at the distal third by penetrating the membrana interossea with a 7 cm 21 Gauge needle.

In case of a small or distal access artery a “sheathless approach” is performed by inserting a guidewire through the needle and inserting of a support-catheter or OTW-balloon over this wire directly through the skin. If a relatively large artery is punctured, usually the proximal anterior tibial artery, a 4F sheath can be inserted.

After passage of the occlusion from revascularization, the wire is snared from antegrade by manoeuvring the tip of the retrograde guidewire into an angled catheter coming from antegrade down, positioned proximal to the occlusion. Once the guidewire is pulled out of the proximal sheath, the balloon or support-catheter inserted into the foot-artery can be removed and reinserted from antegrade over the guidewire, which is now flossing once through the limb. Having pushed the balloon from antegrade through the CTO the guidewire can be removed from the pedal access and reinserted through the balloon from antegrade, now with the floppy tip directing downwards. While the balloon is inflated in the target lesion a second interventionalist is compressing the pedal puncture site for hemostasis.

In 101 cases of failed antegrade recanalization the retrograde attempt was successful in 95% of these cases. Follow-up angiography was performed in 69 cases to rule out an induction of a stenosis or occlusion of the artery at the access-site during follow-up. One occlusion (1.4%) of the access-artery was found after a mean FU time of 8.4 months. Limb-salvage rate after a FU of maximally 1100 days was 92%.

Dr. Schmidt concluded that the retrograde approach for popliteal to tibial occlusions, where an antegrade recanalization-attempt failed, is a valuable, highly successful and safe interventional option.

Source:

VEITHsymposium

Parity legislation that equalizes co-pays for mental health care with co-pays for other medical care will have no effect on seniors in Medicare-managed care plans, based on an analysis by Brown community health researchers. Other measures may be necessary to help more seniors get the care they need.

Despite the intent of recent mental health “parity” legislation, including the Affordable Care Act, even steep reductions in co-pays for outpatient mental health care will not motivate more seniors in managed care plans to seek that care, according to a new study by Brown University researchers.

Parity measures, included in laws passed in 2008 and 2010, end an insurance industry practice of charging higher co-pays for mental health care than for other care. While the laws will allow many seniors who undergo treatment to save money, said Amal Trivedi, professor of community health at Brown University, the new findings suggest that co-pays are not the main barrier to care.

In the study published online in the journal Medical Care, Trivedi and graduate student Chima Ndumele found that seniors did not start mental health care when co-pays dropped and did not quit when they rose.

“Less than half of people with a mental health condition actually seek mental health services,” said Trivedi. “The hope was that insurance parity and reducing co-pays would increase the number of people who would do so. We found that’s unlikely to be the case. At least for this population in managed care plans, rather large increases or decreases in co-pays have no effect on the likelihood of receiving any outpatient mental health care.”

A measurable non-effect

To perform their analysis, Trivedi and Ndumele combed through 252 Medicare plans with outpatient mental health services. They ultimately found 14 that raised co-pay rates by more than 25 percent in the last year of a three-year period, and that could be compared to plans that were similar except that they held co-pay rates constant. They also found three plans that lowered rates by more than 25 percent in a third year that could also be compared to comparable control plans that did not change their co-pay.

Among enrollees in the 14 plans that raised rates, an average of 2.2 percent used mental health services both before and after the increase. In the case of the plans that lowered rates, participation in mental health care held steady at 1.2 percent of enrollees, despite the discount. In both cases, the plans that did not change co-pays averaged a 0.1-percent drop in mental health service use. In short, mental health service use essentially remained unchanged no matter what happened to the co-pay.

The non-effect held true for almost every demographic breakdown of the enrollees, except that black seniors seemed to be motivated by reduced co-pays, increasing their participation in mental health care by almost a whole percentage point.

Barriers remain

Trivedi said at least a partial explanation for the tiny effect of co-pay changes is that other common insurance company policies may have a stronger effect on limiting use of mental health services for most seniors. Those policies include requiring prior authorization of care from primary care doctors and the insurer, and restricted networks of doctors approved to provide mental health care.

“The people who actually receive mental health services have already overcome these additional barriers to use of services,” he said. “If the plan had prior authorization or restricted network, it meant enough for them to go past those barriers. Putting in another co-pay increase didn’t dissuade them from receiving services.”

Similarly, Trivedi said, these policies are probably more of a barrier to seniors starting care than the level of the co-pay.

“Enacting parity is just one step in creating an environment in which individuals in need of mental health services will seek care,” added Ndumele. “Our study indicates that we must identify other steps beyond insurance parity to promote the appropriate use of mental health services among the elderly.”

The study was funded by the National Institutes of Health through a grant from the Minority Opportunities for Research (MORE) Division of the National Institute of General Medical Sciences.

Source:
David Orenstein
Brown University