The Health, Wellness & Beauty Pages

1. The DNA Collection Kit         2. Interim Essentials          3. DNA Assessments         4. Customized Formula

by Sue Shellenbarger | Wednesday, May 26, 2010

Kelley McDonald has always loved exploring new terrain. In home videos as early as age 3, “I’m always off by myself, looking under rocks or catching and studying bees,” she says. Today, at 18, the Apple Valley, Minn., college student is studying for a science career in the fast-growing field of nanotechnology—working with materials at the molecular or atomic level.

That makes her one of the lucky ones—a young adult whose career passion is in sync with one of the hot jobs of the near future.

Predicting the jobs or skills that will be in demand years from now is a tricky task for many teens, young adults and their parents. Luckily, there are rich sources of information on the Web, in books, and in most people’s communities; the challenge is to sift through them all.

Ms. McDonald found her passion through a community-college nanotechnology program funded by the National Science Foundation, where one official foresees hundreds of thousands of job openings in the field in the next five years. Other sources include government forecasts, school or college career counselors, and neighbors and friends employed in growing fields.

The richest vein of job-growth information is the Labor Department’s 10-year forecast for demand, pay and competition for more than 300 jobs in 45 categories. The department’s latest biannual compilation, published last month as the “Occupational Outlook Handbook,” is great for sizing up the long-term outlook for most fields. The forecasts have often been prescient—accurately predicting this decade’s fast growth in special-education teaching jobs and the widening range of hot health-care careers, for example.

In the coming decade, engineering—already known for paying college graduates some of the highest starting salaries—is expected to offer the fastest-growing area: biomedical engineering. Jobs in this field, which centers on developing and testing health-care innovations such as artificial organs or imaging systems, are expected to grow by 72%, the Labor Department says.

Among other professions, job opportunities for physicians should be “very good,” the guide says; health care dominates the list of the fastest-growing jobs, capturing 11 of the top 20 slots. While more attorneys and architects will be needed, competition for these jobs will be intense. Psychologists will be in demand, but growth will be fastest in industrial and organizational psychology.

The forecasts have limitations. The Labor Department’s macroeconomic model works on two noteworthy assumptions—that the economy will rebound to long-term growth and that there won’t be any more big shocks like the 2007-2008 recession. Thus its forecasts don’t predict the big job-market swings or sudden changes in the supply of workers that can easily happen in a volatile economy.

That means you could pick a job from the Labor Department’s “fastest-growing” list when you enter college, only to find the field in a slump by the time you graduate. For example, a 2006 high-school graduate eyeing the government’s 2004-2014 forecast for nursing at that time would have read about excellent job prospects, with “thousands of job openings” predicted because experienced nurses were expected to retire.

While that forecast is likely to hold for the long term, the job market for students graduating from college this year is headed in the opposite direction: Thousands of experienced nurses who had been inactive or retired have been re-entering the work force because of the recession.

Similarly, a high-school grad in 2000 might have picked computer programming—No. 8 at the time on a government list of fast-growing, high-paying jobs—only to graduate to the aftermath of the dot-com collapse.

And finally, no economic model can forecast growth in jobs that are still evolving. While the government’s latest handbook contains a supplement on “green occupations” in emerging industries such as biofuels and wind energy, it has no data on many of the jobs these industries are creating, such as fuel-cell technologists.

The Jobs of the Future

Occupations with the largest percentage growth expected through 2018:

• Biomedical Engineers 72%
• Network Systems Analysts 53%
• Home Health Aides 50%
• Personal, Home-Care Aides 46%
• Financial Examiners 41%
• Medical Scientists 40%
• Physician Assistants 39%
• Skin-Care Specialists 38%
• Biochemists, Biophysicists 37%
• Athletic Trainers 37%

Source: Labor Department ‘Occupational Outlook Handbook’

“Right now, all the projections we have are about a world that existed” in the past, says David Passmore, director of The Pennsylvania State University’s Institute for Research in Training & Development. “We are sitting on the precipice of the next big transformation” in energy production, “and no one in the occupational-projections area knows how to handle that.”

All that leaves much to the resourcefulness, imagination and research skills of young people weighing a career choice. The first step is to explore and try out various fields in order to figure out what kind of work you love and can do well. The next is to learn about broad career fields that are likely to grow; the government’s handbook lists job-by-job career-information contacts, such as professional associations or industry groups. Then, pick a field with this attitude: “I think I’ll jump in and learn what I can learn,” says Bob Templin, president of Northern Virginia Community College in Annandale, Va.

Networking with people in your target industries can help. Russell Wagner, a 20-year-old from Prior Lake, Minn., likes electronics and science, but when he tried robotics in high school, he found it boring. His mother contacted friends in industry and learned nanoscientists are in demand in many industries, developing a wide range of products, from electronic memory devices and coatings for stents to mold-resistant shingle coatings.

At Dakota County Technical College, Rosemount, Minn., where Mr. Wagner and Ms. McDonald are enrolled, program head Deb Newberry says employers contact her trying to fill more job openings than she has students.

All job markets are local, so it is important to check out job demand in the locale where you want to live. Community colleges tune into regional work-force needs and are often set up to provide counseling and work-force advice to the public.

Also, ACT Inc. compiles state-by-state data comparing the career interests of students who have taken its college-entrance exams with the job outlook in each state.

In Virginia, for example, student interest in computer-related jobs is falling far short of likely demand; only 3% of Virginia students are interested in the field, which has projected growth of 23%. To see the data, go to ACT.org, click on “2009 College Readiness Report” and scroll down to the state list; work-force data is on page 10 of each “Readiness Report.”

Of course, many people fare best by holding out for a job doing what they love. Careers in filmmaking are expected to grow very slowly in the coming decade, and competition for jobs will be keen.

But that isn’t stopping Kiel Greenfield. He has loved movies for so long—watching them, talking about them and working with them as a video-rental store employee—that he has decided, at age 28, that filmmaking is the only career for him. He signed on for a film-making program at a respected school, the Zaki Gordon Institute, Sedona, Ariz., and plans to do whatever it takes to land a job in film photography.

“It’s going to be hard,” he says, “but it’s totally worth it.”

Write to Sue Shellenbarger at sue.shellenbarger@wsj.com

Joe Niamtu, DMD May 5, 2010

Dual wavelength lasers target facial spider veins.

STORY HIGHLIGHTS: – Treatment tips with 532-nm lasers - 940-nm laser techniques - Devices for vascular lesions There’s a bounty of light devices and wavelengths capable of treating vascular facial lesions. With any device comes pros and cons as well as decisions on how to integrate it into your office. In my practice, a dual wavelength laser fits my patients’ needs and the operational structure of my business. Continuous wave argon (488 and 514 nm), continuous wave CO2 (10,600 nm) and Nd:YAG (1,064 nm) lasers all can eliminate spider veins but can cause burns, scars and hypopigmentation. The pulse dye laser’s ability to apply precise ablation of unwanted vascular tissue with minimal injury to normal tissue made them the first generation of clinically useful lasers for telangiectasias. However, a two-week healing period with dark purple purpura on patients’ face was often a result. The advent of ultra-long pulse 585 nm laser technology cured the problem of purpura, but some of those systems could be large and expensive. In addition, unless the clinician had a large number of patients in need of treatment of port wine stains, hemangiomas, venous lakes and other big vascular clinical conditions, the expense outweighed the practicality. The KTP (Potassium-titanyl-phosphate) or frequency doubled lasers became an intermediary option for the casual vascular practitioner who needed a light-weight, portable laser that offered the versatility of treating the most common vascular conditions such as telangiectasias, cherry angiomas and small hemangiomatous or venous conglomerations.1-3 In addition, due to the 532 nm wavelength, numerous pigmented lesions such as DPN’s, pigmented nevi, and lentigos can be treated and further boost the effectiveness of this type of laser for virtually any cosmetic practice. In my practice, I’ve found the dual wavelength, frequency doubling laser (Iridex VariLite 532 nm and 940 nm) effectively covers a wide range of facial vascular lesions. Green Light for Red Lesions The 532 nm wavelength is a green light obtained by a process known as frequency doubling. A high-powered 808 nm laser is used to optically pump an Nd:YAG crystal that produces 1064 nm light. This light is then focused onto a potassium titanyl phosphate crystal to double its frequency, which halves the wavelength, producing a 532 nm wavelength. A red diode aiming beam is added to target the 532 nm beam to “point” the laser. The 532 nm wavelength is effective for smaller red telangiectasia and other small vascular and pigmented lesions, but less effective for large vessels, deep vessels or blue vessels. The high absorption 532 nm treatments are preferred for smaller (up to 1 mm) and more superficial vessels. These vessels are more selectively treated using wavelengths that are strongly absorbed by oxyhemoglobin, because the vessels can be heated to a clinical response temperature with minimal incidental energy. The high oxyhemoglobin absorption can, however, limit the depth to which laser light penetrates the skin, making it difficult to treat large or deep vessels with these wavelengths. A good rule of thumb is that when treating small, superficial vessels that primarily contain oxygenated hemoglobin, it is beneficial to use a wavelength near one of the primary absorption peaks. A drawback of the 532 nm wavelength is its high affinity for melanin. The peak absorption for the melanin and hemoglobin are close at the 532 nm wavelength. This means that the 532 nm wavelength may target both red and brown lesions simultaneously, making treatment difficult on tan or pigmented skin. I generally use the 532 nm wavelength at 18-20 J/cm2 for the average telangiectasia (up to 1 mm) or pigmented lesion. Ectatic vessels disappear when treated because the laser creates a steam bubble along the axis of the vessel, clearing the lumen and pushing a column of hot blood along the vessel. As the vessel cools during the thermal relaxation time (TRT), the vapor bubble cools and collapses the vessel wall. Thermal coagulation of the blood beyond the vessel forms an intravascular plug that occludes the vessel wall beyond the site of laser energy exposure.4 Since the vessel walls do not rupture, there is no purpura produced. I generally deliver double laser shots every several millimeters along the vessel during treatment. The key is to find the lowest power setting that ablates the vessel without burning the skin. A more selective photothermolysis can be achieved by using a pulse duration that is close or equal to the TRT of the targeted vessel,2,3 which for telangiectasias is in the range of 10 milliseconds to 60 milliseconds. A pulse dye laser, on the other hand, produces a pulse duration of 450 microseconds to 50 milliseconds. The 532 nm laser has a much longer pulse duration of 60 milliseconds to 100 milliseconds, which more closely matches the TRT of facial telangiectasias. Deeper and larger caliber vessels require a longer pulse duration which makes the 532 wavelength less effective. Infrared Option for Blue Vessels Although the 532 nm wavelength was the mainstay for my facial vascular patients, the option of using the 940 nm wavelength available from the dual wavelength laser has allowed me to cover a broader range of lesions without switching to an additional device. The 940 nm is a near-infrared wavelength that was originally intended to treat larger (over 1 mm), deeper, more resistant and bluer vessels.3 The 940 nm wavelength is emitted directly from a customized indium gallium arsenide diode laser and is chosen for larger and deeper vessels primarily because it is exactly at the peak of the secondary absorption band of oxyhemoglobin in the near IR region of the spectrum. Larger and deeper vessels contain both oxygenated and reduced hemoglobin, and the 940 nm wavelength targets the secondary absorption peak of oxygenated and reduced hemoglobin. Related Content Slideshow: Vascular and Pigmentation Problems Advanced Techniques for Treating Leg Veins More than a Cosmetic Nuisance For deeper blue veins, the target can be venous blood, and it is important to consider the reduced hemoglobin spectrum. Less strongly absorbed wavelengths penetrate deeper and can more uniformly heat through larger diameter vessels. Since there is less absorption, a much higher fluence (10 to 15 times) must be used with the 940 nm platform. Reduced hemoglobin absorption falls rapidly above 950 nm wavelengths, and 940 nm is the longest wavelength for which reduced hemoglobin has adequate absorption. For this reason, the 940 nm is a workhorse.My experience with the 532 nm and 940 nm system has been that both wavelengths are effective for small telangiectasias, but the 940 is superior for larger, bluer and deeper vessels due to it deeper penetration. Tierney and Hanke recently concluded that “both the 532 and 940 nm wavelength were equally efficacious for smaller caliber vessels facial telangiectasias, but we lack evidence to support whether one wavelength is superior. On photographic evaluation, the 940 nm was significantly more efficacious for larger caliber vessels than 532 nm.”3 I employ the 940 wavelength almost exclusively due to it effectiveness with small and large vessels. I turn to the 532 nm only when using the optional ScanLite scanner to treat large areas (which is not compatible with the 940 nm). Although multiple spot size handpieces are available, I exclusively use the 0.7 mm with the 940 nm for telangiectasias. A polarizing headlight loupe system also accompanies the VariLite, which allows the operator to use clear loupes instead of dark goggles that may obscure the finer vessels. The polarizing headlight also reduces skin reflection, which allows superior visualization when compared to the naked eye. Clinicians with extensive vascular practices often rely on pulsed dye lasers and IPLs. However, for practices such as my own, those devices would not receive enough use to justify the expense and maintenance. Cosmetic patients are impulsive, and it is very common for patients to ask for spider vein removal when in for another treatment. Having access to a small, easily portable, dual laser device with no filters to change makes treatments fast and easy. Click page 2 for sidebar: Devices for Vascular Lesions Joe Niamtu, DMD, is a fellow of the American Academy of Cosmetic Surgery and the American Society for Lasers in Medicine and Surgery. He is board certified by the American Board of Oral and Maxillofacial Surgery. Dr. Niamtu served as editor of four textbooks on cosmetic facial surgery and has written chapters in 19 other text books. He runs a cosmetic facial private practice in Midlothian, Va. Disclosure: Dr. Niamtu indicates that he does not have any affiliations with any commercial entities, directly or indirectly, referenced in this article. References 1. Cassuto DA, Ancona DM, Emanuelli G. Treatment of facial telangiectasias with a diode-pumped Nd:YAG laser at 532 nm. J Cutan Laser Ther. 2000;2(3):141-146. 2. Niamtu J. Oral and Maxillofacial Surgery Clinics of North America. Philadelphia:WB Saunders 2000:771-780. 3. Tierney E, Hanke CW. Randomized controlled trial: Comparative efficacy for the treatment of facial telangiectasias with 532 nm versus 940 nm diode laser. Lasers Surg Med. 2009 Oct;41(8):555-62. 4. Landthaler M, Hohenleutner U, Abd el Raheem TA. Therapy of vascular lesions in the head and neck area by means of argon, Nd:YAG, CO2 and flashlamp-pumped pulsed dye lasers. Adv Otorhinolaryngeal, 1995;49:81-86. Stay connected by joining our Facebook community and following Healthy Aging on Twitter.

Treating Telangiectasias

Friday, April 30, 2010

The next time Stephen Quake is prescribed a drug, he says he won’t worry about having a bad reaction. The Stanford University professor will simply consult his genome to see if there are any warning signs in his DNA.

More than two dozen of Quake’s scientist colleagues combed through his genetic code to assess his chances of heart disease, diabetes, cancer and how he might react to common medicines. The results were published Friday in the medical journal, Lancet.

It is an example of the kind of personalized medicine that might one day be possible if doctors have a map of their patients’ DNA. Seven other people have had their genomes sequenced. Last year, Quake’s genome was published in the journal Nature Biotechnology, before it was analyzed for health risks.

But as the gene scan becomes more widely available, experts warn interpreting the data may be trickier than obtaining it. “We need to get better at explaining what this information means for patients,” said Euan Ashley, an assistant professor of medicine at Stanford and the Lancet paper’s lead author.

For months, 30 scientists studied more than 2 million gene variants in Quake’s DNA. They found genes linked with sudden cardiac death and others suggesting he might be resistant to the anti-clotting drug clopidogrel. Based on their findings, Ashley recommended Quake start taking cholesterol-lowering statins. Quake declined.

The research was paid for by the U.S. National Institute of General Medical Sciences, the National Heart, Lung and Blood Institute and others.

When the first human genome was sequenced, it cost about $3 billion. Decoding Quake’s genome cost around $50,000. Experts said the price of getting a complete genome sequence may drop to less than $1,000 in the next few years, tempting more people to get their DNA mapped.

Some experts said legislation might be needed to protect such sensitive information. “The genie is now out of the bottle,” said Nilesh Samani, of the department of cardiovascular sciences at the University of Leicester. He was not connected to the genome research. “We need to think carefully about whether we need laws to prevent genetic information from getting into the wrong hands.”

Muin Khoury, director of the National Office of Public Health Genomics at the U.S. Centers for Disease Control and Prevention, said it wasn’t clear how genome sequences might help. “We simply cannot interpret … the vast amount of emerging data,” he said. “The current information is incomplete, uncertain, potentially misleading and could lead to unnecessary procedures,” he said.

Khoury said that without a medical reason for getting a genome sequence, obtaining one was premature. “The relationships between our genome and most health and disease indicators are so far unknown or unvalidated,” he said.

Quake also cautioned that getting a genome sequence isn’t for everyone. “All you hear about when they talk about your genome is ways you’re going to die and get sick. It doesn’t tell you you’re going to be happy or a great athlete,” he said. “If you’re a worrier, this is not for you.”