Tag: 13/7/23

Gravity-powered Biomedical Devices Pull Droplets Through a Maze

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Biomedical engineers at Duke University have developed an entirely new approach to building point-of-care diagnostic devices that only use gravity to transport, mix and otherwise manipulate the liquid droplets involved. The demonstration, in the journal Device, requires only commercially available materials and very little power to read results, making it a potentially attractive option for applications in low-resource settings.

“The elegance in this approach is all in its simplicity – you can use whatever tools you happen to have to make it work,” said Hamed Vahabi, a former postdoctoral researcher at Duke. “You could theoretically even just use a handsaw and cut the channels needed for the test into a piece of wood.”

The study was conducted in the laboratory of Ashutosh Chilkoti, the Alan L. Kaganov Distinguished Professor of Biomedical Engineering at Duke.

There is no shortage of need for simple, easy-to-use, point-of-care devices. Many demonstrations and commercial devices seek to make diagnoses or measure important biomarkers using only a few drops of liquid with as little power and expertise required as possible. Their goal is to improve health care for the billions of people living in low-resource settings far from traditional hospitals and trained clinicians.

All of these tests have the same basic requirements; they must move, mix and measure small droplets containing biological samples and the active ingredients that make measuring specific biomarkers possible. More expensive examples use tiny electrical pumps to drive these reactions. Others use the physics of liquids within microchannels (microfluidics) that create a sort of suction effect.

This is the first demonstration that only uses gravity. Each approach offers uniquely useful abilities as well as drawbacks.

“Most microfluidic devices need more than just capillary forces to operate,” Chilkoti said. “This approach is much simpler and also allows very complex fluid paths to be deigned and operated, which is not easy or cheap to do with microfluidics.”

The new gravity-driven approach relies on a set of nine commercially available surface coatings that can tweak the wettability and slipperiness at any given point on the device. That is, they can adjust how much droplets flatten down into pancakes or remain spherical while making it easier or harder for them to slide down an incline.

Used together in clever combinations, these surface coatings can create all the microfluidic elements needed in a point-of-care test. For example, if a given location is extremely slippery and a droplet is placed at an intersection where one side pulls liquid flat and the other pushes it into a ball, it will act like a pump and accelerate the droplet toward the former.

“We came up with many different elements to control the motion, interaction, timing and sequence of multiple droplets in the device,” Vahabi said. “All of these phenomena are well-known in the field, but nobody thought of using them to control the motion of droplets in a systematic way before.”

By combining these elements, the researchers created a prototype test to measure the levels of lactate dehydrogenase (LDH) in a sample of human serum. They carved channels within the test platform to create specific pathways for droplets to travel, each coated with a substance that stops the droplets from sticking along their journey. They also primed specific locations with dried reagents needed for the test, which are soaked up by droplets of simple buffer solution as they travel through.

The whole maze-like test is then capped with a lid containing a couple of holes where the sample and buffer solution are dripped in. Once loaded, the test is placed inside a box-like device with a handle that turns the test 90° to allow gravity to do its work. This device is also equipped with a simple LED and light detector that can quickly and easily detect the amount of blue, red, or green in the test results. This means that the researchers can tag three different biomarkers with different colours for various tests to measure.

In the case of this prototype LDH test, the biomarker is tagged with a blue molecule. A simple microcontroller measures how deep of a blue hue the test results become and how quickly it changes colour, which indicates the amount and concentration of LDH in the sample, to generate results.

“We could eventually also use a smart phone down the line to measure results, but that’s not something we explored in this specific paper,” said Jason Liu, a PhD candidate in the Chilkoti lab.

The demonstration provides a new approach for consideration when engineering inexpensive, low-power, point-of-care diagnostic devices. While the group plans to continue developing their idea, they also hope others will take notice and work on similar tests.

“While a well-designed microfluidic system can be fully automated and easy-to-use by passive means, the timing of discrete steps is usually programmed into the design of the device itself, making modifications to protocol more difficult,” added David Kinnamon, a PhD candidate in the Chilkoti group. “In this work, the user retains more control of the timing of steps while only modestly sacrificing ease-of-operation. Again, this is an advantage for more complex protocols.”

Source: Duke University

You’re Not Getting Sleepy: Six Myths and Misconceptions about Hypnosis

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A strange mystic swings a pocket watch back and forth, repeating the phrase “You’re getting sleepy, very sleepy,” giving them absolute command over their subject. That’s not how hypnotism really works, but it’s the way it’s often depicted in pop culture. Even some clinicians and hypnosis educators propagate harmful myths about hypnosis.

Steven Jay Lynn, a professor of psychology at Binghamton University, State University of New York, is an expert on hypnosis who has made major contributions to the judicial system for his insight on the practice. Lynn believes that hypnosis has many useful clinical applications, but that myths keep it from being utilised to its full potential.

In a recent paper published in BJPsych Advances, he and his colleagues, Madeline Stein and Devin Terhune from the Institute of Psychiatry, Psychology & Neuroscience at King’s College, addressed a number of errors and misconceptions regarding the characteristics and practice of hypnosis. These are a few of the common myths that are widely believed and commonly circulated in popular culture.

Hypnotised people can’t resist suggestions

A deeply hypnotised person is believed to display “blind obedience,” going along automatically with whatever the hypnotist suggests. Yet individuals do not lose control over their actions during hypnosis – contrary to the notion the media reinforces that hypnosis is something done to you and that hypnosis can be used to control someone. In fact, people can resist and even oppose hypnotic suggestions. Their experience of control during hypnosis depends on their intentions and expectations regarding whether or not they retain voluntary control.

Hypnosis is a “special state”

Hypnosis is often mischaracterised as a “special state” where defence mechanisms are reduced and a “unique state of physical relaxation and conscious unconsciousness’ allows us to ‘enter our subconscious depths through hypnosis. However, people can respond to hypnotic suggestions even while they are alert and on an exercise bicycle. Aside from being a contradiction in terms, ‘conscious unconsciousness’ is an inaccurate depiction, because during hypnosis even the most highly suggestible individuals remain fully conscious and cognisant of their surroundings. It is more accurate to consider hypnosis as a set of procedures in which verbal suggestions are used to modulate awareness, perception and cognition, rather than to unnecessarily invoke ‘special states.’

People are either hypnotisable or they are not

People’s responsiveness to hypnosis can be relatively stable over time. Yet it is inaccurate to assume that people are either hypnotisable or not. People vary greatly in their responsiveness and often respond to some suggestions but not others. Still, most people are sufficiently hypnotisable to reap substantial benefits from therapeutic suggestions.

Responsiveness to suggestions reflects nothing more than compliance or faking

Suggested behaviours during hypnosis can seem so much a departure from the mundane that questions inevitably arise regarding whether hypnotic responses are genuine. However, neuroimaging studies reveal that the effects of hypnotic suggestions activate brain regions (eg, visual processing) consistent with suggested events (eg, hallucinating an object).These findings provide convincing evidence that hypnotic effects are represented at the neurophysiological level consistent with what people report.

Hypnotic methods require great skill to administer

One popular misconception is that of the mesmerist, or magician-like hypnotist with special powers of influence who can “hypnotise” anyone. This widespread idea is pure myth; in actuality, administering a hypnotic induction and specific suggestions do not require any special skills or abilities beyond those required for basic social interactions and administration of experimental or clinical procedures, such as the ability to establish rapport. However, hypnosis should be practiced only by professionals trained in the use of hypnosis.

Hypnotic age regression can retrieve accurate memories from the distant past

TV shows and movies often feature people being able to recall extremely accurate memories from a distant past life under hypnosis. But research suggests a contrary view. When researchers check the accuracy of memories of people who are “age regressed” to an earlier time (e.g., 10th century) against factual information from the suggested period, they find that the information is almost invariably incorrect. What people report is mostly consistent with information experimenters provide regarding their supposed past life experiences and identities (eg, different race, culture, sex). These findings imply that “recall” reflects participants’ expectancies, fantasies, and beliefs regarding personal characteristics and events during a given historical period.

Source: Binghamton University

High Court Ruling Paves the Way for Affordable Medical Scheme Benefits in South Africa

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The recent judgement by the Pretoria High Court in favour of the Board of Health Funders (BHF) carries substantial implications for medical schemes in South Africa. This follows BHF’s court application, which sought to compel the Council for Medical Schemes (CMS) to give a complete record, providing light on the LCBO’s decision-making process thus far.

The Court ordered the Minister of Health and the CMS to provide all of the papers listed in Rule 30A within 10 days of receiving the applicant’s notice of motion. The completion of this crucial milestone hinges on the provision of several documents, which we eagerly await.

This significant victory brings us closer to the ultimate goal of granting Medical Schemes exemptions to offer Low-Cost Benefit Options (LCBOs), which aim to provide greater access to affordable medical scheme benefits for low-income earners. The BHF’s success aligns with the mission of improving
healthcare accessibility and advancing progress towards universal healthcare coverage (UHC) in the country.

In the main application lodged on 8 August, the BHF requested the High Court to:

  • Lift the moratorium that prevents medical schemes from offering LCBOs when the Council for Medical Schemes (CMS) refuses to grant applications for exemptions to medical schemes, pending the finalisation of LCBO guidelines.
  • Declare the failure by the respondents to develop and implement LCBO guidelines as irrational, unreasonable, and unlawful, as per Section 6 of the Promotion of Administrative Justice Act and Section 1(c) of the Constitution.

The BHF represents the majority of the country’s medical schemes and healthcare funders, encompassing schemes and administrators serving nearly 4.5 million individuals.

According to Charlton Murove, the protracted process of crafting a framework for Low-Cost Benefit Options has taken over seven years and is yet to be finalised. Many policymakers have criticised medical schemes for their lack of affordability. The proposed solution aims to address these concerns and move closer to the principles of UHC, ensuring that the healthcare system grants everyone access to quality and affordable healthcare.

Murove stated, “This application seeks to drive a progressive agenda for the public and private healthcare sectors, fostering collaboration to alleviate the current challenges in our healthcare system. The Council for Medical Schemes and the Minister have pivotal roles in implementing policies that enhance access to healthcare. However, progress with LCBOs has been hindered by the CMS’s failure to take the necessary steps for reform, despite the publication of demarcation regulations in 2016.”

The BHF’s victory in the High Court represents a significant step forward in the pursuit of affordable and accessible medical scheme benefits. By addressing the current burdens faced by the state and ensuring that medical scheme premiums remain affordable, we can strive towards a healthcare system that benefits all South Africans.

Mast Cells Instruct the Brain to Avoid Allergens

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Mast cells functions are still something of a mystery, but scientists have now shown in mice that mast cells act as a sensor that signals the animals to avoid antigens, including harmful allergens, and thereby protect themselves from health-threatening inflammatory reactions. The findings were published in the journal Nature.

Mast cells are found primarily in tissues that separate the outside and inside worlds of the body, such as the epithelia of the gastrointestinal tract and lungs. Within the tissues, mast cells often reside near nerve endings. Mast cells are well known to persons suffering from allergies because they secrete messenger substances such as histamine, which cause annoying to health-threatening allergic symptoms. These symptoms occur when mast cells are activated by IgE class antibodies during repeated antigen contact.

“Why mast cells and IgE exist at all has not yet been conclusively explained,” says immunologist Hans-Reimer Rodewald at the at the German Cancer Research Center (DKFZ). The researcher his team have now been able to show for the first time in mice, in a combination of behavioural experiments and immunological studies, that mast cells act like a sensor that helps to avoid contact with allergens

Mast cells and IgE needed for antigen avoidance

The DKFZ researchers immunised mice with the allergen ovalbumin, a protein component of chicken egg white. They then gave the animals the free choice of preferring either normal or egg white-containing drinking water. Immunised animals avoided the egg white-enriched water, while their non-immunised conspecifics clearly preferred it. A large proportion of the immunised animals avoided the egg white-containing water already one day after immunisation, some mice even after the first sip.

However, when the scientists performed this behavioural test with mice that genetically lack mast cells, both immunised and non-immunised animals preferred the egg white-containing water. Mice genetically unable to produce IgE also showed no avoidance behaviour. Thus, both mast cells and IgE are responsible for antigen avoidance.

When the immunised mice had no choice because the egg white solution was instilled in them, the animals developed inflammation in the stomach and small intestine. “The avoidance behaviour mediated by mast cells apparently protects the animals from harmful immune reactions,” explains Thomas Plum, one of the first authors.

How do mast cells “talk” to the brain?

An important open question for the scientists was now: How can mast cells, as a component of the immune system, influence behaviour? In what ways do immune cells “talk” to the brain? The scientists examined a variety of biologically active substances released by mast cells. These include leukotrienes, pro-inflammatory messengers known to activate sensory nerves. If the researchers blocked leukotriene synthesis, the immunized mice no longer showed the same consequence in avoiding egg white. Leukotrienes therefore appear to be at least partly involved in avoidance behaviour. Further immunological and neurobiological experiments are needed in the future to identify the nerve connections through which the mast cell signal is reported to the brain.

“In the intestine, lungs or skin, immune reactions against non-infectious antigens can occur as a result of so-called barrier disorders, permeability of the tissues from the outside to the inside. In the case of allergy, we call such antigens allergens. Whether these substances are dangerous or not, it is important for the organism to avoid their further intake in order to prevent inflammatory diseases. This is an evolutionary advantage and finally a conclusive explanation of the physiological role of mast cells and IgE,” Rodewald summarizes the results.

Whether mast cells also contribute to the avoidance of harmful antigens in humans must be addressed in further studies.

Source: German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ)

Is A Healthy Diet Using Ultra-processed Food Possible?

Photo by Julia M Cameron

Researchers constructed a healthy diet with 91% of the calories coming from foods classified as ultra-processed but still in line with the 2020–2025 Dietary Guidelines for Americans (DGA). The seven-day diet, which consists more of ultra-processed foods like dried fruit and canned beans instead of doughnuts and hot dogs, was published in The Journal of Nutrition.

“The study is a proof-of-concept that shows a more balanced view of healthy eating patterns, where using ultra-processed foods can be an option,” said Research Nutritionist Julie Hess at the USDA Agricultural Research Service (ARS). “According to current dietary recommendations, the nutrient content of a food and its place in a food group are more important than the extent to which a food was processed.”

In the study, scientists used the NOVA scale to determine which foods to classify as ultra-processed. The NOVA scale first appeared in literature in 2009 and is the most commonly used scale in nutrition science to classify foods by degree of processing.

According to the NOVA scale, foods can be classified into four groups depending on their degree of processing: (1) Unprocessed or minimally processed foods; (2) Processed culinary ingredients; (3) Processed foods; and (4) Ultra-processed foods.

To test if ultra-processed foods can be used to build a healthy diet, ARS scientists and collaborators created a menu with breakfast, lunch, dinner, and snacks using MyPyramid as a guide for a seven-day, 2000-calorie food pattern The menu consisted of foods categorised as ultra-processed by at least two NOVA graders. The foods included in the menu also aligned with 2020 DGA recommendations for servings of groups and subgroups of fruits, vegetables, grains, protein foods, and dairy. Scientists selected food products that have lower levels of saturated fats and added sugars while still containing enough micronutrients and macronutrients. Some of the ultra-processed foods used in this menu included canned beans, instant oatmeal, ultra-filtered milk, whole wheat bread, and dried fruit.

“We used the Healthy Eating Index to assess the quality of the diet as it aligns with key DGA recommendations,” said Hess. “The menu we developed scored 86 of 100 points on the Healthy Eating Index-2015, meeting most of the thresholds, except for sodium content [exceeded recommendations] and whole grains [below recommendations].”

Scientists will continue researching this concept, understanding that observational research indicates that ultra-processed products could be associated with adverse health outcomes. This research shows that there is a role for a variety of foods when building a healthy diet and that more research is needed in this field, especially intervention studies.

Source: US Department of Agriculture – Agricultural Research Service