The Observatory

April 18, 2018
Fast Facts Stroke in the United States

7.2 million
Americans aged 20 years and older have had a stroke.

15 percent
Is the number of strokes preceded by a transient ischemic attack (TIA), known as a “mini-stroke.”

87 percent
of strokes are classified as ischemic, which occurs when a clot blocks a blood vessel, cutting off blood flow to part of the brain.

Is the number of people who have a stroke every year, with three in four being first-time strokes.

Every 40 seconds
someone in the United States has a stroke.

Every 4 minutes
someone in the United States dies of stroke.

Is the number of people who died of stroke in 2014.

50 percent
Are the odds of having a stroke if you’ve a first-degree relative with a history of stroke.

35 percent
Is the reduction of your stroke odds if you practice moderate to vigorous physical activity.

80 percent
of strokes can be prevented.

Source: American Stroke Association,

Infectious Disease

Research offers clues for improved influenza vaccine design. Influenza vaccines that better target the influenza surface protein neuraminidase (NA) could offer broad protection against various influenza virus strains and lessen the severity of illness, according to new research published in Cell. Current seasonal influenza vaccines mainly target a different, more abundant influenza surface protein called hemagglutinin (HA).

However, because influenza vaccines offer varying and sometimes limited protection, scientists are exploring ways to improve vaccine effectiveness.

The new research builds on previous studies of NA and was conducted by a team of scientists including investigators from the Centers of Excellence for Influenza Research and Surveillance (CEIRS) program, which is organized and funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

Investigators analyzed blood samples from people vaccinated against influenza and people diagnosed with either the 2009 H1N1 influenza virus or H3N2 influenza viruses. The analyses indicate that influenza vaccines rarely induce NA-reactive antibodies, whereas natural influenza infection induces these types of antibodies at least as often as they induce HA-reactive antibodies.

Additional laboratory experiments show that the NA-reactive antibodies induced during natural influenza infection are broadly reactive, meaning they could potentially protect against diverse strains of influenza. To test this theory, scientists isolated NA-reactive monoclonal antibodies from the H3N2 and H1N1 influenza patients (N2-reactive antibodies and N1-reactive antibodies, respectively). They administered 13 N2-reactive antibodies to mice and subsequently infected the mice with a different H3N2 virus strain.

Eleven of the 13 N2-reactive antibodies partially or fully protected the mice. They also administered eight N1-reactive antibodies to mice and subsequently infected the mice with a similar H1N1 virus strain or an H5N1-like virus strain. Four of the eight antibodies completely protected the mice against both virus strains.


Genes can help predict children’s risk of type 1 diabetes. A type 1 diabetes genetic score can identify infants at risk for pre-symptomatic type 1 diabetes and could be used to enroll children into type 1 diabetes prevention trials, according to a study published in PLOS Medicine by Anette Ziegler of the Helmholtz Zentrum Muenchen, Germany, and colleagues.

Approximately one in 250 newborns will develop autoimmunity to pancreatic beta cells in childhood and receive a diagnosis of type 1 diabetes before adulthood. In the new study, researchers calculated genetic scores from more than 30 genes for more than 3,000 children with no family history of type 1 diabetes but with gene variants known to convey type 1 diabetes risk. Each participant was enrolled at infancy, between 2004 and 2010, and followed in three to six months intervals for 10 years to track any development of islet autoantibodies and subsequent type 1 diabetes.

The upper quartile of genetic scores in the children was associated with a greater than 10 percent risk for the pre-symptomatic stage of multiple islet autoantibodies by age six. This compares to a background population risk of 0.4 percent. Almost half the children in the study who developed pre-symptomatic or symptomatic diabetes were identified by this score.

The finding “greatly extends the possibilities of enrolling participants into clinical trials aimed at evaluating type 1 diabetes prevention strategies that could be applied in infancy and before the development of autoimmunity,” the authors say.

Mental Health

Vitamin D blood test may speed bipolar diagnosis in kids. A blood test may have the potential to speed accurate diagnosis—and appropriate treatment—of bipolar disorder in children, new research suggests. Ohio State University researchers found children with bipolar disorder had higher blood levels of proteins associated with vitamin D compared to children without mood disorders. Their study appears online in the journal Translational Psychiatry.

A blood test to confirm bipolar disorder could improve care and cut the current 10-year average lag time between onset and diagnosis, says Ouliana Ziouzenkova, the study’s lead author and an associate professor of human nutrition at Ohio State.

In the study of 36 young people, levels of the vitamin D binding protein were 36 percent higher in those with bipolar disorder than in those without a mood disorder.

“Childhood bipolar disorder can be very difficult to distinguish from other disorders, especially in youth with certain types of depression,” says Barbara Gracious, a study lead co-author. Sensitive and specific biomarkers could give clinicians more confidence in choosing the most appropriate treatment, and decrease lags in proper diagnosis.

The clinical part of the pilot study was conducted at Harding Hospital at Ohio State’s Wexner Medical Center and included 13 children without mood disorders, 12 children with diagnosed bipolar disorder, and 11 children with major depressive disorder.

Ziouzenkova says that it made sense to look at vitamin D binding protein because it potentially plays a role in brain inflammation. The researchers also looked at inflammatory markers in the blood, but found no significant correlations. Looking for the nutrient vitamin D in the blood, as opposed to the binding protein, appears to have low diagnostic power, she says.

Finding a reliable blood marker for bipolar diagnosis has been elusive. Ziouzenkova’s lab used an intricate technique to evaluate blood plasma, in which they essentially used biological “bait” to fish for inflammatory factors. That helped identify the vitamin D binding protein as a potential diagnostic target.

If further research confirms the findings, developing a blood test would be a fairly straightforward and relatively inexpensive proposition, Ziouzenkova says.

Cardiac Biomarkers

Blood test may predict future risk of cardiovascular events. Heart disease and type 2 diabetes are among the leading causes of death in the United States, but the mechanisms leading to and linking these two diseases remain incompletely understood. A new study by investigators at Brigham and Women’s Hospital (BWH) may help shed light on a molecular pathway that heart disease and diabetes share, and points to a biomarker that is elevated in women at risk of cardiovascular disease and diabetes. The team’s results were presented by Diedre Tobias, ScD, at the American Heart Association (AHA) Epidemiology and Lifestyle meeting and simultaneously published in Circulation: Genomic and Precision Medicine.

“We examined more than 27,000 women in the Women’s Health Study and found that a one-time measurement of branched chain amino acids in the blood stream—a test that now can be easily done—predicted future risk of cardiovascular events to the same extent and independent of LDL cholesterol and other risk factors,” says corresponding author Samia Mora, MD, of the Center for Lipid Metabolomics at BWH. “This was particularly so for women who developed type 2 diabetes prior to their cardiovascular disease.”

Branched chain amino acids (BCAAs) are thought to play a causal role in the development of insulin resistance and type 2 diabetes. However, few studies have evaluated the association between BCAAs and cardiovascular disease. To investigate, the team measured BCAA levels in blood samples using NMR spectrometry. Of the more than 27,000 women studied, 2,207 experienced a cardiovascular event during the 18-year follow-up period.

The team found a positive association between BCAA levels and incidence of CVD events. This association was much more pronounced in women who developed diabetes before experiencing a cardiovascular event. The team adjusted for other biomarkers related to diabetes, including HbA1c, and found evidence that BCAAs may be tied to downstream biomarkers of type 2 diabetes metabolism.

“Impaired BCAA metabolism may represent a shared pathway of the metabolic pathophysiology that links the risks of T2D and CVD,” the authors conclude.

Industry News

Certified medical laboratory staff needed to supply future workforce. With baby boomers retiring in droves, the medical laboratory profession needs to intensify efforts to recruit the next generation of professionals, according to the newly-released ASCP 2016-2017 Vacancy Survey. According to the Survey, which was published in the March 2018 issue of the journal AJCP, a focus on qualifications and certification status is crucial to addressing the needs of the laboratory workforce of the future.

Retirement rates of laboratory professionals (for those retiring in the next five years) are at their highest across the majority of departments since 2012. Moreover, the rate of supervisory retirements is higher compared with staff, especially in the anatomic pathology, chemistry, toxicology, cytogenetics, cytology, flow cytometry, hematology, coagulation, immunology, microbiology, phlebotomy, point-of-care, send-outs, and specimen departments. Data suggest that these fields will soon be experiencing a drain in personnel who have been working for a long period of time and have a vast amount of experience.

Overall, 24 percent of survey respondents said their primary concern is finding qualified laboratory professionals to staff the labs. They also indicated that the number of applicants is extremely low compared with the number of personnel retiring. To fill the vacancies, some laboratories are hiring non-certified staff, a trend that Carlo Ledesma, SH(ASCP)CM, MT(ASCP), has observed in his region in Oklahoma City, OK.

His team conducted a study to see if there was a difference in quality between certified and noncertified lab professionals. “We wanted to get data from our immediate area. There were increased errors in nontraditional hires (who lack certification) compared to traditional hires. They take longer to train, which means allocating more financial resources. They failed to recognize critical results because they don’t know the clinical difference in a test.”

ASCP has several initiatives in place to address the medical laboratory workforce shortage. These include:

  • ASCP Career Ambassadors 2.0 program, in which ASCP members visit pre-college students across the country to talk about medical laboratory careers.
  • An interactive website targeted toward science-oriented high school students that positions laboratory medicine as a potential career path.
  • NEXTPO, a program at ASCP’s Annual Meeting that brings together ASCP members, educators, and students for hands-on science experiments.