(Regrettably, our local university is the main reason that county STD rates are the second-highest in the state (the highest-ranking county is home to a naval base). Outbreaks are common and rather a grim joke with local healthcare providers. The county has purchased a new emergency radio system and one of their officers has arrived to train our staff on how to use the equipment.)
Instructor: “The great thing about this system is that it is linked to over two hundred towers, state-wide. This means that if you need to, you can communicate not only throughout the county, but with other jurisdictions as well. For example; let’s say you have to set up some kind of emergency clinic at the University for… I don’t know, what’s an epidemic that the students might experience there?”
Me: *without thinking* “Probably chlamydia.”
(My boss shushed me, but our director of nursing almost fell off her chair from laughing so hard.)
Alcohol, Call Center, Emergency Services, Germany, Health & Body | Healthy Right | May 6, 2009
(Note: 1-1-2 is Germany’s version of 9-1-1.)
Me: “1-1-2, what’s your emergency?”
Caller: “Oh, my god! Help me! Help me!”
Me: “Calm down, please. Can you tell me what happened, if someone is hurt, and where you are?”
Caller: “I’m at home, and my brain stopped working!”
Me: “Your brain… stopped working? Sir, if your brain would stop working, you would be dead. Can you tell me exactly what happened? Are you bleeding?”
Caller: “No, no. But my brain stopped working! At least half of it! Oh, my god, will the other half stop working as well?! Will I die?! My wife was right! I can’t believe it!”
(At this point, I’m unsure what to do. The man is really in a state of panic, but sounds otherwise fine.)
Me: “Sir, is your wife at home? Can I speak to her? If not, please tell me exactly what you did when your… brain stopped working.”
Caller: “I watched soccer! And drank beer! My wife always told me ‘When you don’t stop that crap, your brain will stop working’ and now it did! I was sitting on the couch and turned my head to look at the clock and suddenly I can’t move my head anymore because the left side of my brain stopped working! Help!”
Me: “Sir, it sounds like you only cricked your neck!”
(I start describing him what a cricked neck feels like and he agrees that this is indeed his problem and that he’ll see a doctor in the morning. I’m about to end the call, when…)
Caller: “Hey, dude…”
Me: “Yes?”
Caller: “Is she right?”
Me: “Who?”
Caller: “My wife. You seem to know a lot about medicine and stuff, so can my brain really stop working from watching too much soccer and drinking beer?”
Me: “Well, alcohol is known for indeed killing brain cells when you drink too much, but you won’t–”
Caller: “Oh, my god! Thank you! I thought she was only kidding me, but when you say it, then I’ll stop! Thank you so much for saving my life! Thank you!”
Emergency Services, Health & Body, Medication, Respect Your Elders | Healthy Right | August 26, 2008
(An elderly lady falls down in her apartment and has a cut on her wrist.)
Coworker: “Ma’am, I am afraid, we have to go to the hospital. You will need stitches for that cut and an X-ray to make sure your wrist isn’t broken.”
Patient: “No, I don’t wanna go. Just give me a shot and it will be okay.”
Coworker: “You mean for the pain?”
Patient: “No, so it will heal!”
Coworker: “Ma’am, I’m afraid we don’t have this kind of medication.”
Patient: “But it worked last time!”
Coworker: “Someone gave you a shot and the wrist healed by itself?”
Patient: “No, my sugar was too high and they gave me a shot and everything was okay!”
Coworker: “I see… Well, I can’t fool you; you know this stuff! Listen, I can give you a shot for the broken wrist, but this counteracts the anti-sugar medicine. So every time your sugar is too high, you can never get a shot again.”
Patient: “Never ever?”
Coworker: “Never ever again…”
Patient: “So why didn’t you just say so in the first place?”
Coworker: “Well, not every patient has such an understanding of medicine as you, so I always try to keep it simple.”
Crazy Requests, Great Stuff, Health & Body, Hospital | Healthy Right | July 16, 2008
(I witnessed this on the hospital floor where I work. A patient’s daughter comes out of a hospital room and stands in the hallway, staring around looking lost.)
Nurse’s aide: “Can I help you?”
Daughter: “Yeah… can I have a stapler?”
(The nurse’s aide walks about two steps away to get a stapler and then thinks better of this request.)
Nurse’s aide: “Why do you want a stapler?”
Daughter: “My dad’s IV tubing is getting in his way. I thought it would be better if we stapled it to his arm.”
Nurse’s aide: “Um, I think tape would work better for that.”
Daughter: “You guys have tape here?”
Nurse’s aide: “Yeah, I have some here in my pocket.”
(The aide walks into the room to secure the IV tubing before any more of his genius children try to help.)
Daughter: *muttering* “I still think a stapler is a better idea…”
Study shows biomarker accurately diagnoses deadly infant disease
Louisiana State University Health Sciences Center
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New Orleans, LA - A diagnostic study of 136 premature infants found that a protein involved in managing harmful bacteria in the human intestine is a reliable biomarker for the noninvasive detection of necrotizing enterocolitis (NEC). Led by researchers and clinicians at LSU Health New Orleans School of Medicine, this is one of the largest prospective clinical studies in premature infants yet. Results of the study are published online in JAMA Network Open, available online at https://jamanetwork.c om/journals/jamanetworkope n.
According to the National Institutes of Health, necrotizing enterocolitis is a life-threatening illness almost exclusively affecting neonates. NEC has a mortality rate as high as 50%. Inflammation of the intestine leads to bacterial invasion causing cellular damage and cell death, which causes necrosis of the colon and intestine. As NEC progresses, it can lead to intestinal perforation causing peritonitis, sepsis and death. To date, no clinical test has been established as the gold standard to diagnose NEC. X-rays are used to diagnose advanced disease, but their sensitivity can be as low as 44%.
The gut disease is one of concern in Louisiana, as it has one of the highest rates of premature birth in the country, and it disproportionately affects African American infants.
"This study exemplified academic medicine at its best," notes Sunyoung Kim, PhD, Professor of Biochemistry and Molecular Biology at LSU Health New Orleans School of Medicine and senior author. "It creates linkages between unexplained patient presentations and scientific inquiry. We were driven by the desire to build unique and useable tools to fight a disease that has been unexplained for nearly 200 years in the most fragile patient population - preemie babies."
Previous research suggested that NEC is preceded and accompanied by changes in the complex and dynamic collection of microorganisms called gut microbiota, which live in the intestine. In this study, the research team measured and analyzed the activity of the protein, intestinal alkaline phosphatase (iAP) obtained from stool samples from the babies enrolled in the study at Children's Hospital of New Orleans, Touro Infirmary, and St. Louis Children's Hospital. Clinical data collected included gestational age, birth weight, Apgar scores, delivery type, race, gender, feeding, antibiotics, laboratory and radiology results, as well as surgical notes. Eighteen percent of the babies were classified as having severe NEC; 14% had suspected NEC; and 68% were NEC control.
Since iAP activity precedes the chemical process triggering inflammation, the researchers studied the abundance and enzyme activity of iAP shed in stool to assess the correlation of two iAP biochemical measures with disease severity. They found that elevated levels of iAP protein linked to NEC were shed in the samples, but the proteins were dysfunctional in the NEC patients. The accuracy rates using iAP levels and iAP activity as markers for severe NEC were 97% and 76%, respectively. The accuracy values were similar for suspected NEC - 97% and 62%, respectively.
These results indicate that iAP biochemistry and abundance can be used as diagnostic biomarkers for both severe and suspected NEC. Significantly, iAP measures were not biomarkers for sepsis, another potentially fatal condition that can exhibit symptoms similar to NEC. A correct diagnosis is crucial to treatment decisions.
The biomarker has doubled the diagnostic identification of the disease, compared to the current gold standard - a milestone important at both the bench and the bedside.
"Intestinal AP is the first candidate diagnostic biomarker, unique in its predictive value for NEC," reports Dr. Kim. "It is correlated only with NEC and is not associated with sepsis or other non-GI infections. The clinical potential of this noninvasive tool lies in its use to identify infants most at risk to develop NEC, to facilitate management of feeding and antibiotic regimens, and monitor response to treatment."
Besides Kim, other members of the research team from LSU Health New Orleans included Drs. Maya Heath, Zeromeh Gerber, Brian Barkemeyer and Duna Penn in the Section of Neonatology in the Department of Pediatrics; Rebecca Buckley, PhD, and Porcha Davis in the Department of Biochemistry and Molecular Biology; and Zhide Fang, PhD, in the Department of Biostatistics in the School of Public Health. Misty Good, MD, Laura Linneman, RN, and Qingqing Gong, PhD, from Washington University School of Medicine and St. Louis Children's Hospital, also participated in the research.
The research was supported by funding from the National Institutes of Health, National Science Foundation, March of Dimes, Louisiana Board of Regents, Children's Discovery Institute at Washington University and St. Louis Children's Hospital, Department of Pediatrics at Washington University School of Medicine, LSU Health New Orleans School of Medicine and LSU Health Foundation.
Kim is the founder of a spin-out company, Chosen Diagnostics Inc., whose business interests are related to this project. The company is considering an option to license its diagnostic test developed from this work. Dr. Misty Good has financial relationships with Abbott Laboratories and Astarte Medical Partners.
"What began as a collaboration between Biochemistry and Pediatrics at LSU Health New Orleans School of Medicine to address a life-threatening condition has grown into a multicenter national partnership," concludes Kim. "We are working hard here at LSU Health to create solutions for people in our state and to use our discoveries to help infants across the country."
Intended to help human, planetary health, EAT-Lancet diet too costly for 1.6 billion people BOSTON and WASHINGTON, D.C. (Nov. 7, 2019, 6:30 p.m. EST)-- A new study estimates that a diet meant to improve both human and planetary health would be unaffordable for at least 1.58 billion people, mostly in sub-Saharan Africa and South Asia.
Earlier this year, the EAT-Lancet Commission on Food, Planet, Health published recommendations for a universal diet that addresses both human and planetary health. The Commission suggested that adherence to this diet could ensure that our future food systems can sustainably and nutritiously feed the estimated population of 10 billion people in 2050.
The study published today in The Lancet Global Health - from researchers at the Friedman School of Nutrition Science and Policy at Tufts University and the International Food Policy Research Institute (IFPRI) - sought to address what many felt was one of the main components lacking in the creation of the recommended diet, namely affordability.
"When formulating this pioneering benchmark diet - addressing individual health outcomes as well as the health of the planet - the Commission deliberately did not take its cost into account," said senior and corresponding author Will Masters, an economist at the Friedman School of Nutrition at Tufts.
The research team also found that the EAT-Lancet diet was 64 percent more costly than the lowest-cost combination of foods that would provide a balanced mix of 20 essential nutrients. The EAT-Lancet diet has higher quantities of animal-source foods and fruits and vegetables than the minimum required for nutrient adequacy, and much higher quantities than are now consumed in low-income countries.
"We found that the global median of the proposed diet would cost $2.84 per day as of 2011. In low-income countries, that amounts to 89.1 percent of a household's daily per capita income, which is more than people can actually spend on food. In high-income countries, we found that the EAT-Lancet reference diet would cost 6.1 percent of per-capita income, which is often less than what people now spend on food," said Kalle Hirvonen, the lead author and development economist in Ethiopia at the International Food Policy Research Institute.
The EAT-Lancet Commission diet consists of a large amount of vegetables, fruits, whole grain, legumes, nuts and unsaturated oils, some seafood and poultry, and little to no red meat, processed meat, added sugar, refined grains, and starchy vegetables.
Fruits, vegetables, and animal-source foods are often the most expensive components of a healthy diet, but prices vary widely around the world, report the researchers.
To compute the affordability of an EAT-Lancet diet in each country, the researchers drew on retail prices for standardized items obtained through the International Comparison Program, a collaboration between the World Bank and country statistical agencies. They used prices for 744 food items in 159 countries, from which they could identify the lowest-cost combination of items in each country to meet EAT-Lancet criteria. They then did the same for nutrient requirements, and compared the cost of food in each country to survey data on household expenditure and income per capita from the World Bank's PovcalNet system.
"Although 1.58 billion is a lot of people, it is actually a conservative lower limit on the total number who cannot afford the diet recommended by the EAT-Lancet Commission. The cost of food preparation and of non-food necessities ensure that an even larger number of people cannot afford that kind of healthy diet," said Masters.
"Even if many poor consumers were to aspire to consume healthier and more environmentally sustainable foods, income and price constraints frequently render this diet unaffordable. Increased earnings and safety-net transfers, as well as systemic changes to lower food prices, are needed to bring healthy and sustainable diets within reach of the world's poor," concluded Hirvonen.
Limitations to the study include that the models count only the least expensive items in each country, so other research would be needed to address the additional costs and barriers to food use imposed by time constraints, tastes and preferences. Additionally, the study used 2011 prices and nationally aggregated data, so next steps include research on variation within countries as well as over time. There is also uncertainty regarding the nutritional content of the foods whose prices were used in the study's models.
###
Additional authors on this study are Derek Headey, a senior research fellow at the International Food Policy Research Institute, and Yan Bai, a Ph.D. student at the Friedman School of Nutrition Science and Policy.
This work was supported by the Bill & Melinda Gates Foundation, through a project entitled Changing Access to Nutritious Diets in Africa and South Asia, and another project entitled Advancing Research on Nutrition and Agriculture.
Hirvonen, K., Bai, Y., Headey, D., and Masters, W.A. (2019). Affordability of the EAT-Lancet reference diet: A global analysis. The Lancet Global Health, online Nov. 7, 2019, doi: 10.1016/ S2214-109X(19)30447-4
About the Friedman School of Nutrition Science and Policy at Tufts University
The Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University is the only independent school of nutrition in the United States. The school's five divisions - which focus on questions relating to nutrition and chronic diseases, molecular nutrition, agriculture and sustainability, food security, humanitarian assistance, public health nutrition, and food policy and economics - are renowned for the application of scientific research to national and international policy.
About the International Food Policy Research Institute
The International Food Policy Research Institute (IFPRI) seeks sustainable solutions for ending hunger and poverty. IFPRI was established in 1975 to identify and analyze alternative national and international strategies and policies for meeting the food needs of the developing world, with particular emphasis on low-income countries and on the poorer groups in those countries. Visit: http://www.ifpri.org
A Rutgers study presents a model for creating a sustainable neurosurgery programs in poor, remote locations
Rutgers University
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Low- and middle-income countries in remote locations with little access to care can create sustainable neurosurgical programs by recruiting and training young, local doctors, according to a Rutgers study.
Published in the journal World Neurosurgery, the study analyzed the effectiveness over the past 20 years of a successful neurosurgical department, its residency program, an international residency rotation and a medical student exchange program, all in Santarém, a poor, remote region of Brazil in the Amazon rainforest.
Access to care for residents of Brazil's rural north, where Santarém is located, depends on finding affordable transportation to the region's only municipal hospital, which serves an area larger than Texas with limited resources.
Specialized care is almost non-existent. Patients whose conditions cannot be treated locally are transferred to larger regional hospitals. Researchers say attracting medical residents and attending physicians to the remote location - where there is one neurosurgeon for every 200,000 to 500,000 people - has been difficult due to low pay and a lack of surgical supplies.
But what improved conditions and created more access for patients, Rutgers researchers said, is a five-year neurosurgery residency program started in 2014 that has led to upgraded facilities and new surgical equipment as well as expanded partnerships between academic and regional training centers. The program - which adds one new resident who splits clinical duties between the municipal and regional hospital - helped attract surgeons who could navigate health care barriers and work with limited resources.
"Having worked in the Santarém hospital system, I was fascinated by how it was able to create a sustainable neurosurgical program to care for people in a poor area with limited resources by using doctors who were from the local area," said lead author Nicole Silva, a medical student at Rutgers New Jersey Medical School.
The study also looked at neurological health issues, including those of indigenous people, that are unique to the region. Researchers found that neurological surgeries were performed for brain and spinal injuries from shallow water diving, falls from enormous Amazonian trees and from being struck by falling fruit as well as for neurosurgical care, such as spine surgeries, tumor surgeries and hydrocephalus treatment.
"Understanding the effect the environment has on patients from rural Amazonian communities has distinguished the young neurosurgeons of this region from those who trained in the traditional model in Brazil," Silva said. "I was inspired by these doctors who came from the area. They knew they wouldn't be compensated well but considered it a source of pride to provide care for people in the community where they were raised."
The researchers are encouraging other areas with barriers to neurological care to investigate replicating the program in Brazil. "It would require support from the established medical system of that country, a hospital with surgical suite capabilities, attending physicians and medical residents supported by residency education of their healthcare system and medical education system," said Silva. "Each one of these factors differ immensely among low- to middle-income countries worldwide."
Combined tests can predict kidney injury risk in critically ill children
Washington, DC (November 10, 2019) -- Combining 2 tests can improve predictions of severe acute kidney injury in children in intensive care. The findings come from a study that will be presented at ASN Kidney Week 2019 November 5-November 10 at the Walter E. Washington Convention Center in Washington, DC.
Two assessments--the Renal Angina Index (RAI) and measurement of urinary Neutrophil Gelatinase Associated Lipocalin (NGAL)--can be used to determine patients' risk of developing severe acute kidney injury. Kelli Krallman (Cincinnati Children's Hospital Medical Center) and her colleagues looked to determine the potential benefits of combining these assessments.
The team's analysis included 627 pediatric intensive care unit (PICU) admissions. The RAI calculated at 12 hours was found to be a significant predictor of the development of severe acute kidney injury during PICU days 2-4. Adding urinary NGAL assessments for those at risk based off a high RAI score improved the prediction significantly. These RAI+/NGAL+ patients were not only at higher risk for severe acute kidney injury, but also for the need of kidney replacement therapy such as dialysis, longer PICU stay, and longer hospital stay.
"Integration of the RAI and urinary NGAL assessments can be used early in the PICU course to identify patients truly at risk for acute kidney injury and its associated morbidity," said Krallman.
Ultrasound to guide treatment strategy not beneficial in early RA
American College of Rheumatology
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ATLANTA -- According to new research findings presented this week at the 2019 ACR/ARP Annual Meeting, a treatment strategy guided by ultrasound information use does not appear to provide better treatment decisions in patients with early rheumatoid arthritis. The study didn't find any additional reduction in MRI inflammation or structural damage when compared to a conventional treat-to-target strategy (Abstract #280).
Rheumatoid arthritis (RA) is the most common type of autoimmune arthritis. It is caused when the immune system (the body's defense system) is not working properly. RA causes pain and swelling in the wrist and small joints of the hand and feet. While there is no cure, treatments for RA can stop joint pain and swelling, but early treatment provides better results.
Researchers at Diakonhjemmet Hospital in Oslo, Norway wanted to determine whether treatment outcomes in early RA can be improved by targeting imaging remission, assessed by ultrasound in addition to clinical remission. Previous results from the ARCTIC and TaSER trials (Haavardsholm et al. BMJ 2016; Dale et al. ARD 2016), did not show that adding structured ultrasound assessment to a treat-to-target strategy was beneficial to early RA patients. However, results from both of those studies showed a trend toward less radiographic progression in the ultrasound arms.
"Patients who have been seemingly successfully treated and are free of clinical signs and symptoms of disease may continue to develop permanent structural joint damage. There is a need to find better ways to identify these patients and prevent this development," says Espen A. Haavardsholm, MD, PhD a rheumatologist at Diakonhjemmet Hospital and the study's senior author. "The purpose of this follow-up study was to use MRI, which is reliable, objective and more sensitive than X-ray, to make a secondary assessment of inflammatory activity and structural damage progression in the two study arms. If there really were a difference, we would expect to see it in the MRI results."
The randomized trial used data from the ARCTIC trial, including 230 DMARD-naïve patients with early RA who were aged 18 to 75. Patients were randomized 1:1 to follow either an ultrasound-guided strategy targeting DAS (Disease Activity Score) of less than 1.6 with no swollen joints and no power-Doppler signal in any joint, or a conventional strategy targeting DAS of less than 1.6 and no swollen joints. Treatment for all patients began with methotrexate, then escalated to combination therapy with methotrexate/sulfasalazine/hydroxychloroquine, then a biologic DMARD.
In the ultrasound group, patients stepped up their treatment if the ultrasound score indicated a need, overruling the DAS or swollen joint count results. MRI was performed six times on patients' dominant hand, then scored in chronological order by a blinded reader, according to the OMERACT RA MRI Scoring System. There were 218 patients, or 116 using ultrasound-guided strategy and 102 using a conventional strategy, who had MRI at the study's baseline and one or more follow-up visits, and their MRI results were analyzed.
The study's results showed no statistically significant baseline differences between the two treatment groups in either of the combined MRI scores. The mean combined MRI inflammation score decreased during the first year in the ultrasound group by -64.2 and in the conventional strategy group by -59.4, and these scores were maintained at the same level throughout the second year of follow-up. There was no significant difference in change from baseline between the two groups at any time. The mean combined MRI damage score showed a small increase over time, without any significant difference between the two groups. In the ultrasound group, 39 percent of patients had MRI erosive progression compared to 33 percent in the conventional strategy group.
"Our findings confirm the main conclusion from the ARCTIC trial that targeting ultrasound remission does not lead to improved results," says professor Haavardsholm. "The main message is that people with RA should be diagnosed and started on treatment early, monitored closely, and treatment should be stepped up aggressively until the target of clinical remission is reached. This strategy has proven very successful. However, going beyond this by aiming to also achieve imaging remission increases treatment cost and effort, but does not significantly further improve the results.
So, the ARCTIC trial does not support inclusion of ultrasound examination as a routine measure to guide treatment in early RA. Ultrasound might be a useful tool in other settings, such as when clinical findings are inconclusive. For patients, this means that if you feel that the medication has worked, your joints feel well and your rheumatologist cannot find any signs of active joint inflammation by physical examination, there is in most cases no need to go through additional imaging exams to determine that your disease is under satisfactory control with your current medication."
Rising rates of kidney injury in women who are hospitalized during pregnancy
American Society of Nephrology
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Washington, DC (November 9, 2019) -- A recent analysis reveals increasing rates of acute kidney injury in women who are hospitalized during pregnancy, especially among those with diabetes. Also, women with pregnancy-related acute kidney injury were much more likely to die while in the hospital than those without kidney injury. The findings will be presented at ASN Kidney Week 2019 November 5-November 10 at the Walter E. Washington Convention Center in Washington, DC.
Kidney injury during pregnancy is associated with significant maternal and fetal morbidity and mortality. To study the issue, Silvi Shah, MD (University of Cincinnati) and her colleagues analyzed records from the 2006-2015 Nationwide Inpatient Sample, a US database containing information on more than 7 million hospital stays each year.
The researchers identified 42,190,790 hospitalizations during pregnancy, and the overall rate of hospitalizations involving acute kidney injury was 0.08%. The rate increased from 0.04% in 2006 to 0.12% in 2015. Women with pregnancy-related acute kidney injury were older than those who did not develop acute kidney injury. Pregnancy-related acute kidney injury occurred at a higher rate in black women than white women, and in women with diabetes than in those without diabetes. The rate of pregnancy-related hospitalization involving acute kidney injury in diabetic women increased from 0.36% in 2006 to 1.10% in 2015.
Higher rates were observed in southern and midwest geographical regions than in the northeast region, and in urban teaching hospitals than in urban non-teaching hospitals and rural hospitals.
Women with pregnancy-related acute kidney injury were much more likely to die while in the hospital than those without kidney injury (3.98% vs. 0.01%).
"The findings of our study may necessitate change in nationwide policies regarding obstetric care of women and emphasize the need for kidney health monitoring for women hospitalized during pregnancy and during their outpatient prenatal visits," said Dr. Shah
Study points to new weapon in fight against lethal fungi
Monash University
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• Monash University researchers have gained insights into how nanoparticles could develop a biosensor to prevent deadly diseases contracted on medical equipment, such as catheters.
• Candida albicans can become a serious problem for people who are seriously ill or immune-suppressed.
Researchers at Monash University have gained insights into how nanoparticles could be used to identify the presence of invasive and sometimes deadly microbes, and deliver targeted treatments more effectively.
This study was conducted as an interdisciplinary collaboration between microbiologists, immunologists and engineers led by Dr Simon Corrie from Monash University's Department of Chemical Engineering and Professor Ana Traven from the Monash Biomedicine Discovery Institute (BDI). It was recently published in the American Chemical Society journal ACS Applied Interfaces and Material.
Candida albicans, a commonly found microbe, can turn deadly when it colonises on devices such as catheters implanted in the human body. While commonly found in healthy people, this microbe can become a serious problem for those who are seriously ill or immune-suppressed.
The microbe forms a biofilm when it colonises using, for example, a catheter as a source of infection. It then spreads into the bloodstream to infect internal organs.
"The mortality rate in some patient populations can be as high as 30 to 40 per cent even if you treat people. When it colonises, it's highly resistant to anti-fungal treatments," Professor Traven said.
"The idea is that if you can diagnose this infection early, then you can have a much bigger chance of treating it successfully with current anti-fungal drugs and stopping a full-blown systemic infection, but our current diagnostic methods are lacking. A biosensor to detect early stages of colonisation would be highly beneficial."
The researchers investigated the effects of organosilica nanoparticles of different sizes, concentrations and surface coatings to see whether and how they interacted with both C. albicans and with immune cells in the blood.
They found that the nanoparticles bound to fungal cells, but were non-toxic to them.
"They don't kill the microbe, but we can make an anti-fungal particle by binding them to a known anti-fungal drug," Professor Traven said.
The researchers also demonstrated that the particles associate with neutrophils - human white blood cells - in a similar way as they did with C. albicans, remaining noncytotoxic towards them.
"We've identified that these nanoparticles, and by inference a number of different types of nanoparticles, can be made to be interactive with cells of interest," Dr Corrie said.
"We can actually change the surface properties by attaching different things; thereby we can really change the interactions they have with these cells - that's quite significant."
Dr Corrie said while nanoparticles were being investigated in the treatment of cancer, the use of nanoparticle-based technologies in infectious diseases lags behind the cancer nanomedicine field, despite the great potential for new treatments and diagnostics.
"The other unique thing in this study is that rather than using cells grown in culture, we're also looking at how particles act in whole human blood and with neutrophils extracted from fresh human blood," he said.
Professor Traven said the study had benefited greatly from interdisciplinary collaboration.
"We've brought together labs with expertise in infection, microbiology and immunology with a lab that has expertise in engineering, to do state-of-the-art experiments," she said
Hospitalizations among dialysis patients are higher in areas with more black residents
American Society of Nephrology
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Washington, DC (November 9, 2019) -- Patients with kidney failure who receive hemodialysis at US clinics located in residential areas with a high percentage of Black residents are more likely to be hospitalized than those who receive hemodialysis in communities with a lower percentage of Black residents. The findings come from a study that will be presented at ASN Kidney Week 2019 November 5-November 10 at the Walter E. Washington Convention Center in Washington, DC.
The analysis, conducted by Ladan Golestaneh MD, MS (Albert Einstein College of Medicine/Montefiore Medical Center) and her colleagues, included 4,567 patients on hemodialysis from 154 facilities in 127 zip codes in the United States. Patients receiving dialysis in communities with a high percentage of Black residents had higher hospitalization rates (32% higher for communities with ?14.4% Blacks vs. those with ?1.8% Blacks), despite having equivalent dialysis care. The association remained after adjusting for individual race, clinical comorbidities, community level poverty, and dialysis quality and adherence.
"Higher risk for hospitalization in communities with a high percentage of Blacks is likely not a result of differences in quality of dialysis care, adherence practices, or clinical factors, but rather a result of as yet unidentified community level determinants of health," said Dr. Golestaneh. "Healthcare disparities continue to exist even after measures taken by Centers for Medicare and Medicaid services to bridge the quality gap, through measures such as the dialysis Quality Incentive Program, to promote high-quality services in outpatient dialysis facilities in communities across the U.S."
Biologics offer similar disease activity improvement for elderly & young-onset RA patients
American College of Rheumatology
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ATLANTA -- According to new research findings presented this week at the 2019 ACR/ARP Annual Meeting, both patients with rheumatoid arthritis whose disease onset occurred at an older age and those whose disease onset occurred earlier in life have similar improvements in clinical disease at 48 weeks after starting biologic disease-modifying antirheumatic drugs, as well as similar drug maintenance and adverse events discontinuation rates (Abstract #1345 ).
Rheumatoid arthritis (RA) is the most common type of autoimmune arthritis and it is a chronic disease that causes joint pain, stiffness, swelling and decreased movement of the joints. Small joints in the hands and feet are most commonly affected. Sometimes RA can affect your organs, such as eyes, skin or lungs.
"Patients with elderly-onset RA could present with higher disease activities and increased disabilities as compared to those with young-onset RA. Despite this, previous studies showed elderly patients receive biologics less frequently than younger individuals, suggesting patients with elderly-onset RA are potently undertreated," says Sadao Jinno, MD, MSc, instructor of rheumatology at Kobe University School of Medicine and the study's lead author. "On the other hand, in our daily practice, we have seen many elderly-onset RA patients treated with biologics effectively and safely. We wanted to investigate if there are differences in efficacy and safety of biologics between the two age groups."
Researchers in Japan conducted the study with 7,183 patients with RA who were age 18 or older and enrolled in a Japanese multicenter observational registry between September 2009 and December 2017. The patients also had to have a 3.2 or higher on the Disease Activity Score in 28 joints (DAS-28) and erythrocyte sedimentation rate measurement when they started biologics.
They assessed the relationship between age of RA onset and the clinical effectiveness of therapy at 48 weeks. The primary outcome for the study was a Clinical Disease Activity Index (CDAI) score at 48 weeks. Secondary outcomes included biologic retention at 48 weeks, achievement of a clinical disease activity index remission and low disease activity, or remission.
Among the patients on biologics, there were less in the elderly-onset RA group compared to the young-onset RA group. Of 989 patients who initiated biologics, 364 (37 percent) were elderly-onset. After adjusting for differences in baseline characteristics between the two age groups, researchers found no significant differences in the CDAI scores at 48 weeks. They did find a trend toward lower index remission rates in the elderly-onset group, but low disease activity/remission rates were similar between the two groups.
"Our findings showed there were no significant differences in Clinical Disease Activity Index scores at 48 weeks between elderly-onset and young-onset RA, suggesting biologics can be used for those with elderly-onset RA as effectively as for those with young-onset RA. We also found there was no difference of adverse event discontinuation rates between the two groups," says Dr. Jinno. "Clinicians should choose wisely which patients with elderly-onset RA are safely treated with biologics given that they are still at risk of developing adverse events, especially infections. Next, we plan to investigate if patients with elderly-onset RA respond differently to various modes of biologics."
A 'worker' that flies: Chinese researchers design novel flying robot
Chinese Academy of Sciences Headquarters
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IMAGE: The contact aerial manipulator system view more
Credit: Image by MENG Xiangdong
Skyscrapers are rising rapidly around the world, continuously transforming city skylines. However, their repair and maintenance is becoming more and more difficult. So, who can safely perform the job? Will a friendly neighborhood Spider-Man help out?
No, but Chinese researchers at the Shenyang Institute of Automation (SIA) of the Chinese Academy of Sciences have designed a promising alternative.
Recently, they reported the development of a contact aerial manipulator system that shows high flexibility and strong mission adaptability. They presented their findings at the 2019 IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS 2019), an international conference on robotics and intelligent systems held from Nov. 4-8 in Macao.
Traditionally, regular inspection of high-rise buildings with glass curtain walls has been conducted by humans with gondola systems, which can be very dangerous, costly and inefficient.
The new robot represents a major advance in safety and efficiency. It comprises a single-degree-of-freedom manipulator cube-frame end effector and a hex-rotor UAV system.
Compared with general wall-climbing robots, it is capable of avoiding obstacles and even jumping over grooves on wall surfaces. It can also conduct interactive operations while in flight. Importantly, it has been designed so that the whole system's contact force can be controlled precisely without any force sensors.
"How to control the force is considered the most difficult problem, since flying robots usually are sensitive to external force," said MENG Xiangdong, the robot's designer.
MENG said realizing this objective required first making a flying robot with closed loop control behave like a regular spring system. He said that the elastic coefficient could then be easily changed by altering the control parameters. "It means that we can take the robot as a spring system so that the contact process can be safe enough," said MENG.
The research team also conducted experiments to test the system. For example, the researchers fixed a light switch to a wall, then had the robot press the switch to turn the light on and off. The robot was able to safely and smoothly operate the switch via precise force control. In another experiment, the robot smoothly moved along a glass wall, exerting fixed pressure. The robot then used a pen attached to the end of the aerial manipulator to write "SIA" - for Shenyang Institute of Automation - on the glass wall.
"In the near future, we might see an extensive use of this new system in large infrastructure maintenance, and other special applications, such as scientific sampling." said MENG.
New X-ray technology could revolutionize how doctors identify abnormalities
University of Maryland Baltimore County
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Using ground-breaking technology, researchers at the University of Maryland, Baltimore County (UMBC) and University of Baltimore (UMB) are testing a new method of X-ray imaging that uses color to identify microfractures in bones. Microfractures were previously impossible to see using standard X-ray imaging. The findings associated with this advancement in color (spectral) CT (computed tomography) imaging are published in Advanced Functional Materials.
Since the discovery of X-rays in 1895, the basics of the technology have remained consistent. Doctors and scientists use them to see dense materials, like bones, but the technology's capabilities have been limited. Dipanjan Pan, professor of chemical, biochemical and environmental engineering UMBC, and professor of radiology at UMB, is the corresponding author of this new study. Looking ahead to the next generation of X-ray technology, he asks, "How can we detect a bone microcrack, something that is not visible using X-ray imaging?"
Pan explains that to examine this question, his lab developed nanoparticles that navigate and attach specifically to areas where microcracks exist. He likes to call them "GPS particles." They started conducting this research at the University of Illinois Urbana-Champaign. The researchers have programmed the particles to latch onto the correct area of the microcrack. Once the particles attach to microcracks, they remain there, which is crucial to the imaging process.
The particles contain the element hafnium. A new X-ray-based technique developed by a New Zealand-based company MARS then take CT images of the body and the hafnium particles appear in color. This provides a very clear image of where the bone microcracks are located.
Hafnium is used because its composition makes it detectable to X-rays, generating a signal that can then be used to image the cracks. Pan's lab showed that hafnium is stable enough to be used in testing involving living creatures, and can be excreted safely from the body. The lab has not yet begun testing on humans, but the technology to do so may be available as soon as 2020.
As for other applications for spectral CT imaging with this hafnium breakthrough, the research suggests that this methodology could be used to detect much more serious problems. For example, in order to determine whether a person has a blockage in their heart, doctors often will perform a stress test to detect abnormalities, which comes with a significant amount of risk. One day in the near future, doctors may be able to use spectral CT to determine whether there is a blockage in organs.
"Regular CT does not have a soft-tissue contrast. It cannot tell you where your blood vessels are. Spectral CT can help solve that problem," Pan explains. He notes that although more research is needed to begin using spectral CT in this way, he anticipates that it will be a "tremendous" new tool for radiologists. Dr. Fatemeh Ostadhossein, a recent graduate of the Pan lab, was first author on this study
Using AI to predict where and when lightning will strike
Ecole Polytechnique Fédérale de Lausanne
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Lightning is one of the most unpredictable phenomena in nature. It regularly kills people and animals and sets fire to homes and forests. It keeps aircraft grounded and damages power lines, wind turbines and solar-panel installations. However, little is known about what triggers lightning, and there is no simple technology for predicting when and where lightning will strike the ground.
At EPFL's School of Engineering, researchers in the Electromagnetic Compatibility Laboratory, led by Farhad Rachidi, have developed a simple and inexpensive system that can predict when lightning will strike to the nearest 10 to 30 minutes, within a 30-kilometer radius. The system uses a combination of standard meteorological data and artificial intelligence. The research paper has been published in Climate and Atmospheric Science, a Nature partner journal. The researchers are now planning to use their technology in the European Laser Lightning Rod project (see inset).
"Current systems are slow and very complex, and they require expensive external data acquired by radar or satellite," explains Amirhossein Mostajabi, the PhD student who came up with the technique. "Our method uses data that can be obtained from any weather station. That means we can cover remote regions that are out of radar and satellite range and where communication networks are unavailable."
What's more, because the data can be acquired easily and in real time, predictions can be made very quickly - and alerts can be issued even before a storm has formed.
Training the machine using available data
The EPFL researchers' method uses a machine-learning algorithm that has been trained to recognize conditions that lead to lightning. To carry out the training, the researchers used data collected over a ten-year period from 12 Swiss weather stations, located in both urban and mountainous areas.
Four parameters were taken into account: atmospheric pressure, air temperature, relative humidity and wind speed. Those parameters were correlated with recordings from lightning detection and location systems. Using that method, the algorithm was able to learn the conditions under which lightning occurs.
Once trained, the system made predictions that proved correct almost 80% of the time.
This is the first time that a system based on simple meteorological data has been able to predict lightning strikes through real-time calculations. The method offers a simple way of predicting a complex phenomenon.
Flexible yet sturdy robot is designed to 'grow' like a plant
Its extendable appendage can meander through tight spaces and then lift heavy loads
Massachusetts Institute of Technology
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IMAGE: The new "growing robot " can be programmed to grow, or extend, in different directions, based on the sequence of chain units that are locked and fed out from the "growing... view more
Credit: Image courtesy of Harry Asada, Tongxi Yan, Emily Kamienski and Seiichi Teshigawara
In today's factories and warehouses, it's not uncommon to see robots whizzing about, shuttling items or tools from one station to another. For the most part, robots navigate pretty easily across open layouts. But they have a much harder time winding through narrow spaces to carry out tasks such as reaching for a product at the back of a cluttered shelf, or snaking around a car's engine parts to unscrew an oil cap.
Now MIT engineers have developed a robot designed to extend a chain-like appendage flexible enough to twist and turn in any necessary configuration, yet rigid enough to support heavy loads or apply torque to assemble parts in tight spaces. When the task is complete, the robot can retract the appendage and extend it again, at a different length and shape, to suit the next task.
The appendage design is inspired by the way plants grow, which involves the transport of nutrients, in a fluidized form, up to the plant's tip. There, they are converted into solid material to produce, bit by bit, a supportive stem.
Likewise, the robot consists of a "growing point," or gearbox, that pulls a loose chain of interlocking blocks into the box. Gears in the box then lock the chain units together and feed the chain out, unit by unit, as a rigid appendage.
The researchers presented the plant-inspired "growing robot" this week at the IEEE International Conference on Intelligent Robots and Systems (IROS) in Macau. They envision that grippers, cameras, and other sensors could be mounted onto the robot's gearbox, enabling it to meander through an aircraft's propulsion system and tighten a loose screw, or to reach into a shelf and grab a product without disturbing the organization of surrounding inventory, among other tasks.
"Think about changing the oil in your car," says Harry Asada, professor of mechanical engineering at MIT. "After you open the engine roof, you have to be flexible enough to make sharp turns, left and right, to get to the oil filter, and then you have to be strong enough to twist the oil filter cap to remove it."
"Now we have a robot that can potentially accomplish such tasks," says Tongxi Yan, a former graduate student in Asada's lab, who led the work. "It can grow, retract, and grow again to a different shape, to adapt to its environment."
The team also includes MIT graduate student Emily Kamienski and visiting scholar Seiichi Teshigawara, who presented the results at the conference.
The last foot
The design of the new robot is an offshoot of Asada's work in addressing the "last one-foot problem" -- an engineering term referring to the last step, or foot, of a robot's task or exploratory mission. While a robot may spend most of its time traversing open space, the last foot of its mission may involve more nimble navigation through tighter, more complex spaces to complete a task.
Engineers have devised various concepts and prototypes to address the last one-foot problem, including robots made from soft, balloon-like materials that grow like vines to squeeze through narrow crevices. But Asada says such soft extendable robots aren't sturdy enough to support "end effectors," or add-ons such as grippers, cameras, and other sensors that would be necessary in carrying out a task, once the robot has wormed its way to its destination.
"Our solution is not actually soft, but a clever use of rigid materials," says Asada, who is the Ford Foundation Professor of Engineering.
Chain links
Once the team defined the general functional elements of plant growth, they looked to mimic this in a general sense, in an extendable robot.
"The realization of the robot is totally different from a real plant, but it exhibits the same kind of functionality, at a certain abstract level," Asada says.
The researchers designed a gearbox to represent the robot's "growing tip," akin to the bud of a plant, where, as more nutrients flow up to the site, the tip feeds out more rigid stem. Within the box, they fit a system of gears and motors, which works to pull up a fluidized material -- in this case, a bendy sequence of 3-D-printed plastic units interlocked with each other, similar to a bicycle chain.
As the chain is fed into the box, it turns around a winch, which feeds it through a second set of motors programmed to lock certain units in the chain to their neighboring units, creating a rigid appendage as it is fed out of the box.
The researchers can program the robot to lock certain units together while leaving others unlocked, to form specific shapes, or to "grow" in certain directions. In experiments, they were able to program the robot to turn around an obstacle as it extended or grew out from its base.
"It can be locked in different places to be curved in different ways, and have a wide range of motions," Yan says.
When the chain is locked and rigid, it is strong enough to support a heavy, one-pound weight. If a gripper were attached to the robot's growing tip, or gearbox, the researchers say the robot could potentially grow long enough to meander through a narrow space, then apply enough torque to loosen a bolt or unscrew a cap.
Auto maintenance is a good example of tasks the robot could assist with, according to Kamienski. "The space under the hood is relatively open, but it's that last bit where you have to navigate around an engine block or something to get to the oil filter, that a fixed arm wouldn't be able to navigate around. This robot could do something like that."
Study points to new weapon in fight against lethal fungi
Monash University
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• Monash University researchers have gained insights into how nanoparticles could develop a biosensor to prevent deadly diseases contracted on medical equipment, such as catheters.
• Candida albicans can become a serious problem for people who are seriously ill or immune-suppressed.
Researchers at Monash University have gained insights into how nanoparticles could be used to identify the presence of invasive and sometimes deadly microbes, and deliver targeted treatments more effectively.
This study was conducted as an interdisciplinary collaboration between microbiologists, immunologists and engineers led by Dr Simon Corrie from Monash University's Department of Chemical Engineering and Professor Ana Traven from the Monash Biomedicine Discovery Institute (BDI). It was recently published in the American Chemical Society journal ACS Applied Interfaces and Material.
Candida albicans, a commonly found microbe, can turn deadly when it colonises on devices such as catheters implanted in the human body. While commonly found in healthy people, this microbe can become a serious problem for those who are seriously ill or immune-suppressed.
The microbe forms a biofilm when it colonises using, for example, a catheter as a source of infection. It then spreads into the bloodstream to infect internal organs.
"The mortality rate in some patient populations can be as high as 30 to 40 per cent even if you treat people. When it colonises, it's highly resistant to anti-fungal treatments," Professor Traven said.
"The idea is that if you can diagnose this infection early, then you can have a much bigger chance of treating it successfully with current anti-fungal drugs and stopping a full-blown systemic infection, but our current diagnostic methods are lacking. A biosensor to detect early stages of colonisation would be highly beneficial."
The researchers investigated the effects of organosilica nanoparticles of different sizes, concentrations and surface coatings to see whether and how they interacted with both C. albicans and with immune cells in the blood.
They found that the nanoparticles bound to fungal cells, but were non-toxic to them.
"They don't kill the microbe, but we can make an anti-fungal particle by binding them to a known anti-fungal drug," Professor Traven said.
The researchers also demonstrated that the particles associate with neutrophils - human white blood cells - in a similar way as they did with C. albicans, remaining noncytotoxic towards them.
"We've identified that these nanoparticles, and by inference a number of different types of nanoparticles, can be made to be interactive with cells of interest," Dr Corrie said.
"We can actually change the surface properties by attaching different things; thereby we can really change the interactions they have with these cells - that's quite significant."
Dr Corrie said while nanoparticles were being investigated in the treatment of cancer, the use of nanoparticle-based technologies in infectious diseases lags behind the cancer nanomedicine field, despite the great potential for new treatments and diagnostics.
"The other unique thing in this study is that rather than using cells grown in culture, we're also looking at how particles act in whole human blood and with neutrophils extracted from fresh human blood," he said.
Professor Traven said the study had benefited greatly from interdisciplinary collaboration.
"We've brought together labs with expertise in infection, microbiology and immunology with a lab that has expertise in engineering, to do state-of-the-art experiments," she said.
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