May 2016 – AQuAS Blog

«Miss» Stevens and the Y chromosome

26 May

Nettie Maria Stevens (1861-1912) belongs to “the other half of science”: the half that is made up of women who have often been forgotten by history. The glowing obituary which appeared in the Science journal refers to her as Miss Stevens, even though she held a Ph.D. and the centre where she worked (Bryn Mawr College) had offered her a research professorship. Stevens was a researcher in several fields of biology, but her most prominent work was performed in the determination of the chromosomal basis of sex.

After completing her teaching studies at Westfield Normal School (now Westfield State University) in Massachusetts, Stevens worked as a teacher and librarian. However, one of her professors, a disciple of the great naturalist Louis Agassiz, awakened her interest in biology. In 1896, when Stevens was 35, she began studying at Stanford University (California), a modern institution that admitted women and allowed students to choose their own courses. In addition, enrolment was much cheaper than in the universities of New England, where she lived. She graduated in 1899 and published her first article, based on research from her Ph.D., which described two new species of protozoa and changes in the chromosomes during cell division.

In 1900, Stevens moved to Bryn Mawr College, Pennsylvania, which was renowned for its research into cytology. Thomas H. Morgan, a prominent researcher in genetics, evolution and embryology (Nobel Prize in Physiology or Medicine, 1933) directed her doctoral thesis. While preparing her thesis, Stevens received grants for stays in Germany (University of Würzburg) and Italy (Anton Dohrn Naples Zoological Station). Upon completing her Ph.D., she remained at Bryn Mawr College to lecture and continue her research.

The hypothesis that sex could be determined by one chromosome that was different from all the others – then called the “accessory chromosome” – had already been suggested in 1902 by Clarence E. McClung (1870-1946), but it was Nettie Stevens who proved it with her experiments. The first article on the accessory chromosome, published in 1905, was a careful cytological study with 241 drawings made by Stevens herself of what she observed through the microscope. The article proved clearly that all eggs tested from the mealworm beetle Tenebrio molitor, had 10 chromosomes of equal size, while the spermatozoa could contain a set just like that of the eggs, in other words, 10 chromosomes of the same size – or 9 chromosomes of equal size and one smaller chromosome (see figure 186 and 187). In the first case (all the spermatozoa of equal size) always produce females, while in the other (with one smaller) produced males. In addition, somatic (non-reproductive) cells from males always possessed the smaller chromosome.

Some of Stevens’ illustrations

Stevens - figura 1

At the same time Stevens was performing this work, Edmund B. Wilson (1856-1939), who was working independently, described a similar dimorphism in insect spermatozoa. There was no rivalry between both scientists nor did either scientist claim priority of their discoveries. However, many texts attribute the discovery solely to Wilson, despite the fact that he himself stated in the article in Science outlining his observations: “… one of the chromosomes in the male is much smaller than the corresponding one in the female (which is in agreement with the observations of Stevens on the beetle Tenebrio)”.

Unfortunately, Nettie Maria Stevens’ career as a scientist was short-lived. She died in 1912 at the age of 51 from breast cancer.

Bibliography

Studies in spermatogenesis with special reference to the “accessory chromosome.” Article by Nettie M. Stevens, 1905, which describes the study that confirmed that sex was determined by a chromosome which, was different in males. Available from the Project Gutenberg.

Nettie Maria Stevens (1861-1912): Her life and contributions to cytogenetics.
Marilyn Bailey Ogilvie & Clifford J. Choquette.
Proceedings of the American Philosophical Society, 1981, 125:292-311

Post writen by Mercè Piqueras (@lectoracorrent), biologist, science writer, science editor, and translator.

Low-value clinical practices: the physicians give their opinion!

19 May

We continue with the theme of overdiagnosis and overtreatment which we have already dealt with in this post and this other post, but this time from another perspective: that of the health professional.

In 2015, AQuAS in collaboration with the ICS introduced a pilot program to avoid low-value practices in primary care. In order to explore and categorize the insight and opinions of General Practitioners and paediatricians about these practices, a survey was carried out among primary care professionals. The survey, which was submitted to 735 professionals from the Barcelona North Metropolitan Area Primary Care Directorate online and answered anonymously, with a response rate of 34%.

Figure 1. Survey screen capture Essencial - Cuestionario

Below are some of the results from this survey.

What is the current situation of low-value clinical practices?

69% of primary care physicians believe that the low-value practices within the sector are very frequent, 9% believe they are very common and 60% say they are common. In their clinical practices, approximately 80% of physicians are faced with having to take a decision about whether to request a test or prescribing unnecessary treatment at least once a week.

Question: In your opinion, assigning unnecessary tests, procedures and treatment in primary care in our environment is: Essencial - Survey - Frequent

Question: In your practise, how often are you faced with a decision about whether to request a test or prescribe an unnecessary procedure:

Essencial - Survey - Day
What are the underlying causes?

According to doctors, the main causes behind low-value practices are a shortage of time in the examination room (74%), need for more information (doubts or uncertainty on the part of the professional) (63%) and the demand from the patient to prescribe a particular test or treatment (37%).

Question: There are several reasons why physicians request unnecessary tests and treatments. In your clinical practise, which of the following reasons do you believe influence your decision?

Essencial - Survey - Causes

Is this a talking point in the examination room?

Doctors discuss the potential risks of tests or treatment with their patients in the examination room frequently (52%), but do not often discuss the cost involved (21%).

Is there a solution?

Doctors believe that those in the best position to address excessive low-value clinical practice are clinicians themselves (88%), those responsible for elaborating clinical practice guidelines (57%), the Department of Health, in terms of health policy (39%) and representatives from academic/scientific circles (33%).

Moreover, physicians consider that the most effective initiatives to reduce these practices are: availing of more time for consultation to discuss alternatives with patients (87%), ensuring the support from the centre in the event of a patient filing a complaining or report for not having had certain tests performed (65%), integrating and sharing patient information between different levels of care (64%), and carrying out advertising campaigns to raise public awareness (62%).

Question: In your opinion, how effective might the following initiatives be in reducing the number of unnecessary tests, procedures and treatments?

Essencial - Survey - Effective

In Catalonia, this is the first time a survey has been carried out to assess physician’s knowledge and opinions regarding low-value practices. It is significant that these practices are common in the field of primary care. In another context, a survey in the United States carried out by the Choosing Wisely initiative showed that doctors also consider these practices to be common and have to face these choices at least once a week. Among the reasons cited for the occurrence of such low-value practices were concerns about malpractice claims, professional security (diagnostic confirmation) and patient requests.

According to the results of our survey, physicians are those best equipped to address the issue, while healthcare organization also plays a crucial role. It might be that the characteristics of the health system itself and health professionals are not aware of the cost involved in these tests, procedures and treatments.

Based on this survey and armed with the experience of the Essencial Project, we believe that a multifaceted strategy is required, which includes organizational aspects from a standpoint of both professionals and patients, to reduce the occurrence of low-value practices.

Post written by Johanna Caro Mendivelso (@jmcaro103).

Digital journalism and health data: data visualisation tools

12 May

This coming 7th June will take place the second edition of the course titled II Workshop on data Visualisation for healthcare technicians and scientific journalism in an effort to jointly work with tools which make health data more visible and user-friendly. You can register for the course, but beforehand, we would like to present a short report of the topics covered in last year’s edition.

The course was divided into two very different parts: firstly, Eva Domínguez chaired a general discussion about digital journalism media and secondly, Paula Guisado focused on procedures, tools and applications within the area of health data.

When we refer to digital journalism, we are referring to some of the emerging traits for instance new narrative styles, such as immersion, audiovisual development, adapting the varying content to the most suitable format and hybridisation.

Beyond these characteristics we might be led to believe that becoming viral is a very common concept associated with everything digital but the questions remain: Does everybody want, and does everybody have the capacity to generate viral content?

Regardless of the objective, well-known successful factors can be analysed and utilised when deemed adequate by adapting them to the desired objective and context. Certain recommendations in this area reference classic ideas such as emotio (being capable of generating an emotion amongst your audience), universality (a “universally” identifiable concept might be successful) and brevity (eliminating superfluous elements for transmitting the key message).

In practise, how can all this be achieved?

We can approach the idea of universality for example by trying to explain short stories which become big. With regard to generating emotion, the basic idea is to awaken empathy in the reader. From this point onwards, total freedom and creativity and a proposal for working: we must question every technique in an aim to surprise the audience and we must do all this without losing sight of the fact that “Content is King“. Not everything has to be interactive, but we do have to think carefully about what we want to explain and how we wish to go about it.

More ideas. Interactive tools which enable us to identify ourselves work extremely well, whether this is a quantitative or qualitative identification.

Another compelling element is to involve the audience in the story. How can we achieve this goal? The following strategies can be used:

• Transmedia / Multiplatform. Confusion might arise as to whether the end product is a report, a data base, a creative project, a project designed to raise awareness, activism or serialisation. The Spanish serie El Ministerio del Tiempo, for example, has taken a lot out of this.

• Serialisation. Fragmenting information into “chapters” o “instalments”. This can be addictive when performed well. Example: Serial Podcast has managed to create a community of fans explaining a journalistic investigation by weekly deliveries.

• Creating an experience. By way of navigation it is possible to establish a connection with the user in such a way that navigation becomes a factor for immersion. Example: ViceNews about Ebola (Wired).

• Immersion through navigation (or immersion in the area). Interactive tools where the user places themselves inside the story. It is the case of this application of virtual reality that simulates that you are in the Roman Tarraco.

• Let the user participate and find elements that must be discovered. Play, the operative word here, with the fun element of the game … or with the fear element as in Take this lollipop.

• Constructing a story within the story. Example: documentary film Mujeres en venta.

• Immersion narratives in the first person. The aim is to give visibility to large documentaries. Format of the “docu-game”. Example: The refugee project.

• “Make it personal”. A close personal approach tends to work well. Example: Do not track regarding data privacy.

The second part of the course, which revolved around the applications to health data, got underway with a fascinating reflection: journalism with data is not data journalism (The Guardian 2011).

Massive analysis by computational means is the defining characteristic of data journalism. From this point onwards we can see specific patterns and tools:

• Datamining. Tools such as scrapping: tabula, import.io, kimono labs

• Data visualisation tools: adobe edge, hype tumult, cartoDB, datawrapper, infogram, odyssey.js, juxtapose.js

• Data cleanup and transformation: Excel, Open Refine

• Other tools: Tableau, Tableau public, Quadrigam (in the beta phase at the time of the course)

• Final recommendations (unusual ones): Remove to improve, Spurius correlations

We look forward to seeing you for the second edition of the course, which like the first, aims to act as an incentive for innovation and professional development based on the sharing of knowledge and a range of tools between professionals whose objective is to collect the public’s health data, in the best way possible.

You can also see the course information in the web of the Catalan Association on Scientific Comunication, about the 2015 edition and the 2016 edition.

Post written by Marta Millaret (@martamillaret) and Cristina Ribas (@cristinaribas), president of the Catalan Association of Scientific Communication (ACCC).

(Photo credit: dcJohn via Foter.com / CC BY)

Aline Noizet: “Digital tools transform the patient into the CEO of his own health”

5 May

From 10 to 12 May, Barcelona becomes the European capital of digital health innovation, thanks to the Health 2.0 Europe congress. The seventh edition of this event for experts from the healthcare sector gathers more than 120 speakers and around 600 professionals from around the world.

The Agency for Health Quality and Assessment of Catalonia (AQuAS) and the Observatory of Innovation in Healthcare Management (OIGS) will be present in the free panel Digital health tools transforming the nurses’ daily mission, where we can see live demonstrations of technological solutions, developed by and for nurses.

The coordinator of the convention and consultant in digital health Aline Noizet (@anoizet) gives more details in this interview and explains how the European healthcare system is being redefined through these digital tools.

What do we understand by digital health of health 2.0?

The group of all new technologies focused on the patient that can be interconnected and that provide data that facilitate decision-making is known as digital health or health 2.0. They are tools developed for start-ups that encompass items from applications for mobile phones and wearable devides to virtual platforms. They always appear in response to a very specific need and contribute to improving the work of medical professionals and the experience of users.

If experts claim these new technological solutions are redefining the healthcare ecosystem, in what does this transformation consist?

The current ecosystem is vaster and encompasses more agents, directly or indirectly involved in the healthcare management, such as the small technological companies, pharmaceutical industry and insurance companies. The main novelty, however, lies in the fact that it puts the patient in the centre of the healthcare system.

In this system, where everything turns around the patient, how can digital tools improve his experience?

The new solutions facilitate communication between patients and healthcare professionals. Currently, there are platforms and virtual spaces where you can find quality information and clear doubts, almost in real-time. Thanks to the new technologies, the patient can be more involved when it comes to making decisions and can use telematics to explain how he feels and how his treatment progresses. The digital tools grant him more autonomy and convert him into the CEO of his own health.

And the healthcare professionals, how do they benefit from the use of this technology?

There are many benefits to the use of digital tools. They help the medical team to make faster and more accurate diagnoses, and offer a wider view on the users’ health state. Furthermore, they allow cost reduction through patient monitoring at home and they could improve the quality of care with the use of augmented reality glasses. Moreover, new technologies facilitate communication between health professionals from anywhere in the world, who can share information or get a second opinion immediately.

In the panel, with the participation of the Observatory of Innovation and moderated by the Portuguese nurse Tiago Vieira, member of the Advisory Council of the European Forum for Primary Care (EFPC), demos of the most innovating digital health tools will be presented. Whom is this session addressed to?

The session will be most inspiring for nurses, since they are in direct contact with both doctors and patients, and they know from firsthand the needs of both groups. The new technologies are transforming their role and can offer them many advantages with respect to patient care. Entrepreneurs will show them the operation of their solutions and professionals from different European countries will explain the benefits of implementing digitalization in their Center. The session may also be of interest to doctors, patients, entrepreneurs, investors, pharmaceutical laboratories and insurance companies. Start-ups can find inspiration and ideas for new solutions for medical personnel, while investors will have the opportunity to learn about the most innovative projects in digital health. If you’re a healthcare professional, you will discover how these tools can improve your performance in your daily tasks, and if you’re a patient or normal citizen, you can participate by giving your opinion as a user or future user of these new applications.

In order to participate in this free session about health digital tools, you only need to register. We would be delighted if you could join us!

Interview prepared by Neus Solé Peñalver (@neussolep).