Women always stop Latressa Fulton on the street to compliment her on her style. Her fashion trademark; interesting accessories that transform her classic wool pantsuits and jersey wrap dresses into unique looks. We asked the twentysomething medical-research coordinator and graduate student how she puts it all together.

Style influences: “My mother and godmother thought gloves should be worn to church, and that jeans were for hard labor only. Women in my family always dress. This has definitely affected my sensibility.”

Signature look: “I’m a girlie girl at heart. I don’t feel dressed unless I’m in heels. I love to accent basics with unusual color, texture or patterns, so my look is never predictable.”

Wardrobe staples: “Black suits, high-heeled leather boots, colorful blouses, pencil skirts, round-toe pumps. Also a good-looking bag to hold everything from school papers to makeup.”
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On her wish list: “A purple coat and tall white boots-sounds outrageous, I know. I probably won’t wear them together.”

Favorite places to shop: “I live in Loehmann’s and Banana Republic, and buy almost everything on sale. I pick up accessories when I travel. I’m still wearing jewelry I found years ago in Edinburgh, Barcelona, Cairo, Florence and Paris.”

Kenneth Cole leather tote with brass links, $298, (800) KEN-COLE.

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Liza Shtromberg rosewood bangle, $130, lizashtromberg.com.

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Fossil two-tone bracelet watch, $75, fossil.com.

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Miss Sixty wool coat, $549, Miss Sixty stores nationwide.

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Happy David for Bijux.com earrings, $65, bijux.com.

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New York & Company blouse, $37, (800) 853-2920.

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Ann Taylor wool crepe skirt, $98, (800) DIALANN.

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Aldo leather pumps, $150, aldoshoes.com.

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Moment by moment, a movie captures the action as a group of immune cells scrambles to counter an invasion of tuberculosis bacteria. Rushing to the site of infected lung tissue, the cells build a complex sphere of active immune cells, dead immune cells, lung tissue, and trapped bacteria. Remarkably, no lung tissue or bacterium was harmed in the making of this film.

Instead, each immune cell is a computer simulation, programmed to fight virtual tuberculosis bacteria on a square of simulated lung tissue. In their computer-generated environment, these warrior cells spontaneously build a structure similar to the granulomas that medical researchers have noted in human lungs fighting tuberculosis.

The simulation, created by Denise Kirschner of the University of Michigan in Ann Arbor, is an example of an emerging technique called agent-based modeling. This new tool in the world of medical research relies on computing power instead of tissues and test tubes. A growing cadre of researchers, including Kirschner, predicts that agent-based modeling will usher in a broadened understanding of complex interactions within the human body.

The agents in the models are individual players–immune cells in the tuberculosis example. Each player is programmed with rules that govern its behavior. Computer-savvy researchers then set the agents free to cooperate with, compete with, or kill each other. Meanwhile, the agents must navigate the surrounding environment, whose properties can vary over space and time.
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Scientists can manipulate disease progression within the models by changing the agents or their environment and then watching what happens. As opposed to traditional, biologically based in vivo or in vitro experiments, these computer trials are dubbed “in silico.” The results can suggest biological experiments to test the models’ findings and may eventually lead to new medical treatments.

Even simple rules assigned to agents can give rise to surprisingly complex behaviors. When many independent agents interact, they create phenomena–such as the granulomas–that can’t necessarily be predicted by breaking down the system into its separate components, says complex-systems specialist John Holland of the University of Michigan.

You’ve got to study the interactions as well as the parts,” Holland says.

In-silico modeling differs from traditional mathematical modeling, which uses differential equations to understand how molecules or cells behave in an averaged, continuous way. Instead, the agents of in-silico modeling make independent decisions in response to situations that they encounter. As a result, unusual activity of even a small number of cells can change the entire system’s behavior.

Computers can now calculate thousands of interactions with ease, says Alan Perelson of Los Alamos National Laboratory in New Mexico. “Agent-based modeling has only come into its own with the arrival of really powerful computers sitting on people’s desktops, within the last 10 or 15 years,” he notes.

Pioneered for economics and population-dynamics studies (SN: 11/23/96, p. 332; www.sciencenews.org/pages/ sn_arc99/4_10_99/mathland.htm), agent-based modeling has only recently plumbed the inner workings of the human body, Perelson adds. That’s partly because new imaging and genetic techniques are providing crucial data on which agents’ rules can be based.

“Agent-based modeling represents a new frontier with respect to how we do science,” says surgeon Gary An of Cook County Hospital in Chicago. “In medicine in particular, all the diseases that we’re now dealing with are complex problems: sepsis, cancer, AIDS. All these things are disorders of the system as a whole.”

INFLAMMATION SIMULATION An, whom Kirschner calls an in-silico “groundbreaker,” got into agent-based modeling to help people survive traumatic injuries and major infections.

A leading cause of death for patients in intensive care units, An explains, is a syndrome called systemic inflammatory response syndrome/multiple organ failure (SIRS/MOF), also termed sepsis when it occurs in response to an infection. In this syndrome, the body’s inflammatory response rages out of control after a severe injury or bacterial infection. Excessive inflammation can kill a patient by attacking and shutting down vital organs. More commonly, the runaway inflammation paralyzes the rest of the immune response, and the patient then dies of secondary infections.

During the 1990s, researchers performed clinical experiments in an attempt to develop drugs that dampen an overwhelming inflammatory response to injury, An notes. Only one drug, activated protein C, appeared to help patients with SIRS/MOF. An suggests that trials of other drugs failed because they were planned using data representing individual components of the inflammatory response rather than the interactions of the immune system as a whole.

An says, “It’s kind of a Humpty Dumpty syndrome, where after you break the system apart, you can’t put it back together.”

If medical scientists sometimes find it hard to recruit enough volunteers–especially Blacks–to participate in research studies, there may be a good reason, a new University of North Carolina at Chapel Hill study shows. A surprisingly high percentage of Americans surveyed–almost 80 percent of Blacks and 52 percent of Whites–were suspicious that they might be used as “guinea pigs” without their consent.

The first-of-its-kind study, conducted by a UNC School of Medicine investigator and colleagues, relied on data gathered in 1997 through a national telephone survey of 909 people sponsored by the Institute for Minority Health Research at Emory University. It showed that even after controlling for social and economic factors, Whites were not very trusting of doctors, and Blacks were even less so.

“Distrust has been proposed as one of the barriers to participation by minorities in research, but until now there haven’t been any studies to show how big that distrust might be or to substantiate racial differences,” says Dr. Giselle Corbie-Smith, assistant professor of social medicine and medicine at UNC. “For that reason, we tapped an existing database to see if there were differences by race and what might account for them.

“We found that in general, both Blacks and Whites distrusted medicine and medical research, but Blacks were significantly more likely to have high levels of distrust,” Corbie-Smith says. “Those differences didn’t go away when we controlled for factors that might influence them such as income and education.”

A report on the findings appeared in the Nov. 26 issue of the Archives of Internal Medicine, a journal published by the American Medical Association.

Specifically, Corbie-Smith and her colleagues found that 41.7 percent of Blacks and 23.4 percent of Whites did not trust their doctors to explain research participation fully. Almost 46 percent of Blacks and almost 35 percent of Whites felt their doctors exposed them to unnecessary risks when deciding on treatment.

Purpose: This study analyzed the number, type, and content of advance medical directives (AMD) presented by adult patients. Background/Significance: If an individual does have an AMD but it does not meet statutory requirements or is vague in describing the individual’s treatment preferences, complex issues can emerge when attempts are made to implement it. Methods: The AMD documents presented by patients admitted to critical care and medical-surgical units of a 600+ bed community teaching hospital over a 6-month period were reviewed by the investigator to determine type of document, compliance with statutory criteria, and specificity of content related to identification of advocate and treatment preferences. A data collection form was developed for the purpose of the investigation. Content validity was established by expert review. Results: Data revealed 14% of the patients reported having an AMD; however, only half reported bringing the document with them. The majority of documents (94%) met the statutory requirements for a patient advocate designation (durable power of attorney for healthcare). It was identified that 37% lacked information about how to contact the advocate, and 12% did not provide any clear treatment preferences. Coma, persistent vegetative state, and/or terminal illness were cited as criteria for limiting or withdrawing treatment in 86% of the documents that contained preferences. Approximately half of these also cited “quality of life” or “burdens” as additional criteria; however, personal values related to quality of life or burdens were not described. Conclusions: Although advance medical directives may meet statutory requirements, lack of information related to advocates, patient preferences, and/or personal values can limit the ability to interpret and apply the document. Increased efforts are needed to clarify the content of directives before emergencies occur and educate the community about the significance of clear, values-based directives.

Malaria kills more people each year than any other disease, but only 0.3 per cent of money alloted for medical research and development is spent on the sickness, a new report revealed.

The study of malaria research funding, published in the Independent, found “stark inequalities” between the amount of money spent on predominantly Western illnesses and diseases that kill millions every year in developing nations. The authors measured such disparities by comparing how many years of productive life are lost to a disease and the amount of money spent combating them. Although diabetes, for example, is three times less deadly than malaria, it gets six times more money in research and funding.

Like HIV/AIDS and TB, malaria is considered one of the major public health challenges in the world. According to Malaria Foundation International, more than 500 million people still suffer from the disease, while 2.5 billion people risk contracting it in 90 countries–particularly in developing nations. Children make up the vast majority of victims.

Microsoft boss Bill Gates recently promised $258 million in new grants to combat the disease through his charity, the Bill and Melinda Gates Foundation.

“It’s really a tragedy when the world has done so little to stop this disease that kills 2,000 African children every day,” Bill Gates told the Associated Press. “If those children were in rich countries, we would have headlines, we’d take action.”

A Coast Guard Maritime Security and Safety Team, acting on a tip from a law enforcement agency, stakes out the water around a nuclear power plant. Suddenly, the Integrated Anti-Swimmer System detects a swimmer stealthily approaching. When a verbal warning delivered by an underwater loudspeaker does not halt the diver’s progress, bursts of high-pressure air delivered through a submerged air gun create powerful low frequency impulses that cause disorientation and physical pain. The diver, startled and hurt, immediately surfaces and is captured, thus thwarting a planned terrorist attack.

Scientists from the Naval Submarine Medical Research Laboratory (NSMRL) were involved in the development and evaluation of these terrorist-thwarting devices. The lab provided many of the design parameters and performed much of the testing for the various components of the Integrated Anti-Swimmer System and the related Diver Interdiction System.

NSMRL’s Dr. Ed Cudahy has studied the human bioeffects of underwater sound for many years to protect our fleet and Special Operations Forces (SOF) divers. In the last three years, he has applied his vast knowledge to evaluating and validating various elements of potential non-lethal anti-swimmer systems for safety and tested the effectiveness of deterrent sounds for the Joint Non-Lethal Weapons Directorate, Coast Guard and Navy.

The impact of this work is enhancing our nation’s homeland defense and the protection of our nation’s military assets. These are just two examples of the myriad operational applications of the research conducted at this Navy Medicine laboratory, located a few hundred yards from the waterfront at Submarine Base New London, Groton, Conn. Why is NSMRL, whose mission is to protect the health and enhance the performance of our warfighters through focused submarine, diving and surface research solutions, on the frontlines of the global war on terrorism (GWOT)? One must look at our history for the answer.

A Proud History

In 1942, the Medical Research Section of the U.S. Submarine Base New London dispensary was tasked to provide “answers to problems in communications, vision, personnel selection, and environmental medicine which resulted from wartime demands on the submarine force.” Because of the critical importance of submarines during World War II, the lab’s work quickly expanded to include studies on night vision, color vision and lookout training.

A Brave New World

To the Editors of American Demographics:

I work for a company that sells umbilical cord blood and stem cell collection services. From the information we gathered, we believe there are approximately 4 million births a year. It would be very helpful in our marketing efforts to expectant mothers if we knew what percentage of these births were to women over the age of 30, and even more helpful if we could further break down this group by household income levels. Thank you for your consideration.

Dan Boerger

President

Advantage Direct Marketing

Berwyn, Pa.

Dear Dan:

Your inquiry could not have come at a more newsworthy time. In fact, it arrived just as President Bush was calling for more funding of scientific research using stem cells from sources other than human embryos, such as umbilical cord blood.

Now, to answer your question: In July, the Centers for Disease Control (CDC) released preliminary birth data for 2000, which confirms your figure for the number of new births. Indeed, last year there were 4.1 million births, about 106,000 more births than in 1999. Women ages 30 and older gave birth to 36.3 percent of the babies born in 2000, up slightly from 35.7 percent in 1999. Moreover, the CDC reports that in 2000, birth rates (the number of births per 1,000 women) for women ages 30 and older rose to their highest levels in 30 years. Currently, there are 94.2 births per 1,000 women age 30 to 34; 40.3 for women 35 to 39; 7.9 for women age 40 to 44; and 0.5 for women age 45 to 54.

For the income breakdown, we turned to the 2000 Current Population Survey’s (CPS) Fertility of American Women study. Of course, the numbers you desire are not available in a nice, easy-to-read report, so we got crunching. According to American Demographics’ analysis of CPS data on women ages 30 to 44 who gave birth in the past year, 10 percent came from families with an annual income of less than $15,000; 14 percent had incomes between $15,000 and $29,999; 19 percent earned between $30,000 and $49,999; and 23 percent took home between $50,000 and $74,999. The largest share of this population (34 percent) had a combined annual household income of $75,000 or more. That’s what you would call a “sugar mommy.”

The American public is concerned about the fact that many physicians and scientists have financial ties to the drug and device industries, and most people want the news media to do a better job disclosing these ties whenever experts are quoted. These results from a survey conducted by the Center for Science in the Public Interest (CSPI) led this advocacy group to convene a recent conference in Washington, DC, entitled, “Conflicted Science: Corporate Influence on Scientific Research and Science-Based Policy.” The speakers were primarily researchers and investigative journalists who have written articles about this topic which has become the focus of mounting concern for editors of medical journals.

Michael Jacobson, CSPI’s executive director, set the tone for the conference: “The corporate world seeks to influence science and science policy at many different levels, from the sponsorship and design of university research to the creation of scientific journals; from placing sympathetic scientists on federal and international advisory committees to generating publicity in the mass media; from influencing major health charities to creating their own friendly nonprofit organizations.” Jacobson said, as he turned the program over to the speakers, that he had asked them not just to express their concerns, but also to suggest remedies.

Passive smoking is one major area followed by Lisa A. Bero, PhD, Center for Tobacco Control Research and Education, University of California, San Francisco. “Researchers funded by the tobacco industry were nine times more likely to find no relationship between ill health and passive smoking,” she found. When a 1981 study showed a link between lung disease and nonsmoking women living with smokers, Dr. Bero said that the tobacco industry created its own study to refute it. For example, the industry funded studies that found ill effects of other sources of indoor air pollution to distract from the importance of secondhand smoke, reported Dr. Bero. Another tactic is to simply create doubt in the media about the studies that showed adverse health effects associated with smoking and to characterize such findings as “controversial.”

Moment by moment, a movie captures the action as a group of immune cells scrambles to counter an invasion of tuberculosis bacteria. Rushing to the site of infected lung tissue, the cells build a complex sphere of active immune cells, dead immune cells, lung tissue, and trapped bacteria. Remarkably, no lung tissue or bacterium was harmed in the making of this film.

Instead, each immune cell is a computer simulation, programmed to fight virtual tuberculosis bacteria on a square of simulated lung tissue. In their computer-generated environment, these warrior cells spontaneously build a structure similar to the granulomas that medical researchers have noted in human lungs fighting tuberculosis.

The simulation, created by Denise Kirschner of the University of Michigan in Ann Arbor, is an example of an emerging technique called agent-based modeling. This new tool in the world of medical research relies on computing power instead of tissues and test tubes. A growing cadre of researchers, including Kirschner, predicts that agent-based modeling will usher in a broadened understanding of complex interactions within the human body.

The agents in the models are individual players–immune cells in the tuberculosis example. Each player is programmed with rules that govern its behavior. Computer-savvy researchers then set the agents free to cooperate with, compete with, or kill each other. Meanwhile, the agents must navigate the surrounding environment, whose properties can vary over space and time.

Scientists can manipulate disease progression within the models by changing the agents or their environment and then watching what happens. As opposed to traditional, biologically based in vivo or in vitro experiments, these computer trials are dubbed “in silico.” The results can suggest biological experiments to test the models’ findings and may eventually lead to new medical treatments.

Even simple rules assigned to agents can give rise to surprisingly complex behaviors. When many independent agents interact, they create phenomena–such as the granulomas–that can’t necessarily be predicted by breaking down the system into its separate components, says complex-systems specialist John Holland of the University of Michigan.

Women always stop Latressa Fulton on the street to compliment her on her style. Her fashion trademark; interesting accessories that transform her classic wool pantsuits and jersey wrap dresses into unique looks. We asked the twentysomething medical-research coordinator and graduate student how she puts it all together.

Style influences: “My mother and godmother thought gloves should be worn to church, and that jeans were for hard labor only. Women in my family always dress. This has definitely affected my sensibility.”

Signature look: “I’m a girlie girl at heart. I don’t feel dressed unless I’m in heels. I love to accent basics with unusual color, texture or patterns, so my look is never predictable.”

Wardrobe staples: “Black suits, high-heeled leather boots, colorful blouses, pencil skirts, round-toe pumps. Also a good-looking bag to hold everything from school papers to makeup.”

On her wish list: “A purple coat and tall white boots-sounds outrageous, I know. I probably won’t wear them together.”

Favorite places to shop: “I live in Loehmann’s and Banana Republic, and buy almost everything on sale. I pick up accessories when I travel. I’m still wearing jewelry I found years ago in Edinburgh, Barcelona, Cairo, Florence and Paris.”