Research road map for Brain-Computer Interfaces

Research and science fiction has been fascinated by brain-machine or braincomputer interfaces – BCI for short – since the early 1970s. Quite apart from cyborgs and the game industry, the most important application potentials lie in thoughtcontrolled communication and movement support of physically disabled persons. Today BCIs stand on the threshold between laboratory prototypes and user-friendly real applications. Under the auspices of Graz University of Technology, a BCI road map has been developed for BCI research in the coming ten years for the Horizon 2020 EU funding programme. The road map gives a global perspective on BCI research, demonstrates potentials and challenges, and articulates the present gaps between current and future applications.

Market potential between man and machine
As Gernot Müller-Putz from the Institute of Knowledge Discovery at Graz University of Technology, an internationally recognised BCI expert who coordinated the development of the research road map, explains: “In specific terms the BCI road map serves as an orientation guide for research-funding authorities but also presents the research world with a qualified view about the state of affairs and BCI trends.” BCIs have not only come a long way in research, they meanwhile have an enormous market potential – and not only in the field of medicine. “We have identified some 150 companies worldwide concerned with BCI, from technology firms and the marketing sector to the aviation industry. Commercial applications in the entertainment industry are moving increasingly into the spotlight. Without them, BCIs would become unaffordable in the foreseeable future. Our Horizon 2020 road map sketches a path to the actual, affordable and user-friendly application of BCIs,” says Müller-Putz.

BCI now and in the future
The international team behind the BCI road map illustrated its findings with fictive case studies. BCIs of the future can replace, restore, improve and extend bodily functions. “This begins with the ability to communicate, takes place by means of the stimulation of muscles and nerves and extends to enhanced attention capacity,” summarises Müller-Putz. In the year 2025, there will be a broad range of brain-controlled applications which, according to the BCI road map, will be standard in medical treatment and therapy and also in monitoring personal health. Apart from brain signals, there will also be other bio-signals, like heartbeat or the electrical conductivity of the skin, which will play a role in the seamless and intuitive connection between man and machine.

Current focus on neuroprosthetic grippers at Graz
Gernot Müller-Putz, with his team at Graz University of Technology, is currently coordinating a three-year EU research project called “MoreGrasp” with the aim of developing an extremely adaptable neuroprosthetic gripper. If you can no longer grip an object, for example in paraplegia, many everyday tasks from cooking to cleaning your teeth are impossible. Suddenly you are continually reliant on help. Personalised neuroprosthetic grippers can be an enormous help and can give you back sizeable quality of life. The development is based on the fact that brainwave patterns change when you think of certain movements. The brain-computer interface measures these patterns and the neuroprosthetic device stimulates particular muscles in the arms and hands in a targeted way until they move.

Roadmap BNCI Horizon 2020
http://bnci-horizon-2020.eu/images/bncih2020/Roadmap_BNCI_Horizon_2020.pdf


WHO issues best practices for naming new human infectious diseases

The World Health Organization (WHO) has called on scientists, national authorities and the media to follow best practices in naming new human infectious diseases to minimize unnecessary negative effects on nations, economies and people.

“In recent years, several new human infectious diseases have emerged. The use of names such as ‘swine flu’ and ‘Middle East Respiratory Syndrome’ has had unintended negative impacts by stigmatizing certain communities or economic sectors,” says Dr Keiji Fukuda, Assistant Director-General for Health Security, WHO. “This may seem like a trivial issue to some, but disease names really do matter to the people who are directly affected. We’ve seen certain disease names provoke a backlash against members of particular religious or ethnic communities, create unjustified barriers to travel, commerce and trade, and trigger needless slaughtering of food animals. This can have serious consequences for peoples’ lives and livelihoods.”

Diseases are often given common names by people outside of the scientific community. Once disease names are established in common usage through the Internet and social media, they are difficult to change, even if an inappropriate name is being used. Therefore, it is important that whoever first reports on a newly identified human disease uses an appropriate name that is scientifically sound and socially acceptable.

The best practices apply to new infections, syndromes, and diseases that have never been recognized or reported before in humans, that have potential public health impact, and for which there is no disease name in common usage. They do not apply to disease names that are already established. The best practices state that a disease name should consist of generic descriptive terms, based on the symptoms that the disease causes (e.g. respiratory disease, neurologic syndrome, watery diarrhoea) and more specific descriptive terms when robust information is available on how the disease manifests, who it affects, its severity or seasonality (e.g. progressive, juvenile, severe, winter). If the pathogen that causes the disease is known, it should be part of the disease name (e.g. coronavirus, influenza virus, salmonella).

Terms that should be avoided in disease names include geographic locations (e.g. Middle East Respiratory Syndrome, Spanish Flu, Rift Valley fever), people’s names (e.g. Creutzfeldt-Jakob disease, Chagas disease), species of animal or food (e.g. swine flu, bird flu, monkey pox), cultural, population, industry or occupational references (e.g. legionnaires), and terms that incite undue fear (e.g. unknown, fatal, epidemic).

The final name of any new human disease is assigned by the International Classification of Diseases (ICD), which is managed by WHO. ICD is used by doctors, nurses, researchers, health information managers and coders, policymakers, insurers and patient organizations around the world to classify diseases and other health problems and record them in a standardized way on health records and death certificates. This enables the storage and retrieval of diagnostic information for clinical, epidemiological and quality purposes. These records are also used by WHO Member States to compile national mortality and morbidity statistics. Finally, ICD is used for reimbursement and resource allocation decision-making by countries.

International Classification of Diseases
www.who.int/classifications/icd


Essential Medicines List updated

The World Health Organization (WHO) has published the new edition of its Model List of Essential Medicines, which includes ground-breaking new treatments for hepatitis C, a variety of cancers (including breast cancer and leukaemia) and multidrug resistant tuberculosis (TB), among others. The move opens the way to improve access to innovative medicines that show clear clinical benefits and could have enormous public health impact globally.

“When new effective medicines emerge to safely treat serious and widespread diseases, it is vital to ensure that everyone who needs them can obtain them,” said WHO Director General, Dr Margaret Chan. “Placing them on the WHO Essential Medicines List is a first step in that direction.”

Increasingly, governments and institutions around the world are using the WHO list to guide the development of their own essential medicines lists, because they know that every medicine listed has been vetted for efficacy, safety and quality, and that there has been a comparative cost-effectiveness evaluation with other alternatives in the same class of medicines.

The list is updated every two years by an Expert Committee, made up of recognized specialists from academia, research and the medical and pharmaceutical professions. This year, the Committee underscored the urgent need to take action to promote equitable access and use of several new highly effective medicines, some of which are currently too costly even for high-income countries.

These included new medicines to treat Hepatitis C, which affects about 150 million people globally, killing approximately half a million people each year, when chronic infection develops into liver cirrhosis or liver cancer.

Until recently, treatment for the disease presented minimal therapeutic benefits and serious side effects. Five new medicines – direct acting oral antivirals – have recently come on the market transforming chronic hepatitis C from a barely manageable to a curable condition, the new medicines have few side effects and high tolerance in patients. All five products, including sofosbuvir and daclatasvir, were included in the List. But high prices currently make them unaffordable and thus inaccessible to most people who need them.

“While some efforts have been made to reduce their price for low-income countries, without uniform strategies to make these medicines more affordable globally the potential for public health gains will be reduced considerably,” said Dr Marie-Paule Kieny, WHO Assistant Director General for Health Systems and Innovation.

Cancers figure among the leading causes of illness and death worldwide, with approximately 14 million new cases and 8.2 million cancer-related deaths in 2012. The number of new cases is expected to rise by about 70% over the next two decades. New breakthroughs have been made in cancer treatment in the last years, which prompted WHO to revise the full cancer segment of the Essential Medicines List this year: 52 products were reviewed and 30 treatments confirmed, with 16 new medicines included in the List.

“Some of these medicines produce relevant survival benefits for cancers with high incidence, such as trastuzumab for breast cancer,” explained Dr Kees De Joncheere, WHO Director of Essential Medicines. “Other treatment regimens for rare cancers such as leukemia and lymphoma, which can cure up to 90% of patients, were added to set a global standard.”

TB remains one of the world’s most deadly infectious diseases. In 2013, 9 million people fell ill with TB and 1.5 million died from the disease. Over 95% of TB deaths occur in low- and middle-income countries. After about 45 years of scarce innovation for TB medicines, 5 new products were included in the EML. Four of these, including bedaquiline and delamanid, target multi-drug-resistant TB.

The Committee also recommended supporting off-label uses in cases where there is clear evidence of major health benefits, though no licensed indication, such as for many medicines for children.

“It is important to understand that the Essential Medicines List is the starting block and not the finishing line,” concluded Dr Kieny. “Its purpose is to provide guidance for the prioritization of medicines from a clinical and public health perspective. The hard work begins with efforts to ensure that those medicines are actually available to patients.”

Essential Medicines List
www.who.int/medicines/publications/essentialmedicines/EML2015_8-May-15.pdf
Essential Medicines List Children
www.who.int/medicines/publications/essentialmedicines/EMLc2015_8-May-15.pdf


Device created for faster skin biopsies without anaesthesia

Universidad Carlos III de Madrid (UC3M) and the Institute for Health Research of the Hospital “Ramón y Cajal” (IRYCIS have patented a new device for performing skin biopsies. With this new tool a skin biopsy can be performed with fewer instruments and the length of the procedure is shortened from thirty minutes to less than five. Neither local anaesthesia nor specialized personnel are required. As a result, faster diagnosis of pathologies such as skin cancer is possible.

Currently a skin biopsy involves cutting the base layer of the skin manually, removing it with forceps and sewing up the incision with one or two stitches. Thanks to the new automatic device, a simple click will be enough to obtain a sample, explains Jesús Meneses, one of the inventors from the MAQLAB Research Group at the UC3M Department of Mechanical Engineering.

This invention is an ergonomic tool which is “compact and easy to use”, explains Meneses, and makes it possible to obtain a skin sample using only one single instrument. The new device is able to make the incision and remove the tissue sample automatically, and complies with all of the sanitation standards established by the Institute for Health Research “Ramón y Cajal” (IRYCIS), with whom UC3M has jointly applied for the patent.


Earlier detection of skin cancer

This invention will aid in earlier detection of pathologies such as skin cancer and will also allow doctors to see a greater number of patients, which is of the utmost importance in fields such as dermatology which are overwhelmed by high patient demand, assures Emiliano Grillo, a dermatologist at Ramón y Cajal Hospital and an clinical research associate at the IRYCIS. In his own practice, Grillo identified the potential benefits of such an invention “in a doctor’s office overwhelmed by patient demand, such as a dermatology clinic”. The invention would “make it possible for the patient to leave the doctor’s office with the diagnostic tests already done, and to begin earlier treatment if necessary”.

The prototype of this device is ready to perform demonstrations and is protected by a patent application, indicates Cristina Castejón, a researcher at the MAQLAB Research Group. In addition, Juan Carlos García Prada, the head of the MAQLAB Research Group and professor of the Mechanical Engineering Department at UC3M, indicates that the next step is to seek ways to achieve greater social impact, a mission for which the relationship with the UC3M Science Park and the Innovation Unit at IRYCIS is “fundamental” as “they take care of the patent application process and the future technological transfer. In this case, it was the UC3M Science Park who informed us about the needs of doctors at the IRYCIS so that we could consider collaborating on a joint project, and we are proud of the result,” he concludes.

Currently, manufacturers of medical equipment are being sought to develop the product in accordance with licensing agreements


WHO moves to improve global health data

On 6 May the World Health Organization (WHO) and the Institute of Health Metrics and Evaluation (IHME) signed a Memorandum of Understanding defining areas where they will work together to improve the quality and use of global health estimates to measure the world’s health challenges.

The agreement aims to increase transparency, accessibility and consistency of health estimates to help policymakers make informed decisions about what public health programmes should be prioritized and the research that is needed.

“Accurate health statistics are the foundation of a good health system,” says Dr Marie-Paule Kieny, Assistant Director- General for Health Systems and Innovation at WHO. “When we know what makes people ill and why they die, we know where to put resources.”

Currently, complete health data is rarely available for every population and year. Even when it is available, the data may not be directly comparable year-on-year because they come from different sources such as research projects, household surveys and hospital records, and the findings may vary significantly.

Where gaps in, or no, data exist, statistical models are used to make estimates, often leading to very different results. In this regard, collaboration among WHO, other United Nations agencies and academic institutions such as IHME is essential to improve global health estimates.

By committing to increasing transparency regarding data sources and the methods used to calculate global health estimates, WHO and IHME aim to improve the accuracy and utility of health information to help countries to direct resources where they are most needed.

As part of this collaborative work, WHO and IHME are also working with academics, journal editors, and other partners to develop guidelines for good practice in reporting global health estimates. The guidelines aim to ensure that published health estimates serve the needs of their two primary audiences – policymakers and researchers. They underscore the importance of ensuring that studies of health estimates include information about data sources used, clear explanations of analytical methods, how the new estimates compare to previously published studies, and why they differ.

These guidelines are in the final stage of development and will be published online in the coming months.


Sheikh Zayed Institute for Pediatric Surgical Innovation first in US to rid bone tumours with incisionless surgery

Doctors from the Sheikh Zayed Institute for Pediatric Surgical Innovation at Children’s National Medical Center in Washington, DC, are the first in the United States to treat osteoid osteoma, a benign but painful bone tumour that commonly occurs in children and young adults, using an experimental magnetic resonanceguided high-intensity focused ultrasound (MR-HIFU) method.


Two patients, 16-year-old Alfredo Coreas and 10-year-old Niyati Shah, have been treated successfully in a research study aimed at testing the safety and feasibility of this noninvasive and precise treatment option.

“Our team set out to provide a noninvasive treatment option for children with osteoid osteoma and we’re very pleased with the success of the first two treatments,” said Karun Sharma, MD, PhD, Director of Interventional Radiology at Children’s National and Principal Investigator for the osteoid osteoma trial at the Sheikh Zayed Institute. “Both children we treated were very active prior to the onset of their tumour, one a soccer player and the other a swimmer, but because of the pain from the tumour, they have been unable to enjoy their favourite activities, until now.”

Osteoid osteoma was previously treated with orthopaedic surgery that involved scraping the tumour from the bone or removing the affected part of the bone. The most commonly used treatment today is CT-guided radiofrequency ablation (RFA).

While this is a less invasive method, it still requires drilling through muscle and soft tissue into bone. RFA also exposes the patient and operator to ionizing radiation. High-intensity focused ultrasound therapy uses focused sound wave energy to heat and destroy the targeted tumour under MRI guidance. This precise and controlled method does not require a scalpel or needle, greatly reducing the risk of complications like infections and bone fractures.

It is also a faster treatment option, with expected total procedure time of an hour or less. In the US, MR-HIFU is used to treat uterine fibroids and painful bone metastases from several types of cancer in adults, but it has not been used in children.

This breakthrough is the latest from the Image-Guided Non-Invasive Therapeutic Energy (IGNITE) program, a collaboration of the Sheikh Zayed Institute and the division of Radiology, Oncology, Surgery, and Anesthesiology at Children’s National. The goal of the IGNITE program is to improve the quality of life and outcomes for paediatric patients through the development and clinical introduction of novel minimally invasive and noninvasive surgery technologies and combination therapy approaches. The team is led by Peter Kim, MD, CM, PhD, Vice President of the Sheikh Zayed Institute.

“The use of MR-HIFU ablation of osteoid osteoma is a perfect example of our mission in the Sheikh Zayed Institute to make paediatric surgery more precise, less invasive and pain-free,” said Dr. Kim.

“Our leading team of experts are also exploring the use of MR-HIFU as a noninvasive technique of ablating growth plates and paediatric solid tumours. We also have another clinical trial open for children and young adults with refractory soft tissue tumours, which is being performed in collaboration with Dr Bradford Wood’s team at the National Institutes of Health, and if successful, it would be the first in the world.”


                                  
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