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Biology

Surprising behavior in one of the least studied mammals in the world – EurekAlert

image:

Bairds beaked whale, The Commander Islands

Credit: Olga Filatova, University of Southern Denmark

Some animals live in such remote and inaccessible regions of the globe that it is nearly impossible to study them in their natural habitats. Beaked whales, of which 24 species have been found so far, are among them: They live far from land and in deep oceanic waters, where they search for food at depths of 500 meters and more.

The record holder for the deepest dive by a mammal is a Cuvier's beaked whale, which in 2014 was measured to dive at least 2992 meters. A beaked whale also holds the mammalian record for the longest dive; 222 minutes.

Now, the world gets a new and surprising insight into the world of distant beaked whales through a scientific study of a population of Baird's beaked whales. The population has unexpectedly been found near the coast and in shallower waters than previously observed.

The study is led by whale biologists Olga Filatova and Ivan Fedutin from the University of Southern Denmark/Fjord&Blt, and it ispublished in the journal Animal Behaviour.

Filatova and Fedutin have many years of whale studies in the northern Pacific behind them, and it was during an expedition to the Commander Islands in 2008 that they first saw a group of Baird's beaked whales near the coast.

"We were there to look for killer whales and humpback whales, so we just noted that we had seen a group of Baird's beaked whales and didn't do much about it. But we also saw them in the following years, and after five years, we suspected that it was a stable community frequently visiting the same area. We saw them every year until 2020, when Covid 19 prevented us from going back to the Commander Islands," explains Olga Filatova,a whale expert and postdoc at Department of Biology and SDU Climate Cluster, University of Southern Denmark.

The studied population of Baird's beaked whales came close to the coast - within four km from land, and they were observed in shallow water; less than 300 meters.

"It is uncharacteristic for this species," says Olga Filatova, who also points out that the population likely has adapted to this particular habitat and thus deviates from the established perception that all beaked whales roam far out at sea and in deep waters.

"It means that you cannot expect all individuals within a specific species to behave the same way. This makes it difficult to plan species protection - in this case, for example, you cannot plan based on the assumption that beaked whales only live far out in deep sea. We have shown that they can also live in shallow and coastal waters. There may be other different habitats that we are not aware of yet," says Olga Filatova.

There are many examples of individuals from the same whale species not behaving the same. In the whale world, it is common to find groups of the same species living in different places, eating different prey, communicating differently, and not liking to mingle with fellow species in other groups.

Some killer whale groups only hunt marine mammals like seals and porpoises, others only herring. Some humpback whales migrate between the tropics and the Arctic, others are residents in certain areas. Some sperm whale groups develop their own dialects for internal communication and do not like to communicate with others outside the group.

According to Olga Filatova, social learning is at play when groups develop preferences for, for example, habitats and prey.

There are many forms of social learning in the animal world. Imitation is the most complex form; the animal sees what others do and understands the motivation and reasoning behind it. Then there is "local enhancement," where an animal sees another animal heading to a specific place, follows, and learns that the place has value. This has been observed in many animals, including fish.

Olga Filatova believes that the population of Baird's beaked whales at the Commander Islands learns through "local enhancement": They see that some peers go to the shallow water near the coast, follow, and discover that it is a good place, probably because there are many fish.

"It becomes a cultural tradition, and it is the first time a cultural tradition has been observed among beaked whales," she says.

Other examples of cultural traditions in whales include when they develop specific hunting traditions: some slap their tails to stun fish, some generate waves to wash seals off ice floes, some chase fish onto the beach.

The researchers observed a total of 186 individuals of the Baird's beaked whale species at the Commander Islands from 2008-2019. 107 were only observed once and thus assessed to be transient whales. 79 individuals were spotted for more than one year and were thus assessed to be residents.

61 of the transient whales were seen interacting with the residents, and seven of them were seen in shallow water.

"The transients are not as familiar with local conditions as the residents, and therefore, they usually seek food at the depths that are normal for their species. But we actually observed some transients in the shallow area. These were individuals who had some form of social contact with the residents. It must be in that contact that they learned about the shallow water and its advantages," says Olga Filatova.

It is unclear how many Baird's beaked whales exist in the world.

The study was supported by Rufford Small Grants, Whale and Dolphin Conservation, Animal Welfare Institut and Russian Fund for Fundamental Research.Olga Filatova's research is also supported by Human Frontier Science Program.

Beaked whalesWe know 24 species of beaked whales, which belong to the toothed whales. Some are known only from strandings and skull finds, and photos of them are generally rare. Baird's beaked whale is the largest of the beaked whales, reaching a length of up to 10 meters. The female is slightly larger than the male. Both females and males have a characteristic underbite with two pairs of teeth in the lower jaw.

Observational study

Animals

Unusual use of shallow habitats may be evidence of a cultural tradition in Baird's beaked whales

22-Jan-2024

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

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Surprising behavior in one of the least studied mammals in the world - EurekAlert

Biology

Exploring the Role of Non-Protein Ubiquitination in Cellular Biology – Medriva

Ubiquitination, a process fundamental to cellular biology, has traditionally been associated with protein regulation. However, recent research has expanded its scope to non-protein biomolecules, diving into a whole new realm of biological complexity. This article delves into the concept of non-lysine ubiquitination and its extension to biomolecules other than proteins, exploring the challenges, potential, and significance of this emerging field.

Ubiquitination, the process of attaching ubiquitin protein to biomolecules, is well-known for regulating protein degradation, localization, and activity. Recently, scientists have discovered that ubiquitination can also occur on non-protein molecules such as bacterial lipopolysaccharides, phosphatidylethanolamine, saccharides, and ADP-ribose. This has opened up new avenues of study, but has also presented unique difficulties in terms of quantification and detection.

E3 ligases, the enzymes that facilitate the transfer of ubiquitin to the target molecule, play a critical role in non-proteinaceous ubiquitination. Understanding the biological functions of these ligases can be complex, mainly due to the vast variety and specificity of E3 ligases. Nevertheless, their study is crucial for unravelling the intricacies of non-protein ubiquitination.

Proteasomes, cellular complexes that break down proteins, have been found to interact with ubiquitinated molecules. Research has shown that proteasomes can catalyze peptide splicing of full-length proteins, producing a variety of peptides with regulatory activities in cells. On the other hand, proteasome inhibitors (PIs) have demonstrated the potential to target the 26S proteasome in hematologic malignancies, prevent the degradation of tumor suppressor proteins, and inhibit the NF B signaling pathway. However, the resistance to these inhibitors remains a significant limitation.

Ubiquitinations role extends beyond normal cellular function and into disease pathology. For instance, Central Congenital Hypoventilation Syndrome (CCHS), a rare and life-threatening condition, has been linked to the ubiquitin transfer system. Expansion mutations of the poly-alanine tract in PHOX2B have been found to disrupt proper ubiquitin transfer to neural proteins, leading to cell death and triggering CCHS.

Despite the challenges in studying non-proteinaceous ubiquitination, the potential for groundbreaking discoveries and therapeutic development is immense. Antioxidant activity of protein-derived peptides, for example, has shown promise in disease prevention, management, and treatment, hinting at the diverse applications of ubiquitination knowledge. To fully realize this potential, interdisciplinary collaboration is needed, along with the development of novel methods for research in this field.

In conclusion, non-protein ubiquitination is a complex and promising field of study that can revolutionize our understanding of cellular biology and disease mechanisms. By overcoming the challenges associated with studying this process, we can unlock new therapeutic avenues and contribute to a deeper understanding of lifes intricate processes.

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Exploring the Role of Non-Protein Ubiquitination in Cellular Biology - Medriva

Biology

Lost Loves: USU Neuroscientists Learn About Grief From Widowed Coyotes – Utah State University

Utah State University Honors student Rachel Tong says that prior to working in a neuroscience lab, she gave little thought to the source of her emotions.

Like everyone, I sometimes feel sad, mad or happy, says Tong, a human biology and communications studies major with minors in chemistry and psychology. But I never thought about what was actually happening inside my brain that was driving these responses and feelings.

With faculty mentor Sara Freeman, assistant professor in USUs Department of Biology, Tong is delving into brains not human brains, but the brains of another socially monogamous mammal: the coyote.

It surprises many people to learn coyotes are a socially monogamous species, as are all wild canid species studied to date, Freeman says. This makes coyotes a valuable subject of study.

Female coyotes rely on their mates to help with each litter. The survival of their offspring has much more chance for success with the cooperation of both parents. Biologists whove studied the canids report coyotes generally mate for life and only seek a new partner if a mate dies.

Freeman and her students study adult male-female pairs of coyotes (Canis latrans) housed in the USDA APHIS National Wildlife Research Center Predator Ecology and Behavior Project Field Station in Millville, Utah, along with the brains of deceased coyotes.

Tong, a recipient of a USU College of Science Minigrant in 2023 and a USU Undergraduate Research and Creative Opportunities (URCO) grant for spring 2024, is studying brains from female coyotes that died from natural causes, including some that had live mates and some that lost their mates prior to death.

Her research focuses on a neuropeptide produced in both human and canid brains called corticotropin-releasing factor, or CRF.

CRF plays a major role in both human and coyote behaviors following stress and anxiety, Tong says. In response to stress, including grief, CRF causes the brains stress system, known as the hypothalamic-pituitary-adrenal axis, to release cortisol into the bloodstream. Cortisol is a stress hormone that regulates many body processes, and mobilizes the bodys response to stressful or threatening stimuli.

With her study, Tong is exploring where CRF receptors in the brain are located and if the amounts of these receptors change in the brains of female coyotes that experienced social loss.

To do this, Tong carefully slices 20-micron sections of brain tissue, using an instrument called a cryostat, for microscopic analysis. Its a skill shes conscientiously honed since joining Freemans lab in fall 2021.

Each section is about the width of a human hair, she says.

Tong examines the intricately branching, folding regions of each brain section and, using digital densitometry tools that help to visualize the densest areas of receptor expression, she can identify the location of CRF receptors.

Its fascinating and Im excited to see if we see significant differences in the brains of paired coyotes versus the widowed coyotes, she says.

An aspiring physician, Tongs research efforts are now competing with her preparations for taking the MCAT a step toward applying to medical schools. The Undergraduate Research Fellow has shadowed a pediatrician and an emergency medicine physician.

I was impressed not only by their knowledge and skills, but also by how they dealt with different cases and established strong patient-provider communications and relationships, she says.

Since working in Freemans lab, Tong has developed an affinity for neuroscience, which is enhanced by her campus efforts to foster social well-being among her fellow students. She serves as the College of Science student representative for the USU Honors Student Advisory Board, which includes working with her peers to foster access and inclusion, along with student success and retention.

Tong is also president of the Biology Undergraduate Student Association, and serves on USUs International Student Council and with the universitys Asian Student Association. She also volunteers with the iHelp Foundation, the ReadingBud program at Adams Elementary School and at the English Language Center of Cache Valley.

Helping fellow students feel included, giving encouragement to children struggling to read and sharing experiences with people adapting to a new culture as I did, when I arrived in the United States are all ways of helping people feel a sense of belonging and community, says Tong, who is from Singapore. Its been interesting and beneficial to me to interact with different age groups and with people from different cultures. Coming out of a global pandemic, we all need to establish supportive social bonds to be healthy both mentally and physically.

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Lost Loves: USU Neuroscientists Learn About Grief From Widowed Coyotes - Utah State University

Biology

Unraveling the Complexities of Multiple Sclerosis: A New Approach to Understanding Chronic Diseases – Medriva

Unraveling the Complexities of Multiple Sclerosis

An international study led by the Department of Medicine and Life Sciences (MELIS) at Pompeu Fabra University has developed a cutting-edge computational biology tool that offers an integrated vision of multiple sclerosis (MS). This study used multi-level network analysis in a groundbreaking method that simultaneously analyzes data from genes to the whole organism. The tool has been developed with the potential to revolutionize the understanding and management of complex diseases such as MS and various forms of dementia.

This innovative tool is based on the analysis of multiomic data, brain and retinal images, and clinical data of 328 patients with MS and 90 healthy individuals. Multiomic data include genomic, phosphoproteomic, and cytomic data, providing a comprehensive perspective of the disease at various biological levels. The analysis offers valuable insights into the complexity of chronic diseases, revealing correlations and interactions that were previously elusive.

Notably, the tool has revealed a significant correlation between the protein MK03, T cell count, retinal nerve fiber thickness, and the timed gait test. These findings offer a comprehensive understanding of the interplay between proteins, cells, tissues, and behavior in MS. The identification of such correlations and their potential impact on disability and disease progression could lead to future strategies for personalized MS therapeutics.

The potential of this tool extends beyond MS. The method used for multi-level network analysis could be applied to study other complex diseases such as Alzheimers and other types of dementia. By providing an integrated view of these diseases, the tool could help identify essential biomarkers, inform treatment strategies, and contribute to the development of personalized medicine.

The researchers emphasize the significance of understanding the relationships between biological elements in building a coherent picture of complex diseases. This integrated approach is a big leap in medical research, bridging the gap between molecular, cellular, and phenotypic scales. The tools ability to link genomics, proteomics, cytomics, imaging, and clinical data underlines the importance of considering all these factors in the study of complex diseases.

This study represents a major advancement in our understanding and management of complex diseases like MS. The computational biology tool developed provides an integrated vision of these diseases, opening new avenues for research and therapeutic intervention. As the study continues, it is hoped that this tool could provide new insights, improve diagnosis, and contribute to the development of personalized medicine for chronic diseases.

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Unraveling the Complexities of Multiple Sclerosis: A New Approach to Understanding Chronic Diseases - Medriva

Emergency Medicine

VISTA grant to fund hospital-based research training in heart, lung, blood, sleep disorders – VUMC Reporter

Vanderbilt University Medical Center has received a five-year, $2.4 million federal grant to establish a first-of-its-kind training program in patient-oriented and health systems research focused on acute heart, lung, blood and sleep disorders in the hospital setting.

Supported by the National Institutes of Health, and the National Heart, Lung and Blood Institute, the Vanderbilt Interdisciplinary Hospital-based Systems of Care Research Training ProgrAm (VISTA) will provide two years of mentored training to prepare postdoctoral investigators for the next stage in their careers.

Program co-directors are Michael Ward, MD, PhD, MBA, and Alan Storrow, MD, vice chair and associate chair of Research, respectively, Department of Emergency Medicine, and Sunil Kripalani, MD, MSc, director of the Center for Health Services Research and the Center for Clinical Quality and Implementation Research.

Heart, lung, blood and sleep disorders are among the leading indications for hospital admission in the United States. Most patients are admitted through the emergency department, then transitioned to hospital care.

As the first hospital-based research program on cardiovascular disease supported by a T32 training grant, VISTA will support research across the continuum of care, from emergency assessment through hospital care and follow-up, said Ward, who with Storrow is an associate professor and leader in emergency medicine research at VUMC.

A clinical and research collaboration between hospital medicine and emergency medicine, the program will use the Learning Health System (LHS) framework to train postdoctoral health care professionals in the discovery and implementation of new ways to deliver high quality care while simultaneously advancing science.

Trainees in this program will conduct research in the real-world setting that has immediate application to improve the care of common heart, lung, blood and sleep disorders which are treated in the hospital, said Kripalani, professor of Medicine and a national leader in LHS and implementation science.

The program, which begins in July, is accepting applications from candidates with MD/DO, PharmD, DDS, and PhD or equivalent degrees in disciplines relevant to health systems research, including health economics, policy, nursing, psychology, social work, epidemiology and informatics.

Two to three trainees will be selected each year. They will receive support for mentored research and career development focused on the delivery of care in emergency medicine and hospital medicine settings.

To apply, and for more information, visit https://www.vanderbiltem.com/vista.

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VISTA grant to fund hospital-based research training in heart, lung, blood, sleep disorders - VUMC Reporter

Emergency Medicine

Creation of a National Emergency Medicine Medical Education Journal Club – Cureus

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Creation of a National Emergency Medicine Medical Education Journal Club - Cureus

Emergency Medicine

Meet the doctor/entrepreneur and her product that the governor touted in his speech – Maryland Matters

Dr. Elizabeth Clayborne was recognized by Gov. Wes Moore during his 2024 State of the State address on Feb. 7, 2024. Photo by Danielle J. Brown

Laurel resident Elizabeth Clayborne, an emergency room physician and a mother of two, is attempting to more effectively treat a common frustration for children and elderly adults: nosebleeds.

Despite the relatively low risks associated with nosebleeds, Clayborne said that there are a surprising number of people who go to the emergency room for them.

We actually see about 500,000 ER visits annually in the U.S. for nosebleeds, which is kind of hard for people to believe, she said in an interview with Maryland Matters. They are most common in kids, aged 2 to 10, and in older adults, 55 to 80, especially if they are on blood thinners.

Clayborne was born and raised in Denver, but did her emergency room residency with George Washington University. She is an adjunct assistant professor of emergency medicine at the University of Maryland School of Medicine and she is the founder and CEO of NasaClip, which created a hands-free device to stop nosebleeds.

During his State of the State address Wednesday, Gov. Wes Moore (D) hailed Clayborne, who was in the House gallery for his speech, as an example of a Black woman overcoming challenges through Maryland entrepreneurial programs.

She said that people who come into the emergency room for nosebleeds are not usually in need of serious health care, but but some do not properly address their nosebleeds and are unable to stop the bleeding.

A lot of people will mismanage their nosebleeds, so theyll put their head backwards instead of forwardThey dont hold constant pressure, which is one of the most challenging issues because you need to hold uninterrupted pressure for 10 to 20 minutes, she said. And thats really hard to do, especially if you are a little kid, or an older adult or panicked because youre bleeding. And then they cant stop the bleeding, so they come to the ER.

The issue of nosebleeds in the emergency room connects to a larger concern about extended wait-times in Marylands emergency departments.

Clayborne said that as an ER doctor, she finds that nosebleeds usually are not serious medical concerns and should be fairly simple to address. But low staff numbers in emergency departments and increased patient volume can lead to someone waiting hours before being seen by a medical professional.

So even if you have a simple issue like a nosebleed, you might be waiting hours, because we cant get you back, she said.

Thats what prompted her to develop the product she called NasaClip, which is placed on a patients nose to help stanch the bleeding.

Part of what I like about NasaClip is that it does actually help us start the treatment for a patient immediately, she said. Because the device is over-the-counter, it can be applied upfront by a nurse, a technician, a patient themselvesWe can begin that treatment and manage them from the waiting room, and sometimes discharge them from the waiting room.

NasaClip for pediatric patients with nosebleeds. Courtesy of NasaClip website.

In 2023, NasaClip received at total of $750,000 in start-up investments from Marylands Technology Development Corporation (TEDCO), an independent entity created by the Maryland General Assembly in 1998 to help support business and economic opportunities across the state.

Clayborne hopes that NasaClip becomes the Band-Aid of nosebleeds, meaning that they are readily available in everyday households and stocked in childrens daycare facilities, athletic and sports facilities, school clinics, and hospitals. They currently run an average of $17 per unit, but Clayborne says that the company is developing a lower-cost version.

During his speech, Moore praised Claybornes fortitude, dedication to medicine and her entrepreneurial spirit.

As a woman of color, she struggled to find capital to get her idea off the ground.Dr. Clayborne doesnt give up. She was six months pregnant at the height of COVID and STILL went into work on the front lines at Prince Georges Hospital Center, Moore said. She raised enough money to start her business. And today, she is the founder and CEO of her own medical device company thats focused on helping children and families; And its located in Baltimore, Maryland.

Clayborne said that the intitial start-up support from TEDCO helped get her business off the ground, which was critical, because women and people of color are often overlooked by venture capital companies and other investors.

She said that she was honored to be recognized by the governor, and hopes that it can be a moment of inspiration for other Black women and others living in Maryland to pursue entrepreneurial endeavors.

I believe that representation matters, she said. Id like to serve as an example for other young women and minorities to pursue their entrepreneurial dreams.

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Meet the doctor/entrepreneur and her product that the governor touted in his speech - Maryland Matters

Emergency Medicine

WVSOM regional assistant dean: Medical students must learn to connect with patients – The Steubenville Herald-Star

Contributed ALWAYS TEACHING Dr. Jane Daugherty-Luck, a native of Colliers, helps students connect in her role as an assistant dean with the West Virginia School of Osteopathic Medicine.

LEWISBURG For nearly three decades, Dr. Jane Daugherty-Luck was an emergency medicine physician, where quick decisions can restore the health of a sick or injured patient.

Today, in her role as one of eight regional assistant deans serving the West Virginia School of Osteopathic Medicines Statewide Campus, shes responsible for another type of transformation helping third- and fourth-year medical students navigate their latter years of medical school.

Medical students dont realize all the little things they dont know, Daugherty-Luck said. Guiding them along that path is great. Its a gradual climb for a while, and then all of a sudden they hit a peak and soar straight up. Its nice to watch them succeed.

Daugherty-Luck, a graduate of WVSOMs Class of 1991, oversees students in the schools Northern Region, which encompasses West Virginias Brooke, Hancock, Marshall, Ohio, Tyler and Wetzel counties. Born and raised in Colliers, she developed an interest in science during her childhood and said medicine was one of the only professions that seemed suitable for smart girls at the time.

I cant remember not thinking about medicine. It just seemed the thing for me, she said. I liked solving mysteries and puzzles, and I liked the idea of hearing peoples stories. I liked that you get to hear interesting accounts of how something happened or how someone came to be diagnosed.

After earning a bachelors degree in chemistry from Alderson Broaddus College in Philippi, W.Va., Daugherty-Luck interviewed with two of West Virginias medical schools. She was influenced to consider WVSOM by her grandfather, whose beloved primary care physician was a doctor of osteopathic medicine, but her choice ultimately came down to the school she believed was a better fit for her personality.

On my other interviews, I didnt like the people I was interviewing with. They seemed dull and stuffy. At WVSOM, I interviewed with friendly people I felt I would enjoy hanging out and studying with. They would talk about other things in their life besides their career, and thats what made them interesting, she said.

Daugherty-Luck discovered her future specialty during an internship, noting that she fell into it accidentally.

At that time we had to do a one-year rotating internship, and the only rotation I liked was emergency medicine, because that was where I felt people actually wanted to teach me, she said. I remember a nurse coming to me, saying, This lady is in atrial fibrillation, and I said, Really? Shes here for finger pain. The nurse said, I took her pulse, and its really fast. Thats how I learned that vital signs could point you to the actual diagnosis. It turned out that the finger pain was referred from her heart.

After completing a residency at Clevelands Brentwood Hospital (now known as South Pointe Hospital), Daugherty-Luck worked as an emergency medicine physician in nearby Richmond Heights for two years before relocating to northwestern Kansas, where she would spend the next 12 years as assistant director of emergency medicine at Hays Medical Center.

It was during this period that she developed an interest in niche topics that she has continued to lecture on during her time at WVSOM. Following the Sept. 11, 2001, terrorist attacks, Daugherty-Luck assembled informational lectures to help emergency department staff learn about disaster planning and decontamination. She subsequently attended an incident response to terrorist bombings class presented by the U.S. Department of Homeland Security.

The class was a great experience. I learned about different types of explosive materials and the unique problems associated with these situations. A bomb that goes off in an open square, in a crowd of people, will create a different pattern of injuries than a bomb that goes off in a confined space or in water, and injury patterns are important to emergency medicine, she said.

Daugherty-Luck returned to West Virginia in 2009, working at Ohio Valley Medical Center in Wheeling and East Ohio Regional Hospital in Martins Ferry, and acting as an associate faculty member in the two hospitals emergency medicine residency program.

She also served as a preceptor, providing clinical training and mentoring to students in a variety of health care fields, and delivered lectures on terrorism and bombing response to WVSOM students during a popular wilderness medicine rotation established by former faculty member Dr. Lisa Hrutkay. It was only natural that when the opportunity came in 2022 to become a regional assistant dean, she would return to her alma mater full time.

Today, Daugherty-Luck works to ensure that medical students on clinical rotations feel supported, are in effective learning environments and stay on track to graduate. But the best guidance she can offer students has nothing to do with the classroom or the clinic, she said.

Her advice?

Know that theres more to life than medical school. Students need to get out and go to the movies, read books, do things that have nothing to do with medicine. Theyll say they dont have time, but if I were in their situation, I would find a way. It makes you relatable. It makes you interesting. It makes you a person. If youre only talking doctor stuff to a patient, its hard to make a connection. But if you can say, I read that book thats in your bag, or, I saw that movie too, thats how you connect.

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WVSOM regional assistant dean: Medical students must learn to connect with patients - The Steubenville Herald-Star

Emergency Medicine

Long emergency department wait times are perilous. Fix this stat! – The Boston Globe

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Globe Opinion's weekly take on politics, delivered every Wednesday.

As Kowalczyk points out, medical patients are also affected, as is anyone experiencing a true emergency in a department with its beds occupied by boarders.

Boarding is visible in emergency departments, but it is not an ER problem. It is a problem of hospital throughput. Emergency physicians look forward to collaborating at all levels of the health care system, from hospitals and insurers to elected officials, to identify immediate and longer-term solutions to the nations urgent boarding crisis.

Dr. Joseph Tennyson

Northborough

The writer is president of the Massachusetts College of Emergency Physicians, director of clinical operations and chief of emergency medicine at the UMass Memorial Health Alliance-Clinton Hospital Emergency Department, and an associate professor of emergency medicine at the UMass Chan Medical School.

As an occupational therapy student at Boston University, I was intrigued by the article Waits longer than ever in area ERs.

The reporter cites how increased wait times in emergency departments are unacceptable for hospital staff and could lead to medical errors for patients but does not mention the potential long-term effects of delayed care and hospital overcrowding on patient health and the overall health care system.

Delayed provision of emergency care for example, for strokes or cardiac events can lead to increased severity of medical events and a greater risk of further hospitalization or rehabilitation. Many rehab facilities and nursing homes are also understaffed and overcrowded, so these increased ER wait times would lead to an increased burden on an already-strained system and decrease the quality of patient care. This in turn could affect the available length of stay for patients as they recover, sending some home sooner than advised.

Bringing more attention to the greater and potentially widespread impact of ER wait times could motivate legislators and heads of hospitals to urgently address this issue.

Natalie Schmidt

Allston

Many of the observers cited in the Globes article focused on process interventions such as improved utilization of observation beds or transfers of patients to inpatient units to shorten emergency department wait times. My colleagues and I published a study in the Journal of Emergency Nursing investigating a range of hospital characteristics associated with how much time it took for a patient to be diagnostically evaluated in 67 Massachusetts emergency departments. Our research demonstrated that this wait significantly increased when emergency nurses cared for higher numbers of patients.

Importantly, while 17 other potential process factors were included in the statistical analysis, such as hospital occupancy, staffed hospital beds, ICU beds, Medicare case mix, observational beds, and profit and loss figures, the most important factor affecting wait times in Massachusetts ERs was nurse-to-patient ratios.

If Massachusetts hospitals want to lower these wait times, the evidence seems clear: Hire and staff more registered nurses.

Judith Shindul-Rothschild

Sherborn

The writer is a registered nurse and is a research professor at William F. Connell School of Nursing at Boston College. She holds a masters degree in psychiatric nursing and a doctoral degree in social economy and social policy.

Liz Kowalczyks story on ER wait times highlighted a distressing reality at a fragile time for American health care. Heres what patients should know as our state addresses these challenges.

First, the root causes: About 19,000 hospital job vacancies in Massachusetts have led to fewer overall care beds. More than 1,000 beds are unavailable on any given day simply because hospitals cannot move patients to lower-level facilities. Patients are experiencing longer stays. Community-based care is constrained. Virus seasons are intensifying. This perfect storm of factors has come together to create the delays many patients are experiencing today.

Second, the solutions: Just as they did throughout the COVID-19 pandemic, health care organizations are working with the state and one another to balance out care demand and share available resources. It is a daily, round-the-clock effort centered around treating the sickest patients immediately. As the pandemic showed, cutting back on planned procedures leads to greater illness and contributes to the capacity crisis we are experiencing now. It would be a mistake to dismiss the importance these procedures have on patients long-term health.

Most of all, patients should know that hospitals have their backs, and they should not hesitate to seek care when they need it. Patients can help local providers by visiting urgent care centers and primary care doctors when they are not in an emergency, keeping up with medical appointments, and treating caregivers with the respect they deserve.

Patricia Noga

Vice president, clinical affairs

Massachusetts Health & Hospital Association

Burlington

The writer is a registered nurse.

One major reason for such overuse of emergency departments is the collapse of outpatient care. Try to get in touch with an outpatient provider. You might get to leave a phone message (after wading through a complicated list of options).

Some people wont, or cant, wait weeks or months to see a provider. Emergency departments are always open, and one can be seen immediately (so to speak) and expect to get good care. So thats what people opt to do rather than see an outpatient provider. Urgent care centers are a good option, but they usually close in the evening.

The care systems are broken. Its helpful to report on pieces of the problem, but Id like to see a report on the fragmented system of health care itself.

Dr. George Sigel

Norwood

The long waits in emergency departments are just another symptom of a much bigger problem. When an industry is led by those without the proper training, the probability of failure is high. The day-to-day workflow of hospitals has increasingly been managed by risk managers, data analysts, and business graduates. However, medicine is a service industry with unanticipated consequences, not a commodity with neatly drawn revenue projections. Corporate models dont apply. Yet it has devolved into a series of billable events governed not by clinical judgment but by insurance company protocols and stakeholder margins. Lets try putting those with a license to practice medicine back in charge of medical care so that we can start to clean up the mess. Its not that complicated to take good care of a patient.

Dr. Paula Muto

Andover

The writer, a practicing surgeon, is the founder and CEO of the technology platform Uberdoc, which promotes access and price transparency.

Read more from the original source:

Long emergency department wait times are perilous. Fix this stat! - The Boston Globe