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International Hospital

Tag Archive for: Research

Research

Posts

Brain cortical surfaces

Researchers create new hi-res map of developing cerebral cortex

neurology, Research, 22 August 2022/in E-News /by panglobal
Brain cortical surfaces

Brain cortical surfaces are represented by triangular meshes. The surface area of each vertex (e.g., the red point) is one third of the total surface area of its one-ring neighboring triangles (the red hexagon). Credit: Gang Li Lab, UNC School of Medicine

 

 

Scientists at the University of North Carolina (UNC) School of Medicine have mapped the surface of the cortex of the young human brain with unprecedented resolution, revealing the development of key functional regions from two months before birth to two years after.

The new cortical development mapping, reported online in the Proceedings of the National Academy of Sciences, represents a valuable resource for further research on brain development and offers a powerful new approach to the study of brain-development conditions such as autism and schizophrenia.

“These results provide an important reference for exploring and understanding the dynamics of early brain development,” said study senior author Gang Li, PhD, associate professor of radiology at the UNC School of Medicine.

The study’s first author was Ying Huang, a PhD candidate in Li’s laboratory.

The cortex is a sheet of brain cells that wraps around much of the rest of the brain. The most evolutionarily advanced brain region, it is proportionately larger in humans than in other mammals, and is responsible for higher, distinctively human functions including language abilities and abstract reasoning.

Most dynamic period in cortical development

The third trimester of pregnancy through the first two years of life is the most dynamic period in cortical development. The cortex thickens markedly during this interval, and grows at an even faster pace in terms of surface area, by forming complicated cortical folds.

Disruptions to cortical thickening and expansion in this phase have been linked to autism and schizophrenia. However, neuroscientists haven’t had as detailed an understanding of this developmental phase as they would like. In particular, they’ve had a need for more comprehensive, high-resolution mapping, across the foetal-to-toddler age range, that divides or “parcellates” the developing cortex into distinct regions with their own growth rates – especially surface area growth rates.

In the study, Li and colleagues performed just such a mapping. They first gathered a set of 1,037 high-quality magnetic resonance imaging (MRI) scans of infants in the third-trimester-to-two-year age interval. The scans came from two other research projects, the UNC/UMN Baby Connectome Project (BCP) and the Developing Human Connectome Project. The team analyzed the scan data using state-of-the-art, computer-based image-processing methods, essentially dividing the cortical surface into a virtual mesh containing thousands of tiny circular areas, and calculating the surface expansion rate for each of these areas.

Locations of brain structures

The analysis didn’t start with assumptions about the locations of brain structures or functional regions, but this regionalization of the brain became evident anyway from the resulting maps, based solely on the different rates at which areas of the surface expanded. In all, the researchers defined 18 distinct regions, which they found correlated well with what is already known about the developing cortex’s functional regions.

“All these regions show dramatic expansion in surface area during this developmental window, with each region having a distinct trajectory,” Li said.

Apparent sex differences

The maps revealed that each region tended to have the same developmental path as its counterpart in the cortex’s opposite hemisphere. Sex differences were apparent too. Even when controlling for sex differences in overall surface area – male brains having greater area – there remained differences in multiple regions. For example, the medial prefrontal region in the left hemisphere, which is believed to host important functions such as attention and working memory, became proportionately larger in males early in the second year of postnatal life.

The analysis also showed that the patterns of cortical surface area expansion in this early period of life were very different from the patterns of cortical thickness development, suggesting that these two measures of brain development involve distinct mechanisms.

All in all, Li said, the mapping provides fundamental new insights into brain development.

He and his team now plan to extend this approach with MRI scan datasets that start at earlier ages and end at older ones. They also hope eventually to study scan datasets covering children who have autism-spectrum or other neurodevelopmental conditions. Such analyses might offer not only clues to the origins of these conditions, but also the identification of early signs or biomarkers, which in the future could be used to administer early and more effective treatments. 

Reference:

Ying Huang, Zhengwang Wu, Fan Wang, et. al. “Mapping developmental regionalization and patterns of cortical surface area from 29 post-menstrual weeks to 2 years of age.” PNAS, August 8, 2022. doi: https://doi.org/10.1073/pnas.2121748119

https://interhospi.com/wp-content/uploads/sites/3/2022/08/brain_cortex.png 1022 1440 panglobal https://interhospi.com/wp-content/uploads/sites/3/2020/06/Component-6-–-1.png panglobal2022-08-22 11:52:092022-08-22 11:53:08Researchers create new hi-res map of developing cerebral cortex
climate change aggravtaes spread of human disease pathogens

Large study shows climate change aggravates more than 58% of all known pathogenic human diseases

climate change, Research, 10 August 2022/in E-News, Editors' Picks, Featured Articles /by panglobal

Researchers warn there are too many diseases and pathways of transmission to adapt to climate change

climate change aggravtaes spread of human disease pathogens

 

 

A comprehensive assessment of scientific literature has uncovered empirical evidence that more than 58% of human diseases caused by pathogens, such as dengue, hepatitis, pneumonia, malaria, Zika and more, have been – at some point – aggravated by the hazards of climate change. That alarming finding is the result of a research paper published on August 8 in Nature Climate Change by a team of researchers from the University of Hawaiʻi at Mānoa.

The researchers carried out a systemic search for empirical examples about the impacts of 10 climatic hazards sensitive to greenhouse gas (GHG) emissions on each known human pathogenic disease. These hazards included warming, drought, heatwaves, wildfires, extreme precipitation, floods, storms, sea level rise, ocean biogeochemical change, and land cover change.

Combining two authoritative lists of all known infections and pathogenic diseases that have affected humanity in recorded history, researchers then reviewed more than 70,000 scientific papers for empirical examples about each possible combination of a climatic hazard impacting each of the known diseases.

The research revealed that warming, precipitation, floods, drought, storm, land cover change, ocean climate change, fires, heatwaves and sea level changes were all found to influence diseases triggered by viruses, bacteria, animals, fungi, protozoans, plants and chromists. Pathogenic diseases were primarily transmitted by vectors, although case examples were also found for waterborne, airborne, direct contact and foodborne transmission pathways.

Ultimately, the research found that more than 58% (218 out of 375) of known human pathogenic diseases had been affected at some point, by at least one climatic hazard, via 1,006 unique pathways.

“Given the extensive and pervasive consequences of the COVID 19 pandemic, it was truly scary to discover the massive health vulnerability resulting as a consequence of greenhouse gas emissions,” said Camilo Mora, geography professor in the College of Social Sciences (CSS) and lead author of the study. “There are just too many diseases, and pathways of transmission, for us to think that we can truly adapt to climate change. It highlights the urgent need to reduce greenhouse gas emissions globally.”

Online tool shows link between climate hazard and disease

An interactive web-page showing each connection between a climatic hazard and a disease case was developed by the research team. The tool allows users to query specific hazards, pathways and disease groups, and see the available evidence.

Other key findings include:

  • Climatic hazards are bringing pathogens closer to people. Numerous climatic hazards are increasing the area and duration of environmental suitability facilitating the spatial and temporal expansion of vectors and pathogens. Warming and precipitation changes, for instance, were associated with range expansion of vectors such as mosquitoes, ticks, fleas, birds and several mammals implicated in outbreaks by viruses, bacteria, animals and protozoans, including dengue, chikungunya, plague, Lyme disease, West Nile virus, Zika, trypanosomiasis, echinococcosis and malaria to name a few.
  • Climatic hazards are bringing people closer to pathogens. Climatic hazards were also implicated with the forced displacement and migration of people causing or increasing new contacts with pathogens. Heatwaves, for instance, have been associated with rising cases of several waterborne diseases such as Vibrio (a kind of bacteria)-associated infections, primary amoebic meningoencephalitis and gastroenteritis. Storms, floods and sea level rise caused human displacements implicated in cases of leptospirosis, cryptosporidiosis, Lassa fever, giardiasis, gastroenteritis, Legionnaires’ diseases, cholera, salmonellosis, shigellosis, pneumonia, typhoid, hepatitis, respiratory disease and skin diseases among others.
  • Climatic hazards have enhanced specific aspects of pathogens, including improved climate suitability for reproduction, acceleration of the life cycle, increasing seasons/length of likely exposure, enhancing pathogen vector interactions (for example, by shortening incubations) and increased virulence. For instance, storms, heavy rainfall and floods created stagnant water, increasing breeding and growing grounds for mosquitoes and the array of pathogens that they transmit (for example, leishmaniasis, malaria, Rift Valley fever, yellow fever, St. Louis encephalitis, dengue and West Nile fever). Climatic hazards were also implicated in the increasing capacity of pathogens to cause more severe illness. For example, heatwaves were suggested as a natural selective pressure toward “heat resistant” viruses, whose spillover into human populations results in increased virulence as viruses can better cope with the human body’s main defense, which is fever.
  • Climatic hazards have also diminished human capacity to cope with pathogens by altering body condition; adding stress from exposure to hazardous conditions; forcing people into unsafe conditions; and damaging infrastructure, forcing exposure to pathogens and/or reducing access to medical care. Drought, for instance, was conducive to poor sanitation responsible for cases of trachoma, chlamydia, cholera, conjunctivitis, Cryptosporidium, diarrheal diseases, dysentery, Escherichia coli, Giardia, Salmonella, scabies and typhoid fever.

climate change and health

Researchers also found that, while the great majority of diseases were aggravated by climatic hazards, 63 out of 286 diseases diseases were diminished by some climatic hazards, although 54 of them were at times also aggravated by other climatic hazards; only nine pathogenic diseases were exclusively diminished by climatic hazards. Warming, for example, appears to have reduced the spread of viral diseases probably related to unsuitable conditions for the virus or because of a stronger immune system in warmer conditions.

“We knew that climate change can affect human pathogenic diseases,” said co-author Kira Webster, CSS geography PhD student. “Yet, as our database grew, we became both fascinated and distressed by the overwhelming number of available case studies that already show how vulnerable we are becoming to our ongoing growing emissions of greenhouse gases.”

https://interhospi.com/wp-content/uploads/sites/3/2022/08/climate-change_1.jpg 1160 1701 panglobal https://interhospi.com/wp-content/uploads/sites/3/2020/06/Component-6-–-1.png panglobal2022-08-10 09:47:562022-08-10 09:50:30Large study shows climate change aggravates more than 58% of all known pathogenic human diseases
Neurologist Randall J. Bateman, MD

Large international study shows blood test for Alzheimer’s is highly accurate

Research, 23 February 2022/in E-News /by panglobal

When combined with genetic risk factors, test up to 93% accurate at identifying people at risk of Alzheimer’s dementia

Neurologist Randall J. Bateman, MD

Neurologist Randall J. Bateman, MD, the Charles F. and Joanne Knight Distinguished Professor of Neurology, inspects a mass spectrometry machine at Washington University School of Medicine in St. Louis. Using mass spectrometry, Bateman and colleagues have developed a blood test that is up to 93% accurate at identifying people at risk of Alzheimer’s dementia. CREDIT: Matt Miller/Washington University

 

A blood test developed at Washington University School of Medicine in St. Louis has proven highly accurate in detecting early signs of Alzheimer’s disease in a study involving nearly 500 patients from across three continents, providing further evidence that the test should be considered for routine screening and diagnosis.

The study is published in the journal Neurology [1].

“Our study shows that the blood test provides a robust measure for detecting amyloid plaques associated with Alzheimer’s disease, even among patients not yet experiencing cognitive declines,” said senior author Randall J. Bateman, MD, the Charles F. and Joanne Knight Distinguished Professor of Neurology.

“A blood test for Alzheimer’s provides a huge boost for Alzheimer’s research and diagnosis, drastically cutting the time and cost of identifying patients for clinical trials and spurring the development of new treatment options,” Bateman said. “As new drugs become available, a blood test could determine who might benefit from treatment, including those at very early stages of the disease.”

Low-cost, easily accessible blood test for Alzheimer’s

Developed by Bateman and colleagues, the blood test assesses whether amyloid plaques have begun accumulating in the brain based on the ratio of the levels of the amyloid beta proteins Aβ42 and Aβ40 in the blood.

Researchers have long pursued a low-cost, easily accessible blood test for Alzheimer’s as an alternative to the expensive brain scans and invasive spinal taps now used to assess the presence and progression of the disease within the brain.

Evaluating the disease using PET brain scans – still the gold standard – requires a radioactive brain scan, at an average cost of $5,000 to $8,000 per scan. Another common test, which analyses levels of amyloid-beta and tau protein in cerebrospinal fluid, costs about $1,000 but requires a spinal tap process that some patients may be unwilling to endure.

This study estimates that prescreening with a $500 blood test could reduce by half both the cost and the time it takes to enrol patients in clinical trials that use PET scans. Screening with blood tests alone could be completed in less than six months and cut costs by tenfold or more, the study finds.

CLIA certification

A commercial test based on Bateman’s research was certified in 2020 under the Clinical Laboratory Improvement Amendments (CLIA) program. The CLIA certification program is run by the Food and Drug Administration in partnership with the Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services.

Known as Precivity AD, the commercial version of the test is marketed by C2N Diagnostics, a Washington University startup founded by Bateman and his colleague David Holtzman, MD, the Barbara Burton and Reuben M. Morriss III Distinguished Professor of Neurology. Bateman and Holtzman are inventors on a patent the university licensed to C2N.

CLIA certification makes the test available for doctors in the United States. It is intended to provide information that will aid the medical evaluation and care of patients who already have symptoms of cognitive decline. A similar certification makes the test available in Europe. The test is not yet covered by most health insurance.

What’s important about this study?

The current study shows that the blood test remains highly accurate, even when performed in different labs following different protocols, and in different cohorts across three continents.

Scientists didn’t know if small differences in sampling methods, such as whether blood is collected after fasting or the type of anti-coagulant used in blood processing, could have a big impact on test accuracy because results are based on subtle shifts in amyloid beta protein levels in the blood. Differences that interfere with the precise measurement of these amyloid protein ratios could have triggered a false negative or positive result.

To confirm the test’s accuracy, researchers applied it to blood samples from individuals enrolled in ongoing Alzheimer’s studies in the United States, Australia and Sweden, each of which uses different protocols for the processing of blood samples and related brain imaging.

Findings from this study confirmed that the Aβ42/Aβ40 blood test using a high-precision immunoprecipitation mass spectrometry technique developed at Washington University provides highly accurate and consistent results for both cognitively impaired and unimpaired individuals across all three studies.

When blood amyloid levels were combined with another major Alzheimer’s risk factor – the presence of the genetic variant APOE4 – the accuracy of the blood test was 88% when compared to brain imaging and 93% when compared to spinal tap.

“These results suggest the test can be useful in identifying nonimpaired patients who may be at risk for future dementia, offering them the opportunity to get enrolled in clinical trials when early intervention has the potential to do the most good,” Bateman said. “A negative test result also could help doctors rule out Alzheimer’s in patients whose impairments may be related to some other health issue, disease or medication.”

 

Reference:

[1] Li Y, Schindler SE, Bollinger JG, et al. Validation of Plasma Amyloid-β 42/40 for Detecting Alzheimer Disease Amyloid Plaques. Neurology. First published Dec. 14, 2021.
doi: https://doi.org/10.1212/WNL.0000000000013211.

 

 

 

https://interhospi.com/wp-content/uploads/sites/3/2022/02/alzheimers_blood_test.jpg 400 600 panglobal https://interhospi.com/wp-content/uploads/sites/3/2020/06/Component-6-–-1.png panglobal2022-02-23 09:10:122022-02-23 09:10:12Large international study shows blood test for Alzheimer’s is highly accurate

Biotronik partners with EU-funded SIMCor to pioneer heart and blood vessel simulation

Research, 25 August 2021/in E-News /by panglobal

 

 

What if a computer simulation model of the heart and blood vessel could reduce the need for human or animal data in clinical trials, while speeding up product development? Biotronik and their research partners are looking into exactly that question in the new EU-funded SIMCor project. One of the first likely developments from this partnership will be an implantable sensor to better manage heart failure.

More than 10 million people in Europe suffer from heart failure. Beyond its obvious impacts on patient quality of life, treating heart failure uses 1-2% of a developed country’s health budget every year, with two-thirds of that taken up by hospital stays. If we can help reduce hospital visits related to heart failure, we can both help heart failure patients live better lives and reduce overall healthcare costs. That’s just one reason why Biotronik is taking part in SIMCor, a three-year EU-funded project to develop an implantable pressure sensor that aims to help heart failure patients and physicians better manage their condition.

Along with Biotronik, SimCor includes 11 partners from eight countries, including Berlin’s Charité Hospital. By pooling resources and data, SIMCor’s goal is to speed up the development of this technology and achieve results as fast as possible.

Beyond a new and innovative technology to support heart failure patients, the SIMCor partnership also has the potential to provide even longer-lasting benefits. If successful, computer simulations of the heart-implant interaction could speed up product testing and regulatory approval, providing many patients with technology that can save and improve their lives in a more timely manner.

How the SIMCor partnership can speed up the development process

The SIMCor project focuses on developing computer simulation technology that can help test and validate medical devices. These computerized tests could replace the need for animal testing and help make clinical studies even safer for patients. If a large and high-quality dataset is available, researchers can simulate clinical interventions in virtual patient cohorts. Over the longer term, this could reduce clinical trial size by 25%, with 30% less time required to complete studies. In the end, this allows medical devices to be quickly approved to help patients. The US FDA has already noted the potential positive effects such modelling could have, and is encouraging the development of simulation technology. By working together, Biotronik and its SIMCor partners can conduct these simulations using far bigger datasets than would otherwise be available, yielding the sophisticated modelling required to simulate heart and blood vessels.

Dr Torsten Luther

Dr. Torsten Luther, Director of Product Development for Delivery Tools, Leads & Accessories in R&D at Biotronik

“We need to demonstrate that implants perform well across the whole patient population. That’s a long and sometimes challenging process because patient anatomy can vary widely, especially due to diseases,” said Dr. Torsten Luther, Director of Product Development for Delivery Tools, Leads & Accessories in R&D at Biotronik. “Using a large data pool to simulate different parts of the cardiovascular system, such as the heart or pulmonary artery, allows us to test implant performance across a wide range of anatomies representing the whole patient population. We can then optimize our technology for everyone.”

Collaboration is an important driver for innovation

Research and development have always been a priority at Biotronik. Since developing the first German pacemaker in 1963, Biotronik has continued to pave the way for pioneering innovations. In its Berlin headquarters alone, one out of every five employees work in R&D, ensuring that medical technology keeps pace with the interests and needs of future patients and physicians.

By investing in clinical trials and initiating research projects, Biotronik seeks to address research gaps and offer practical treatment options.

Dr Andreas Arndt

Dr. Andreas Arndt, Team Lead R&D Sensors and SIMCor project coordinator at Biotronik

“The SimCor project is a great example of how we work together with like-minded partners from different industries as well as academic institutions across Europe. We profit from each other’s knowledge and together, we can make an impactful contribution to medical research. In this regard, I believe that collaboration can be a key driver for innovation,” said Dr. Andreas Arndt, Team Lead R&D Sensors and SIMCor project coordinator at Biotronik.

See a Computer Simulation of the Pulmonary Artery

YouTube: https://youtu.be/8YMsoXsH4P8

https://interhospi.com/wp-content/uploads/sites/3/2021/08/pulmonary-artery-simulation.jpg 1530 2360 panglobal https://interhospi.com/wp-content/uploads/sites/3/2020/06/Component-6-–-1.png panglobal2021-08-25 09:31:442021-08-25 09:31:44Biotronik partners with EU-funded SIMCor to pioneer heart and blood vessel simulation
Crohns mouse model

Researchers create bioengineered organism that could diagnose Crohn’s disease flareups

Research, 19 May 2021/in E-News /by panglobal
Jeff Tabor, associate professor of bioengineering in Rice’s Brown School of Engineering

Jeff Tabor, associate professor of bioengineering in Rice’s Brown School of Engineering (Credit: Jeff Fitlow/Rice University)

In an important step toward the clinical application of synthetic biology, Rice University researchers have engineered a bacterium with the necessary capabilities for diagnosing a human disease.

The engineered strain of the gut bacteria E. coli senses pH and glows when it encounters acidosis, an acidic condition that often occurs during flareups of inflammatory bowel diseases like colitis, ileitis and Crohn’s disease.

Crohns mouse model

Rice University researchers engineered a strain of the gut bacteria E. coli to detect gastrointestinal acidosis. The organism produces fluorescent molecules that allow researchers to see it with standard optical equipment. Under normal conditions (left) it produces molecules that glow red. When it encounters acidic conditions (right), it glows green, and the brightness of the glow reflects the level of acidity. (Image courtesy of Jeff Tabor/Rice University)

Researchers at the University of Colorado (CU) School of Medicine used the Rice-created organism in a mouse model of Crohn’s disease to show acidosis activates a signature set of genes. The corresponding genetic signature in humans has previously been observed during active inflammation in Crohn’s disease patients. The results are available online in the Proceedings of the National Academy of Sciences.

Colours that show up in the toilet

Study co-author Jeffrey Tabor, whose lab engineered the pH-sensing bacterium, said it could be reprogrammed to make colours that show up in the toilet instead of the fluorescent tags used in the CU School of Medicine experiments.

“We think it could be added to food and programmed to turn toilet water blue to warn patients when a flareup is just beginning,” said Tabor, an associate professor of bioengineering in Rice’s Brown School of Engineering.

Over their 3.5 billion-year history, bacteria have evolved countless specific and sensitive genetic circuits to sense their surroundings. Tabor and colleagues developed a biohacking toolkit that allows them to mix and match the inputs and outputs of these bacterial sensors. The pH-sensing circuit was discovered by Rice Ph.D. student Kathryn Brink in a 2019 demonstration of the plug-and-play toolkit.

pH sensor

PNAS study co-authors Sean Colgan, the director of the CU School of Medicine’s mucosal inflammation program, and Ian Cartwright, a postdoctoral fellow in Colgan’s lab, read about the pH sensor and contacted Tabor to see if it could be adapted for use in a mouse model of Crohn’s disease.

“It turns out that measuring pH within the intestine through noninvasive ways is quite difficult,” said Colgan, the Levine-Kern Professor of Medicine and Immunology in the CU School of Medicine.

So Brink spent a few weeks splicing the necessary sensor circuits into an organism and sent it to Colgan’s lab.

“Normally, the pH in your intestines is around seven, which is neutral, but you get a lot of inflammation in Crohn’s disease, and pH goes to something like three, which is very acidic,” Tabor said.

Colgan and colleagues have studied the genes that are turned on and off under such conditions and “needed a tool to measure pH in the intestine to show that the things they were observing in in vitro experiments were also really happening in a live animal,” Tabor said.

Biological tool

“Colonizing this bacterial strain was the perfect biological tool to monitor acidosis during active inflammation,” Colgan said. “Correlating intestinal gene expression with the bacterial pH sensing bacteria proved to be a useful and valuable set of biomarkers for active inflammation in the intestine.”

Tabor said he believes the pH-sensing bacterium could potentially be advanced for human clinical trials in several years.

https://interhospi.com/wp-content/uploads/sites/3/2021/05/CROHNS-mouse_web.jpg 856 804 panglobal https://interhospi.com/wp-content/uploads/sites/3/2020/06/Component-6-–-1.png panglobal2021-05-19 11:35:382021-05-19 11:35:38Researchers create bioengineered organism that could diagnose Crohn’s disease flareups
more nurses leads to shorter patient stays

More nurses lead to shorter hospital stays, less readmissions and fewer patient deaths

Research, 19 May 2021/in E-News /by panglobal

Australian study shows that savings made from shorter stays are double the cost of hiring more staff

more nurses lead to fewer patient deaths

 

 

 

 

 

 

 

 

 

 

 

 

 

A study across 55 hospitals in Queensland, Australia suggests that a recent state policy to introduce a minimum ratio of one nurse to four patients for day shifts has successfully improved patient care, with a 7% drop in the chance of death and readmission, and 3% reduction in length of stay for every one less patient a nurse has on their workload.

The study of more than 400,000 patients and 17,000 nurses in 27 hospitals that implemented the policy and 28 comparison hospitals is published in The Lancet. It is the first prospective evaluation of the health policy aimed at boosting nurse numbers in hospitals to ensure a minimum safe standard and suggests that savings made from shorter hospital stays and fewer readmissions were double the cost of hiring more staff.

Despite some evidence that more nurses in hospitals could benefit patient safety, similar policies have not been widely implemented across the globe, partly due to an absence of data on the long-term effects and costs, as well as limited resources. In recent years, Scotland, Wales, and Ireland have mandated numbers of patients per nurse, but strategies to improve nursing levels remains debated worldwide.

Study fills data gap

“Our findings plug a crucial data gap that has delayed a widespread roll-out of nurse staffing mandates. Opponents of these policies often raise concerns that there is no clear evaluation of policy, so we hope that our data convinces people of the need for minimum nurse-to-patient ratios by clearly demonstrating that quality nursing is vital to patient safety and care,” says lead author, Professor Matthew McHugh of the University of Pennsylvania School of Nursing, USA.

In 2016, 27 public hospitals in Queensland were required to instate a minimum of one dedicated nurse for every four patients during day shifts and one for every seven patients for night shifts on medical-surgical wards.

The research team collected data from those 27 Queensland hospitals that instated ratios and from 28 other hospitals in the state that did not, at baseline in 2016 and at follow-up in 2018 (two years after the policy was implemented). Only nurses in direct contact with adult patients in medical-surgical wards were included – data from patients in birthing suites and psychiatric units were not assessed in the study.

Researchers used patient data to assess demographics, diagnoses, and discharge details for patients, as well as length of hospital stay. These data were then linked to death records for 30 days following discharge, and to readmissions within seven days of discharge.

The researchers sent an email survey to nurses in each hospital to ask about the numbers of bedside nurses and patients on their most recent shift. The responses were used to establish the numbers of nurses per patient and then averaged across wards and hospitals. Responses were received from 8,732 nurses (of a possible 26,871) at baseline in 2016, and 8,278 (of a possible 30,658) in 2018.
more nurses leads to shorter patient stays

The study includes baseline data for 231,902 patients (142,986 in hospitals that implemented the policy and 88,916 in comparison hospitals), and for 257,253 patients (160,167 in hospitals that implemented the policy and 97,086 in comparison hospitals) after the policy was brought in.

Comparison hospitals had no change in staffing, with six patients per nurse in 2016 and the same ratio (1:6) in the follow-up period in 2018. Intervention hospitals averaged five patients per nurse at baseline in 2016, with a reduction to four per nurse after the policy implementation.

Patient deaths

To compare the changes in outcomes in the intervention and comparison hospitals over time, the researchers estimated the odds of dying within 30 days of admission and of being readmitted within seven days of discharge, and the additional length of stay, after adjusting for factors such as patient age, sex, existing health conditions and hospital size. They found that the chance of death rose between 2016 and 2018 by 7% in hospitals that did not implement the policy, and fell by 11% in hospitals that did implement the policy.

Readmissions

The chances of being readmitted increased by 6% in the comparison hospitals over time, but stayed the same in hospitals that implemented the policy. Between 2016 and 2018, the length of stay fell by 5% in the hospitals that did not implement the policy, and by 9% in hospitals that did.

Nurse workloads

Further analyses found that when nurse workloads improved by one less patient per nurse, the chance of death and readmissions fell by 7%, and the length of hospital stay dropped by 3%.

Using their modelling to predict figures that would have been expected without the policy in place, the researchers estimated that there could have been 145 more deaths, 255 more readmissions and 29,222 additional days in hospital in the 27 hospitals that implemented the policy between 2016 and 2018.

Financial impact of employing more nurses

To calculate the financial impact of the staffing policy, the researchers used state data to estimate the cost of funding the 167 extra staff needed to reduce workload by one patient per nurse at approximately $33,000,000 (AUD) in the first two years. Based on Australian health economic data, they further estimated that preventing readmissions and reducing lengths of stay resulted in an approximate saving of $69,150,858 in the 27 hospitals across the two years following the mandate.

“Part of the reluctance to bring in a minimum nurse-patient ratio mandate from some policy-makers is the expected rise in costs from increased staffing. Our findings suggest that this is short-sighted and that the savings created by preventing readmissions and reducing length of stay were more than twice the cost of employing the additional nurses needed to meet the required staffing levels – a clear return on investment. Often, policy-makers are concerned about whether they can afford to implement such a policy. We would encourage governments to look at these figures and consider if they can afford not to,” says Professor Patsy Yates of the Queensland University of Technology School of Nursing, Australia.

Study limitations

The authors note that there are a number of limitations associated with the study. Hospitals in the research were not randomly assigned to comparison or intervention groups, as only 27 hospitals in the state were mandated to follow the policy. Furthermore, the hospitals included in both groups were not matched for size or patient demographics and health conditions, although this is accounted for in adjusted analyses.

Access the study: Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: a prospective study in a panel of hospitals. The Lancet. May 11, 2021. https://doi.org/10.1016/S0140-6736(21)00768-6

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brain-to-text BCI

Brain-to-text: Researchers develop brain-computer interface that turns neural signals into typed text in real time

Research, 13 May 2021/in E-News /by panglobal
brain-to-text BCI

Thoughts turned into text: Two implanted electrode arrays record the brain activity produced by thinking about writing letters. This information is then collected and processed in real-time by a computer, which converts that data into words on a screen. Courtesy Shenoy lab & Erika Woodrum (artist)

 

Scientists have developed a brain-computer interface (BCI) which for the first time enables neural signals associated with handwriting to be decoded and turned into text in real time.

This breakthrough in BCI technology has the potential to enable paralysed or paraplegic individuals – unable to write or speak – to communicate in writing, at speed, in real time.

The study was published in Nature, May 12.

The researchers developed an intracortical BCI that decodes attempted handwriting movements from neural activity in the motor cortex and translates it to text in real time, using a recurrent neural network decoding system.

They tested the device in a participant with paralysis which in essence enabled him to type without using his hands. By thinking about handwriting letters, the researchers were able to decode the neural signals with an algorithm which turned the letters into typed text on a screen in real time.

The study participant typed 90 characters per minute – more than double the previous record for typing with such a BCI. However, previous studies had not used decoded neural handwriting signals. They had instead used thought-controlled cursor movements on a virtual keyboard.

Neural signals associated with handwriting

Study coauthor Krishna Shenoy, a Howard Hughes Medical Institute (HHMI) investigator at Stanford University and his team have in recent years been studying neural activity associated with speech in an effort to reproduce it. However, they had not considered trying to decode neural signals associated with handwriting, says Frank Willett, an HHMI research specialist and neuroscientist in Shenoy’s group.

First, the participant was asked to copy letters that were displayed on the screen, which included the 26 lower-case letters along with some punctuation: “>” which was used as a space and “~” which was used as a “full stop.” At the same time, implanted electrodes recorded the brain activity from approximately 200 individual neurons associated with handwriting that responded differently while he mentally “wrote” each individual character. After a series of training sessions, the BCI’s computer algorithms learned how to recognize neural patterns corresponding to individual letters, allowing the participant to “write” new sentences that hadn’t been printed out before, with the computer displaying the letters in real time.

“This method is a marked improvement over existing communication BCIs that rely on using the brain to move a cursor to ‘type’ words on a screen,” said Willett, the study’s lead author. “Attempting to write each letter produces a unique pattern of activity in the brain, making it easier for the computer to identify what is being written with much greater accuracy and speed.”

Level of flexibility

This system also provides a level of flexibility that is crucial to restoring communication. Some studies have gone as far as attempting direct thought-to-speech BCIs that, while promising, are currently limited by what is possible through recordings from the surface of the brain which averages responses across thousands of neurons.

“Right now, other investigators can achieve about a 50-word dictionary using machine learning methods when decoding speech,” said Dr. Shenoy. “By using handwriting to record from hundreds of individual neurons, we can write any letter and thus any word which provides a truly ‘open vocabulary’ that can be used in almost any life situation.”

Although it is still relatively early days for this technology, it offers the potential to help those who have completely lost the ability to write and speak.

In the future, Dr. Shenoy’s team intends to test the system on a patient who has lost the ability to speak, such as someone with advanced ALS. In addition, they are looking to increase the number of characters available to the participants (such as capital letters and numbers).

The participant is part of a clinical trial, called BrainGate2, which is being conducted by a collaboration of internationally recognized laboratories, universities, and hospitals working to advance brain-computer interface technologies.

 

Reference

Willett, F.R., Avansino, D.T., Hochberg, L.R. et al. High-performance brain-to-text communication via handwriting. Nature 593, 249–254 (2021). https://doi.org/10.1038/s41586-021-03506-2

https://interhospi.com/wp-content/uploads/sites/3/2021/05/bci.png 584 816 panglobal https://interhospi.com/wp-content/uploads/sites/3/2020/06/Component-6-–-1.png panglobal2021-05-13 12:42:292021-05-13 12:42:29Brain-to-text: Researchers develop brain-computer interface that turns neural signals into typed text in real time
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