In a recent article, Lisa Lacy at ClickZ analyzes the U.S. Census Bureau's use of social media in its public relations campaign. Since the census is only conducted once every 10 years, this marks the first time that social media has played such a large part in the process of trying to count the estimated 300 million people who live in the U.S.
The Census Bureau has a presence on all of the major sites — Facebook, Twitter, MySpace, YouTube, Flickr — as well as its own blog. Critics of the Bureau's efforts think the agency should have focused on one rather than spreading itself so thin.
[Keva Silversmith, public affairs specialist with the Census Bureau …] has found Twitter to be a great resource for engaging in conversation and disseminating facts, but notes it is difficult to boil down answers to 140 characters. As a result, it must often provide links to Web sites where more detailed explanations can be found. On the other hand, Twitter has enabled the Census Bureau to respond in real time to concerns like wasted money on its Super Bowl ad.
Another strong reason for the social media efforts is to reach 18- to 24-year-olds who are hard to count since they are "unattached mobiles," i.e., primarily renters and/or college students. "This group lives a lot online and in social media and this is a great opportunity for us to reach these folks," Silversmith said.
Image by swanksalot, used under its Creative Commons license.


With the development of the network communications, the optical fiber as a medium used in the integrated cabling systems to transmit data is used by more and more people, because of its advantages such as large transmission rate and distance. It is well known that optical fiber has no electrical conductivity and can prevent from impact current. Fiber optic cables have good protection performance, and the metal components of cable's insulation value is so high that lightning current can not enter the cable easily. However, because fiber optic cable has strengthened core, especially the direct-buried fiber optic cable has armoring layer, thus when the optical fiber cable line experience lightning, the cables might be destroyed or damaged. And this blog talks about the main measures of lightning protection in fiber cabling.
Station Grounding Method: the metal part of the cables in the joints should be all connected to make sure the strengthened cores, moistureproof layers, and armoured layers are in connected state in the relay cable lines.
Electrical Disconnect Treatment should be done in the cable tapping of moistureproof layers, armoured layers and strengthened cores, and do not connect the ground for the insulation status. This method can avoid the accumulation of induced lightning current in the cables. Also, it can avoid lightning current enetr in the cables by grounding devices, which is caused by the difference of loop impedance to ground between the lightning discharge flow and the cables' metal components.
Aerial fiber optic cables should be electrical connected and connected to the ground every 2 km. The grounding can be directly done or or by suitable surge protection devices.
After fiber optic cables enter the fiber optic terminal boxes, the boxes should be connect to the ground so they can rapidly release the lightning current to realize the protection when the lightning current enter the fiber optic cables' metal layers. When using direct-buried fiber optic cables with armoured layers and strengthened cores, the polyethylene outer sheath can be effectively anticorrosive and prevent from rat bites as well as the lightning stroke.


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Aquaculture Reform
By: Amanda Douglas
The Bill is aimed at removing current constraints on the growth of the aquaculture industry, given that no new aquaculture space has been created under the regime put in place in 2004. Currently, aquaculture activities may take place only within aquaculture management areas identified in regional coastal plans. The government considers that the existing system is overly complex, and offers poor incentives for councils and industry to plan for and invest in aquaculture.
The Bill removes the requirement for aquaculture management areas, so that applicants may apply directly for resource consent in any part of the coastal marine area, subject to the provisions of the relevant regional coastal plan.
However, the Bill also contains a requirement that no rule may be included in a regional coastal plan which authorises, as a permitted activity, any aquaculture activity in the coastal marine area. For regional coastal plans which already contain such rules, a review to change those rules in order to comply with this requirement must be initiated within 2 years of the section coming into effect.
Replacement Consenting Made Easier
A new clause 88(2B) is to be inserted, which provides that the assessment of effects on the environment accompanying an application by an existing permit holder (where that permit holder obtained the coastal permit to occupy space for aquaculture activities after 1 January 2005) need only relate to information about the effects of the activity and changes to the environment that mean that the effects of the activity are no longer the same or similar in character, intensity, or scale to those anticipated at the time the original consent was granted. This change will make the process for obtaining a replacement coastal permit to undertake an aquaculture activity considerably less onerous than is currently the case.
Currently, the Act provides that a consent authority, when considering an application by an existing permit holder for further occupation of coastal marine area space for aquaculture activities, must take into account the applicant's conduct in relation to the use of current industry good practice for any current aquaculture activities. The Bill deletes that requirement.
Link with Ministry of Fisheries Process
A new process is to be created whereby the making of an aquaculture decision (either a determination or a reservation) by the Ministry of Fisheries is linked to and follows on from the process of obtaining a coastal permit for an aquaculture activity from the resource consent authority.
Where an application for a coastal permit authorising aquaculture activities to be undertaken in the coastal marine area is lodged with a consent authority, the authority must copy the application to the Ministry of Fisheries, as well as any information or report obtained under section 42C, 42A, 92 or 149, and copies of any submissions received. Once the consent authority makes its decision, that must also be copied to the Ministry. The applicant is to be advised that the consent authority's decision is still subject to an aquaculture decision by the chief executive of the Ministry of Fisheries, so that the decision will not commence until after that further process has taken place (in accordance with new section 116A).
If the chief executive makes a determination is made in relation to the permit, that may result in additional conditions being imposed on the permit. If the chief executive makes a reservation, then the coastal permit may be amended to remove the areas affected by the reservation, and cancelled to the extent that it applies to the removed areas.
20 Year Minimum Term of Consent
A new section 123A provides that a coastal permit authorising aquaculture activities to be undertaken in the coastal marine area must not be granted for a period of less than 20 years from the commencement date, unless the applicant has requested a shorter period, or a shorter period is required to ensure that adverse effects on the environment are adequately managed. The current upper limit of 35 years remains under section 123A(3).
Shorter Lapsing Period
An amendment is made to section 125, which is the section that provides that a resource consent lapses 5 years from the date of commencement unless it is given effect to, or unless an application for extension of the lapsing period is made, before the consent lapses. The amendment provides that, for consents which authorise aquaculture activities to be undertaken in the coastal marine area, there is a shorter lapsing period of 3 years from the date of commencement.
Allocation Methods
A new procedure will provide for ministerial approval of the use, by regional councils, of methods for allocating aquaculture authorisations. Where it is the regional council's opinion that it is desirable, due to actual or anticipated high demand or competing demands for coastal permits for occupation of space in the coastal marine area for the purpose of an activity or activities, that an allocation method be used to allocation authorisations for the space, the regional council may request the Minister of Conservation to approve allocation (by public tender or another method) of authorisations for space in the coastal marine area. The request must be publicly notified.
Where a request has been made, then no person may apply for a coastal permit to occupy any space that is the subject of the request for the purpose of the activity in the request while the request is being processed and a decision made.
As the clause is drafted, the high or competing demand for coastal permits for occupation need not arise from aquaculture activities in order to enable a request to be made. If that demand arises from "an activity or activities", the regional council may request the use of an allocation method. The request must state the activities it is proposed the public tender or allocation method will apply to.
The stay on applications while the request is being processed only prevents applications for the activity specified in the request being lodged. It would seem that other activities which are proposed to take place in the space specified in the request, and which may be competing for space with the specified activities in that space, may be the subject of an application while a request is being processed.
The Minister may approve the request on the terms specified in the request, or approve it on terms that, in the Minister's opinion, will better manage the actual or anticipated high demand or competing demands in the space, or decline the request. There is no right of appeal against the Minister's decision provided for by the legislation, and the Bill requires any application for judicial review of the Minister's decision to be lodged within 15 working days notification of the decision.
If the Minister approves the method for allocation authorisations, then during the period that the approval is in force, no person may apply for a coastal permit authorising occupation of the space for an activity covered by the approval unless the person is the holder of an authorisation that relates to that space and activity. However, it appears to remain open for a person to apply for a coastal permit authorising occupation of the space for an activity which is not covered by the approval, whether or not that person holds an authorisation.
The Minister of Aquaculture may suspend the receipt of application for coastal permits authorising aquaculture activities to be undertaken in the coastal marine area, in response to a request by a regional council, and only if the Minister is satisfied that suspension is necessary or desirable because of actual or anticipated high demand or competing demands, and the existing methods are not adequate to deal with that.
The Minister of Aquaculture may also direct a consent authority to process and hear together applications for coastal permits authorising aquaculture activities to be undertaken in the coastal marine area. Such a direction does not need to have been initiated by a request from the regional council, and the section does not specify any matters about which the Minister must be satisfied prior to making such a direction.
Regional Coastal Plans May be Amended by Regulation
The Bill enables the Governor-General, by Order in Council, to amend provisions in a regional coastal plan that relate to the management of aquaculture activities in the coastal marine area. Any such regulations must be made on the recommendation of the Minister of Aquaculture, after consultation with the Minister of Conservation, the regional council that will be affected, and others with whom the Minister of Aquaculture considers it appropriate to consult.
Before making the recommendation, the Minister must be satisfied that
the proposed regulations are necessary or desirable for the management of aquaculture development in accordance with the Government's policy for aquaculture in the coastal marine area;
the matters to be address are of regional or national significance;
the amended plan will continue to give effect to any national policy statement, New Zealand coastal policy statement, and any regional policy statement; and
the amended plan will not duplicate or conflict with any national environmental standard.
However, there is no requirement for the Minister of Aquaculture to carry out an evaluation under section 32 of the Act, prior to making a recommendation.
This procedure does not enable any person to make a submission on the proposed changes to a regional coastal plan, nor provide any ability to appeal the Minister's decision, although judicial review of the decision remains possible.
Regional Coastal Plans Amended by the Amending Act
The Amending Bill contains, in schedules 2 and 3, extensive amendments to the proposed Tasman regional coastal plan and the Waikato regional coastal plan respectively.
It is a very unusual step to amend plans through legislation in this manner, as it removes the ability for persons affected by and interested in the plan to have input to the plan-making process (apart from making a submission on this Bill), and also removes any ability to appeal the new provisions of the plan to the Environment Court.
Extension of Time for Considering Imposition of Coastal Occupation Charges
Currently, section 64A requires regional councils, when preparing or changes regional coastal plans, to consider matters relating to the imposition of coastal occupation charges. Sections 401A(3) and (4) suspended the requirement to comply with section 64A until 1 July 2007. The Bill amends those sections by extending the suspension period until 3 years after the commencement of the Amendment Act.
The Bill also contains some amendments which apply to all resource consent processes, and are not confines to aquaculture applications.
Discounting on Resource Consent Applications
Section 36AA is amended. That section provides for local authorities to discount their administrative charges where the Act's timeframes for resource consent processing have not been met, and the responsibility for that failure rests with the local authority.
Currently, section 36AA(1) states that a local authority may provide a discount on an administrative charge imposed under section 36 in accordance with regulations made under section 360(1)(hj). The amendment tightens this up, so that a local authority must provide a discount on an administrative charge imposed under section 36 in accordance with -
(a) regulations made under section 360(1)(hj); or
(b) any policy it has adopted under subsection (3), if the policy is more generous than that provided for in the regulations.
The current wording allows an argument to be made that discounting of administrative charges is optional, whereas the amendment would make discounting mandatory, on a basis at least as generous as provided for in the regulations.
Who may be given Hearing Authority?
Section 39B, which is the section setting out which persons may be given hearing authority, is amended by the Bill.
The scope of the existing section is expanded to include hearings on council-initiated plan changes.
The amended section will require all of the persons on a hearing panel to be accredited, whereas the current provisions only require the chair of a hearing panel to be accredited.
There is an exemption for exceptional circumstances that do not provide the time or opportunity to ensure that all persons in the group are accredited. Sometimes it is necessary or desirable to appoint a decision-maker with particular technical expertise to a panel, and where the pool of suitably qualified experts is small, it may not be possible to appoint somebody who has carried out the accreditation course.
If enacted in its current form, this amendment would not come into force until 2 years after the date on which the Bill receives the Royal assent. This should enable any districts and regions which are currently operating with a substantial number of unaccredited hearing members to have their decision-makers accredited before the amendment takes force.
Activity Status for Prohibited Activities in Proposed Plans
Section 87A(6) is amended to correct a drafting error. That section currently provides that, if an activity is described in the Act, regulations, a plan or a proposed plan as a prohibited activity, then no application for a resource consent may be made for the activity; and the consent authority must not grant a consent for it. That was inconsistent with section 87B(1)(c), which stated that an application for a resource consent for an activity must be treated as an application for a resource consent for a discretionary activity if a rule in a proposed plan describes the activity as a prohibited activity and the rule has not become operative. The amendment corrects the inconsistency by removing the phrase "or proposed plan" from section 87A(6).
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This is a "considerable failure" of the legal services market to meet the needs of small businesses, a major lobbying group has told the Competition and Markets Authority (CMA).
The Federation of Small Business (FSB), which has 200,000 members, welcomed the CMA's investigation into the market as "the first step along the road to a better commercial legal services sector fit-for-purpose for small businesses".
In its response to the CMA's call for evidence, the FSB said the barriers small businesses face in resolving legal problems were "numerous", starting with difficulties in recognising whether the issue they faced was a one amenable to resolution through the law in the first place.
Even when they did, the FSB said the instinct of small businesses was to avoid using formal legal services and instead rely on informal advice, solve the problem themselves or use "existing trusted partners such as their accountants".
Perceptions about the risks of taking a legal route "often turn small businesses away at this stage of the 'consumer journey'", it continued. These included "high and uncertain costs", complexity and associated fear and time commitments, the risk of escalation, difficulty in identifying the right provider, and "the perceived lack of practicality and understanding of business by lawyers".
And even when businesses still press ahead, they faced problems with "evaluating the quality and range of the legal services providers available and to identify and choose the very best options".
The FSB said: "The sector is lacking in many of the elements of a mature market including the provision of clear, usable comparative data for consumers about value-for-money, specialisation etc." Further, it could be difficult to identify the return on the purchase of a legal service.
The lobbying group said these demand-side barriers were "compounded by supply-side issues such as the lack of transparency about providers and products in the market and consequently high search and information costs".
These included pricing. The FSB said it was "often not provided upfront", and only after a consultation. "This approach prolongs the search process generating considerable sunk costs for a small business and increasing the search costs of looking around the market for alternatives.
"It is time-consuming for a business owner to have to go through numerous initial consultations just to compare prices.
"While there is evidence that fixed fees are becoming more common in part through the unbundling of services, the extent to which these have spread to commercial legal services is not clear.
The FSB also backed arguments from the Legal Ombudsman (LeO), that it should be able to deal with complaints about unregulated firms.
The FSB said it was "not always clear" who was regulated and who was not, and the CMA "should consider the case" for giving micro-businesses access to LeO.
"It is better and more efficient if potential purchasers of legal services can avoid the poor-quality providers in the first place. This requires useable information on the quality of providers to be more readily available to potential buyers.
LeO argued earlier this month in its latest draft strategy, that the government review of the Legal Services Act needed to give clients of unregulated providers access to its service so as to close off a "competitive advantage" enjoyed by those that are regulated.
Meanwhile, a report by Citizens Advice on the experience of litigants in person (LiPs) in the family courts has highlighted the problems people have understanding and trusting lawyers.
"They spend large sums of money on services they neither understand or trust. Distrust of lawyers is exacerbated by stories in the media about 'fat-cat' lawyers who overcharge and underdeliver. It is these frustrations with lawyers' methods that can cause people to take matters into their own hands." At the same time, the report found that many people subsequently realise the value of having a lawyer.
The report identified eight ways to improve the process of going to the family court alone, including the need for "more information to make the most of lawyers' services".
I would have thought the FSB are in the best place to do something about it – if not only to provide extra value to its members. Research the market. Create a panel. Preferential rates for members.
Instead – moan about it.
There is a solution out there- us! I've written to the FSB saying that a low cost package, costs-up-front service is out there: LawPlan by Stormcatcher Law; I'd be happy to point anyone in the right direction. From £49 a month, no catch. Sadly the majority don't know we're out there- let's hope we can grow to give more members the benefit.


American society places a lot of value in the lone maverick, scraping and scrapping his way to the top. But in reality, no one reaches success without the help of others. Unfortunately, many people don't ask for help, either because they're afraid they'll be perceived as weak or unknowledgable or because they fear rejection. However, to reach your goals in your business and/or career, learning to seek and ask for help will be crucial to your success. Here are tips to asking for help.
Why aren't you asking? Before you can ask for help, you need to figure out what's stopped you in the past. Are you a diehard do-it-yourselfer? Are you worried what others will think? Are you afraid you'll be told 'no'? Whatever the reason, find ways to overcome those limiting thoughts. Achieving success means getting out of your own way and stepping outside your comfort zone.
What is you want specifically? If you're not clear on what you want, it will be difficult for others to help you get it. Let potential helpers know specifically the kind of help you need. For example, are you looking for a partner on a joint venture?
Prepare and practice. Whether you're making a formal or an informal request for help, prepare your ask before hand and practice it. If you stumble and mumble through your pitch, people won't think you've thought your goal through. People like to help others who are confident and clear in their goals.
Enlist the help of your network. Once you know what you need and are prepared to ask for help, begin with your network. Even if members of your circle of friends and colleagues can't help you, they may know others who can.
Be grateful. Show gratitude for help you get. Send a thank you note and offer to help in return. Gratitude and goodwill go a long way in manifesting more help and support for your endeavor.
No one achieves success in a vacuum. While it does take hard work and commitment, it also requires the help and support of others. Don't be afraid to ask for what you need.


To say that Washington Capitals forward Martin Erat's season has been frustrating might be an understatement. The 12-year-veteran has yet to score (though his 21 assists without a goal would set an NHL single-season record for forwards if the season were to end today) and a lack of clarity regarding his role led him to publicly ask for a trade in November, a request that has gone unfulfilled.
Yet Erat received some good news on Tuesday when it was announced that he will replace injured St. Louis Blues forward Vladimir Sobotka on the Czech Republic roster for the upcoming Winter Olympics.
According to Czech Republic coach Alois Hadamczik, Erat was the most logical choice to replace Sobotka, who injured his left leg this past weekend.
"We've counted with Vladimir Sobotka as a top two-way forward, he is extraordinary on defense," Hadamczik said. "After he got injured, we had to find similar kind of a player and Martin Erat is best in defense among all candidates."
The unexpected invitation (perhaps in more ways than one considering his season to date) came at an interesting time for Erat, who is expecting his second child with wife Vera on Feb. 25, two days after the gold-medal game in Sochi. The 32-year-old, however, did not hesitate when asked to join the Olympic team.
As for his play on the ice, Erat, who was a healthy scratch five times in January, has recently been provided with the kind of opportunity that he expected to receive upon his arrival from the Nashville Predators last season.
With injuries beginning to mount among Washington's forwards, Erat has been skating alongside fellow Olympians Nicklas Backstrom and Alex Ovechkin on the first line and will do so again on Tuesday against the New York Islanders. That, plus a two-week hiatus from his uneasy situation with the Capitals, may serve to rejuvenate him.
"His job is to be professional about it but in saying that it's hard every day mentally. I think it affected him at times," coach Adam Oates said, referring to Erat's unhappiness in Washington. "I know I talked to his agent about two weeks ago and talked to him about in terms of no matter what happens, he's got to try and be as emotionally involved in every game that you can.


The 12th Personalized Medicine World Conference (PMWC) and the first on the East Coast of the United States was held May 24-25 at Duke University in North Carolina, and featured major biotech and medical figures from around the world. The meeting was opened by Program Co-Chair Ralph Snyderman, MD, Chancellor Emeritus, Duke University, James B. Duke Professor of Medicine, Duke University Medical School, and Director of the Duke Center for Research on Personalized Health Care. Dr. Snyderman said that with the completed sequencing of the human genome in 2003, there was a vision that health care would be transformed by new technologies and genomic advances, and that already remarkable progress has been made toward extending the healthy living and longevity of every person. He highlighted the strengths of Research Triangle Park and compared it favorably with Silicon Valley, particularly with respect to innovation. He paid tribute to the meeting co-hosts: Duke, Duke Health, Johns Hopkins University, Intermountain Healthcare, and UCSF, and then called upon Tal Behar, Co-Founder and President of PMWC International to say a few welcoming words to the over 400 meeting registrants. Tal said the PMWC was thrilled and honored to be at Duke for the first East Coast PMWC meeting and she thanked the meeting co-chairs, Dr. Snyderman and Geoff Ginsburg. MD, PhD, Professor of Medicine and Director of the Duke Center for Applied Genomic and Precision Medicine, for their efforts in organizing this truly spectacular meeting. She wished everyone two very productive days and then called on Dr. Ginsburg to make a few opening remarks. Dr. Ginsburg emphasized that precision medicine involves the convergence of many fields and focuses on the centrality of the patient. He noted that the drive to convergence requires productive collisions and he hoped that productive collisions at this meeting would provide the spark to make precision medicine a reality. Dr. Ginsburg then introduced Duke's Mary A. Klotman, MD, Chairman of the Department of Medicine, and Dean-Elect of the Duke University Medical School. She raised the question of how to move the drive of quantitative science into the clinic, and she noted that this meeting is part of a critical revolution of learning that will help harness the power of precision medicine to change health.
Next, Dr. Snyderman returned to the podium to introduced a highly honored guest, North Carolina Governor Roy Cooper(D), who took office in January 2017. After noting that Governor Cooper, had strayed briefly by getting his undergrad and law degrees just down the road at the University of North Carolina, Dr. Snyderman applauded the Governor's stances on health, education, diversity, and the common good. In particular, he noted that Governor Cooper has appointed a cabinet that is the most diverse in state history.
The Governor came forward and graciously thanked Dr. Snyderman and Tal Behar for their efforts and he warmly welcomed the over 400 attendees to an epicenter of health and medicine and hoped they would come back for years to come. He noted that 10 million people live in North Carolina and that he works for all of them—with particular concerns for better education, better health, and the opportunity to live more abundant and purposeful lives. One of his goals is to make North Carolina one of the top ten educated states by 2025. He mentioned his plans for Smart Start for early education and his plans to develop free community colleges. He emphasized the need to invest in mental health, particularly for substance abuse problems such as opioid addiction which is a huge problem in North Carolina. He said "we can't arrest our way out of this problem." He mentioned tha RTP has been the home of many cutting-edge discoveries, including taxol and AZT . He intends to keep encouraging this kind of innovation to improve the lives of everyday North Carolinians. He said we should work together to build better lives for everyone and he expressed his admiration and thanks to everyone for coming to North Caolina.
Next, Dr. Snyderman introduced NIH Director Francis Collins (photo), MD, PhD, as "the most important scientist in the biomedicine field in the last 20 years," who has been responsible for many spectacular advances, including the positional cloning of the cystic fibrosis gene. While Dr. Collins was Director of the National Human Genome Research Institute, he led the public Human Genome Project, that culminated in the complete sequencing of the human genome, an amazing feat that opened our eyes for the first to predictive rather than reactive medicine. In 2009, Dr. Collin became Director of the NIH, where he has beeni involved in the launching of many major programs, including the Brain Initiative, the Cancer Moonshot, and the Precision Medicine Initiative, which is now called the All of Us program.
In terms of patient enrollment, Dr. Collins said that 15,000 individuals should be enrolled by the time of beta testing of the system in a month or two. By the end of 2017, a total of 32,000 should be enrolled, and by 2012, the goal of 1 ,000,000 volunteers should be reached. Volunteers may join up online at https://www.joinallofus.org/. Dr. Collins then showed a brief moving video on the significance and potential impact of the All of Us program and this video is available on the All of Us web site.
The next speaker was Dr. Ginsburg who spoke on "Implementing Genomics into Medicine--Locally, Nationally, and Globally." He began by emphasizing the importance of constructive implementation and cited two examples of major projects for which implementation had not been successful and those were the Framingham Study and the lung cancer EGFR test. He noted the quote "Vision without implementation is hallucination," and stressed the importance of implementing the findings of precision medicine down to the patient level in the clinic. He highlighted the IGNITE (Implementing Genomics in Practice network (https://ignite-genomics.org/), the North Carolina Precision Health Collaborative (NCPHC) (http://www.ncbiotech.org/Precision-Health), and the Global Genomic Medicine Collaborative, as highly promising precision medicine projects underway now.
IGNITE is an NIH-funded network dedicated to supporting the implementation of genomics in healthcare. The network is comprised of six research sites, a coordinating center, a steering committee, and working and interest groups. The National Human Genome Research Institute and an external scientific panel provide oversight for all network activity. The six research sites are Duke University School of Medicine, University of Florida College of Pharmacy, Icahn School of Medicine at Mount Sinai, Vanderbilt University School of Medicine, Indiana University School of Medicine, and the University of Maryland School of Medicine.
The NCPHC has the vision of advancing transformative, data-driven precision health and its mission is to accelerate collaborative initiatives that foster research, enable providers, engage industry, and empower citizens to improve health outcomes and optimize resource utilization in North Carolina.
The Global Genomic Medicine Collaborative (G2MC) is an action collaborative among global leaders in the implementation of genomic medicine in clinical care. Arising from the 2014 Global Leaders in Genomic Medicine Summit, the purpose of G2MC is to identify opportunities and foster global collaborations for enabling the demonstration of value and the effective use of genomics in medicine. Engaging multiple stakeholders across the globe, the G2MC group seeks to improve global health by catalyzing the implementation of genomic tools and knowledge into health care delivery globally. To accomplish these goals, seven working groups were created, including communications, education, evidence, IT/bioinformatics, pharmacogenomics, policy, and a steering group to guide and support efforts among working groups. Dr. Ginsburg noted that the G2MC now includes over 50 nations around the world.
Charles Perou, PhD, Professor of Molecular Oncology of the Lineberger Cancer Center at the University of North Carolina, spoke next on precision medicine studies in breast cancer and lung cancer. Dr. Perou's lab has done major work in the genomic characterization of tumors, which resulted in the identification of five intrinsic subtypes of breast cancer. This gene expression-based classification was the first to identify the basal-like/triple-negative breast Cancer (TNBC) subtype, which has been translated into a test that is being used in the breast cancer clinic worldwide. Dr. Perou noted that, in cancer, it is necessary to look at multiple features and he said that his lab is currently using a variety of experimental methods on tumor specimens include RNA-sequencing (RNA-seq), DNA exome sequencing, whole genome sequencing (WGS), cell/tissue culturing, and proteomics, with a special focus on the basal-like/TNBC subtype. He also spoke of studies of lung cancer and the need to consider genomic data and pathology when assigning a cancer risk score.
The next speaker was Vandana Shashi, MD, a pediatric medical genetics specialist and Professor of Pediatrics at Duke. Dr. Shashi spoke on "Undiagnosed Diseases: Resolving One Diagnosis at a Time." She began by saying that rare, difficult-to-diagnose diseases, while rare on their own, are not rare at all when considered in aggregate, with 10% of the US population or 30 million people affected by these diseases. She added that as much as 80% of these diseases have some genetic basis. She then described the Undiagnosed Diseases Network (UDN) (https://undiagnosed.hms.harvard.edu/). This is a research study that is funded by the National Institutes of Health Common Fund. Its purpose is to bring together clinical and research experts from across the United States to solve the most challenging medical mysteries using advanced technologies. Through this study, members hope to both help individual patients and families living with the burden of undiagnosed diseases, and contribute to the understanding of how the human body works. Among the participating sites are Duke, Stanford, UCLA, Vanderbilt, Harvard, and Mass General. The theme of the UDN is "Solving Medical Mysteries through Team Science." Dr. Shashi gave a few examples of where work through the network had led to profound and life-saving insight into dire rare diseases of children. In one case, a 20-month-old young girl in deteriorating condition was found, by whole exome sequencing, to have a mutation in a riboflavin transporter gene. Dr. Shasta administered high-dose riboblavin (1500x the normal dose) to the girl and she is now two years into the treatment and doing well. Dr. Shashi is a member of the North Carolina Rare Disease Advisory Council for the North Carolina Rare Disease Network (http://www.med.unc.edu/ncrarediseasenetwork).
Later in the morning, Matthias Gromier, MD, Professor of Neurosurgery at Duke gave a riveting presentation on the use of oncolytic polio virus in the immunotherapy treatment of glioblastoma. He said that a strong polio virus receptor (CD155) is produced on glioblastoma cells, as well as on a number of other cancer cell types. The Duke scientists engineered a version of the polio virus that would not infect normal cells, but would infect and replicate in glioblastoma cells. The therapy was to inject the engineered virus directly into the glioblastoma tumor. The treatment produced shrinkage to disappearance of the tumor. Dr. Gromier quickly noted this effect was not due to the lytic effect of the virus, but rather to the fact that the viral infection stimulated the immune response in the brain. In particular, there was a "whopping" increase in the type 1 interferon response and that dendritic cells were stimulated to present antgens. This approach to glioblastoma therapy is currently in a phase 1 clinical trial and was a featured in a 60 Minutes story on March 29, 2015. (See: http://www.bioquicknews.com/node/2494).
Next, Daniel Simon, Vice President of Pharma Business Development at Guardant Health, and John Strickler, MD, Assistant Professor of Medicine and Member of the Duke Cancer Institute, spoke on the detection and analysis of circulating tumor DNA (ctDNA) in "liquid biopsies." Guardant Health uses proprietary digital sequencing technology to identify a patient's individual genomic alterations from the noise of interfering data that is inherent to standard next-generation sequencing technologies. The company's Guardant360 analysis looks for actionable somatic mutations across all solid tumor sites. Mr. Simon believes that the analysis of ctDNA can drive greater actionability for patients with the approximately 1,500 anti-cancer drugs that are currently available.
Dr. Strickler spoke in particular about colon cancer and the need for novel therapies for this cancer that can become refractory to chemotherapy. Liquid biopsies of ctDNA offer the opportunity for greater insight into the cancer and for target discovery. He gave an example of one colon cancer patient whose ctDNA analysis failed to show MET ctDNA, but did show Her2/Neu ctDNA, which is very rare in colon cancer. Based on this finding, the patient was treated with breast cancer chemotherapy and showed a dramatic response.
Eric Schadt, PhD, Director and Founder of the Icahn Institute for Genomics and Multiscale Biology at the Icahn School of Medicine spoke on the information-driven approach and machine learning as enabling the reinvention of medicine. He noted that the largest automobile company today (Uber) owns no cars and the largest hotel company (Airbnb) owns no hotels. He predicts that in the future the largest health company will own no hospitals, but will be driven by individual implantable, portable, and wearable devices. According to Wikipedia, "Schadt's work combines supercomputing and advanced computational modeling with diverse biological data to understand the relationship between genes, gene products, other molecular features such as cells, organs, organisms, and communities and their impact on complex human traits such as disease. He is known for calling for a shift in molecular biology toward a network-oriented view of living systems to complement the reductionist, single-gene approaches that currently dominate biology to more accurately model the complexity of biological systems." Dr. Schadt noted that he and some 300 colleagues from Mount Sinai, will soon be leaving to start a new company called Sema4 (http://sema4genomics.com/) that will be in the reproductive health space. Originating from the Mount Sinai Health System in New York City, Sema4 is an interdisciplinary partnership of scientists, doctors, engineers, clinicians, and genetic counselors. With a strong foundation of more than 160 years of clinical experience, world-class academic research, and pioneering information science, the company leaders believe it is uniquely positioned to drive innovation in health. It further believes that the synthesis of information science and machine learning with the power of biodata at scale will revolutionize our ability to diagnose, treat, and prevent disease. At the center of the company's pursuit is a strong commitment to engaging patients as partners and sharing the data, so that every patient's journey helps complete the greater picture.
Jeffrey Rogers, PhD, Global Research Leader, Cognitive Internet of Things (IoT) for Healthcare, IBM, spoke about creating spaces with layered sensing and described, in particular, a house on the IBM campus in which Parkinson's patients live during the day and data is gathered on a wide variety of parameters, such as gait, that can provide insight into the individual's disease. He emphasized the importance of having the patient's trust in these studies. At the end, he noted that the analysis of two minutes of speech can provide a wealth of information, for instance, distinguishing among control, manic, and schizophrenic individuals.
John Ryals, PhD, President, CEO, and Chairman, Metabolon, spoke about how metabolomics provides a snapshot of an individual's current health state and actionable clinical information, making it a valuable first-line health assessment tool. He said Metabolon is focused on the world of small molecules and, in particular on 2,000 small molecules that can be identified with clinical precision by mass spectrometry techniques. These are 2,000 small molecules in the plasma that are maintained homeostatically and, of these, 250 are bacterial in origin. He noted that the data quality of the metabolite analysis continues to improve and that the standard deviation was 48% in 2005 and in 2016 was less than 4.5%. He gave an example of a small molecule (dimethylglycine) whose concentration is not affected by age, but is affected by disease. He highlighted Archibald Garrod's classic book "Inborn Errors of Metabolism," published in 1909 as an early marker of the connection between metabolic defects and disease. Recently, Metabolon has worked with Arthur Beaudet, MD, Professor and Chair of Molecular and Human Genetics at Baylor College of Medicine to demonstrate the capability of their system to specifically detect known metabolic defects and avoid false positives. Dr. Beaudet provided Metabolon with 200 blinded samples of 70 healthy controls and 130 metabolic disease samples. Metabolon identified 70/70 controls correctly and 129/130 metabolic disease samples. And there was an explanation for the one disease sample missed. Dr. Ryals described Metabolon's Meta IMD™ test, which was launched in September 2016 as a CLIA laboratory-developed test and is an adjunctive, first-line clinical tool that can save time to diagnosis and potentially thousands of dollars in associated costs. It offers a comprehensive analysis of hundreds of metabolites associated with a wide range of inherited metabolic disorders (IMDs). Meta IMD is not meant to replace diagnostic testing for specific conditions, but provides detailed biochemical information to assist physicians in deciding what additional clinical tests are needed to confirm or clarify a diagnosis. The test requires only 250 µL of plasma. It simultaneously surveys individual metabolites and pathways across amino acids, carbohydrates, organic acids, fatty acids, neurotransmitters, nucleotides and bile acids to detect biochemical abnormalities associated with a wide range of IMDs. Meta IMD may also spot disorders for which there is presently no biochemical testing available. Results are typically delivered in about 21 days. At the end of the two-day PMWC 2017 Duke meeting, Dr. Ryals hosted a tour of the Metabolon lab site that is located not far from Duke in Durham, North Carolina.
Elaine Mardis, PhD, Co-Director of the Genomics Institute at the Nationwide Children's Hospital in Columbus, Ohio, and former Co-Director of the McDonnell Genome Institute at Washington University in St. Louis, outlined various computational tools used to interpret cancer genomics data in the context of targeted therapies. She highlighted a website—"Clinical Interpretations of Variants in Cancer" (https://civic.genome.wustl.edu/home)--that carries out evidence curation by crowd sourcing to provide a resource for the clinical interpretation of cancer variants. She also referenced the "Drug Gene Interaction Database" (http://dgidb.genome.wustl.edu/) that is a for-research-use-only database for searching on interactions by gene or drug name. She gave an example of an n-of-1 study in which sequence analysis of a low-grade glioma in a 12-year-old child revealed a 3-base-pair insertion in BRAF. The child was treated with a RAF inhibitor and is doing well two years out, Dr. Mardis reported. She said that future progress would be sped by high-throughput functional genomics, work on model organisms, the development of new genomic tools, and the broad communication of advances.
Antony Rosen, MD, Director of the Division of Rheumatology at the Johns Hopkins School of Medicine, spoke about investigating a curious link between cancer and autoimmune sclerodoma. Normally, he said, it is rare to see both diseases occurring at the same time. However, his group identified a subgroup of patients for which this phenomenon occurred in 20% of the cases. This subgroup was characterized by having a mutation in the gene for RNA polymerase III. Dr. Rosen suggested that this mutation initially elicited an immune response directed against the mutation, but later that immune response broadened to be directed against wild-type RNA polymerase III, initiating the autoimmune disease. He closed by emphasizing the power of anchoring today's revolutionary tools of measurement to disease biology.
Please stay tuned to BioQuick News for additional stories on the two-day PMWC 2017 Conference at Duke. Additional stories on Day 1 will focus on patient access to investigational drugs, on ME/Chronic Fatigue Syndrome as a mysterious illness that science has yet to unravel, and on the evening presentation of Pioneer & Luminary awards to distinguished figures in precision medicine. Day 2 stories will also follow.