Newly Discovered Gene Regulator Could Precisely Target Sickle Cell Disease

 A research team from Dana-Farber/Boston Children's Cancer and Blood Disorders Center and other institutions has discovered a new genetic target for potential therapy of sickle cell disease (SCD). The target, called an enhancer, controls a molecular switch in red blood cells called BCL11A that, in turn, regulates hemoglobin production.

The researchers—led by Daniel Bauer, MD, PhD, and Stuart Orkin, MD, of Dana-Farber/Boston Children's—reported their findings today in Science.

Prior work by Orkin and others has shown that when flipped off, BCL11A causes red blood cells to produce fetal hemoglobin that, in SCD patients, is unaffected by the sickle cell mutation and counteracts the deleterious effects of sickle hemoglobin. BCL11A is thus an attractive target for treating SCD.

The disease affects roughly 90,000 to 100,000 people in the United States and millions worldwide.

However, BCL11A plays important roles in other cell types, including the immune system's antibody-producing B cells, which raises concerns that targeting it directly in sickle cell patients could have unwanted consequences.

The discovery of this enhancer—which regulates BCL11A only in red blood cells—opens the door to targeting BCL11A in a more precise manner. Approaches that disable the enhancer would have the same end result of turning on fetal hemoglobin in red blood cells due to loss of BCL11A, but without off-target effects in other cell types.

The findings were spurred by the observation that some patients with SCD spontaneously produce higher levels of fetal hemoglobin and enjoy an improved prognosis. The researchers found that these individuals possess naturally occurring beneficial mutations that function to weaken the enhancer, turning BCL11A's activity down and allowing red blood cells to manufacture some fetal hemoglobin.

"This finding gives us a very specific target for sickle cell disease therapies," said Orkin, a leader of Dana-Farber/Boston Children's who serves as chairman of pediatric oncology at Dana-Farber Cancer Institute and associate chief of hematology/oncology at Boston Children's Hospital. "Coupled with recent advances in technologies for gene engineering in intact cells, it could lead to powerful ways of manipulating hemoglobin production and new treatment options for hemoglobin diseases."

"This is a very exciting study," said Feng Zhang, PhD, a molecular biologist and specialist in genome engineering at the McGovern Institute for Brain Research at the Massachusetts Institute of Technology (MIT) and the Broad Institute of MIT and Harvard, who was not involved in the study. "The findings suggest a potential new approach to treating sickle cell disease and related diseases, one that relies on nucleases to remove this regulatory region, rather than adding an exogenous gene as in classic gene therapy."

The study was supported by the National Heart, Lung and Blood Institute, the National Institute of Diabetes and Digestive and Kidney Diseases, the Doris Duke Charitable Foundation and the Howard Hughes Medical Institute.

The Dana-Farber/Boston Children’s Cancer and Blood Disorders Center brings together two internationally known research and teaching institutions that have provided comprehensive care for pediatric oncology and hematology patients since 1947. The Harvard Medical School affiliates share a clinical staff that delivers inpatient care at Boston Children’s Hospital and outpatient care at the Dana-Farber Cancer Institute’s Jimmy Fund Clinic. Dana-Farber/Boston Children’s brings the results of its pioneering research and clinical trials to patients’ bedsides through five clinical centers: the Blood Disorders Center, the Brain Tumor Center, the Hematologic Malignancies Center, the Solid Tumors Center, and the Stem Cell Transplant Center.

$1 5 M gift of Chobani supports dairy innovation

Newswise, ITHACA, New York - through the production of 692 million pounds of yogurt, New York surpassed California as the leading producer in the United States in 2012. A gift of $1.5 million from industry leader Chobani, a company based in new Berlin, N.y., will support research and training in dairy quality work force to help maintain the competitive advantage of New York.

"Today is an exciting day for Chobani - formalize and strengthen our commitment to food innovation and quality," said Chobani President and Chief Operating Officer David Denholm. "Cornell's Food Science Department is one of the leading programs of its kind in the world - a match for the role of Chobani Greek yogurt in."

The gift will benefit the dairy industry through staffing and training programs that support the quality dairy, leadership and innovation. The funding will be used to create opportunities on the site for teachers, students, and staff, which includes workshops of quality and food safety, as well as graduate student support initiatives of relevant research.

"This partnership will strengthen the science behind industry dairy and help us better achieve our land-grant mission to bring new information, technologies and a staff that is well prepared for this expansive industry, New York", said Kathryn J. Boor, Ronald P. Lynch Dean of the College of agriculture and life sciences. "Our goal is not only high quality dairy products, but also the economic growth in the communities that need it most."

Yogurt, including high-protein Greek yogurt, has become an economic power in the North of the State of New York, with New York firms now account for 70 percent of all sales of Greek yogurt. Founded in 2005, Chobani now has nearly 3,000 employees worldwide and sales of more than $1 trillion a year.

Horacio Valeiras and Bernard Saint-Donat Elected to Scripps Research Institute Board of Trustees

The Scripps Research Institute (TSRI) Board of Trustees has elected two new members: Horacio Valeiras of La Jolla, CA, who is managing partner of investment firm HAV Capital, and Bernard Saint-Donat of New York, who is president of financial consulting firm Saint-Donat & Co.

“We would like to offer Horacio and Bernard a warm welcome,” said Dick Gephardt, President/CEO of Gephardt Government Affairs and chairman of the Scripps Research Board of Trustees. "We are confident their contributions to the board will help foster the Institute's continued preeminence in biomedical research and graduate education."

“We are honored to have Horacio and Bernard join our board,” said Scripps Research President and CEO Michael A. Marletta. “Their deep financial and business experience will be invaluable to Scripps as we chart our future course. All of us enthusiastically look forward to working with them.”

 

At the La Jolla, California-based HAV Capital, Valeiras manages the start-up investment firm’s asset allocation, alternative investment and real estate services.

Previous positions include chief investment officer and managing director at Allianz Global Investors Capital and president of Nicholas Applegate Institutional Funds, both in the San Diego region, as well as senior positions with Morgan Stanley Investment Management, Miller, Anderson & Sherrerd and Credit Suisse First Boston. At the beginning of his career, Valeiras was also an instructor at the Massachusetts Institute of Technology and a research engineer for Chevron Research Company.

Valeiras holds two degrees in chemical engineering—a BS from Virginia Polytechnic Institute and State University and a master’s from the Massachusetts Institute of Technology—as well as an MBA in finance from the University of California, Berkeley. He is also a Chartered Financial Analyst (CFA).

A resident of La Jolla, Valeiras serves on the San Diego Foundation’s Board of Governors and on the boards of The Bishop’s School in La Jolla and InHand Electronics in Rockville, Maryland. He has also chaired the Virginia Tech Foundation board and is a past board member of the San Diego Rowing Club.

Bernard Saint-Donat

At his New York-based firm, Saint-Donat offers independent advice to families in areas including asset allocation, manager selection, estate planning, charitable giving and corporate advisory.

Previously, he held senior positions at Lehman Brothers, Lazard Frères & Company, Crédit Commercial de France (now part of HSBC) and La Compagnie Financière Edmond de Rothschild.

Saint-Donat, who holds a doctorate in mathematics from Harvard University and the University of Paris, has been a faculty member at Columbia and Yale Universities, a member of Harvard University’s Overseer’s Committee for Mathematics and founder and president of the Friends of the Institut des Hautes Études Scientifiques. He is currently chairman of the Friends of the Mathematics Department at Harvard.

About The Scripps Research Institute

The Scripps Research Institute (TSRI) is one of the world's largest independent, not-for-profit organizations focusing on research in the biomedical sciences. TSRI is internationally recognized for its contributions to science and health, including its role in laying the foundation for new treatments for cancer, rheumatoid arthritis, hemophilia, and other diseases. An institution that evolved from the Scripps Metabolic Clinic founded by philanthropist Ellen Browning Scripps in 1924, the institute now employs about 3,000 people on its campuses in La Jolla, CA, and Jupiter, FL, where its renowned scientists—including three Nobel laureates—work toward their next discoveries. The institute's graduate program, which awards PhD degrees in biology and chemistry, ranks among the top ten of its kind in the nation.

Urine Biomarkers Reveal Mitochondrial Dysfunction in Diabetic Kidney Disease

Newswise — Researchers at the University of California, San Diego School of Medicine have identified 13 metabolites – small molecules produced by cellular metabolism – that are significantly different in patients with diabetes and chronic kidney disease compared to healthy controls.

Twelve of the 13 metabolites are linked to mitochondrial function, suggesting that suppression of mitochondria – the powerhouses of cells – is a fundamental characteristic of diabetic kidney disease. The findings are published in the November edition of the Journal of the American Society of Nephology.

“This work provides strong evidence that reduced mitochondrial function is a dominant feature of human diabetic kidney disease,” said first author Kumar Sharma, MD, professor of medicine and director of the Center for Renal Translational Medicine at UC San Diego. “We found that a specific cellular pathway, AMPK-PGC1a, likely plays a key role to reduce mitochondrial function and content, which means that new therapeutic approaches that restore and increase mitochondrial function and content could ameliorate or perhaps even arrest chronic kidney disease.”

Diabetic kidney disease is the leading cause of end-stage kidney disease, which is the eighth leading cause of death in the United States and a major risk factor for cardiovascular disease, the nation’s leading killer. An estimated 26 million American adults have chronic kidney disease (CKD), with millions more at increased risk. These patients often require dialysis or an organ transplant.

The primary causes of CKD are high blood pressure and diabetes. Rates of both CKD and diabetes have risen dramatically in the last decade, particularly among people aged 65 and older. According to the National Kidney and Urologic Diseases Information Clearinghouse, the annual mortality rate for end-stage renal disease rose from 10,478 in 1980 to 90,118 in 2009, though it has declined somewhat in recent years.

After analyzing a total of 193 urine samples from patients with diabetes and CKD, diabetes but no CKD and healthy controls with neither condition, Sharma and colleagues quantified 94 metabolites in the samples. Thirteen metabolites were significantly different between patients with diabetes and CKD versus controls. Twelve remained significant when compared to patients with diabetes but not CKD. Twelve metabolites play a role in mitochondrial metabolism and were present in lower levels in patients with diabetes and CKD, suggesting that this major diabetic complication is at least partly the consequence of suppressed mitochondrial activity.

Sharma said measuring urine metabolites to detect and assess diabetic kidney disease is a major diagnostic step forward. “The urine metabolites can indicate the underlying function of the kidney at a biochemical and intracellular level,” he said, “and are well-conserved compared to many cell-based and protein measurements. Urine metabolomics also offers an opportunity to gauge effects of new treatments which will be an advantage to guide precision medicine.”

Co-authors include Bethany Karl and Maggie Diamond-Stanic, UCSD Institute of Metabolic Medicine, UCSD Center for Renal Translational Medicine and Division of Nephology-Hypertension, VA San Diego Healthcare System; Anna V. Mathew, UCSD Center for Renal Translational Medicine and Division of Nephology-Hypertension, VA San Diego Healthcare System, now at the University of Michigan; Jon A. Gangoiti, Bruce Barshop, William Nyhan, Biochemical Genetics Program and Institute of Metabolomic Medicine, UCSD; Christina L. Wassel and Minya Pu, Department of Family and Preventive Medicine, UCSD; Rintaro Saito, UCSD Institute of Metabolic Medicine, UCSD Center for Renal Translational Medicine and Division of Medical Genetics, UCSD; Shoba Sharma and Young You, UCSD Center for Renal Translational Medicine; Lin Wang, Mitochondrial and Metabolic Disease Center, UCSD; Maja T. Lindenmeyer and Clemens D. Cohen Division of Nephology, University Hospital Zurich, Switzerland; Carol Forsblom, Folkhalsan Institute of Genetics, Helsinki Finland; Wei Wu and Sanjay K. Nigam, Departments of Pediatrics and Cell and Molecular Medicine, UCSD; Joachim H. Ix, Division of Nephology-Hypertension, VA San Diego Healthcare System, UCSD Center for Renal Translational Medicine; Trey Ideker, Division of Medical Genetics, UCSD; Jeffrey B. Koop, National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health; Per-Henrik Groop, Folkhalsan Institute of Genetics, Helsinki, Finland and IDI Baker Heart and Diabetes Institute, Melbourne, Australia; Loki Natarajan, UCSD Institute of Metabolomic Medicine and Department of Family and Preventive Medicine, UCSD; and Robert K. Naviaux, Mitochondrial and Metabolic Disease Center, UCSD, UCSD Institute of Metabolomic Medicine, Division of Medical Genetics, UCSD, Biochemical Genetics Program, UCSD.

Support for this research includes funding from the Juvenile Diabetes Research Foundation, the National Institute of Diabetes and Digestive and Kidney Disease, the Folkhalsan Research Foundation, the Wilhelm and Else Stockmann Foundation, the Liv och Halsa Foundation, the UCSD Christini Fund, the Wright Family Foundation, the Lennox Foundation, the Else Kroner-Fresnius Foundation, the Swiss National Center of Competence in Research and National Institutes of Health grants P41 GM103505 and P50 GM085764.

 

NYU sponsors Committee headed by Gordon Brown to update the Universal Declaration of human rights

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Newswise — Does the Universal Declaration on Human Rights, crafted in the aftermath of World War II, continue to serve well in a world in which political and religious extremism, climate change, globalization and other trans-national issues have come to dominate the international agenda?

That is the key question that will be taken up by a Global Citizenship Commission of leading public figures, human rights leaders, and public intellectuals led by The Right Honourable Gordon Brown, MP, former UK Prime Minister and a Distinguished Global Leader in Residence at NYU, which is sponsoring the Commission’s work. The Commission will reexamine the 1948 Universal Declaration on Human Rights and, taking into account the myriad global developments since its passing over 60 years ago, formulate a report that will suggest revisions or ways of updating this fundamental document.

The Commission’s inaugural meeting will take place on Oct. 18, 2013 at the University of Edinburgh. Speaking at the event will be education and women’s’ rights campaigner Malala Yousafzai, whose activism on universal education and women’s rights brought her into direct conflict with the Taliban, which attempted to assassinate her in October 2012.

Mr. Brown, who serves as the UN Secretary-General’s Special Envoy for Global Education, developed the idea for the Commission after convening a series of high-level dialogues at NYU over 2010-11 that explored the moral and ethical underpinnings for the creation of a global civil society.

Mr. Brown said: “The debate around ethics and the protection of human rights is as important today as it was in 1948, when the Universal Declaration was signed.

“This Commission brings together global leaders in the field of ethics and citizenship, and crucially allows members of the public to join the debate. After all, it is their rights of global citizens that this historic document enshrines.

"Global citizenship is at the heart of the UN Secretary-General's Education First initiative which he launched last year, and I look forward to relaying our discussions to him before the end of 2015."

“NYU is proud to provide the support necessary to convene this talented and experienced group of Commissioners from across the world, and is especially excited to be working closely with such an outstanding and learned leader as Gordon Brown. In an era in which discussion of the great challenges of our times often bog down in partisanship, universities – with their tradition of free inquiry – serve a difficult-to-replicate role as a forum for thoughtful discussion. We think NYU -- with its unequalled global presence, its network of academic sites, and its diverse group of students and faculty – is especially well suited to support the Commission’s activities,” NYU President John Sexton said.

The Commission will bring together distinguished leaders from across many sectors—politics, the academy, international public interest organizations, business, religious institutions, law, and philanthropy. The commissioners have been selected from among the highest levels of their professions that will each bring unique perspective to the relevant areas of the Commission’s work. In addition to Mr. Brown, the members of the Commission include:
• K. Anthony Appiah, Laurance S. Rockefeller University Professor of Philosophy, Princeton University;
• Aung San Suu Kyi, Chairperson and General Secretary of the National League for Democracy in Burma; Member of the Burmese House of Representatives;
• Zaniab Hawa Bangura, United Nations Special Representative on Sexual Violence in Conflict;
• Laurel Bellows, Principal, The Bellows Law Group, P.C. & Immediate Past President, American Bar Association;
• Nicolas Beggruen, Chairman, Berggruen Holdings;
• Paul Boghossian, Silver Professor of Philosophy, New York University;
• Derek Bok, 300th Anniversary University Professor; Professor of Law; President Emeritus, Harvard University;
• Sissela Bok, Senior Visiting Fellow, Harvard Center for Population and Development Studies, Harvard University;
• Mohamed El Baradei, Former Director General, International Atomic Energy Agency;
• Craig Calhoun, Director, London School of Economics and Political Science;
• Andrew Forrest, Philanthropist; Non-executive Chairman, Fortescue Metals Group;
• Ronald George, 27th Chief Justice of California (retired);
• His Excellency John Kufuor, Former President of Ghana; Graça Machel, Former First Lady of South Africa and Mozambique;
• Graça Machel, Former First Lady of South Africa and Mozambique
• Kate O’Regan, Chairperson, International Justice Council of the United Nations; Phumzile Mlambo-Ngcuka, Executive Director, UN Women;
• Emma Rothschild; Jeremy and Jane Knowles Professor of History; Director, Center for History and Economics, Harvard University;
• Robert Rubin, Co-Chairman, Council on Foreign Relations; Former United States Secretary of the Treasury;
• Jonathan Sacks, Chief Rabbi, United Kingdom;
• Michael Sandel, Anne T. and Robert M. Bass Professor of Government, Harvard University;
• Klaus Schwab, Founder and Executive Chairman, World Economic Forum;
• Amartya Sen, Thomas W. Lamont University Professor; Professor of Economics and Philosophy, Harvard University;
• John Sexton, president, NYU;
• Robert Shrum, Senior Fellow, Robert F. Wagner Graduate School of Public Service, New York University;
• Jeremy Waldron, University Professor, New York University School of Law; Chichele Professor of Social & Political Theory, All Souls College, Oxford University;
• Joseph Weiler, President, European University Institute;
• The Most Reverend Rowan Williams, former Archbishop of Canterbury.

The intellectual underpinnings of the Commission’s work will be framed by the efforts of a Philosophers’ Committee, established under the auspices of and funded by NYU’s Global Institute for Advanced Study; the Philosophers’ Committee will be led by NYU/Oxford University Professor Jeremy Waldron.. Diane C. Yu, Deputy President of NYU, will serve as the Commission’s Executive Director.

The inaugural meeting of the Global Commission will be held on 18 October 2013 at the University of Edinburgh, in Scotland. The Commission will hold public meetings beginning on 19 October 2013 that will allow members of the public—including from the civic, academic, and at-large communities—to enter their comments related to the work of the Commission into its formal record. This event will be held in the University of Edinburgh’s historic McEwan Hall and will be open to the public, though advance tickets and RSVPs are required.

University of Edinburgh Principal Timothy O’Shea said: “The University is delighted to welcome this important Commission to Edinburgh. How we understand and promote human rights is a matter of global significance and it is a privilege to host the first public hearing of the Commission.”

The inaugural meeting of the Commission has been made possible through the generous support and encouragement of the Carnegie UK Trust, based in nearby Dunfermline, the birthplace of Andrew Carnegie, which is celebrating its centennial this year with a number of special events.

Martyn Evans, Chief Executive of Carnegie UK Trust, the key supporter of the public event, said: “The theme of wellbeing lies at the heart of the work of our Trust, and it motivated our founder, Andrew Carnegie, to leave his fortune to improve the welfare of society one hundred years ago.

“We are delighted to be supporting such an ambitious and timely event. It will bring together global leaders in ethics and citizenship to review and revitalize the relevance of human rights around the world.”

The Commission plans to engage in its work over the course of the next two years, with meetings and public hearings set to take place in cities across the world. The tentative plan for future meetings and hearings is as follows:

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Weight Loss Apps Lack Key Ingredients for Success

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Stephanie Stephens, HBNS Contributing Writer
American Journal of Preventive Medicine

Key Points:
* Mobile applications for weight loss typically include features for setting weight and diet goals, and tracking calories.

* Current weight loss apps lack proven behavioral strategies, such as stress reduction, advice about managing social cues, dealing with negative thinking and time management.

Newswise — Weight loss mobile applications may work well as basic tracking devices, but need to do more to help dieters improve motivation, reduce stress and solve problems, according to a new report in the American Journal of Preventive Medicine.

Many of the country’s 285 million mobile phone subscribers want to lose weight, but neither consumers nor doctors really understand current apps, said lead study author Sherry Pagoto, Ph.D., an associate professor in the division of preventive and behavioral medicine at the University of Massachusetts Medical School.

“Apps are generally good but we need more science behind this effort,” she said. “Busy healthcare providers hesitate to recommend apps because they don’t really know what they’re telling patients to use. Patients also worry about receiving incorrect information or offensive advertising when they open an app.”

“But because of their ‘advanced technical features,’ some apps accomplish what we can’t with weight loss behavioral counseling alone,” said Pagoto.

The researchers looked for weight loss apps that included behavioral strategies currently used in evidence-based weight loss programs. Out of nearly 900 apps available in “health and fitness” categories, 30 apps designed for both iPhone and Android platforms were reviewed in depth. Basic features of the apps studied included the capacity to track weight, diet and physical activity.

Common behavioral strategies included setting weight loss goals, dietary goal-setting and balancing calories. However, seven evidence-based behavioral strategies for weight loss were completely missing, such as stress reduction, relapse prevention, social cues, negative thinking, developing regular patterns of eating, time management, and instructions on reading nutrition labels.

“We think apps can grow into more sophisticated and impactful tools if they include strategies to help with diet motivation and adherence, which are super important for weight loss,” Pagoto noted.

“The ability for real-time information, monitoring and support may help individuals change their diets and exercise in ways that have previously required time-intensive and/or face-to-face intervention, “ said Wendy Nilsen, Ph.D., a health scientist administrator at the NIH Office of Behavioral and Social Sciences Research (OBSSR). “The authors’ findings, similar to work in smoking cessation, highlight the lack of integrated behavioral science in app development.”

There’s more to do, Nilsen added. “For apps to be able to effect maximal behavior change, developers are missing important opportunities to improve their applications by overlooking a well established literature in the behavioral sciences and to incorporate existing knowledge into new technologies. Further, this work can help determine when a well-designed app alone is most likely to help someone to reach their health goals and when more intensive intervention, such as the use of a coach, is needed. With technology and science paired, the optimal app strategies can be developed in a way that helps people live healthier lives.”

TERMS OF USE: This story is protected by copyright. When reproducing any material, including interview excerpts, attribution to the Health Behavior News Service, part of the Center for Advancing Health, is required. While the information provided in this news story is from the latest peer-reviewed research, it is not intended to provide medical advice or treatment recommendations. For medical questions or concerns, please consult a health care provider.

American Journal of Preventive Medicine: Contact the editorial office at (858) 534-9340 or eAJPM@ucsd.edu.

Sherry Pagoto, PhD, Kristin Schneider, PhD, Mirjana Jojic, MD, Michele DeBiasse, MS, RD,
CNSD, Devin Mann, MD, MS. (2013) Evidence-Based Strategies in Weight Loss Mobile Apps. American Journal of Preventive Medicine.

Tips to Celebrate Halloween Safely From The Scariest Place of All - The Emergency Department

Each year, 9.2 million babies, children, and teens are injured severely enough to need treatment in emergency departments all across America, reports the Centers for Disease Control and Prevention. "Nothing is scarier than a trip to the emergency room," said Mark Cichon, DO, chair, Department of Emergency Medicine, Loyola University Health System. "In a season devoted to frights, it is our goal to keep everyone safe."

Here are Dr. Cichon's top tips to avoid going bump in the night and for a healthy, happy Halloween:
Invest in a pumpkin carving kit and avoid knives. "Manipulating a sharp knife in a rigid pumpkin rind without injury is almost impossible for an adult or child," said Dr. Cichon. "Proper tools make sure you carve the jack o' lantern and not yourself or a loved one."

Supervise anything that is burning, from scented candles to carved pumpkins to firepits. "Fires can happen in a flash and get quickly out of control," said Dr. Cichon. "The colder temperatures invite the warm glow of candles to the excitement of an end-of-season bonfire. Watch out for burning leaf piles."

Use extra precaution when climbing ladders to hang decorations inside and outside. "Falls from ladders are one of the top reasons adults come to the emergency room and they are largely avoidable," said Dr. Cichon. "Use the right-sized ladder, and one that is safe, and work with a partner to do the job right."

Make sure Halloween costumes offer visibility and ease of movement. "Masks, hats, wigs, glasses, hoods -- costumes often include headgear that can obstruct vision and lead to trips and falls," said Dr. Cichon. "And make sure it is easy to walk in the costume without tripping or catching on things."

Dress for the weather. "It is easy to get overheated or too cold in the Midwest at this time of year, without the addition of wearing a costume," said Dr. Cichon. "Check skin temperature and watch for signs such as shivering or lethargy. Don't forget to wear waterproof footgear that has treads for sure footing."

Have one adult in the trick-or-treating group wear a reflective safety vest and give each child a glow stick or flashlight to increase visibility. "You want to be able to see where you are going and also for others to see you, especially around moving vehicles," said Dr. Cichon. Stay in a group and put kids on the buddy system.

Avoid alcohol use when supervising children. "Don't drink and accompany your kids as they trick-or-treat," said Dr. Cichon. "If you choose, enjoy a beer or cocktail at the end of the night after kids are safely indoors, or better yet, in bed."

Avoid over-tiring children. "Fatigue can lower resistance, leading to illness and injury," said Dr. Cichon. Make sure a good night's sleep starts Halloween day and rest up before the night's activities. Eat healthy meals and drink plenty of water to stay hydrated. Maintain regular bedtimes.

Inspect treats when you get home. "Make sure candy and goodies are age-appropriate; avoid smaller pieces for younger children that could be a choking hazard," said Dr. Cichon.

Balance candy consumption with healthy foods. "When my four children were younger my wife and I would hide their candy and allow them each to choose two pieces after dinner to limit over-consumption," said Dr. Cichon.

Be aware of the potential for loud and scary noises. "Playful scaring antics by enthusiastic celebrants and even barking dogs can frighten children and cause them to react suddenly," said Dr. Cichon. "Falling down porch stairs, tripping over curbs and even colliding with others can result in harm."

Drive vehicles slowly and cautiously on Halloween, especially on sidestreets. "Watch for trick-or-treaters but also be aware of any flying eggs or other debris that could impede vision," said Dr. Cichon.

Since 1995, annual patient volumes in Loyola's emergency division have increased from 29,000 to 53,000 patients. The Loyola emergency medicine division is classified as a Level 1 Trauma Center, providing the highest level of surgical care to trauma patients. The division also has been recognized by groups such as The Joint Commission, the Commission on Accreditation of Medical Transport Systems, the American College of Surgeons for Trauma and the Illinois Department of Public Health for Trauma, Burns, Pediatric and Emergency departments.