Day: October 27, 2023

A New Robotic ‘Hand’ that can Carry out Clinical Breast Examination

The device. Credit: George Jenkinson

University of Bristol researchers have created a robotic hand that could carry out Clinical Breast Examinations (CBE). The device is able to apply very specific forces over a range similar to forces used by human examiners and can detect lumps using sensor technology at larger depths than before.

This could revolutionise how women monitor their breast health by giving them access to safe electronic CBEs, located in easily accessible places, such as pharmacies and health centres, which provide accurate results. The technology is described in the journal Sensors.

Precision, repeatability and accuracy are of paramount importance in these tactile medical examinations to ensure favourable patient outcomes. A range of automatic and semi-automatic devices have been proposed to aid with optimising this task, particularly for difficult to detect and hard to reach situations such as during minimally invasive surgery.

The research team included a mix of postgraduate and undergraduate researchers, supervised by Dr Antonia Tzemanaki from Bristol Robotics Laboratory. Lead author George Jenkinson explained: “There are conflicting ideas about how useful carrying out Clinical Breast Examinations (CBE) are for the health outcomes of the population.

“It’s generally agreed upon that if it is well performed, then it can be a very useful and low risk diagnostic technique.

“There have been a few attempts in the past to use technology to improve the standard to which healthcare professionals can perform a CBE by having a robot or electronic device physically palpate breast tissue. But the last decade or so of technological advances in manipulation and sensor technology mean that we are now in a better position to do this.

“The first question that we want to answer as part of this is whether a specialised manipulator can be demonstrated to have the dexterity necessary to palpate a realistic breast size and shape.”

The team created their manipulator using 3D printing and other Computerised Numerical Control techniques and employed a combination of laboratory experiments and simulated experiments on a fake (silicone) breast and its digital twin, both modelled on a volunteer at the Simulation and Modelling in Medicine and Surgery research group at Imperial College London.

The simulations allowed the team to perform thousands of palpations and test lots of hypothetical scenarios such as calculating the difference in efficiency when using two, three, or four sensors at the same time. In the lab, they were able to carry out the experiments on the silicone breast to demonstrate the simulations were accurate and to experimentally discover the forces for the real equipment.

George added: “We hope that the research can contribute to and complement the arsenal of techniques used to diagnose breast cancer, and to generate a large amount of data associated with it that may be useful in trying to identify large scale trends that could help diagnose breast cancer early.

“One advantage that some doctors have mentioned anecdotally is that this could provide a low-risk way to objectively record health data. This could be used, for example, to compare successive examinations more easily, or as part of the information packet sent to a specialist if a patient is referred for further examination.”

As a next step, the team will combine CBE techniques learned from professionals with AI, and fully equip the manipulator with sensors to determine the effectiveness of the whole system at identifying potential cancer risks.

The ultimate goal is that the device and sensors will have the capability to detect lumps more accurately and deeper than it is possible only from applying human touch. It could also be combined with other existing techniques, such as ultrasound examination.

“So far we have laid all of the groundwork,” said George. “We have shown that our robotic system has the dexterity necessary to carry out a clinical breast examination – we hope that in the future this could be a real help in diagnosing cancers early.”

Source: The University of Bristol

The Seasons Affect Appetite in Unexpected Ways

Photo by Julian Jagtenberg on Pexels

Many people may feel that they are healthier in the summer: the sun is shining, they get plenty of vitamin D, and the days are long. However, recent research from the University of Copenhagen suggests that eating habits in winter may be better for metabolic health than eating habits in summer – at least in the case of mice. Researchers have examined the metabolism and weight of mice exposed to both ‘winter light’ and ‘summer light’.

“We found that even in non-seasonal animals, differences in light hours between summer and winter do cause differences in energy metabolism. In this case, body weight, fat mass and liver fat content,” says Lewin Small, who carried out the research while a postdoc at Novo Nordisk Foundation Center for Basic Metabolic Research at the University of Copenhagen. He adds:

“We found this mostly in mice exposed to winter light hours. These mice had less body weight gain and adiposity. They have more rhythmicity in the way they eat over a 24-hour period. And this then led to benefits in metabolic health.”

The study, published in Cell Metabolism, is the first of its kind to examine light hour’s influence on metabolism in mice, that are not considered seasonal animals as like humans they do not only breed in specific seasons. Animals breeding in specific seasons gain weight before the breeding season to save energy supplies.

Light hours impact metabolism

Lewin Small’s inspiration for initiating the study stemmed from the significant variation in daylight hours across various regions of the world.

“We study the influence of the time-of-day on aspects of metabolism such as exercise, obesity and diabetes. However, most studies that investigate this link do so assuming an equal length of day and night all year round,” says Lewin Small.

Therefore, they wanted to find out what the seasonal light differences meant for the metabolism. Most people in the world live with at least a two-hour difference in light between summer and winter.

“I come from Australia, and when I first moved to Denmark, I was not used to the huge difference in light between summer and winter and I was interested in how this might affect both circadian rhythms and metabolism,” says Lewin Small and adds:

“Therefore, we exposed laboratory mice to different light hours representing different seasons and measured markers of metabolic health and the circadian rhythms of these animals.”

Because the research was conducted using mice as the experimental subjects, it is not possible to assume that the same thing goes for humans.

“This is a proof of principle. Do differences in light hours affect energy metabolism? Yes, it does. Further studies in humans may find that altering our exposure to artificial light at night or natural light exposure over the year could be used to improve our metabolic health,” says Juleen Zierath, Professor at the Novo Nordisk Center for Basic Metabolism Research (CBMR) and senior author of the study.

Lewin Small adds that the findings are important to understand how eating patterns are affected by the light and seasons which might help us understand why some people gain more weight or if people gain more weight in a specific time of year.

“Differences in light between summer and winter could affect our hunger pathways and when we get hungry during the day,” he says.

Source: University of Copenhagen – The Faculty of Health and Medical Sciences

How Sleep Disruption Can Make Pain Feel Worse

Photo by Andrea Piacquadio on Pexels

People often experience headaches and body pain after a lack of sleep, but the mechanisms behind this phenomenon are unclear. A new study published in Nature Communications reveals that a certain endocannabinoid neurotransmitter plays a major role.

The animal-based study, led by investigators at Massachusetts General Hospital (MGH), a founding member of Mass General Brigham (MGB), found that the heightened pain sensitivity than can result from chronic sleep disruption (CSD) – or CSD-induced hyperalgaesia – involved signalling from a part of a brain known as the thalamic reticular nucleus (TRN).

Analyses of metabolites showed that the level of N-arachidonoyl dopamine (NADA), a type of neurotransmitter called an endocannabinoid, decreased in the TRN as a result of sleep deprivation.

Activity of the cannabinoid receptor 1, which is involved in controlling pain perception, also decreased in the thalamic reticular nucleus after CSD.

Administering NADA to the TRN reduced CSD-induced hyperalgaesia in mice.

This beneficial effect of administered NADA could be countered by blocking the cannabinoid receptor 1, suggesting that both the receptor and NADA play a role in pain sensitivity due to sleep deprivation.

“We provide a mechanism as to how sleep disruption leads to exaggerated pain, suggesting that harnessing the endocannabinoid system might break the vicious cycle between pain and sleep loss,” says co-senior author Shiqian Shen, MD, the clinical director of MGH’s Tele Pain Program.

Source: Massachusetts General Hospital

Science Finally Tackles the Question of How Warming up Improves Performance

Photo by Olga Guryanova on Unsplash

While top sports teams like the Springboks all know the importance of warming up their muscles before a game, it has not always been clear as to what is actually going on when muscles are warmed up, and whether all muscles are the same. Now, in a study recently published in the Journal of General Physiology, a Japanese research team has revealed how heating affects the contraction of different muscles, and how this might benefit populations in need of improved exercise performance as well as on the sports field.

Skeletal muscle contracts in response to electrical signals from the nervous system, which activate proteins in muscle cells, resulting in movement. The team previously explored how cardiac muscle contractions are affected by temperature, determining that the heart can contract efficiently within the body temperature range.

Next, using muscle proteins and advanced microscopy, the Osaka University-led team wanted to determine how temperature affects skeletal muscle: do skeletal muscles have similar temperature sensitivity, or are they different from cardiac muscle?

The research team found that some of the proteins in the muscle cells act as a temperature sensor, and that heating affects skeletal and cardiac contractile systems differently. “Our findings point to differences in the temperature sensitivity of proteins responsible for contraction in skeletal vs. cardiac muscles,” says co-lead author Kotaro Oyama. “Basically, the skeletal muscle that moves our body around is more sensitive to heating than the heart.”

The physiological significance of these findings will become clear when the functional difference between skeletal and cardiac muscle is considered. While skeletal muscle only generates a certain amount of force when required, the heart is meant to beat continuously.

“The higher temperature dependence of skeletal muscle may allow it to contract relatively quickly upon warming up, even from slight warming due to light movement or exercise. This means that the muscle can save energy and rest when not needed. In contrast, the lower temperature sensitivity of the heart may be beneficial for maintaining a continuous beat, regardless of temperature,” explains co-lead author Shuya Ishii.

This study provides new insights into how, at the protein level, warm-up before exercise enhances muscle performance. The discovery that some muscle proteins act as a temperature sensor may lead to a new hyperthermia strategy, in which skeletal muscle performance is improved by warming up the muscle. Incorporating appropriate warm-up routines into the daily lives of individuals, particularly the elderly population, could improve their muscle and exercise performance, thereby reducing the risk of injury and helping to maintain their independence.

Source: Osaka University

Opinion Piece: The Rise of Affordable Medical Insurance

Reaching the masses with quality healthcare services

Photo by Hush Naidoo Jade Photography on Unsplash

By Sandra Sampson, Director at Allmed Healthcare Professionals

With its two-tiered, highly unequal healthcare system, only 14.86% of South Africa’s population can currently afford private healthcare, and rising costs are making it difficult for many to keep paying their monthly medical aid premiums. There are plans to implement National Health Insurance (NHI) to fund healthcare in the public and private sectors, although this process which began in August 2011 has been slow, and the NHI Bill is still under consideration in the National Assembly.

Despite concerns about the state’s ability to implement the NHI effectively and competently, delivering quality medical care to the population must continue to be a priority for every healthcare provider. This is where a specialist Temporary Employment Services (TES) provider can assist – delivering a flexible, competent, quality workforce on demand for institutions in both the public and private sectors.

Increasing access to quality healthcare

The public healthcare sector is primarily intended to serve those who are unable to access private medical aid and is currently accessible to all, regardless of immigration status or nationality. Significant funding is a massive drawcard for specialists in the private sector, which has resulted in a widening gap between public and private healthcare facilities in much of the country. The impending NHI is intended to address this gap and enable greater access to specialist care and more free services for all, while improving the quality of public healthcare by establishing a national fund that will allow for the purchasing of healthcare services on behalf of users. Estimates for funding this national health initiative range from R165bn to R450bn, and the government has been given the go-ahead by the Gauteng High Court to continue its recruitment drive before the bill has even passed.

Access starts with affordability

In line with this move, affordable healthcare insurance is on the rise. This trend starts with partnerships between healthcare and financial services providers, and has already been seen in the likes of Dischem, Clicks and Tyme Bank’s TymeHealth, all offering medical insurance, enabling access to high-quality healthcare specialists to a market that was previously woefully under-serviced. As the demand for quality healthcare increases, there will be a proportionate increase in the need for healthcare professionals.

Practical resourcing alternatives

It is not economically or practically feasible for healthcare institutions (whether in the private or public sector) to hire more medical professionals permanently, which means they will have to explore other resourcing options. This is becoming increasingly difficult in South Africa, as many skilled medical staff are seeking work elsewhere as a result of poor working conditions created by loadshedding, corruption, and incompetent administration. Although the Department of Home Affairs has added new skills to our country’s critical skills list (many of which include medical practitioners and individual specialisations) the healthcare industry is still severely understaffed. Hospital groups are only growing more frustrated with the government’s inability to address the decreasing number of medical practitioners, particularly nurses. The Hospital Association of South Africa (HASA) has reported that nurses in the country are reaching retirement age without the necessary inflow of younger employees. In 2020, there were more than 21,000 nurses in training, but South Africa still needs as many as 26,000 additional nurses to meet the growing demand.

Meeting the demand flexibly

TES providers in the healthcare sector have the potential to meet the demand of healthcare institutions for nurses and specialists, without these institutions having to commit to the responsibilities and costs associated with full-time employment. TES providers are on hand to supply the vetted and highly-skilled workers so desperately needed. Every healthcare institution can be supplied with the resources necessary on a shift-by-shift basis. So, if, for example, there is a deficit of five ICU nurses at a certain hospital, a TES provider can meet this with very short notice. If, on the other hand, patients are discharged or rerouted, these additional nurses can be cancelled at short notice, and the TES provider picks up the hospital’s slack and answers it with flexible resources on demand. Additionally, when it comes to meeting the fluctuating demand for speciality staff, a TES partner will become indispensable.

Equitability and affordability depend on agility

Ultimately, regardless of when the NHI comes to fruition, healthcare institutions should begin partnering with a TES provider if they haven’t already. Along with providing medical professionals on demand, this comes with cost-saving benefits for the hospital or clinic. Not having to employ full-time staff to meet fluctuating needs is a cost-saving exercise. Not only from a wage standpoint but also from an HR perspective in terms of payroll, industrial relations and skills development. The TES partner is responsible for all aspects of the employment relationship, while the healthcare institution gains access to qualified healthcare professionals as needed, at a fixed rate on flexible terms. This means that as soon as hospitals decide to invest in making their wards and spaces bigger and more efficient, they will have access to the medical resources necessary to staff them in a manner that enables equitable access to quality healthcare.