Expectations are growing stronger for health care to be person-centered, and therefore emanate from a partnership between staff, patients and relatives. But at the same times, the process of introducing and maintaining this way of working is slow and laborious in many places.

We already know that person-centred care can shorten hospital stay and reduce uncertainty in health care. Now, instead, we need to concentrate on how to achieve it, the researchers behind the broad BMJ article argue.

The study offers advice and tools for further research on, and development of, person-centred care. The corresponding author is Axel Wolf, Associate Professor of Health Care Sciences at the Institute of Health and Care Sciences at the Sahlgrenska Academy, University of Gothenburg. Axel Wolf is also affiliated to the University of Gothenburg Centre for Person-centred Care (GPCC).

“One of the key pieces of advice is that person-centred care must be practiced systematically on an everyday basis. This entails creating the organisational and individual conditions for developing a partnership between the patient, the patient’s relatives if applicable, and the staff at every meeting — not just when it fits into the schedule,” Wolf says.

“To achieve the best clinical effect, it is important for person-centred care not to be just a matter between the patient and the individual professional representative. It has to permeate the whole organisation. There is also a big challenge involved in increasing the understanding of how person-centred care differs from current care practice.”

It is fundamental for health care professionals to take the time to listen to what patients have experienced and wants to achieve in relation to their health. They must let the patient’s goals, such as returning to work or being able to take a walk, guide the wording of a jointly agreed health plan. The patient’s priorities and resources must be reflected in the health-plan, which must also be subject to continuous evaluation. The documentation must then accompany and be accessible to the patient, and this includes any move from hospital to primary care or municipal social care.

Since it set out ten years ago GPCC, a national research centre, has led the way in developing, testing, evaluating and implementing person-centred care in many different health care contexts, in Sweden and abroad.

Together with his colleague Professor Nicky Britten of the University of Exeter in England, Axel Wolf has lead an international research group investigating the enablers and the obstacles experienced by researchers, clinicians, and patients during clinical studies within the GPCC framework, and in everyday implementation of research results.

Among the obstacles described in the current study are hierarchical care structures, rigid occupational roles, and the conviction that one is already working in a person-centred way.

“With the current shift in Swedish health care to “good quality local health care,” which is permeated by person-centred principles, the ethical approach focusing on the person and not only the diagnosis must be practiced constantly to optimize conditions. This requires systematic education and training, lifelong learning, and tools that facilitate the partnership,” Axel Wolf concludes.

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Materials provided by University of Gothenburg. Note: Content may be edited for style and length.

Scientists at the U.S. Department of Energy’s (DOE) Argonne National Laboratory led a team to investigate reactions in PEMFCs, and their discoveries informed the creation of technology that could bring fuel cells one step closer to realizing their full market potential.

PEMFCs rely on hydrogen as a fuel, which is oxidized on the cell’s anode side through a hydrogen oxidation reaction, while oxygen from the air is used for an oxygen reduction reaction (ORR) at the cathode. Through these processes, fuel cells produce electricity to power electric motors in vehicles and other applications, emitting water as the only by-product.

Platinum-based, nano-sized particles are the most effective materials for promoting reactions in fuel cells, including the ORR in the cathode. However, in addition to their high cost, platinum nanoparticles suffer from gradual degradation, especially in the cathode, which limits catalytic performance and reduces the lifetime of the fuel cell.

The research team, which included DOE’s Oak Ridge National Laboratory and several university partners, used a novel approach to examine dissolution processes of platinum at the atomic and molecular level. The investigation enabled them to identify the degradation mechanism during the cathodic ORR, and the insights guided the design of a nanocatalyst that uses gold to eliminate platinum dissolution.

“The dissolution of platinum occurs at the atomic and molecular scale during exposure to the highly corrosive environment in fuel cells,” said Vojislav Stamenkovic, a senior scientist and group leader for the Energy Conversion and Storage group in Argonne’s Materials Science Division (MSD). “This material degradation affects the fuel cell’s long-term operations, presenting an obstacle for fuel cell implementation in transportation, specifically in heavy duty applications such as long-haul trucks.”

Starting small

The scientists used a range of customized characterization tools to investigate the dissolution of well-defined platinum structures in single-crystal surfaces, thin films and nanoparticles.

“We have developed capabilities to observe processes at the atomic scale to understand the mechanisms responsible for dissolution and to identify the conditions under which it occurs,” said Pietro Papa Lopes, a scientist in Argonne’s MSD and first author on the study. “Then we implemented this knowledge into material design to mitigate dissolution and increase durability.”

The team studied the nature of dissolution at the fundamental level using surface-specific tools, electrochemical methods, inductively coupled plasma mass spectrometry, computational modeling and atomic force, scanning tunneling and high-resolution transmission microscopies.

In addition, the scientists relied on a high-precision synthesis approach to create structures with well-defined physical and chemical properties, ensuring that the relationships between structure and stability discovered from studying 2D surfaces were carried over to the 3D nanoparticles they produced.

“We performed these studies — from single crystals, to thin films, to nanoparticles — which showed us how to synthesize platinum catalysts to increase durability,” said Lopes, “and by looking at these different materials, we also identified strategies for using gold to protect the platinum.”

Going for gold

As the scientists uncovered the fundamental nature of dissolution by observing its occurrence in several testbed scenarios, the team used the knowledge to mitigate dissolution with the addition of gold.

The researchers used transmission electron microscopy capabilities at Argonne’s Center for Nanoscale Materials and at the Center for Nanophase Materials Sciences at Oak Ridge National Laboratory — both DOE Office of Science User Facilities — to image platinum nanoparticles after synthesis and before and after operation. This technique allowed the scientists to compare the stability of the nanoparticles with and without incorporated gold.

The team found that controlled placement of gold in the core promotes the arrangement of platinum in an optimal surface structure that grants high stability. In addition, gold was selectively deposited on the surface to protect specific sites that the team identified as particularly vulnerable for dissolution. This strategy eliminates dissolution of platinum from even the smallest nanoparticles used in this study by keeping platinum atoms attached to the sites where they can still effectively catalyze the ORR.

Atomic-level understanding

Understanding the mechanisms behind dissolution at the atomic level is essential to uncovering the correlation between platinum loss, surface structure and size and ratio of platinum nanoparticles, and determining how these relationships affect long-term operation.

“The novel part of this research is resolving the mechanisms and fully mitigating platinum dissolution by material design at different scales, from single crystals and thin films to nanoparticles,” said Stamenkovic. “It’s the insights we gained in conjunction with the design and synthesis of a nanomaterial that addresses durability issues in fuel cells, as well as the ability to delineate and quantify dissolution of platinum catalyst from other processes that contribute to fuel cell performance decay.”

The team is also developing a predictive aging algorithm to assess the long-term durability of the platinum-based nanoparticles and found a 30-fold improvement in durability compared to nanoparticles without gold.

The findings are reported today, Sept. 9, in Science

In the experiments, the lead antiviral candidate, named LCB1, rivaled the best-known SARS-CoV-2 neutralizing antibodies in its protective actions. LCB1 is currently being evaluated in rodents.

Coronaviruses are studded with so-called Spike proteins. These latch onto human cells to enable the virus to break in and infect them. The development of drugs that interfere with this entry mechanism could lead to treatment of or even prevention of infection.

Institute for Protein Design researchers at the University of Washington School of Medicine used computers to originate new proteins that bind tightly to SARS-CoV-2 Spike protein and obstruct it from infecting cells.

Beginning in January, more than two million candidate Spike-binding proteins were designed on the computer. Over 118,000 were then produced and tested in the lab.

“Although extensive clinical testing is still needed, we believe the best of these computer-generated antivirals are quite promising,” said lead author Longxing Cao, a postdoctoral scholar at the Institute for Protein Design.

“They appear to block SARS-CoV-2 infection at least as well as monoclonal antibodies, but are much easier to produce and far more stable, potentially eliminating the need for refrigeration,” he added.

The researchers created antiviral proteins through two approaches. First, a segment of the ACE2 receptor, which SARS-CoV-2 naturally binds to on the surface of human cells, was incorporated into a series of small protein scaffolds.

Second, completely synthetic proteins were designed from scratch. The latter method produced the most potent antivirals, including LCB1, which is roughly six times more potent on a per mass basis than the most effective monoclonal antibodies reported thus far.

Scientists from the University of Washington School of Medicine in Seattle and Washington University School of Medicine in St. Louis collaborated on this work.

“Our success in designing high-affinity antiviral proteins from scratch is further proof that computational protein design can be used to create promising drug candidates,” said senior author and Howard Hughes Medical Institute Investigator David Baker, professor of biochemistry at the UW School of Medicine and head of the Institute for Protein Design. In 2019, Baker gave a TED talk on how protein design might be used to stop viruses.

To confirm that the new antiviral proteins attached to the coronavirus Spike protein as intended, the team collected snapshots of the two molecules interacting by using cryo-electron microscopy. These experiments were performed by researchers in the laboratories of David Veesler, assistant professor of biochemistry at the UW School of Medicine, and Michael S. Diamond, the Herbert S. Gasser Professor in the Division of Infectious Diseases at Washington University School of Medicine in St. Louis.

“The hyperstable minibinders provide promising starting points for new SARS-CoV-2 therapeutics,” the antiviral research team wrote in their study pre-print, “and illustrate the power of computational protein design for rapidly generating potential therapeutic candidates against pandemic threats.”

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Materials provided by University of Washington Health Sciences/UW Medicine. Original written by Ian Haydon, Institute for Protein Design. Note: Content may be edited for style and length.

“A lot of imaging techniques make images look a little bit better, a little bit less noisy, but this is really something where we make the invisible visible,” said Gordon Wetzstein, assistant professor of electrical engineering at Stanford and senior author of the paper. “This is really pushing the frontier of what may be possible with any kind of sensing system. It’s like superhuman vision.”

This technique complements other vision systems that can see through barriers on the microscopic scale — for applications in medicine — because it’s more focused on large-scale situations, such as navigating self-driving cars in fog or heavy rain and satellite imaging of the surface of Earth and other planets through hazy atmosphere.

Supersight from scattered light

In order to see through environments that scatter light every-which-way, the system pairs a laser with a super-sensitive photon detector that records every bit of laser light that hits it. As the laser scans an obstruction like a wall of foam, an occasional photon will manage to pass through the foam, hit the objects hidden behind it and pass back through the foam to reach the detector. The algorithm-supported software then uses those few photons — and information about where and when they hit the detector — to reconstruct the hidden objects in 3D.

This is not the first system with the ability to reveal hidden objects through scattering environments, but it circumvents limitations associated with other techniques. For example, some require knowledge about how far away the object of interest is. It is also common that these systems only use information from ballistic photons, which are photons that travel to and from the hidden object through the scattering field but without actually scattering along the way.

“We were interested in being able to image through scattering media without these assumptions and to collect all the photons that have been scattered to reconstruct the image,” said David Lindell, a graduate student in electrical engineering and lead author of the paper. “This makes our system especially useful for large-scale applications, where there would be very few ballistic photons.”

In order to make their algorithm amenable to the complexities of scattering, the researchers had to closely co-design their hardware and software, although the hardware components they used are only slightly more advanced than what is currently found in autonomous cars. Depending on the brightness of the hidden objects, scanning in their tests took anywhere from one minute to one hour, but the algorithm reconstructed the obscured scene in real-time and could be run on a laptop.

“You couldn’t see through the foam with your own eyes, and even just looking at the photon measurements from the detector, you really don’t see anything,” said Lindell. “But, with just a handful of photons, the reconstruction algorithm can expose these objects — and you can see not only what they look like, but where they are in 3D space.”

Space and fog

Someday, a descendant of this system could be sent through space to other planets and moons to help see through icy clouds to deeper layers and surfaces. In the nearer term, the researchers would like to experiment with different scattering environments to simulate other circumstances where this technology could be useful.

“We’re excited to push this further with other types of scattering geometries,” said Lindell. “So, not just objects hidden behind a thick slab of material but objects that are embedded in densely scattering material, which would be like seeing an object that’s surrounded by fog.”

Lindell and Wetzstein are also enthusiastic about how this work represents a deeply interdisciplinary intersection of science and engineering.

“These sensing systems are devices with lasers, detectors and advanced algorithms, which puts them in an interdisciplinary research area between hardware and physics and applied math,” said Wetzstein. “All of those are critical, core fields in this work and that’s what’s the most exciting for me.”

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Materials provided by Stanford University. Original written by Taylor Kubota. Note: Content may be edited for style and length.