Researchers working toward automating sedation in intensive care units

Researchers working toward automating sedation in intensive care units

Georgia Institute of Technology Research News) Researchers are one step closer to their goal of automating the management of sedation in hospital intensive care units. They have developed control algorithms that use clinical data to accurately determine a patient’s level of sedation and can notify medical staff if there is a change in the level.

 

 

From the February 15, 2011 Eureka news alert

Computer system for evaluating sedation level shows strong agreement with clinical assessment

		IMAGE: Georgia Tech researchers Wassim Haddad, Allen Tannenbaum and Behnood Gholami (left-right) and Northeast Georgia Medical Center chief medical informatics officer James Bailey have developed control algorithms to automate sedation in… Click here for more information.

Researchers at the Georgia Institute of Technology and the Northeast Georgia Medical Center are one step closer to their goal of automating the management of sedation in hospital intensive care units (ICUs). They have developed control algorithms that use clinical data to accurately determine a patient’s level of sedation and can notify medical staff if there is a change in the level.

“ICU nurses have one of the most task-laden jobs in medicine and typically take care of multiple patients at the same time, so if we can use control system technology to automate the task of sedation, patient safety will be enhanced and drug delivery will improve in the ICU,” said James Bailey, the chief medical informatics officer at the Northeast Georgia Medical Center in Gainesville, Ga. Bailey is also a certified anesthesiologist and intensive care specialist.

During a presentation at the IEEE Conference on Decision and Control, the researchers reported on their analysis of more than 15,000 clinical measurements from 366 ICU patients they classified as “agitated” or “not agitated.” Agitation is a measure of the level of patient sedation. The algorithm returned the same results as the assessment by hospital staff 92 percent of the time.

“Manual sedation control can be tedious, imprecise, time-consuming and sometimes of poor quality, depending on the skills and judgment of the ICU nurse,” said Wassim Haddad, a professor in the Georgia Tech School of Aerospace Engineering. “Ultimately, we envision an automated system in which the ICU nurse evaluates the ICU patient, enters the patient’s sedation level into a controller, which then adjusts the sedative dosing regimen to maintain sedation at the desired level by continuously collecting and analyzing quantitative clinical data on the patient.”…

		IMAGE: Georgia Tech researchers Allen Tannenbaum, Wassim Haddad and Behnood Gholami (left-right) and Northeast Georgia Medical Center chief medical informatics officer James Bailey have developed control algorithms to automate sedation in… Click here for more information.

 

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This project is supported in part by the U.S. Army Medical Research and Material Command (Grant No. 08108002). The content is solely the responsibility of the principal investigator (Wassim Haddad) and does not necessarily represent the official views of the U.S. Army….

 

 

 

 

Quest for designer bacteria uncovers a ‘Spy’

Quest for designer bacteria uncovers a ‘Spy’

A cradle-shaped molecular assistant called Spy aids in protein refolding and protects unstable proteins from being cut up or sticking to other proteins.

(University of Michigan) Scientists have discovered a molecular assistant called Spy that helps bacteria excel at producing proteins for medical and industrial purposes.

From the February 15, 2011 Eureka news alert

ANN ARBOR, Mich.—Scientists have discovered a molecular assistant called Spy that helps bacteria excel at producing proteins for medical and industrial purposes.

Bacteria are widely used to manufacture proteins used in medicine and industry, but the bugs often bungle the job. Many proteins fall apart and get cut up inside the bacteria before they can be harvested. Others collapse into useless tangles instead of folding properly, as they must in order to function normally.

A research team led by James Bardwell, who is a professor of molecular, cellular and developmental biology and of biological chemistry, as well as a Howard Hughes Medical Institute investigator, at the University of Michigan, developed a way to coerce bacteria into making large quantities of stable, functional proteins. Then, in exploring why these designer bacteria were so successful, the scientists discovered the molecular helper, Spy.

The research is scheduled for online publication Feb.13 in the journal Nature Structural & Molecular Biology.***

In the first phase of the research, the team designed biosensors that directly link protein stability to the antibiotic resistance of bacteria. When a poorly folded, unstable protein is inserted into the middle of the biosensor in a bacterium, it disrupts the bug’s resistance to antibiotics. When the protein is stabilized, resistance is restored.

The researchers inserted a particularly unstable protein into Escherichia coli (E. coli), which forced the bacteria to either adapt by improving protein stability or die when exposed to antibiotics. Through a “directed evolution” experiment, in which the scientists selected colonies with increasing antibiotic resistance—and increasing protein stability—the team generated designer bacteria that produced up to 700 times more of the previously unstable protein.

“It is exciting to realize that if even bacteria are asked in the right way, they can come up with good solutions to hard problems,” said postdoctoral fellow Shu Quan, who spearheaded the work.

In looking to see why the designer bacteria were so much better at producing proteins, the scientists found that the efficient microbes were making much more of a small protein called Spy. Further study showed that the cradle-shaped Spy aids in protein refolding and protects unstable proteins from being cut up or sticking to other proteins.

“Our work may usher in an era of designer bacteria that have had their folding environment customized so that they can now efficiently fold normally unstable proteins,” Bardwell said.

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The work was conducted in Bardwell’s lab at U-M. Mirek Cygler’s laboratory at McGill University solved the structure of the Spy protein. In addition to Bardwell, Quan and Cygler, the paper’s authors are masters students Philipp Koldewey and Stephan Hofmann; undergraduate students Nadine Kirsch and Jennifer Pfizenmaier; postdoctoral research associates Tim Tapley, Linda Foit and Guoping Ren; associate professor Ursula Jakob and associate professor Zhaohui Xu; all of U-M; and Karen Ruane and Rong Shi of McGill University.

The researchers received funding from Howard Hughes Medical Institute and the Canadian Institutes of Health Research.

For more information:

James Bardwell: http://www.ns.umich.edu/htdocs/public/experts/ExpDisplay.php?beginswith=Bardwell

Nature Molecular and Structural Biology: http://www.cell.com/molecular-cell/home

*** For suggestions on how to get this article for free or at low cost, click here

 

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Choosing your neighbors: MBL scientists see how microbes relate in space

		IMAGE: This is a spectral fluorescence image of 15 different species of human oral microbes grown in the laboratory and labeled with taxon specific probes in a CLASI-FISH experiment.

MBL, WOODS HOLE, MA—Like people in cities, microbes often live in complex communities that contain many different microbial types. Also like us, microbes tend to gravitate to and “hang out” with certain other types in their community, more than with the rest. And sometimes, when opportunities arise, they move to more favorable locations.

 

 

 

Boston University School of Medicine professor co-authors first book on deaf ethnicity

Boston University School of Medicine professor co-authors first book on deaf ethnicity

(Boston University Medical Center) In the first book to examine the 300-year ancestry of deaf people in America, Richard C. Pillard, M.D., a professor of psychiatry at Boston University School of Medicine and his co-authors argue that deaf people who use sign language to communicate are members of an ethnic group.

From the February 15, 2011 Eureka news release

(Boston) – In the first book to examine the 300-year ancestry of deaf people in America, Richard C. Pillard, MD, a professor of psychiatry at Boston University School of Medicine (BUSM) and his co-authors argue that deaf people who use sign language to communicate are members of an ethnic group. The book, “The People of the Eye: Deaf Ethnicity and Ancestry,” examines the lives and culture of the people who identify themselves as members of Deaf-World and compares them to other ethnic groups, delving into controversial questions surrounding whether being deaf is always a disability or, for some, an ethnicity.

There are more than 10 million deaf and hard of hearing people in the United States, most of whom communicate using spoken language and identify themselves ethnically based on factors other than deafness. For these, loss of hearing is indeed a disability. However, most of the estimated 500,000 Deaf people who use sign language constitute an ethnic group, so say the authors, because they share a language, a history, a culture, social institutions, a sense of shared identity, and a name – the Deaf-World. Moreover, a majority are kin in that they share ancestry as do the members of many ethnic groups.

“Characterizing the Deaf-World as an ethnic group is challenging because it argues that Deaf individuals who use American Sign Language (ASL) to communicate are not disabled; instead, like many ethnic groups, they have a physical difference that goes with their ethnicity – in this case, reliance on vision. Members of the Deaf-World generally do not see themselves as disabled though many doctors would disagree,” said Pillard.

The book includes the first compiled ancestries of Deaf families dating back to the 17th century. The authors have traced more than 200 lineages most of which can be accessed from an on-line data base. These provide information for those curious about their personal ancestry or relations to the Deaf-World, and they identify the persons and conditions that led to the founding of the Deaf-World in America.

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The book’s senior author is Harlan Lane, professor of psychology at Northeastern University and author of a number of books about the history and culture of the Deaf. A second co-author is Gallaudet University‘s Director of Deaf Library Collections and Archives, Ulf Hedberg. The book is published by Oxford University Press.

 

 

 

Elsevier/MEDai enhances real-time clinical surveillance system for hospitals

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Elsevier/MEDai enhances real-time clinical surveillance system for hospitals

From the February 15, 2011 Eureka news alert

(Elsevier) Elsevier/MEDai, a leading provider of advanced clinical analytic health-care solutions, announced today the launch of the latest version of Pinpoint Review, its real-time, clinical surveillance system for hospitals. The new version will feature an expanded set of clinical watch triggers, expanded core measure alerts and three new predictions: ICU Admission Prediction, Length of Stay Prediction and Mortality Prediction.

ORLANDO, FL – 14 February, 2011 – Elsevier / MEDai, a leading provider of advanced clinical analytic healthcare solutions, announced today the launch of the latest version of Pinpoint Review®, its real-time, clinical surveillance system for hospitals. The new version will feature an expanded set of clinical watch triggers, expanded core measure alerts and three new predictions: ICU Admission Prediction, Length of Stay Prediction and Mortality Prediction.

“Hospitals are facing an enormous amount of pressure to provide better, safer care with fewer complications while managing costs,” said Swati Abbott, President of Elsevier / MEDai. “Elsevier / MEDai has enhanced its predictive analytics product to continuously give hospitals and clinicians the most up-to-date tools they need to lower mortality rates and healthcare costs, provide a higher quality of care, increase patient safety and maintain regulatory compliance.”

Pinpoint Review generates predictions for acute-care patients, focusing on the likelihood of a patient developing a complication, contracting a healthcare-acquired infection or being readmitted within 30 days of discharge, while patients are still in the hospital and there is time to adjust care to avoid a negative outcome.

With the expansion of Pinpoint Review’s new predictions, care givers are able to enhance their efforts in proactive care management. Pinpoint Review unlocks the power of clinical and administrative hospital data by utilizing predictive technologies to turn data into actionable information. Empowering today’s hospitals with the ability to predict whether or not a patient will be admitted to the ICU or higher intensity care unit, a predicted length of hospital stay or patient expiration goes a long way in driving down the cost of care and brings a proactive approach to quality improvement.

Pinpoint Review addresses the increasing pressure on hospitals from entities such as the Agency for Healthcare Research and Quality and the Joint Commission on Accreditation of Healthcare Organizations to deliver a higher quality of care and fewer medical errors. Pinpoint Review alerts care providers to patients at risk for developing several of the conditions that the Centers for Medicare and Medicaid Services (CMS) no longer reimburse.

Updated heart disease prevention guidelines for women focus more on ‘real-world’ recommendations

Updated heart disease prevention guidelines for women focus more on ‘real-world’ recommendations

From the February 15 2011 Eureka news alert

Updated cardiovascular prevention guidelines for women [link goes to free full text of the article] focus on what works best in the “real world” vs. clinical research settings and consider personal and socioeconomic factors that can keep women from following medical advice and treatment. The guidelines also incorporate illnesses that increase heart disease risk in women, such as lupus, rheumatoid arthritis and pregnancy complications Helping women — and their doctors — understand risks and take practical steps can be most effective in preventing heart disease and stroke.

 

The 2011 update identifies barriers that hinder both patients and doctors from following guidelines, while outlining key strategies for addressing those obstacles.

“Awareness continues to be a key driver to optimal care,” said Mosca, director of preventive cardiology at New York-Presbyterian Hospital and professor of Medicine at Columbia University Medical Center. “Cause initiatives such as Go Red for Women and provider compliance programs such as Get With The Guidelines® are strong components in our efforts to broaden awareness and improve adherence among patients and providers.”

She said getting a dialogue started between a woman and her doctor is a critical first step.

“If the doctor doesn’t ask the woman if she’s taking her medicine regularly, if she’s having any side effects or if she’s following recommended lifestyle behaviors, the problems may remain undetected,” she said. “Improving adherence to preventive medications and lifestyle behaviors is one of the best strategies we have to lower the burden of heart disease in women.”

To evaluate patient risk, the guidelines incorporate illnesses linked to higher risk of cardiovascular disease in women, including lupus and rheumatoid arthritis, and pregnancy complications such as preeclampsia, gestational diabetes or pregnancy-induced hypertension. Mosca said women with a history of preeclampsia face double the risk of stroke, heart disease and dangerous clotting in veins during the five to 15 years after pregnancy. Essentially, having pregnancy complications can now be considered equivalent to having failed a stress test.

“These have not traditionally been top of mind as risk factors for heart disease,” she said. “But if your doctor doesn’t bring it up, you should ask if you’re at risk for heart disease because of pregnancy complications or other medical conditions you’ve experienced.”

The updated guidelines also emphasize the importance of recognizing racial and ethnic diversity and its impact on cardiovascular disease. For example, hypertension is a particular problem among African-American women and diabetes among Hispanic women.

Although putting clinical research into practical, everyday adherence can be challenging, solid scientific evidence is still the basis for many of the guidelines, Mosca said. Some commonly considered therapies for women are specifically noted in the guidelines as lacking strong clinical evidence in their effectiveness for preventing cardiovascular disease and, in fact, may be harmful to some women. Those include the use of hormone replacement therapy, antioxidants and folic acid.

The update includes depression screening as part of an overall evaluation of women for cardiovascular risk, because while treating depression has not been shown to directly improve cardiovascular health, depression might affect whether women follow their doctor’s advice.

Despite a growing body of clinical evidence to fight heart disease and stroke in women, more is needed, Mosca said. Coronary heart disease death rates in women dropped by two-thirds from 1980 to 2007, due to both effective treatment and risk factor reduction, according to the American Heart Association, but cardiovascular disease still kills about one woman every minute in the United States.

In future studies, researchers should look at interventions during specific times throughout a woman’s lifespan ― including puberty, pregnancy and menopause ― to identify risks and determine effective prevention opportunities during those critical times, Mosca said. More cost-effective analyses and clinical trial research with male- and female-specific results are also needed, especially regarding risks posed by preventive therapies.

“Now that science has shown the benefits are often similar for men and women, there is a need to understand if the risks are also similar and acceptable,” she said.

“These guidelines are a critical weapon in the war against heart disease, the leading killer of women,” Mosca said. “They are an important evolution in our understanding of women and heart disease. And I cannot stress personal awareness and education enough. Initiatives such as Go Red For Women give women access to the latest information and real-life solutions to lower their risk of heart disease.”

 

 

Growing number of farm animals spawn new diseases

Growing number of farm animals spawn new diseases

 

HONG KONG (Reuters) – A growing number of livestock, such as cows and pigs, are fuelling new animal epidemics worldwide and posing more severe problems in developing countries as it threatens their food security, according to a report released on Friday.

Epidemics in recent years, such as SARS and the H1N1 swine flu, are estimated to have caused billions of dollars in economic costs.

Some 700 million people keep farm animals in developing countries and these animals generate up to 40 percent of household income, the report by the International Livestock Research Institute said.

“Wealthy countries are effectively dealing with livestock diseases, but in Africa and Asia, the capacity of veterinary services to track and control outbreaks is lagging dangerously behind livestock intensification,” John McDermott and Delia Grace at the Nairobi-based institute said in a statement on the report.

“This lack of capacity is particularly dangerous because many poor people in the world still rely on farm animals to feed their families, while rising demand for meat, milk and eggs among urban consumers in the developing world is fueling a rapid intensification of livestock production.”

Seventy-five percent of emerging infectious diseases originate in animals, they added. Of these 61 percent are transmissible between animals and humans.

“A new disease emerges every four months; many are trivial but HIV, SARS and avian influenza (eg. H5N1) illustrate the huge potential impacts,” McDermott and Grace wrote in the report.

HUGE ECONOMIC COSTS

Epidemics like SARS in 2003, sporadic outbreaks of the H5N1 avian flu since 1997 and the H1N1 swine flu pandemic of 2009 racked up enormous economic costs around the world.

While SARS cost between $50 billion to $100 billion, the report cited a World Bank estimate in 2010 which pinned the potential costs of an avian flu pandemic at $3 trillion.

The report warned that rapid urbanization and climate change could act as “wild cards,” altering the present distribution of diseases, sometimes “dramatically for the worse.”

The two researchers urged developing countries to improve animal disease surveillance and speed up testing procedures to help contain livestock epidemics before they become widespread.

(Reporting by Tan Ee Lyn; Editing by Yoko Nishikawa)

Reuters Health

 

 

 

Quick, Simple Test Can Detect Concussion in Athletes

Quick, Simple Test Can Detect Concussion in Athletes

Screening superior to other sideline tests in spotting early signs of brain trauma, researchers say

 

 

From the February 13, 2011 Health Day news item by Robert Preidt

SATURDAY, Feb. 12 (HealthDay News) — A quick, simple test done on the sidelines of sports events can accurately detect concussion in athletes, a new study says.

The screening — known as the King-Devick test — is superior to current sideline tests that can fail to assess a wide range of brain functions, according to the researchers at the University of Pennsylvania School of Medicine.

For this test, athletes are asked to read single digit numbers on index-sized cards. Normally, it takes about one minute. Any increase in the time needed to complete the test suggests the athlete has suffered a concussion, particularly if the delay is more than five seconds longer than the athlete’s baseline test time.

The researchers said the test can detect impairments in eye movement, attention, language and other symptoms of concussion. This study of 39 boxers found that test times improved an average of one second for those who didn’t experience head trauma, but worsened 11.1 seconds for those who did suffer head trauma and 18 seconds for those who were knocked out.

The study appears online in the journal Neurology.

“This rapid screening test provides an effective way to detect early signs of concussion, which can improve outcomes and hopefully prevent repetitive concussions,” senior author Dr. Laura Balcer, a professor of neurology, ophthalmology and epidemiology, said in a university news release.

“If validated in future studies, this test has the potential to become a standard sideline test for athletes,” she added.

SOURCE: University of Pennsylvania, news release, Feb. 2, 2011