It’s possible that I shall make an ass of myself. But in that case one can always get out of it with a little dialectic. I have, of course, so worded my proposition as to be right either way (K.Marx, Letter to F.Engels on the Indian Mutiny)
Monday, January 11, 2021
Unravelling the mystery that makes viruses infectious
IMAGE: VISUALISATION OF AN ENTEROVIRUS-E VIRION ASSEMBLING view more
CREDIT: UNIVERSITY OF LEEDS
Researchers have for the first time identified the way viruses like the poliovirus and the common cold virus 'package up' their genetic code, allowing them to infect cells.
The findings, published in the journal PLOS Pathogens by a team from the Universities of York and Leeds, open up the possibility that drugs or anti-viral agents can be developed that would stop such infections.
Once a cell is infected, a virus needs to spread its genetic material to other cells. This is a complex process involving the creation of what are known as virions - newly -formed infectious copies of the virus. Each virion is a protein shell containing a complete copy of the virus's genetic code. The virions can then infect other cells and cause disease.
What has been a mystery until now is a detailed understanding of the way the virus assembles these daughter virions.
Professor Reidun Twarock, from the University of York's Department of Mathematics, said: "Understanding in detail how this process works, and the fact that it appears conserved in an entire family of viral pathogens, will enable the pharmaceutical industry to develop anti-viral agents that can block these key interactions and prevent disease."
The study focuses on a harmless bovine virus that is non-infectious in people, Enterovirus-E, which is the universally adopted surrogate for the poliovirus. The poliovirus is a dangerous virus that infects people, causing polio and is the target of a virus eradication initiative by the World Health Organization.
The enterovirus group also includes the human rhinovirus, which causes the common cold.
Professor Peter Stockley, former Director of the Astbury Centre for Structural Molecular Biology at Leeds, said: "This study is extremely important because of the way it shifts our thinking about how we can control some viral diseases. If we can disrupt the mechanism of virion formation, then there is the potential to stop an infection in its tracks.
"Our analysis suggests that the molecular features that control the process of virion formation are genetically conserved, meaning they do not mutate easily - reducing the risk that the virus could change and make any new drugs ineffective."
The study details the role of what are called RNA packaging signals, short regions of the RNA molecule which together with proteins from the virus's casing ensure accurate and efficient formation of an infectious virion.
Using a combination of molecular and mathematical biology, the researchers were able to identify possible sites on the RNA molecule that could act as packaging signals. Using advanced electron microscopes, scientists were able to directly visualise this process - the first time that has been possible with any virus of this type.
###
The work was funded by the Wellcome Trust, the Engineering and Physical Sciences Research Council (EPSRC) and the British Medical Foundation for Medical Researc
TU Graz identifies bacterium that protects rice plants against diseases
Bacterium inside the seed can lead to complete resistance to a particular pathogen and is naturally transmitted from one plant generation to another
IMAGE: RISING GLOBAL WARMING IS PROBLEMATIC FOR THE WATER-INTENSIVE CULTIVATION OF RICE, THE STAPLE FOOD FOR ABOUT HALF THE WORLD'S POPULATION. view more
CREDIT: MENGCEN WANG
Rice is the staple food of about half the world's population. The cultivation of the rice plant is very water-intensive and, according to the German aid organization Welthungerhilfe, around 15 per cent of rice is grown in areas with a high risk of drought. Global warming is therefore becoming increasingly problematic for rice cultivation, leading more and more often to small harvests and hunger crises. Crop failures caused by plant pathogens further aggravate the situation. Here, conventional agriculture is trying to counteract this with pesticides, which are mostly used as a precautionary measure in rice cultivation. The breeding of resistant plants is the only alternative to these environmentally harmful agents - and currently only moderately successful. If the plants are resistant to one pathogen thanks to their breeding, they are usually more susceptible to other pathogens or are less robust under adverse environmental conditions.
Bacterium confers pathogen resistance
For this reason, an international research group which includes the Institute of Environmental Biotechnology at Graz University of Technology has been studying the microbiome of rice plant seeds for some time now in order to establish correlations between plant health and the occurrence of certain microorganisms. The group has now achieved a major breakthrough. They identified a bacterium inside the seed that can lead to complete resistance to a particular pathogen and is naturally transmitted from one plant generation to another. The findings published in the scientific journal Nature Plants provide a completely new basis for designing biological plant protection products and additionally reducing harmful biotoxins produced by plant pathogens.
The microbiome of rice
In conventional rice cultivation in the Chinese province of Zhejiang, it was observed that one genotype of rice plants (cultivar Zhongzao 39) sometimes develops resistance to the plant pathogen Burkholderia plantarii. This pathogen leads to crop failures and also produces a biotoxin that can cause organ damage and tumours in persistently exposed humans and animals. "Up to now, the sporadic resistance of rice plants to this pathogen could not be explained," says Tomislav Cernava from the Institute of Environmental Biotechnology at Graz University of Technology. Together with the luminary of microbiome research and Institute head, Gabriele Berg, and his institute colleague Peter Kusstatscher, Cernava has been investigating the microbiome of rice seeds from different cultivation regions in detail in the context of a collaboration with Zhejiang University (Hangzhou) and Nanjing Agricultural University in China as well as with the Japanese Hokkaido University in Sapporo.
Bacterial composition as a decisive factor
The scientists found that the resistant plants have a different bacterial composition inside the seeds than the disease-susceptible plants. The bacterial genus Sphingomonas in particular was found significantly more often in resistant seeds. The researchers therefore isolated bacteria of this genus from the seeds and identified the bacterium Sphingomonas melonis as the responsible agent for disease resistance. This bacterium produces an organic acid (anthranilic acid), which inhibits the pathogen and thereby renders it harmless. "This also works when the isolated Sphingomonas melonis is applied to non-resistant rice plants. This automatically makes them resistant to the plant pathogen Burkholderia plantarii," explains Tomislav Cernava. In addition, the bacterium establishes itself in certain rice genotypes and is then passed on naturally from one plant generation to the next. "The potential of this finding is enormous. In the future, we will be able to use this strategy to reduce pesticides in agriculture and at the same time achieve good crop yields," emphasizes Cernava.
###
This research is anchored in the Field of Expertise "Human & Biotechnology", one of five strategic foci of Graz University of Technology.
Details of the original publication:
Bacterial seed endophyte shapes disease resistance in rice. Haruna Matsumoto, Xiaoyan Fan, Yue Wang, Peter Kusstatscher, Jie Duan, Sanling Wu, Sunlu Chen, Kun Qiao, Yiling Wang, Bin Ma, Guonian Zhu, Yasuyuki Hashidoko, Gabriele Berg, Tomislav Cernava, Mengcen Wang. Nature Plants, January 2021. DOI: 10.1038/s41477-020-00826-5 https://www.nature.com/articles/s41477-020-00826-5
Articles on previous results of the Institute's microbiome research:
IMAGE: ERIK PRYTZ, SENIOR LECTURER AT LINKÖPING UNIVERSITY view more
CREDIT: LINKOPING UNIVERSITY
When an accident occurs, the reactions of bystanders are important. Researchers have studied whether laypeople realise the severity of the situation when someone in their proximity begins to bleed, and whether they can estimate how much the person is bleeding. The results show a discrepancy related to the victim's gender: for a woman losing blood, both blood loss and life-threatening injuries were underestimated. The study has been published in the scientific journal PLoS One.
Researchers from Linköping University and Old Dominion University in the United States wanted to study the ability of laypeople to visually assess blood loss, and what influences them when judging the severity of an injury.
"Laypeople's knowledge of haemorrhage is very important because many deaths occur outside the hospital. Our study showed, among other things, that haemorrhage in women is perceived as less serious, which can have profound consequences", says Erik Prytz at Linköping University and the Centre for Teaching & Research in Disaster Medicine and Traumatology.
Previous research has shown that people have difficulty estimating how much an injured person is bleeding. Those with medical training often overestimate small volumes of blood, and underestimate larger volumes. Also, previous studies point to differences in how laypeople treat victims, depending on the victim's gender. For this reason, the researchers wanted to investigate the role of victim gender in the laypeople's ability to estimate blood loss - a factor that has never been studied.
The researchers had 125 study participants view 78 video clips of female or male actors who appear to be bleeding from the inside of the thigh. The participants got to see the simulated injuries from various angles, and the victims bled at different rates and with different volumes. Based on this, the participants were to assess whether the blood loss was not dangerous, dangerous or life-threatening. Bleeding is normally considered life-threatening when 1.5 litres of blood is lost.
The result supported previous research; laypeople also overestimated small volumes of blood and underestimated larger volumes of blood. However the study, unlike previous studies, also showed at which volumes the test participants made incorrect estimates. Blood losses of up to 2 decilitres were perceived as larger than they actually were, while volumes of more than 4 decilitres were underestimated. Blood volumes of 3 decilitres, however, were estimated correctly.
The study also showed that the participants underestimated blood loss among female victims more than for male victims, regardless of volume. And for female victims, the loss was classified as less life-threatening.
In Sweden, and especially in the United States, laypeople are trained to intervene in the event of an accident. In the United States, this training has become more common as a response to the many school shootings; more people must know how to stop a haemorrhage. What the researchers learn from the study, they will incorporate in the design of this training.
"If gender affects how a layperson perceives an injury, we must include this in the calculation when planning the training" says Erik Prytz.
Erik Prytz stresses that further study is required into how gender affects the response given to haemorrhaging victims.
###
The other authors of the study are Marc Friberg, Mattias Lantz Cronqvist and Carl-Oscar Jonson from Linköping University, and Rachel Phillips from Old Dominion University in the United States.
The study received funding from the Swedish Civil Contingencies Agency
Inspired by kombucha tea, engineers create "living materials"
A symbiotic culture of specialized yeast and bacteria can generate tough materials able to perform a variety of functions.
CAMBRIDGE, MA -- Engineers at MIT and Imperial College London have developed a new way to generate tough, functional materials using a mixture of bacteria and yeast similar to the "kombucha mother" used to ferment tea.
Using this mixture, also called a SCOBY (symbiotic culture of bacteria and yeast), the researchers were able to produce cellulose embedded with enzymes that can perform a variety of functions, such as sensing environmental pollutants. They also showed that they could incorporate yeast directly into the material, creating "living materials" that could be used to purify water or to make "smart" packaging materials that can detect damage.
"We foresee a future where diverse materials could be grown at home or in local production facilities, using biology rather than resource-intensive centralized manufacturing," says Timothy Lu, an MIT associate professor of electrical engineering and computer science and of biological engineering.
Lu and Tom Ellis, a professor of bioengineering at Imperial College London, are the senior authors of the paper, which appears today in Nature Materials. The paper's lead authors are MIT graduate student Tzu-Chieh Tang and Cambridge University postdoc Charlie Gilbert.
Division of labor
Several years ago, Lu's lab developed a way to use E. coli to generate biofilms embedded with materials such as gold nanowires. However, those films are very small and thin, making them difficult to use in most large-scale applications. In the new study, the researchers set out to find a way to use microbes to generate larger quantities of more substantial materials.
They thought of creating a microbe population similar to a kombucha mother, which is a mixture of certain types of bacteria and yeast. These fermentation factories, which usually contain one species of bacteria and one or more yeast species, produce ethanol, cellulose, and acetic acid, which gives kombucha tea its distinctive flavor.
Most of the wild yeast strains used for fermentation are difficult to genetically modify, so the researchers replaced them with a strain of laboratory yeast called Saccharomyces cerevisiae. They combined the yeast with a type of bacteria called Komagataeibacter rhaeticus, which their collaborators at Imperial College London had previously isolated from a kombucha mother. This species can produce large quantities of cellulose.
Because the researchers used a laboratory strain of yeast, they could engineer the cells to do any of the things that lab yeast can do -- for example, producing enzymes that glow in the dark, or sensing pollutants in the environment. The yeast can also be programmed so that they can break down pollutants after detecting them.
Meanwhile, the bacteria in the culture produce large-scale quantities of tough cellulose to serve as a scaffold. The researchers designed their system so that they can control whether the yeast themselves, or just the enzymes that they produce, are incorporated into the cellulose structure. It takes only a few days to grow the material, and if left long enough, it can thicken to occupy a space as large as a bathtub.
"We think this is a good system that is very cheap and very easy to make in very large quantities," Tang says. "It's at least a thousand times more material than the E.coli system."
Just add tea
To demonstrate the potential of their microbe culture, which they call "Syn-SCOBY," the researchers created a material incorporating yeast that senses estradiol, which is sometimes found as an environmental pollutant. In another version, they used a strain of yeast that produces a glowing protein called luciferase when exposed to blue light. These yeasts could be swapped out for other strains that detect other pollutants, metals, or pathogens.
The culture can be grown in normal yeast culture medium, which the researchers used for most of their studies, but they have also shown that it can grow in tea with sugar. The researchers envision that the cultures could be customized for people to use at home for growing water filters or other useful materials.
"Pretty much everyone can do this in their kitchen or at home," Tang says. "You don't have to be an expert. You just need sugar, you need tea to provide the nutrients, and you need a piece of Syn-SCOBY mother."
###
The research was funded, in part, by the U.S. Army Research Office, the MIT Institute for Soldier Nanotechnologies, and the MIT-MISTI MIT-Imperial College London Seed Fund. Tang was supported by the MIT J-WAFS Fellowship.
Carbon monoxide reduced to valuable liquid fuels
Rice engineers' reactor converts gas directly into acetic acid
IMAGE: AN ELECTRON MICROSCOPE IMAGES SHOWS COPPER NANOCUBES USED BY RICE UNIVERSITY ENGINEERS TO CATALYZE THE TRANSFORMATION OF CARBON MONOXIDE INTO ACETIC ACID. view more
CREDIT: WANG GROUP/SENFTLE GROUP/RICE UNIVERSITY
HOUSTON - (Jan. 11, 2021) - A sweet new process is making sour more practical.
Rice University engineers are turning carbon monoxide directly into acetic acid -- the widely used chemical agent that gives vinegar its tang -- with a continuous catalytic reactor that can use renewable electricity efficiently to turn out a highly purified product.
The electrochemical process by the labs of chemical and biomolecular engineers Haotian Wang and Thomas Senftle of Rice's Brown School of Engineering resolves issues with previous attempts to reduce carbon monoxide (CO) into acetic acid. Those processes required additional steps to purify the product.
The environmentally friendly reactor uses nanoscale cubes of copper as the primary catalyst along with a unique solid-state electrolyte.
In 150 hours of continuous lab operation, the device produced a solution that was up to 2% acetic acid in water. The acid component was up to 98% pure, far better than that produced through earlier attempts to catalyze CO into liquid fuel.
Details appear in the Proceedings of the National Academy of Sciences.
Along with vinegar and other foods, acetic acid is used as an antiseptic in medical applications; as a solvent for ink, paint and coatings; and in the production of vinyl acetate, a precursor to common white glue.
The Rice process builds upon the Wang lab's reactor to produce formic acid from carbon dioxide (CO2). That research established an important foundation for Wang, recently named a Packard Fellow, to win a $2 million National Science Foundation (NSF) grant to continue exploring the conversion of greenhouse gases into liquid fuels.
"We're upgrading the product from a one-carbon chemical, the formic acid, to two-carbon, which is more challenging," Wang said. "People traditionally produce acetic acid in liquid electrolytes, but they still have the issue of low performance as well as separating the product from the electrolyte."
"Acetic acid is typically not synthesized, of course, from CO or CO2," Senftle added. "That's the key here: We're taking waste gases we want to mitigate and turning them into a useful product."
It took a careful coupling between the copper catalyst and solid electrolyte, the latter carried over from the formic acid reactor. "Sometimes copper will produce chemicals along two different pathways," Wang said. "It can reduce CO into acetic acid and alcohols. We engineered copper cubes dominated by one facet that can help this carbon-carbon coupling, with edges that direct the carbon-carbon coupling towards acetic acid instead of other products."
Computational models by Senftle and his team helped refine the cubes' form factor. "We were able to show there are types of edge on the cube, basically more corrugated surfaces, that facilitate breaking certain C-O bonds that steer the products one way or the other," he said. "Having more edge sites favors breaking the right bonds at the right time."
Senftle said the project was a great demonstration of how theory and experiment should mesh. "It's a nice example of engineering on many levels, from integration of the components in a reactor all the way down to the mechanism at the atomistic level," he said. "It fits with the themes of molecular nanotechnology, showing how we can scale it up to real-world devices."
The next step in development of a scalable system is to improve upon the system's stability and further reduce the amount of energy the process requires, Wang said.
Rice graduate students Peng Zhu and Chun-Yen Liu and Chuan Xia, the J. Evans Attwell-Welch Postdoctoral Fellow, are co-lead authors of the paper. Co-authors are Rice research scientist Guanhui Gao, postdoctoral researcher Xiao Zhang and graduate student Yang Xia; former Rice postdoctoral researcher Kun Jiang of Shanghai Jiao Tong University, China; and graduate student Yongjiu Lei and Husam Alshareef, a professor of material science and engineering, at King Abdullah University of Science and Technology, Saudi Arabia. Wang and Senftle are assistant professors of chemical and biomolecular engineering.
The NSF and the CIFAR Azrieli Global Scholars Program supported the research.
CAPTION
Rice University engineers have developed a reactor to produce liquid acetic acid directly from carbon monoxide. The reactor uses a catalyst of copper nanocubes and a solid-state electrolyte.
https://news-network.rice.edu/news/files/2021/01/0111_ACETIC-2-web.jpg Rice University engineers have developed a reactor to produce liquid acetic acid directly from carbon monoxide. The reactor uses a catalyst of copper nanocubes and a solid-state electrolyte. (Credit: Illustration by Peng Zhu/Rice University)
Located on a 300-acre forested campus in Houston, Rice University is consistently ranked among the nation's top 20 universities by U.S. News & World Report. Rice has highly respected schools of Architecture, Business, Continuing Studies, Engineering, Humanities, Music, Natural Sciences and Social Sciences and is home to the Baker Institute for Public Policy. With 3,978 undergraduates and 3,192 graduate students, Rice's undergraduate student-to-faculty ratio is just under 6-to-1. Its residential college system builds close-knit communities and lifelong friendships, just one reason why Rice is ranked No. 1 for lots of race/class interaction and No. 1 for quality of life by the Princeton Review. Rice is also rated as a best value among private universities by Kiplinger's Personal Finance.
New process more efficiently recycles excess CO2 into fuel, study finds
UNIVERSITY OF ILLINOIS AT URBANA-CHAMPAIGN, NEWS BUREAU
IMAGE: ILLINOIS RESEARCHERS ANDREW GEWIRTH, LEFT, AND STEPHANIE CHEN DESIGNED A NEW COPPER-POLYMER ELECTRODE THAT CAN HELP RECYCLE EXCESS CO2 INTO ETHYLENE, A USEFUL CARBON-BASED CHEMICAL THAT CAN BE USED AS... view more
CREDIT: PHOTO BY L. BRIAN STAUFFER
CHAMPAIGN, Ill. -- For years, researchers have worked to repurpose excess atmospheric carbon dioxide into new chemicals, fuels and other products traditionally made from hydrocarbons harvested from fossil fuels. The recent push to mitigate the climactic effects of greenhouse gases in the atmosphere has chemists on their toes to find the most efficient means possible. A new study introduces an electrochemical reaction, enhanced by polymers, to improve CO2-to-ethylene conversion efficiency over previous attempts.
The results of the study led by University of Illinois Urbana-Champaign chemistry professor Andrew Gewirth and graduate student Xinyi (Stephanie) Chen are published in the journal Natural Catalysis.
Allowing CO2 gas to flow through a reaction chamber fitted with copper electrodes and an electrolyte solution is the most common method researchers use to convert CO2 to useful carbon-containing chemicals, the study reports.
"Copper metal is highly selective toward the type of carbon that forms ethylene," Gewirth said. "Different electrode materials will produce different chemicals like carbon monoxide instead of ethylene, or a mix of other carbon chemicals. What we have done in this study is to design a new kind of copper electrode that produces almost entirely ethylene."
Previous studies have used other metals and molecular coatings on the electrode to help direct the CO2-reduction reactions, the study reports. However, these coatings are not stable, often break down during the reaction process and fall away from the electrodes. "What we did differently in this study was to combine the copper ions and polymers into a solution, then apply that solution to an electrode, entraining the polymer into the copper," Chen said.
In the lab, the team found that the new polymer-entrained electrodes were less likely to break down and produced more stable chemical intermediates, resulting in more efficient ethylene production. "We were able to convert CO2 to ethylene at a rate of up to 87%, depending on the electrolyte used," Chen said. "That is up from previous reports of conversion rates of about 80% using other types of electrodes."
"With the development of economic sources of electricity, combined with the increased interest in CO2-reduction technology, we see great potential for commercialization of this process," Gewirth said.
###
The International Institute for Carbon Neutral Energy Research, Shell's New Energy Research and Technology and the National Science Foundation supported this research.
Gewirth also is affiliated with the Materials Research Laboratory at Illinois.
The paper "Electrochemical CO2-to-ethylene conversion on polyamine-incorporated Cu electrodes" is available online and from the U. of I. News Bureau. DOI: 10.1038/s41929-020-00547-0
Good results for groin hernia operations not performed by doctors in Sierra Leone
IMAGE: JENNY LÖFGREN, ASSISTANT PROFESSOR AT THE DEPARTMENT OF MOLECULAR MEDICINE AND SURGERY, KAROLINSKA INSTITUTET. view more
CREDIT: ULF SIRBORN.
In countries with a severe shortage of surgeons it is common for some operations to be carried out by medical staff with lower formal qualifications. Researchers at Karolinska Institutet, Sweden, have led an international study on the safety and efficacy of a common surgical procedure. The study, published in JAMA Network Open, shows that inguinal hernia operations performed by associate clinicians at a hospital in Sierra Leone were just as safe and effective as those performed by doctors.
Many Sub-Saharan countries have a desperate shortage of surgeons, and to ensure that as many patients as possible can be treated, some operations are carried out by medical professionals who are not specialists in surgery. Such task sharing is supported by several bodies, including the World Health Organisation.
There are to date few clinical investigations into the safety and effectiveness of task sharing. Now researchers at Karolinska Institutet and, amongst other places, Kamakwie Wesleyan Hospital, Sierra Leone, have compared inguinal hernia operations performed by associate clinicians with those performed by non-specialist medical doctors. In Sierra Leone, medical doctors have no specific training in surgery but routinely perform surgical procedures as part of their regular work.
An estimated 220 million people around the world live with an inguinal hernia, which causes significant suffering and, 40,000 deaths each year. Twenty million inguinal hernia operations are performed every year, making it the most common general surgical procedure in the world, including in low-income countries like Sierra Leone. In Sierra Leone there are fewer than one surgeon per 100,000 population, and task sharing between MDs and associate clinicians is one way to provide general surgery to many people.
The study included 229 men operated on for inguinal hernia between 2017 and 2018 at a district hospital in rural Sierra Leone. The patients were randomly assigned to a doctor or an associate clinician for their surgery and were followed up after two weeks and one year.
The results suggest that task sharing with associate clinicians provides safe and effective surgery for non-life threatening inguinal hernias in countries where there is a shortage of surgeons.
"The study showed that associate clinicians were not inferior to registered doctors when it comes to recurrence, complications, groin pain or patient satisfaction," says the paper's last author Jenny Löfgren, assistant professor at the Department of Molecular Medicine and Surgery, Karolinska Institutet. "There were even fewer cases of recurrence in the patients who had been operated on by associate clinicians compared to the group operated on by MDs. This was an extremely unexpected finding and task sharing appears to be an attractive option that can help the millions of people suffering from inguinal hernia."
The researchers' next step is to develop training programmes for doctors and associate clinicians in order to expand surgical services. Forthcoming studies will be conducted in Sierra Leone and Uganda.
###
The study was financed by the Swedish Research Council. Authors Håkon Bolkan, Alex van Duinen and Thomas Ashley are unpaid members of the CapaCare board. There are no other reported conflicts of interest.
Publication: "Outcomes after elective inguinal hernia repair performed by associate clinicians versus medical doctors - a randomized, single blinded non-inferiority trial." Thomas Ashley, Hannah Ashley, Andreas Wladis, Håkon A. Bolkan, Alex J. van Duinen, Jessica H. Beard, Hertta Kalsi, Juuli Palmu, Pär Nordin, Kristina Holm, Michael Ohene-Yeboah, Jenny Löfgren. JAMA Network Open, online 11 January, 2020.
Trained medical staff can perform safe, effective hernia surgery
Single blind, randomized clinical trial in Sierra Leone showed that task sharing can expand access to medical care without compromising quality
IMAGE: TRAINEES GET ON-THE-JOB TRAINING AT MASSANGA HOSPITAL IN SIERRA LEONE. PHOTO: CAPACARE view more
CREDIT: CAPACARE
Many Sub-Saharan countries have a desperate shortage of surgeons, and to ensure that as many patients as possible can be treated, some operations are carried out by medical professionals who are not specialists in surgery.
This approach, called task sharing, is supported by the World Health Organisation, but the practice remains controversial. Now a team of medical researchers from Norway, Sweden, Sierra Leone and the Netherlands shows that groin hernia operations performed by associate clinicians, who are trained medical personnel but not doctors, are just as safe and effective as those performed by doctors. The study has been published in JAMA Network Open.
"The study showed that associate clinicians were not inferior to registered doctors when it comes to recurrence, complications, groin pain or patient satisfaction," said co-authors Håkon A. Bolkan and Alex van Duinen at the Department of Clinical and Molecular Medicine, NTNU.
An estimated 220 million people around the world live with an inguinal hernia, which causes significant suffering and, 40,000 deaths each year.
Twenty million inguinal hernia operations are performed every year, making it the most common general surgical procedure in the world, including in low-income countries like Sierra Leone, where the study was conducted.
Sierra Leone has fewer than one surgeon per 100,000 population. The shortage of surgeons in Sierra Leone means that the country's medical doctors, who have no specific training in surgery, routinely perform surgical procedures as part of their regular work.
Since 2011, the Norwegian non-profit organization CapaCare has worked with the Sierra Leone Ministry of Health and Sanitation and the United Nations Population Fund to address the shortage in surgical care through task sharing. CapaCare offers a three-year training programme for community health officers, after which they can perform basic lifesaving surgeries, such as groin hernia repairs.
CapaCare graduates are called associate clinicians and their education level is between that of a nurse and a doctor.
The study included 229 men operated on for inguinal hernia between 2017 and 2018 at a district hospital in rural Sierra Leone. The patients were randomly assigned to a doctor or an associate clinician for their surgery and were followed up after two weeks and one year. The researchers also plan a follow-up visit to patients three years after their surgery.
"There were even fewer cases of recurrence in the patients who had been operated on by associate clinicians compared to the group operated on by medical doctors," Bolkan and van Duinen said. "This was an extremely unexpected finding and task sharing appears to be an attractive option that can help the millions of people suffering from inguinal hernia."
The researchers' next step is to develop training programmes for doctors and associate clinicians in order to expand surgical services. Forthcoming studies will be conducted in Sierra Leone and Uganda.
The study was financed by the Swedish Research Council. Authors Håkon Bolkan, Alex van Duinen and Thomas Ashley are unpaid members of the CapaCare board.
Publication: "Outcomes after elective inguinal hernia repair performed by associate clinicians versus medical doctors - a randomized, single blinded non-inferiority trial." Thomas Ashley, Hannah Ashley, Andreas Wladis, Håkon A. Bolkan, Alex J. van Duinen, Jessica H. Beard, Hertta Kalsi, Juuli Palmu, Pär Nordin, Kristina Holm, Michael Ohene-Yeboah, Jenny Löfgren. JAMA Network Open, Many Sub-Saharan countries have a desperate shortage of surgeons, and to ensure that as many patients as possible can be treated, some operations are carried out by medical professionals who are not specialists in surgery.
This approach, called task sharing, is supported by the World Health Organisation, but the practice remains controversial. Now a team of medical researchers from Norway, Sweden, Sierra Leone and the Netherlands shows that groin hernia operations performed by associate clinicians, who are trained medical personnel but not doctors, are just as safe and effective as those performed by doctors. The study has been published in JAMA Network Open.
"The study showed that associate clinicians were not inferior to registered doctors when it comes to recurrence, complications, groin pain or patient satisfaction," said co-authors Håkon A. Bolkan and Alex van Duinen at the Department of Clinical and Molecular Medicine, NTNU.
Training and task sharing as a way to address shortages
An estimated 220 million people around the world live with an inguinal hernia, which causes significant suffering and, 40,000 deaths each year.
Twenty million inguinal hernia operations are performed every year, making it the most common general surgical procedure in the world, including in low-income countries like Sierra Leone, where the study was conducted.
Sierra Leone has fewer than one surgeon per 100,000 population. The shortage of surgeons in Sierra Leone means that the country's medical doctors, who have no specific training in surgery, routinely perform surgical procedures as part of their regular work.
Since 2011, the Norwegian non-profit organization CapaCare has worked with the Sierra Leone Ministry of Health and Sanitation and the United Nations Population Fund to address the shortage in surgical care through task sharing. CapaCare offers a three-year training programme for community health officers, after which they can perform basic lifesaving surgeries, such as groin hernia repairs.
CapaCare graduates are called associate clinicians and their education level is between that of a nurse and a doctor.
An unexpected finding
The study included 229 men operated on for inguinal hernia between 2017 and 2018 at a district hospital in rural Sierra Leone. The patients were randomly assigned to a doctor or an associate clinician for their surgery and were followed up after two weeks and one year. The researchers also plan a follow-up visit to patients three years after their surgery.
"There were even fewer cases of recurrence in the patients who had been operated on by associate clinicians compared to the group operated on by medical doctors," Bolkan and van Duinen said. "This was an extremely unexpected finding and task sharing appears to be an attractive option that can help the millions of people suffering from inguinal hernia."
The researchers' next step is to develop training programmes for doctors and associate clinicians in order to expand surgical services. Forthcoming studies will be conducted in Sierra Leone and Uganda.
###
The study was financed by the Swedish Research Council. Authors Håkon Bolkan, Alex van Duinen and Thomas Ashley are unpaid members of the CapaCare board.
Publication: "Outcomes after elective inguinal hernia repair performed by associate clinicians versus medical doctors - a randomized, single blinded non-inferiority trial." Thomas Ashley, Hannah Ashley, Andreas Wladis, Håkon A. Bolkan, Alex J. van Duinen, Jessica H. Beard, Hertta Kalsi, Juuli Palmu, Pär Nordin, Kristina Holm, Michael Ohene-Yeboah, Jenny Löfgren. JAMA Network Open, 2021;4(1):32032681
