Fish schools work a bit like the brain

Peer-Reviewed Publication

TECHNISCHE UNIVERSITÄT BERLIN – SCIENCE OF INTELLIGENCE

 

IMAGE: SULPHUR MOLLIES view more 

CREDIT: JULIANE LUKAS

What do the brain and a school of fish have in common? They are both capable of efficient collective information processing, although each unit within them only has access to local information. In the brain, it is the stimuli from 86 billion neurons that form the basis for information processing; in the shoal, it is the decisions of each individual on how to move and interact with neighbors. However, little is known about how biological systems like the brain or a swarm of fish manage to optimally bring together a multitude of individual pieces of information from different locations. There is a hypothesis according to which the best performance of the brain lies at the border between order and chaos, in the state of so-called criticality. Researchers of the Cluster of Excellence "Science of Intelligence" from Humboldt-Universität (HU), the Technical University of Berlin (TU), and IGB have now been able to demonstrate this hypothesis on a large school of fish. The study was published in Nature Physics.

"Swarm behaviour is often about information spreading like an avalanche. In this state, the individuals react maximally quickly to external stimuli with maximally effective information transfer. We wanted to investigate whether the regularity of criticality, which has already been demonstrated for neuronal networks, describes this state," explained study leader Pawel Romanczuk, Professor in the Department of Biology at HU and a member of the Cluster of Excellence.

Criticality: The brain works most effectively at the threshold between order and chaos

Information processing in the brain is based on a network of around 86 billion neurons. They pass on information in the form of voltage impulses. According to a thesis in neurobiology called "the critical brain hypothesis", the reason why our brain is so efficient at processing information is that the brain is permanently at a critical point between two dynamic states, namely order and chaos, where order means neurons are active in a highly synchronized manner, and chaos means that the cells emit impulses independently of each other.

According to the critical brain hypothesis, transmission of information within the brain works best when neural connections are neither too weak nor too strong, i.e. at an intermediate state between order and chaos, known as criticality. In this state, the brain is maximally excitable and even small stimuli suddenly cause a multitude of neurons to fire and information spreads like an avalanche and can easily be transmitted, even to areas of the brain that are far away from the starting point.

Mexican wave for maximum alertness

Sulphur mollies, which are small fish living in sulphidic springs in Mexico, swim in shoals by the hundreds of thousands and show a typical and unusual behaviour: They dive up and down in waves; from a bird’s eye view, it looks like a huge Mexican wave that is repeated manifold. At first, as the team has already shown in a previous study, the small fish use the waving behavior to successfully confuse attacking birds. But this behaviour could also have a different function: it could be putting the swarm in a state of optimal alert – in a way that closely resembles a brain’s state of criticality described above. This last-second alertness is needed because the animals are exposed to high predator pressure.

However, the fish also perform their wave motions when there are no birds attacking. "For this reason, we wanted to find out whether this wave motion in the resting stage could be an analogy to the neuronal lockstep of the brain, as in, few surface waves when no birds attack, stronger and more waves when birds attack.  If so, the observed collective diving of the swarm would indeed happen at criticality, with the highest possible alertness," explained first author Luis Gómez-Nava, a researcher at the Cluster of Excellence.

The researchers combined empirical data from behavioural studies in the field with mathematical models, and were thus able to show that the spatio-temporal collective dynamics of large swarms of sulphur mollies actually do mimic an excitable system at criticality – in a way that is similar to the brain.

Maximum discrimination of environmental stimuli and maximum communication range

Being at a critical point allows the sulphur molly swarms to constantly watch out for disturbances in the environment, and to pass on information about the intensity of the cue, even over long distances. This was demonstrated in collaboration with other members of the Cluster of Excellence working in the field of artificial intelligence, Robert Lange and Professor Henning Sprekeler.  They used state-of-the-art machine learning algorithms to test the response of the system to different intensities of disturbances in the environment and concluded that, indeed, the swarm is able to efficiently process the information of external stimuli  – like attacking birds – to their advantage.

"In the case of sulphur mollies, stimulus intensity correlates with danger, as hunting birds often enter the water with their bodies resulting in high-intensity visual, acoustic and hydrodynamic disturbances, whereas birds in overflight provide little visual cues. Therefore, information about the intensity of the stimulus is very important for fish to coordinate appropriate responses, which might even include repeated diving for several minutes. Moreover, this information can be transmitted over long distances so that fish can act even when they are not in the danger zone – as a prevention mechanism," explained first author Luis Gómez-Nava, a researcher at the Cluster of Excellence. “And this is similar to the way the brain works,” he concluded.

Nevertheless, there are also important differences between the fish swarm and neuronal systems. In neuronal systems, the structure of the interaction network between individual elements (neurons) changes at a much slower time scale than the dynamic behaviour in the school of fish. "The dynamical group structure and individual behavioural parameters such as individual speed or attention to conspecifics have strong effects on collective behaviour, and can lead to alternative mechanisms of self-organisation towards criticality by modulating individual behavior. Here, many questions remain open, and we continue to investigate," said co-author Jens Krause, Professor at HU, IGB and in the Cluster of Excellence.

The resemblance between the diving behavior of fish and the neuronal activity in the brain could provide insights into a better understanding of collective systems in nature, also giving clues as to how far the complex patterns displayed by groups of animals could be interpreted as a sort of “collective mind”.

Sulphur mollies

Sulphur mollies

CREDIT

© Juliane Lukas

Publication:

Gómez-Nava, L., Lange, R.T., Klamser, P.P. et al. Fish shoals resemble a stochastic excitable system driven by environmental perturbations. Nat. Phys. (2023). https://doi.org/10.1038/s41567-022-01916-1

Fish shoals resemble a stochastic excitable system driven by environmental perturbations | Nature Physics

JOURNAL

Nature Physics

DOI

10.1038/s41567-022-01916-1 

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

Animals

ARTICLE TITLE

Fish shoals resemble a stochastic excitable system driven by environmental perturbations.

ARTICLE PUBLICATION DATE

6-Feb-2023

Phthalate exposure may increase diabetes risk in women

Further research needed on chemical’s impact in racial and ethnic groups

Peer-Reviewed Publication

THE ENDOCRINE SOCIETY

WASHINGTON—Endocrine-disrupting chemicals (EDCs) in plastics may contribute to diabetes risk in women, according to a new study published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism.

Phthalates are chemicals widely used in plastics such as personal care products, children’s toys, and food and beverage packaging. Phthalate exposure is associated with reduced fertility, diabetes and other endocrine disorders.

"Our research found phthalates may contribute to a higher incidence of diabetes in women, especially White women, over a six-year period,” said Sung Kyun Park, Sc.D., M.P.H., of the University of Michigan School of Public Health in Ann Arbor, Mich. “People are exposed to phthalates daily increasing their risk of several metabolic diseases. It’s important that we address EDCs now as they are harmful to human health.”

The researchers studied 1,308 women from the Study of Women’s Health Across the Nation-(SWAN) over six years to see if phthalates contributed to incident diabetes in this population. About 5% of the women developed diabetes over six years. These women had concentrations of phthalates in their urine similar to middle-aged women in the U.S. in the early 2000s, when the urine samples were collected. White women exposed to high levels of some phthalates had a 30-63% higher chance of developing diabetes, while the harmful chemicals were not linked to diabetes in Black or Asian women.

The other authors of this study are Mia Q. Peng, Carrie A. Karvonen-Gutierrez and Bhramar Mukherjee of the University of Michigan School of Public Health; and William H. Herman of the University of Michigan School of Public Health and the University of Michigan Medical School in Ann Arbor, Mich.

The study received funding from the National Institutes of Health, the SWAN Repository, the National Center for Research Resources and the National Center for Advancing Translational Sciences.

“Our research is a step in the right direction towards better understanding phthalates’ effect on metabolic diseases, but further investigation is needed,” Park said.

The manuscript, “Phthalates and Incident Diabetes in Midlife Women: The Study of Women’s Health Across the Nation (SWAN),” was published online, ahead of print.

# # #

Endocrinologists are at the core of solving the most pressing health problems of our time, from diabetes and obesity to infertility, bone health, and hormone-related cancers. The Endocrine Society is the world’s oldest and largest organization of scientists devoted to hormone research and physicians who care for people with hormone-related conditions.

The Society has more than 18,000 members, including scientists, physicians, educators, nurses and students in 122 countries. To learn more about the Society and the field of endocrinology, visit our site at www.endocrine.org. Follow us on Twitter at @TheEndoSociety and @EndoMedia.

---

JOURNAL

The Journal of Clinical Endocrinology & Metabolism

The environmental benefits of a food-sharing economy are highly dependent on how the money saved is then used

Researchers from Tel Aviv University and Ben Gurion University found:

Peer-Reviewed Publication

TEL-AVIV UNIVERSITY

 

IMAGE: DR. VERED BLASS view more 

CREDIT: PHOTO CREDIT: TEL AVIV UNIVERSITY. (TEL AVIV UNIVERSITY GRANTS PERMISSION FOR THE USE OF THESE PHOTOS/IMAGES FOR STORIES ON TAU RESEARCH).

Does the digital sharing economy really reduce harm to the environment? The researchers found that food sharing has significant environmental advantages, but that a substantial part of the benefits of online sharing platforms are offset due to the use of the saved money for purposes that are not necessarily green.

Researchers from Tel Aviv University and Ben Gurion University explored the true benefit of the digital food sharing economy (when people advertise and pass on surplus food items to others instead of throwing them away). Is this indeed a recommended environmentally-friendly practice that saves resources and significantly reduces harm to the environment? To answer this question, the researchers focused on the effectiveness of food sharing according to three environmental indicators: water depletion, land use, and global warming. They found that a significant proportion of the benefit to the environment is offset when the money saved as a result of sharing is used for purposes that have a negative environmental impact.

The study was led by Tamar Meshulam, under the guidance of Dr. Vered Blass of the Porter School of Environment and Earth Sciences at Tel Aviv University and Dr. Tamar Makov of Ben-Gurion University, and in collaboration with Dr. David Font-Vivanco, an expert on “rebound effect.” The article won the award for the “Best Article” at the PLATE (Product Lifetimes and the Environment) conference, and was published in the Journal of Industrial Ecology.

Tamar Meshulam explains: “food waste is a critical environmental problem. We all throw away food, from the farmer in the field to the consumer at home. In total, about a third of the food produced in the world is lost or wasted. This wasted food is responsible for roughly 10 percent of GHG emissions, and the land area used to grow food that is then wasted is equal in size to the vast territory of Canada! That’s why it is so important to look for ways to reduce food waste, and examine their potential contribution to mitigating climate change”

Dr. Makov: “Internet platforms for sharing food are gaining popularity all over the world, and are seen as a natural solution that can help tackle both food waste and food insecurity at the same time. While there is nothing new about sharing food, digitalization has lowered transaction costs substantially, allowing food to be shared not only within social circles of family and friends but also with absolute strangers. At the same time, sharing platforms as well as other digitally enabled food waste reduction platforms (e.g. too good to go) can save users a lot of money, which raises the question what do people typically do with such savings? considering what people do with the money they save via sharing platforms is critical for evaluating environmental impacts”

Dr. Blass adds: “Is it possible that at least some of the money saved is then spent on carbon intensive products and services that negate the benefit of sharing? Here’s a small example to illustrate: Let’s say that for one month a young couple lives only on food they obtained for free through a sharing platform, and then decides to use the money they saved to fly abroad. In such a case, it’s obvious that the plane they will be flying in creates pollution that harms the environment more than all the benefits of sharing. In this study, we sought to examine this troubling issue in depth.”

The researchers chose to focus on the app OLIO, an international peer-to-peer food-sharing platform, and specifically on its activity in the United Kingdom between the years 2017 and 2019. Combining models from the fields of industrial ecology, economics and data science, they measured the benefits of sharing food using three environmental indicators: global warming, the depletion of water sources, and land use. To understand how OLIO users spend their savings they used     statistical data published by the UK Office for National Statistics on household spending by consumption purpose to as COICOP (classification of individual consumption according to purpose).

Tamar Meshulam: “The location in which the food-sharing took place allowed us to assign each collecting user to their UK income percentile. We found that about 60 percent of the app's users belong to the bottom five deciles, while about 40 percent of the shares were carried out by the top five deciles. We also found that the second and tenth deciles made up a relatively large number of shares, so we chose to focus on them, along with data on the general population – what they spend their money on, and what the significance of these consumption habits is with regard to the savings made possible by sharing.”

The researchers performed a variety of statistical analyses, which yielded fascinating findings. In many cases, there was a considerable gap, or “rebound effect” between the expected environmental benefit and the benefit that was actually attained. This rebound effect changed depending on the population and the environmental impact category. Tamar Meshulam cites several examples: For the general population, 68% of the benefit was offset in the global warming category, about 35% was offset in the water depletion category, and about 40% was offset in the land use category. Furthermore, in households that used half of their savings for food expenses, the rebound effect      in all categories increased to 80 to 95 percent.

The researchers sum up: “The conclusion from our research is that the actual environmental benefits from efficiency improvements often fall short of expectations.  This is because the infrastructures supporting human activities are still carbon intensive. As long as our savings are measured in money, and the money is used for additional expenses, the rebound effect will erode our ability to reduce environmental burdens through greater efficiency”.

“In this context, it is important to note that we also examined what the results would have been if the sharing had been conducted in 2011 (these results are not included in this article). A comparison with the findings of 2019 shows a significant improvement. The explanation for this is that in recent years, Britain has made great efforts to switch to renewable energies, and the impact of this is evident in the decrease of greenhouse gas emissions. The bottom line is, as our findings demonstrate, that we need to combine a transition to green infrastructure with green consumerism. Each of these individually will not achieve the desired and critical impact needed for humanity and the planet.”

Link to the article:

https://onlinelibrary.wiley.com/doi/full/10.1111/jiec.13319

 

---

DOI

10.1111/jiec.13319 

Caribou have been using same Arctic calving grounds for 3,000 years

Epic migration leads caribou to same areas to give birth every spring

Peer-Reviewed Publication

UNIVERSITY OF CINCINNATI

 

IMAGE: ALASKA'S BARREN-GROUND CARIBOU HAVE BEEN USING THE SAME PARTS OF THE ARCTIC NATIONAL WILDLIFE REFUGE TO GIVE BIRTH TO THEIR CALVES FOR AT LEAST 3,000 YEARS, ACCORDING TO RESEARCHERS. view more 

CREDIT: MICHAEL MILLER

Caribou have been using the same Arctic calving grounds for more than 3,000 years, according to a new study by the University of Cincinnati.

Female caribou shed their antlers within days of giving birth, leaving behind a record of their annual travels across Alaska and Canada’s Yukon that persists on the cold tundra for hundreds or even thousands of years. Researchers recovered antlers that have sat undisturbed on the arctic tundra since the Bronze Age.

“To walk around the landscape and pick up something that’s 3,000 years old is truly amazing,” said Joshua Miller, an assistant professor of geosciences at the University of Cincinnati.

He has been leading summer expeditions to the Arctic National Wildlife Refuge since 2010, using rafts to navigate remote rivers to search for caribou antlers exposed on the tundra.

“We think about having to dig down into the soil to find that kind of ecological history, but on the Coastal Plain, the vegetation grows extremely slowly,” Miller said. “Bones dropped by animals that lived dozens or even hundreds of generations in the past can provide really meaningful information.”

The study demonstrates how important the area is for an animal that native Alaskans and Candians still depend on for sustenance, even as energy companies seek to exploit oil and gas resources in this protected area.

The Biden Administration in 2021 suspended drilling leases in the Arctic National Wildlife Refuge, the largest tract of undeveloped wilderness in the United States. 

“We know this region of the Arctic National Wildlife Refuge has been an important area for caribou for millennia,” Miller said. “That should give us pause on how we think about those landscapes.”

The study was published in the journal Frontiers in Ecology and Evolution.

Barren ground caribou undertake nature’s longest overland migration, traveling as far as 800 miles each year to reach their spring calving grounds in the Arctic National Wildlife Refuge and Canada’s Ivvavik National Park. The largest herd in this area, named for the Porcupine River, numbers in the hundreds of thousands of animals.

Scientists think caribou use these areas because they have fewer predators and offer seasonal vegetation near places where they can avoid the worst of the mosquitoes.

“The mosquitoes are horrible,” Miller said. “You get swarmed — literally covered in them. They can do significant damage to a young calf.”

Whatever the reason, the antlers they leave behind provide a physical record of their epic yearly travels that researchers can unlock through isotopic analysis. 

Caribou antlers, like those of elk, deer and moose, are made of fast-growing bone that the animals shed each year and regrow the following year.

“It is amazing to think that the oldest of the antlers found in our study were growing approximately the same time Homer was penning ‘the Iliad’ and ‘the Odyssey,’” study co-author Patrick Druckenmiller said.

He is director of the University of Alaska Museum and professor of the Department of Geology and Geophysics at the University of Alaska Fairbanks. Eric Wald from the U.S. Fish and Wildlife Service also co-authored the study.

The antler surveys in the vast expanse of the Arctic refuge require meticulous logistical planning, Miller said. Small planes deposit researchers and their gear deep in the interior, where they have to be watchful for grizzly and polar bears. They pilot rafts to the Beaufort Sea, conducting a  grid search of suitable caribou habitat identified in advance using aerial photography.

“We search for antlers along old river terraces, walking back and forth, covering every inch of habitat to find those ancient treasures,” Miller said. 

While male caribou antlers span four feet and weigh more than 20 pounds, female caribou antlers are much smaller. The antlers contain nutrients such as phosphorus and calcium that are important to plants and animals.

The dropped antlers create “nutrient sinks,” which could have a profound effect on the area’s vegetation. Miller said the caribou’s migration serves as a nutrient “conveyor belt” that might even draw caribou back to reap the benefits of this fertilizer in a reinforcement loop.

Caribou and other mammals are known to chew on dropped antlers for their valuable minerals. This could be an important dietary supplement for new caribou moms.

“We’d like to know to what degree this conveyor belt influences why caribou are going there in the first place,” Miller said.
The study was supported by the U.S. Fish and Wildlife Service, the National Geographic Society, the National Science Foundation, the Wildlife Society and the UC Office of Research.

Miller said the Arctic is warming faster than other parts of the globe. Parts of the Arctic that were once barren tundra are sprouting new spruce forests.

“We were in Arctic Village this summer, just south of the calving grounds, talking to elders about the changes they have seen,” Miller said. “Where once it was open tundra, large stretches of this barren ground are now full of trees everywhere. What will happen to the barren ground caribou as this habitat gets converted into forest?”

By comparing isotopes in shed antlers to the geology of Alaska, researchers can tell where caribou have spent the year feeding.

University of Cincinnati assistant professor Joshua Miller holds an antler shed by a female caribou in the Arctic National Wildlife Refuge. By conducting an isotopic analysis of the antler, researchers can track the animal's migration over the previous year.

CREDIT

Colleen Kelley/UC

---

JOURNAL

Frontiers in Ecology and Evolution

DOI

10.3389/fevo.2022.1059456 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

Animals

ARTICLE TITLE

Shed female caribou antlers extend records of calving activity on the Arctic National Wildlife Refuge by millennia

Spanish lagoon used to better understand wet-to-dry transition of Mars

Peer-Reviewed Publication

CORNELL UNIVERSITY

ITHACA, N.Y. – In the ongoing search for signs of life on Mars, a new study proposes focusing on “time-resolved analogs” – dynamic and similar Earth environments where changes can be analyzed over many years.

Alberto Fairén, visiting scientist of astronomy at Cornell University, led an investigation in the extremely salty Tirez lagoon in central Spain, which had experienced alternating dry and wet periods over the course of two decades before reaching total desiccation in 2015.

The key findings: If life existed on Mars when the planet had liquid water on its surface, its desiccation would not have necessarily implied that life disappeared for good. In addition, lipids – such as fatty acids or their derivatives – have a higher resistance to degradation and should be preferred targets in the search for life in a waterless world.

When analyzing Mars, Fairén’s research group focused particularly on locations that contained water ponds before drying up during the Noachian (around 4 billion years ago) and Hesperian (3.7 to 3 billion years ago) periods. They closely monitored Tirez’s gradual desiccation over 25 years, using it as an opportunity to better understand the evolution of microbial communities in small, dried-out lagoons.

Samples from Tirez were collected and analyzed in 2002, during the early stages of desiccation, and again in 2021, when the lagoon was completely dry.

“We conclude that any possible early ecosystems on Mars probably collapsed when liquid water disappeared,” Fairén said, “but the changing environment would have triggered global ecological successions, with hypothetical microorganisms evolving strategies similar to those of microorganisms living in Tirez now, adapted to thrive at very low water activity in the desiccated sediments.”

The group will continue to monitor Tirez, Fairén said, noting that any changes in its status regarding water content would be of interest.

“It would be particularly interesting if the ongoing dry decade in central Spain would experience some alleviation and we could witness at least a partial comeback of the water table,” he said. “That would allow us to extend even more our concept of the astrobiological time-analog for Mars, because the desiccation of Mars was a stepwise process.

“Analyzing the response of the microbiota in Tirez to the presence of liquid water again, after years of complete desiccation, would provide new insights to understand the evolution of possible ancient ecosystems on Mars,” Fairén noted.

The study published February 8 in the Nature journal Scientific Reports.

For additional information, see this Cornell Chronicle story.

Cornell University has dedicated television and audio studios available for media interviews.

-30-

---

JOURNAL

Scientific Reports

DOI

10.1038/s41598-023-28327-3 

First nursery of multiple shark species in the Eastern Atlantic described in Cape Verde

Peer-Reviewed Publication

FACULTY OF SCIENCES OF THE UNIVERSITY OF LISBON

 

IMAGE: JUVENILE MILK SHARK (RHIZOPRIONODON ACUTUS). view more 

CREDIT: VASCO PISSARRA

A new study carried out by Portuguese and Cape Verdean researchers reveals a shark nursery in the Sal Rey bay (Boa Vista island, Cape Verde): home to juveniles of several endangered species, including the iconic hammerhead shark, this is a unique region in the eastern Atlantic.

“Identifying and protecting nursery areas is crucial for the conservation of sharks, one of the most endangered animal groups in the world”, highlights Rui Rosa, researcher at the Faculty of Sciences of the University of Lisbon (Portugal) and lead author of this study, now published at Frontiers in Marine Science.

By monitoring the bycatch of sharks, and integrating the observations and knowledge of local fishermen, the research team evidences the consistent and preferential use of this zone by newborns of at least five shark species – all of them at imminent risk of extinction, according to the International Union for the Conservation of Nature (IUCN).

“The relevance of this region is clearly recognized by the local fishing community”, adds Rui Rosa. Since it is also used by marine mammals and turtles, “the protection of Sal Rei bay will be important not only for sharks, but for the conservation of a whole diversity of highly charismatic marine organisms and for the sustainable use of the marine resources in the region”, concludes the researcher.

This study was developed within the scope of the NGANDU research project, financed by the Portuguese Foundation for Science and Technology and for the Aga Khan Development Network.

Juvenile scalloped hammerhead (Sphyrna lewini).

Sal Rei bay (Boa Vista, Cape Verde)

CREDIT

Vasco Pissarra

---

JOURNAL

Frontiers in Marine Science

DOI

10.3389/fmars.2023.1077748 

ARTICLE TITLE

Evidence for the first multi-species shark nursery area in Atlantic Africa (Boa Vista Island, Cabo Verde)

Regenstrief-led study shows enhanced spiritual care improves well-being of ICU surrogate decision-makers

Importance of chaplains to the long-term psychological health of surrogate decision-makers demonstrated

Peer-Reviewed Publication

REGENSTRIEF INSTITUTE

INDIANAPOLIS – Family members or others who make decisions for patients in a hospital intensive care unit (ICU) often experience significant anxiety, depression and post-traumatic stress.

In one of the first studies to address the effect of spiritual support on the well-being of these surrogate decision-makers, researchers led by Alexia Torke, M.D., with Regenstrief Institute and Indiana University School of Medicine, found that those receiving enhanced spiritual care had a clinically significant decline in anxiety. Additionally, family surrogates receiving enhanced spiritual support experienced higher spiritual well-being and satisfaction with spiritual care compared to individuals receiving usual care from a hospital chaplain.

The enhanced spiritual care model, developed and implemented by the researchers, many of whom are chaplains, addressed the most important questions about religion and spirituality that ICU patients and their family members were likely to face. The researchers noted that board-certified chaplains provide spiritual care to patients of all religions or no religion. Spirituality is defined to include big questions about life, including meaning, purpose, spiritual experiences and connection to oneself and others.

“Throughout my career as a physician, as I have spoken with patients and family members about critical illness and life and death decision-making, many of them have talked about their religious and spiritual practices and beliefs. Yet, studies addressing the effect of spiritual support on family members of these very sick individuals are lacking,” said Dr. Torke. “This study, one of the first of its kind, enabled us to actually measure the impact of spiritual care on those who are making decisions for ICU patients who are unable to do so for themselves.” A clinician-researcher focused on palliative care, Dr. Torke directs the Daniel F. Evans Center for Spiritual and Religious Values in Healthcare at IU Health.

A total of 128 pairs of patients (age 18 and older) admitted to an ICU and unable to make medical decisions and their surrogate decision-makers – typically family members – participated in the study.

Patients and family members in the usual care arm of the study saw a chaplain, on average, two times during the patient’s ICU stay.

Patients and family members participating in the enhanced spiritual care arm of the study saw a chaplain, on average, four times during their relative’s ICU stay. Surrogates were contacted again six to eight weeks after the patient’s discharge from the hospital. If, however, the patient died during hospitalization, study chaplains attempted a bereavement visit, in person or by telephone, within 48 hours of the patient’s death.

Dr. Torke notes that the study’s enhanced spiritual care model, which builds upon usual chaplain practice, is scalable and could be adapted by hospitals across the country and around the world because it is uncomplicated and was developed to fit well into existing spiritual care departments.

The primary endpoint of the study was measurement of the surrogate's anxiety, six to eight weeks after the patient’s discharge. The researchers found that those enrolled in the expanded chaplain interaction arm of the study had a clinically significant decline in anxiety and showed improvement in their spiritual well-being and satisfaction with spiritual care.

“As we discuss in the paper, spiritual care does not bring in revenue for a hospital. Chaplains, at this point in time, don't bill the way physicians do, and so they are not generating income for a hospital. And sometimes when budgets are tight, it's very tempting to cut chaplain programs,” said Dr. Torke. “By building a research base and research knowledge about spiritual care, we are demonstrating the importance of chaplains to the long-term well-being of our patients and their family members. Even though they're not bringing in money, chaplains are an extremely important part of the care environment, providing real support to family members as well as patients in critical ways that not only affect satisfaction and but also health outcomes.”

“Effects of Spiritual Care on Well-being of Intensive Care Family Surrogates: A Clinical Trial” is published in the Journal of Pain and Symptom Management.

The authors concluded, “results of this study can inform hospitals, payors and policymakers about the value of chaplain-delivered spiritual care to improve emotional and spiritual support for ICU families. These results provide evidence for greater inclusion of chaplains in palliative and intensive care and inform the field about important elements of high-quality spiritual care such as proactive contact, comprehensive assessment, and tailored interventions.”

The study was supported by IU School of Medicine, the Daniel F. Evans Center and the National Institutes of Health’s National Institute on Aging.

Author list

Alexia M. Torke, M.D., M.S.1; Shelley E. Varner-Perez, MDiv, MPH, CPH, BCC2; Emily S. Burke, B.A.3; Tracy A. Taylor, B.S.3; James E. Slaven, M.S., M.A.4; Kathryn L. Kozinski, MDiv, BCC5; Saneta M. Maiko, PhD, M.S.6; Bruce J. Pfeffer, MAHL, BCC7; and Sarah K. Banks, B.S.8

Author affiliations

1 IU Center for Aging Research (A.M.T., S.E.V.P., E.S.B., T.A.T.), Regenstrief Institute, Indianapolis, Indiana; Indiana University School of Medicine (A.M.T., S.M.M., S.K.B.), Indianapolis, Indiana; Daniel F. Evans Center (A.M.T., S.E.V.P., S.M.M., B.J.P.), Indiana University Health, Indianapolis, Indiana.

2 IU Center for Aging Research (A.M.T., S.E.V.P., E.S.B., T.A.T.), Regenstrief Institute, Indianapolis, Indiana; Daniel F. Evans Center (A.M.T., S.E.V.P., S.M.M., B.J.P.), Indiana University Health, Indianapolis, Indiana; Spiritual Care and Chaplaincy. Department (S.E.V.P., B.J.P.), Indiana University Health, Indianapolis, Indiana

3 IU Center for Aging Research (A.M.T., S.E.V.P., E.S.B., T.A.T.), Regenstrief Institute, Indianapolis, Indiana.

4 Department of Biostatistics and Health Data Science (J.E.S.), Indiana University School of Medicine, Indianapolis, Indiana.

5 Maine General Health (K.L.K.), Augusta, Maine.

6 Indiana University School of Medicine (A.M.T., S.M.M., S.K.B.), Indianapolis, Indiana;

Daniel F. Evans Center (A.M.T., S.E.V.P., S.M.M., B.J.P.), Indiana University Health, Indianapolis, Indiana.

7 Daniel F. Evans Center (A.M.T., S.E.V.P., S.M.M., B.J.P.), Indiana University Health, Indianapolis, Indiana; Spiritual Care and Chaplaincy Department (S.E.V.P., B.J.P.), Indiana University Health, Indianapolis, Indiana.

8 Indiana University School of Medicine (A.M.T., S.M.M., S.K.B.), Indianapolis, Indiana

About Alexia Torke, M.D., M.S.

In addition to her Regenstrief appointment, Alexia Torke, M.D., M.S., is a professor of medicine and chief of the Section of Palliative Medicine at Indiana University School of Medicine. She also directs the Daniel F. Evans Center for Spiritual and Religious Values in Healthcare at Indiana University Health.

About Regenstrief Institute

Founded in 1969 in Indianapolis, the Regenstrief Institute is a local, national and global leader dedicated to a world where better information empowers people to end disease and realize true health. A key research partner to Indiana University, Regenstrief and its research scientists are responsible for a growing number of major healthcare innovations and studies. Examples range from the development of global health information technology standards that enable the use and interoperability of electronic health records to improving patient-physician communications, to creating models of care that inform practice and improve the lives of patients around the globe.

Sam Regenstrief, a nationally successful entrepreneur from Connersville, Indiana, founded the institute with the goal of making healthcare more efficient and accessible for everyone. His vision continues to guide the institute’s research mission.

About IU School of Medicine

IU School of Medicine is the largest medical school in the U.S. and is annually ranked among the top medical schools in the nation by U.S. News & World Report. The school offers high-quality medical education, access to leading medical research and rich campus life in nine Indiana cities, including rural and urban locations consistently recognized for livability.

---

JOURNAL

Journal of Pain and Symptom Management

DOI

10.1016/j.jpainsymman.2022.12.007 

ARTICLE TITLE

Effects of Spiritual Care on Well-being of Intensive Care Family Surrogates: A Clinical Trial