'Antisocial’ damselfish are scaring off cleaner fish customers – and this could contribute to coral reef breakdown

Damselfish have been discovered to disrupt ‘cleaning services’ vital to the health of reefs. And climate change may mean this is only likely to get worse.

Peer-Reviewed Publication

UNIVERSITY OF CAMBRIDG

VIDEO: A DAMSELFISH DISRUPTS A CLEANING INTERACTION AND CHASES THE CLIENT AWAY view more 

PRESS RELEASE FROM THE UNIVERSITY OF CAMBRIDGE

Photos, footage and paper: https://drive.google.com/drive/folders/1YqZYHV2g7-5R0mLOqVjIXgeII-636Xr_?usp=share_link 

Film: https://youtu.be/GBij2Him348 

‘Antisocial’ damselfish are scaring off cleaner fish customers – and this could contribute to coral reef breakdown

Damselfish have been discovered to disrupt ‘cleaning services’ vital to the health of reefs. And climate change may mean this is only likely to get worse.

The meal of choice for the Caribbean cleaner fish, the sharknose goby, is a platter of parasites, dead tissue, scales and mucus picked off the bodies of other fishes. By removing these morsels, gobies are offering their ‘cleaning services’ to other marine life – a famous example of a mutually beneficial relationship between species.

But new research from the University of Cambridge and Cardiff University shows that when gobies inadvertently set up shop within the territories of aggressive damselfish, damselfish scare off the gobies’ ‘choosy client customers’.

The study, published today in Behavioral Ecology, is an example of a largely unexplored phenomenon: a mutually beneficial relationship in nature being disrupted by a third party. 

Sharknose gobies work solo or band together and set up a ‘cleaning station’: a fixed location in a particular nook of coral reef, where other marine life burdened by parasites go to take advantage of the gobies’ dietary needs.

“Gobies wait at cleaning stations for customers to visit, similar to shops. And with customers, come the parasites,” said Dr Katie Dunkley, a behavioural ecologist at the University of Cambridge’s Department of Zoology. “In return for providing a cleaning service the gobies receive a payment of food.”

Customers are varied and include parrotfish, surgeonfish and butterflyfish. These choosy client fish shop around, visiting different cleaning stations open for business. If interested, they will adopt a stationary pose that makes a clean more likely – typically a head or tail-stand position with all fins flared.

During a clean – which could last from a few seconds to several minutes – gobies make physical contact with the customer, removing parasites and other dead body tissue. This is known as ‘tactile stimulation’ and, as well as getting rid of parasites, it may act as a massage reducing the customer’s stress, says Dunkley. Previous research has established the importance of cleaners – their removal led to fewer numbers and less variety of fish species on reefs.

“Cleaning stations act as a marketplace, and if customers stop showing up, over time a cleaning station is going to go out of business,” said Dunkley.

Five researchers spent over 34 hours observing cleaning stations on a shallow fringing reef in Tobago over a period of six weeks. Equipped with snorkels and waterproof paper they recorded underwater interactions for 10-minute periods from 8am-5:15pm each day.

They found that client fish were less likely to go to cleaning stations that were more often patrolled by damselfish, who scared ‘intruders’ away. 

“I thought that damselfish might play a role as they visit cleaning stations too – although don’t often get cleaned – but to see just how influential they were was startling.

“Damselfish act like farmers as they weed out algae they don’t want, to encourage their preferred algae to grow. Damselfish are protective over their algal territories, and these antisocial fish spend a lot of time patrolling their territories, scaring away intruders through biting, attacking, chasing or threatening displays.”

Damselfish’s territories cover up to 70% of some reefs. On a healthy coral reef, a balance is maintained between algae and coral. But as reefs deteriorate and overfishing intensifies, algae thrive. As reefs deteriorate damselfish may become more common and/or aggressive – leading to fewer species receiving the goby cleaning treatment needed to keep them healthy, says Dunkley. This could ultimately contribute to the breakdown of delicate ecosystems supported by reefs.

“In future we’d like to tease out the motives of damselfish. Are they driven by wanting to protect their algae farms or monopolise cleaning stations?” said Dunkley, a Charles Darwin and Galapagos Islands Fund Junior Research Fellow at Christ’s College, Cambridge.

“Just as humans are connected through family, friends and colleagues, all fish are connected to each other. It’s important that we don’t just look at relationships in isolated bubbles. We need to step back and see how all fish are connected so that we can protect ecosystems like coral reefs.”

The study was funded by a Natural Environment Research Council GW4+ studentship and Christ’s College University of Cambridge Galapagos Islands Fund (both awarded to first author, Katie Dunkley). Last author, James Herbert-Read, was supported by the Whitten Lectureship in Marine Biology, and a Swedish Research Council Grant (2018–04076).

ENDS.

Reference: Dunkley et al, The presence of territorial damselfish predicts choosy client species richness at cleaning stations, Behavioral Ecology, DOI: doi.org/10.1093/beheco/arac122 

Contact details:

Charis Goodyear, Communications Coordinator, University of Cambridge Office of External Affairs and Communications Charis.Goodyear@admin.cam.ac.uk

Dr Katie Dunkley, Department of Zoology, University of Cambridge kd482@cam.ac.uk 

About the University of Cambridge

The University of Cambridge is one of the world’s leading universities, with a rich history of radical thinking dating back to 1209. Its mission is to contribute to society through the pursuit of education, learning and research at the highest international levels of excellence. 

Cambridge was second in the influential 2023 QS World University Rankings, the highest rated institution in the UK. 

The University comprises 31 autonomous Colleges and over 100 departments, faculties and institutions. Its 20,000 students include around 9,000 international students from 147 countries. In 2022, 72.5% of its new undergraduate students were from state schools and more than 25% from economically disadvantaged backgrounds.

Cambridge research spans almost every discipline, from science, technology, engineering and medicine through to the arts, humanities and social sciences, with multi-disciplinary teams working to address major global challenges. In the Times Higher Education’s rankings based on the UK Research Excellence Framework, the University was rated as the highest scoring institution covering all the major disciplines.

The University sits at the heart of the ‘Cambridge cluster’, in which more than 5,200 knowledge-intensive firms employ more than 71,000 people and generate £19 billion in turnover. Cambridge has the highest number of patent applications per 100,000 residents in the UK.

www.cam.ac.uk

 

  

A damselfish has just chased a client away

  

A damselfish seen with a filefish at a cleaning station

A damselfish disrupts a cleaning interaction and chases the client away

CREDIT

Katie Dunkley

JOURNAL

Behavioral Ecology

DOI

10.1093/beheco/arac122 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

Animals

ARTICLE TITLE

The presence of territorial damselfish predicts choosy client species richness at cleaning stations

ARTICLE PUBLICATION DATE

22-Feb-2023

 Parkinson’s disease patients experience significant reduction in symptoms with non-surgical focused ultrasound treatment

Study led to FDA approval of focused ultrasound device that provides novel treatment option without requiring incision

Peer-Reviewed Publication

UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE

VIDEOS: Interviews, B-Roll

https://www.dropbox.com/scl/fo/b1tpiamgunp5ekymyxaks/h?dl=0&rlkey=zk15bee6kru69ebryxaha0g3j

YouTube Video. Unlisted & only viewable w/ link until embargo lifts. https://youtu.be/Ceg7R3sw7Qs

 

Patients with Parkinson’s disease achieved a significant improvement in their tremors, mobility, and other physical symptoms after having a minimally invasive procedure involving focused ultrasound, according to a new study today published in the New England Journal of Medicine.

The clinical trial was led by researchers at the University of Maryland School of Medicine (UMSOM) and involved 94 Parkinson’s disease patients who were randomly assigned to undergo focused ultrasound to ablate a targeted region on one side of the brain or to have a sham procedure. Nearly 70 percent of patients in the treatment group were considered successful responders to treatment after three months of follow-up, compared to 32 percent in the control group who had an inactive procedure without focused ultrasound.

Two-thirds of those who responded initially to the focused ultrasound treatment continued to have a successful response from the treatment a year later. 

Patients were treated at the University of Maryland Medical Center (UMMC), the academic flagship hospital for the University of Maryland Medical System, and 15 other sites in North America, Asia, and Europe.

“These results are very promising and offer Parkinson’s disease patients a new form of therapy to manage their symptoms. There is no incision involved, which means no risk of a serious infection or brain bleeding,” said study corresponding author Howard Eisenberg, MD, the Raymond K. Thompson Professor of Neurosurgery at UMSOM and a neurosurgeon at UMMC.

About one million Americans have Parkinson’s disease, a neurodegenerative disorder that affects brain cells or neurons in a specific area of the brain that produce the brain chemical dopamine. Symptoms include shaking, stiffness, and difficulty with balance and coordination. Other treatments for Parkinson’s include medications and deep brain stimulation (DBS) from surgically implanted electrodes. The medications can cause involuntary, erratic movements called dyskinesia as doses are increased to control symptoms.  Usually offered when medications fail, DBS involves brain surgery to insert the electrodes through two small openings in the skull. The procedure carries a small risk of serious side effects including brain hemorrhage and infection.

 “Our study will help doctors and patients make an informed decision when considering this new treatment modality to help better manage symptoms,” said study co-author  Paul Fishman, MD, PhD, Professor of Neurology at UMSOM and a neurologist at UMMC. “But it’s important for patients to realize that none of the treatments currently available will cure Parkinson’s disease.”

Focused ultrasound is an incisionless procedure, performed without the need for anesthesia or an in-patient stay in the hospital. Patients, who remain fully alert, lie in a magnetic resonance imaging (MRI) scanner, wearing a transducer helmet. Ultrasonic energy is targeted through the skull to the globus pallidus, a structure deep in the brain that helps control regular voluntary movement. MRI images provide doctors with a real-time temperature map of the area being treated, to precisely pinpoint the target and to apply a high enough temperature to ablate it. During the procedure, the patient is awake and providing feedback, which allows doctors to monitor the immediate effects of the tissue ablation and make adjustments as needed.

The device, called Exablate Neuro, was approved over a year ago by the US Food and Drug Administration (FDA) to treat advanced Parkinson’s disease on one side of the brain. The FDA approval was based on findings from the UMSOM clinical trial published today. The procedure is now widely available at the University of Maryland Medical Center (UMMC). However, it is not yet covered by insurance, including Medicare, so patients currently need to pay out of pocket for the procedure.

“Focused ultrasound is only approved by the FDA to treat one side of the brain in Parkinson’s disease patients, so it may be more appropriate at this time for patients with symptoms predominantly on one side,” said study co-author Vibhor Krishna, MD, a professor of neurosurgery at the University of North Carolina, Chapel Hill.

Diagnosed with Parkinson’s disease in 2020, Melanie Carlson, a 41-year-old mother of a toddler, found that the medications she was taking to manage the condition caused her to have uncontrollable shaking. Her symptoms were so severe, she was dependent on a walker and unable to take her daughter to the playground. Last June, she opted to have focused ultrasound at UMMC after learning about the FDA approval. 

“Focused ultrasound was really transformative. So many of my fine motor skills have returned. I’m putting on eyeliner again and taking showers again without falling,” Carlson said. “This honestly feels like one of the best years of my life.  I just feel so fortunate. I hope more people can benefit from this procedure.”

Patients enrolled in the trial -- with moderate Parkinson’s who were not responding well to medications -- were treated with one session of focused ultrasound on the side of their brain that controlled the side of their body where symptoms were more severe. The study was designed as a crossover trial, where 25 patients in the control group were offered the active treatment three months after their sham procedure; 20 out of 25 opted to have the focused-ultrasound treatment and experienced similar benefits as the initial treatment group.

Those in the treatment group had an immediate improvement of at least three points on a standard assessment -- measuring tremors, walking abilities, and rigidity in the legs and arms -- compared to an 0.3 point improvement in the control group. They also experienced relief from side effects from Parkinson’s medications. They were assessed again at three months and at 12 months. Patients will continue to be followed for five years to evaluate how long the treatment lasts and progression of the disease.

Adverse events from the procedure included headache, dizziness, and nausea that resolved within a day or two of treatment. Some patients experienced mild side effects from the focused ultrasound treatment, including slurred speech, walking issues, and loss of taste. These usually resolved within the first few weeks. 

Dr. Eisenberg and his colleagues are currently conducting a clinical trial to test the Exablate Neuro device on both sides of the brain, delivering focused ultrasound treatments in two sessions, six months apart. “So far, we’ve had promising results,” Dr. Eisenberg said.

The study was funded by Insightec, manufacturer of Exablate Neuro.

 “We are on the edge of the frontier with focused ultrasound, as ongoing research evaluates the procedure in different brain areas affected by Parkinson’s, such as the subthalamic nucleus, which controls movement regulation,” said UMSOM Dean, Mark T. Gladwin, MD, who is also Vice President for Medical Affairs, University of Maryland, Baltimore, and the John Z. and Akiko K. Bowers Distinguished Professor. “Researchers also are studying how focused ultrasound could be used to temporarily open the blood-brain barrier to help experimental Parkinson’s treatments, like immunotherapy, get into the brain more easily.”

“As home to one of the top movement disorder centers in the country, and one of only a few medical centers that offer focused ultrasound for Parkinson’s, we see firsthand the technology’s impact on people’s lives. Congratulations to the researchers—and the trial participants—for exemplifying the innovation and discovery that will make focused ultrasound available to more people in the years to come,” said Bert W. O'Malley, MD, President and CEO of UMMC.

About the University of Maryland School of Medicine

Now in its third century, the University of Maryland School of Medicine was chartered in 1807 as the first public medical school in the United States. It continues today as one of the fastest growing, top-tier biomedical research enterprises in the world -- with 46 academic departments, centers, institutes, and programs, and a faculty of more than 3,000 physicians, scientists, and allied health professionals, including members of the National Academy of Medicine and the National Academy of Sciences, and a distinguished two-time winner of the Albert E. Lasker Award in Medical Research. With an operating budget of more than $1.3 billion, the School of Medicine works closely in partnership with the University of Maryland Medical Center and Medical System to provide research-intensive, academic, and clinically based care for nearly 2 million patients each year. The School of Medicine has nearly $600 million in extramural funding, with most of its academic departments highly ranked among all medical schools in the nation in research funding. As one of the seven professional schools that make up the University of Maryland, Baltimore campus, the School of Medicine has a total population of nearly 9,000 faculty and staff, including 2,500 students, trainees, residents, and fellows. The combined School of Medicine and Medical System (“University of Maryland Medicine”) has an annual budget of over $6 billion and an economic impact of nearly $20 billion on the state and local community. The School of Medicine, which ranks as the 8th highest among public medical schools in research productivity (according to the Association of American Medical Colleges profile) is an innovator in translational medicine, with 606 active patents and 52 start-up companies. In the latest U.S. News & World Report ranking of the Best Medical Schools, published in 2021, the UM School of Medicine is ranked #9 among the 92 public medical schools in the U.S., and in the top 15 percent (#27) of all 192 public and private U.S. medical schools. The School of Medicine works locally, nationally, and globally, with research and treatment facilities in 36 countries around the world. Visit medschool.umaryland.edu

 

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JOURNAL

New England Journal of Medicine

DOI

10.1056/NEJMoa2202721 

METHOD OF RESEARCH

Randomized controlled/clinical trial

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Trial of globus pallidus focused ultrasound ablation in Parkinson’s disease

ARTICLE PUBLICATION DATE

23-Feb-2023

COI STATEMENT

Funded by Insightec.

New design for lithium-air battery could offer much longer driving range compared with the lithium-ion battery

New batteries could one day power cars, airplanes, trucks

Peer-Reviewed Publication

DOE/ARGONNE NATIONAL LABORATORY

 

IMAGE: SCHEMATIC SHOWS LITHIUM-AIR BATTERY CELL CONSISTING OF LITHIUM METAL ANODE, AIR-BASED CATHODE, AND SOLID CERAMIC POLYMER ELECTROLYTE (CPE). ON DISCHARGE AND CHARGE, LITHIUM IONS (LI+) GO FROM ANODE TO CATHODE, THEN BACK. view more 

CREDIT: (IMAGE BY ARGONNE NATIONAL LABORATORY.)

Many owners of electric cars have wished for a battery pack that could power their vehicle for more than a thousand miles on a single charge. Researchers at the Illinois Institute of Technology (IIT) and U.S. Department of Energy’s (DOE) Argonne National Laboratory have developed a lithium-air battery that could make that dream a reality. The team’s new battery design could also one day power domestic airplanes and long-haul trucks.

The main new component in this lithium-air battery is a solid electrolyte instead of the usual liquid variety. Batteries with solid electrolytes are not subject to the safety issue  with the liquid electrolytes used in lithium-ion and other battery types, which can overheat and catch fire.

“The lithium-air battery has the highest projected energy density of any battery technology being considered for the next generation of batteries beyond lithium ion.” — Larry Curtiss, Argonne Distinguished Fellow

More importantly, the team’s battery chemistry with the solid electrolyte can potentially boost the energy density by as much as four times above batteries">lithium-ion batteries, which translates  into longer driving range.

“For over a decade, scientists at Argonne and elsewhere have been working overtime to develop a lithium battery that makes use of the oxygen in air,” said Larry Curtiss, an Argonne Distinguished Fellow.  ​“The lithium-air battery has the highest projected energy density of any battery technology being considered for the next generation of batteries beyond lithium-ion.”

In past lithium-air designs, the lithium in a lithium metal anode moves through a liquid electrolyte to combine with oxygen during the discharge, yielding lithium peroxide (Li2O2) or superoxide (LiO2) at the cathode. The lithium peroxide or superoxide is then broken back down into its lithium and oxygen components during the charge. This chemical sequence stores and releases energy on demand.

The team’s new solid electrolyte is composed of  a ceramic polymer material made from relatively inexpensive elements in nanoparticle form. This new solid enables chemical reactions that produce lithium oxide (Li2O) on discharge.

“The chemical reaction for lithium superoxide or peroxide only involves one or two electrons stored per oxygen molecule, whereas that for lithium oxide involves four electrons,” said Argonne chemist Rachid Amine. More electrons stored means higher energy density.

The team’s lithium-air design is the first lithium-air battery that has achieved a four-electron reaction at room temperature. It also operates with oxygen supplied by air from the surrounding environment. The capability to run with air avoids the need for oxygen tanks to operate, a problem with earlier designs.

The team employed many different techniques to establish that a four-electron reaction was actually taking place. One key technique was transmission electron microscopy (TEM) of the discharge products on the cathode surface, which was carried out at Argonne’s Center for Nanoscale Materials, a DOE Office of Science user facility. The TEM images provided valuable insight into the four-electron discharge mechanism.

Past lithium-air test cells suffered from very short cycle lives. The team established that this shortcoming is not the case for their new battery design by building and operating a test cell for 1000 cycles, demonstrating its stability over repeated charge and discharge.

“With further development, we expect our new design for the lithium-air battery to also reach a record energy density of 1200 watt-hours per kilogram,” said Curtiss. ​“That is nearly four times better than lithium-ion batteries.”

This research was published in a recent issue of Science. Argonne authors include Larry Curtiss, Rachid Amine, Lei Yu, Jianguo Wen, Tongchao Liu, Hsien-Hau Wang, Paul C. Redfern, Christopher Johnson and Khalil Amine. Authors from IIT include Mohammad Asadi, Mohammadreza Esmaeilirad and Ahmad Mosen Harzandi. And Authors from the University of Illinois Chicago include Reza Shahbazian-Yassar, Mahmoud Tamadoni Saray, Nannan Shan and Anh Ngo.

The research was funded by the DOE Vehicle Technologies Office and the Office of Basic Energy Sciences through the Joint Center for Energy Storage Research.

About Argonne’s Center for Nanoscale Materials
The Center for Nanoscale Materials is one of the five DOE Nanoscale Science Research Centers, premier national user facilities for interdisciplinary research at the nanoscale supported by the DOE Office of Science. Together the NSRCs comprise a suite of complementary facilities that provide researchers with state-of-the-art capabilities to fabricate, process, characterize and model nanoscale materials, and constitute the largest infrastructure investment of the National Nanotechnology Initiative. The NSRCs are located at DOE’s Argonne, Brookhaven, Lawrence Berkeley, Oak Ridge, Sandia and Los Alamos National Laboratories. For more information about the DOE NSRCs, please visit https://​sci​ence​.osti​.gov/​U​s​e​r​-​F​a​c​i​l​i​t​i​e​s​/​U​s​e​r​-​F​a​c​i​l​i​t​i​e​s​-​a​t​-​a​-​G​lance.

The Joint Center for Energy Storage Research (JCESR), a DOE Energy Innovation Hub, is a major partnership that integrates researchers from many disciplines to overcome critical scientific and technical barriers and create new breakthrough energy storage technology. Led by the U.S. Department of Energy’s Argonne National Laboratory, partners include national leaders in science and engineering from academia, the private sector, and national laboratories. Their combined expertise spans the full range of the technology-development pipeline from basic research to prototype development to product engineering to market delivery.

Argonne National Laboratory seeks solutions to pressing national problems in science and technology. The nation’s first national laboratory, Argonne conducts leading-edge basic and applied scientific research in virtually every scientific discipline. Argonne researchers work closely with researchers from hundreds of companies, universities, and federal, state and municipal agencies to help them solve their specific problems, advance America’s scientific leadership and prepare the nation for a better future. With employees from more than 60 nations, Argonne is managed by UChicago Argonne, LLC for the U.S. Department of Energy’s Office of Science.

The U.S. Department of Energy’s Office of Science is the single largest supporter of basic research in the physical sciences in the United States and is working to address some of the most pressing challenges of our time. For more information, visit https://​ener​gy​.gov/​s​c​ience.

TAGS: batteries-and-fuel-cells">Batteries And Fuel Cells, Scientific User Facilities

---

JOURNAL

Science

DOI

10.1126/science.abq1347 

ARTICLE TITLE

A room temperature rechargeable Li2O-based lithium-air battery enabled by a solid electrolyte

CAMH study first to examine contextual factors associated with higher rates of suicide in the Americas

Social determinants of health among factors affecting suicide rates

Peer-Reviewed Publication

CENTRE FOR ADDICTION AND MENTAL HEALTH

A CAMH-led study of national suicide rates in 33 countries in the Americas over the past 20 years has found several key contextual factors associated with national rates of suicide.

The authors state that while suicide rates in the rest of the world have been going down in the past two decades, they have been increasing in North, Central and South America, highlighting what they say is an urgent need for more enhanced and targeted suicide prevention efforts.

The study, just published in The Lancet Regional Health – Americas, is believed to be the first of its kind to examine the impact of specific contextual factors associated with national suicide rates in the Americas. Using public health data from the World Health Organization Global Health Estimates database from 2000 to 2019, the authors found eight population-level factors associated with suicide rates: alcohol use, education inequality, health expenditure, homicide rate, intravenous drug use, number of employed doctors, population density and unemployment rate.

“By quantifying the associations between these specific factors and country-level suicide rates, we can provide decision-makers with the evidence they need to create effective national suicidal prevention strategies,” said author Dr. Shannon Lange, Independent Scientist at the Institute for Mental Health Policy Research at CAMH. “Our results indicate that multi-sectoral measures targeting health and social well-being should be emphasized.”

Overall, the study found that there are some significant differences in the factors associated with male and female suicide rates. For example, when education inequality (unequal distribution of academic resources) increased, the suicide rate increased among females, in particular.

“Our findings highlight the vital importance of considering gender differences when developing, adapting and testing suicide risk reduction initiatives,” said. Dr. Lange. “Gender norms and expectations are likely to influence suicide risk factors so it can’t be a one-size fits all approach.”

Overall, Canadian men and women had the 6th highest suicide rate among the 33 countries studied in North, Central and South America.

About The Centre for Addiction and Mental Health (CAMH)

CAMH is Canada's largest mental health and addiction teaching hospital and a world leading research centre in this field. CAMH combines clinical care, research, education, policy development and health promotion to help transform the lives of people affected by mental illness and addiction. CAMH is fully affiliated with the University of Toronto, and is a Pan American Health Organization/World Health Organization Collaborating Centre. For more information, please visit camh.ca or follow @CAMHnews on Twitter.

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JOURNAL

The Lancet Regional Health - Americas

METHOD OF RESEARCH

Meta-analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Contextual factors associated with country-level suicide mortality in the Americas, 2000–2019: a cross-sectional ecological study

ARTICLE PUBLICATION DATE

23-Feb-2023

COI STATEMENT

S.L. received compensation from the Pan American Health Organization for carrying-out this investigation.

https://lecerveau.mcgill.ca/flash/capsules/articles_pdf/suicide.pdf

Suicide (1897) 

Durkheim responded by showing that the social suicide rate bears no definite relation to that of neurasthenia, and that the latter thus has no necessary effect ...

After 25 years of AI health tech research computers are slowly beginning to listen to patients

Mental health and other chronic conditions leading way in combining AI potential with patient reported outcomes

Peer-Reviewed Publication

UNIVERSITY OF BIRMINGHAM

Patients experiences of health conditions are slowly being integrated into healthcare AI studies, a review of 25 years of studies has found.

In a new paper published in Lancet Digital Health along with an associated opinion piece, experts from the University of Birmingham and University Hospitals Birmingham have looked at more than 600 interventional studies on AI healthcare technologies.

While the team, funded by the National Institute for Health and Care Research (NIHR), found that only 24% of studies have a patient reported outcome element included in their study, there has been an increase in the number in recent years with 2021 and 2022 seeing nearly two thirds of all studies included.

Dr Samantha Cruz Rivera from the Centre for Patient Reported Outcomes at the University of Birmingham said:

“The opportunities for AI to revolutionise healthcare are only going to make patients’ lives better if those models consider how patients actually feel and respond to healthcare interventions. Our review shows that patient reported outcomes, such as measures of symptom burden and quality of life, are increasingly being incorporated into AI studies which is very encouraging.

“The future could see AI healthcare tech analysing and raising  an alert if a patient’s health is declining, but such a future is going to depend on having large-scale patient reported outcome datasets so that AI can support or drive care in a specific condition, and incorporate patient experience. Integrating PROs within AI can support the humanisation of AI for health and ensure that the patient’s voice is not lost in a rush to digitise and automate health care.”

 

Chronic health leading the way

Patient reported outcomes from chronic health conditions such as mental health and arthritis are being adopted into more AI studies than other conditions according to the review.

The research into patient reported outcomes is a key theme of the National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre. The team involved in this paper say that the adoption of PROs for testing AI healthcare technologies in chronic conditions demonstrates how important patient voices are for long-term health management.

Melanie Calvert, Professor of Outcomes Methodology at the University of Birmingham said:

“Managing long term health conditions places a huge burden on patients and their families, but also the NHS and social care system.  AI systems can help support patients and healthcare systems to aid decision-making, improve workflow and lead to more efficient care with improved outcomes.  Encouragingly, we are seeing more research into AI tech solutions for chronic conditions incorporating patient reported outcomes.

“It’s clear that having technology that can analyse and predict patient outcomes to help prioritise care is going to be a part of healthcare’s future. However, we must ensure that the patient reported outcome data used to train the AI systems are applicable to the population they are intended to serve. If we don’t do this, the gaps between advantaged and disadvantaged populations will only get worse.”

Chronic conditions with the highest numbers of AI studies incorporating PROs:

• Osteoarthritis – 57% (16 of 28 trials)
• mental and behavioural health - 54% (38 of 70 trials)
• endocrine, nutritional, and metabolic health, such as diabetes – 46% (22 of 48 trials); and
• neurological system health – 41% (18 of 44 trials)

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JOURNAL

The Lancet Digital Health

METHOD OF RESEARCH

Systematic review

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

The role of patient-reported outcome measures in trials of artificial intelligence health technologies: a systematic evaluation of ClinicalTrials.gov records (1997–2022)

ARTICLE PUBLICATION DATE

22-Feb-2023

Is living close to parks, water better for your brain?

Adults living closer to green, blue spaces may have lower psychological distress

Meeting Announcement

AMERICAN ACADEMY OF NEUROLOGY

MINNEAPOLIS – Living closer to outdoor spaces and water sources may reduce older people’s risk of having serious psychological distress, which can lead to mild cognitive impairment and dementia, according to a preliminary study released today, February 22, 2023, that will be presented at the American Academy of Neurology’s 75th Annual Meeting being held in person in Boston and live online from April 22-27, 2023.

Researchers defined serious psychological distress as mental health problems that require treatment and have a moderate to severe effect on a person’s ability to participate in work, school and social situations.

“Since we lack effective prevention methods or treatments for mild cognitive impairment and dementia, we need to get creative in how we look at these issues,” said Solmaz Amiri, DDes, of Washington State University Elson S. Floyd College of Medicine in Spokane, Washington. “Our hope is that this study showing better mental health among people living close to parks and water will trigger other studies about how these benefits work and whether this proximity can help prevent or delay mild cognitive impairment and dementia.”

The study involved 42,980 people age 65 or older living in urban areas in the state of Washington.

Researchers looked at data from the U.S. Census and the Centers for Disease Control and Prevention to identify how close participants lived to green and blue spaces. Green space was defined as public parks, community gardens and cemeteries. Blue space was defined as water bodies such as lakes, reservoirs, large rivers and coasts.

Participants completed a questionnaire to assess psychological distress. They answered six questions on how often they felt depression and anxiety symptoms using a five-point scale ranging from zero, meaning none of the time, to four, meaning all the time.

Questions included items like how many days they were unable to work due to psychological distress, how many days their productivity was at least halved by distress, and how many times they sought professional help. Scores ranged from 0 to 24, with an average score of 2. Participants who scored above 13 on the test were considered to have serious psychological distress.

Researchers reported that around 2% of the participants had serious psychological distress.

Of the total participants, 70% lived within half a mile of a green space and 60% lived within half a mile of  a blue space.

People living within half a mile of green or blue spaces had a 17% lower risk of experiencing serious psychological distress compared to people living further than half a mile from green or blue spaces.

Of the people who lived within a half mile of parks and water, 1.3% had serious psychological distress, compared to 1.5% of the people who lived further than half a mile.

“Our hope is that this study may help inform public health policies in the future, from where residential facilities are located to programs to improve mental health outcomes of people living in long-term care centers or nursing homes,” Amiri added.

A limitation of the study was that people reported on their psychological distress and may not have remembered and reported all details accurately.

Learn more about brain health at BrainandLife.org, home of the American Academy of Neurology’s free patient and caregiver magazine focused on the intersection of neurologic disease and brain health. Follow Brain & Life® on Facebook, Twitter and Instagram.

When posting to social media channels about this research, we encourage you to use the American Academy of Neurology’s Annual Meeting hashtag #AANAM.

The American Academy of Neurology is the world’s largest association of neurologists and neuroscience professionals, with over 38,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.

For more information about the American Academy of Neurology, visit AAN.com or find us on Facebook, Twitter, Instagram, LinkedIn and YouTube.

Why migraine frequently occurs during menstruation

Peer-Reviewed Publication

CHARITÉ - UNIVERSITÄTSMEDIZIN BERLIN

When women suffer migraine attacks, it is often just before or during their monthly period. A team of researchers from Charité – Universitätsmedizin Berlin has now identified a possible explanation. According to their study, published in the journal Neurology,* women who experience migraines have higher levels of CGRP during menstruation. CGRP is a neurotransmitter that is known to play an important role in triggering migraines.

Women suffer migraines at triple the rate that men do. The attacks tend to cluster around the time of menstruation, when they are also more severe, and the same is true at the onset of menopause. In many cases, symptoms improve during pregnancy, and the frequency of migraines also declines after menopause. Researchers have long known that there was a connection between hormonal fluctuations and migraines, but how exactly these changes trigger migraine remains largely unclear.

“Animal models suggest that fluctuations in female hormones, especially estrogen, lead to an increased release of CGRP, an inflammatory neurotransmitter, in the brain,” explains study lead Dr. Bianca Raffaelli of the Headache Center at the Department of Neurology with Experimental Neurology at Charité’s Mitte campus. “CGRP’s full name is calcitonin gene-related peptide. It is a naturally occurring substance in the body, and when a person has a migraine attack, increasing levels are released, significantly dilating – or widening – the blood vessels in the brain. This causes an inflammatory response that could be one of the reasons behind the severe headaches people experience with migraine.”

Increased CGRP levels during menstruation

The Charité research group studied a total of 180 women to determine whether the link between female hormones and the release of CGRP also exists in humans. The researchers tested the CGRP levels in migraine patients twice during their cycle, with one measurement taken during menstruation and the other during ovulation. When the data were compared to those of women who do not suffer migraines, it became clear that migraine patients have significantly higher concentrations of CGRP during menstruation than healthy subjects. “This means that when estrogen levels drop immediately before the start of a menstrual period, migraine patients release more CGRP,” says Raffaelli, who is also a fellow with the Clinician Scientist Program jointly operated by Charité and the Berlin Institute of Health (BIH) at Charité. “This could explain why these patients suffer more migraine attacks just before and during their monthly period.”

In women who take oral contraception, by contrast, there are hardly any fluctuations in estrogen levels. As researchers showed in this study, CGRP concentrations are also uniform over the course of the “artificial cycle” caused by oral contraception, with comparable levels seen in both female migraine patients and healthy women. The researchers made a similar observation in postmenopausal women.

“The data will still need to be confirmed by larger studies, but our findings do suggest that the release of CGRP depends on hormonal status in humans, as it does in the animal model,” Raffaelli notes. “Taking birth control pills and the end of menopause do in fact bring relief for some female migraine patients. But as our study also shows, there are women who suffer from migraine even without any hormonal fluctuations. We suspect that other processes in the body play a role in triggering attacks in those patients. After all, CGRP isn’t the only inflammatory peptide that can cause a migraine attack.”

Possible relevance for migraine medications

Since CGRP plays such a pivotal role in migraines, researchers have developed new medications known as CGRP inhibitors to target this neurotransmitter in recent years. Raffaelli comments: “Based on our study, the question now is, Do CGRP inhibitors work differently in differing hormonal states? So might it be a good idea to administer these drugs depending on where a person is in their cycle? Further studies will be needed on these points.”

The team now plans to study what other physical processes are influenced by the menstrual cycle, potentially contributing to migraine – such as the functioning of the blood vessels or brain excitability. The researchers also plan to take a closer look at CGRP levels in men of varying age groups.

 

*Raffaelli B et al. Sex hormones and Calcitonin Gene-Related Peptide (CGRP) in women with migraine: a cross-sectional, matched cohort study. Neurology 2023 Feb 22. doi: 10.1212/WNL.0000000000207114

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JOURNAL

Neurology

DOI

10.1212/WNL.0000000000207114 

ARTICLE TITLE

Sex hormones and Calcitonin Gene-Related Peptide (CGRP) in women with migraine: a cross-sectional, matched cohort study

Genetic links between migraine and blood sugar levels confirmed

Genomes of thousands of migraine patients revealed culprit genes.

Peer-Reviewed Publication

QUEENSLAND UNIVERSITY OF TECHNOLOGY

• Headache, migraine and blood sugar imbalance have long been reported to co-occur in sufferers

• Migraine and headache share some links to blood sugar regulation, while migraine has several genes with risk factors

• Findings open the door to new prevention and therapeutics

In a study published in Human Genetics, QUT Professor Dale Nyholt and QUT PhD researcher Rafiqul Islam, describe using large-scale genome-wide associations studies (GWAS) summary statistics to analyse hundreds of thousands of human genomes from headache and migraine sufferers and non-sufferers.

Professor Nyholt, from the QUT Centre for Genomics and Personalised Health, said the co-occurrence of migraine and glycaemic (blood sugar levels) traits had been reported in observational epidemiological studies but it was unknown how they were genetically linked.

“About 15 per cent of the global population is affected by migraine and as far back as 1935 migraine was described as a ‘glycaemic headache’,” Professor Nyholt said.

“Glycaemic traits such as insulin resistance, hyperinsulinemia (too much insulin), hypoglycaemia (low blood sugar level) and type 2 diabetes are associated with migraine and headache.

“By identifying genetic correlations and shared loci and genes in our analyses we have inferred causal association and thus confirmed and improved understanding of the relationship between migraine, headache and glycaemic traits.”

Mr Islam said the researchers performed cross-trait analyses to estimate genetic correlation, identify shared genomic regions, loci, genes, and pathways, and then tested for causal relationships.

“Out of the nine glycaemic traits we looked at, we found a significant genetic correlation for fasting insulin (blood insulin level) and glycated haemoglobin with both migraine and headache, while two-hour glucose was genetically correlated only with migraine,” he said.

“We also found regions harbouring genetic risk factors shared between migraine and fasting insulin, fasting glucose, and glycated haemoglobin, and for headache, shared regions with glucose, fasting insulin, glycated haemoglobin, and fasting proinsulin.

“Further analyses produced evidence for a causal relationship between migraine and headache with multiple glycaemic traits.

“Our findings provide avenues to develop novel treatment strategies for managing glycaemic traits in migraine and headache patients, particularly increasing fasting proinsulin level to protect against headache.”

The study, Genetic overlap analysis identifies shared loci and genes between migraine and headache with glycaemic traits, was published in Human Genetics.

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JOURNAL

Human Genetics

DOI

10.1007/s00439-023-02532-6 

METHOD OF RESEARCH

Meta-analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Cross-trait analyses identify shared genetics between migraine, headache, and glycemic traits, and a causal relationship with fasting proinsulin