A medical device for Cystic Fibrosis (CF) sufferers which lessens their exposure to infections resulting in fewer doctors’ visits, reduced antibiotic usage and shorter hospital stays, is expected to be market ready within two years.
University of Limerick (UL) inventors recently secured funding for the new percussion device that helps remove mucus from the airways and will, they hope, greatly improve the quality of life for cystic fibrosis patients.
Ireland has the highest incidence of CF in the world and CF is the most common, fatal hereditary disease in the United States.
Professor Colum Dunne, who is Foundation Chair and Director of Research at UL’s Graduate Entry Medical School (GEMS), explained the background to the development of the product.
‘Patients with respiratory diseases use various devices, which help the removal of mucus from the airways and the improvement of pulmonary or lung function. One example that we have focused on here is the CF patient airway, which is defective in ciliary function; resulting, due to ineffective removal, in a mucus-rich environment favouring growth of bacteria. These bacteria include potential pathogens, associated with chronic infection, decreased lung function and accelerated respiratory disease’.

Currently, there are percussion-based chest physiotherapy devices on the market, but according to Professor Dunne, these ‘can sometimes become reservoirs for the bacteria that cause infections in Cystic Fibrosis patients’. Because the new device, SoloPep, is disposable, it poses no threat of reinfection.
‘In our research, we have observed that compliance with hygiene practices for reusable devices, by patient, is potentially poor. As such, despite even excellent compliance with prescribed antimicrobial regimens, the devices may become colonised with problematic or opportunistic pathogenic microbes,’ Professor Dunne outlined.

‘The devices may, therefore, function as a reservoir that does not come into contact with the antimicrobial agents. Subsequently, re-infection may occur post-antimicrobial cessation by microbes present in the reservoir. Therefore, there is a need to develop novel inexpensive, single-use devices,’ he added.

‘Ireland has the highest per capita incidence of Cystic Fibrosis globally. Because of this, it is reasonable to expect treatment innovations generated by Irish researchers and carers. In this case, our studies included patient involvement from the outset and allowed us to develop something that is truly technologically disruptive. The design of this new positive expiratory pressure (PEP) device is clever and focused on the end user from the beginning. It removes significant risk for patients by improving their microbiology hygiene and safety,’ Professor Dunne added.

Dr Leonard O’Sullivan from UL’s School of Design is co-principal investigator for this device.
‘SoloPEP is a good example of user-centred design and it will have a dramatic impact on the quality of life of cystic fibrosis patients in a sector with significant commercial opportunity,’ he said.
‘This product has the potential to improve the lives of Cystic Fibrosis and other patients. But for that to happen the product must actually be available to them,’ Professor Dunne concluded.

University of Limerick www.ul.ie/gems/news/new-cystic-fibrosis-device-reduce-antibiotic-usage

The immunotherapy nivolumab is kinder than chemotherapy for people with advanced head and neck cancer – easing many of the negative effects of the disease on patients’ quality of life.
Both head and neck cancer and the treatment for it can have a huge impact on patients – affecting their speech, breathing, eating and drinking, facial appearance, and general wellbeing.
All of this can cause substantial psychological, as well as physical, distress.
But patients taking part in a major phase III clinical trial – led by researchers at The Institute of Cancer Research, London, and The Royal Marsden NHS Foundation Trust – reported that nivolumab helped them maintain a better quality of life for longer.
By contrast, the same study also found that people treated with standard chemotherapies docetaxel, methotrexate or cetuximab reported a decline in quality of life from the start of treatment.
Last year, the clinical trial of 361 patients found that nivolumab – which sparks the immune system into action against cancers – greatly increased survival for people with recurrent or metastatic head and neck cancer.
But the drug was initially rejected by NICE in April this year and is currently under consultation before a final decision is due.
The new results add to the growing body of evidence that immunotherapy can be a smarter, kinder treatment for people with cancer.
In the latest study, 129 patients on the trial filled in questionnaires about their quality of life – covering physical symptoms, mental health and general wellbeing.
While patients on chemotherapy judged their quality of life to be lower at nine and 15 weeks into the trial, patients on nivolumab gave consistently better ratings throughout.
After nine weeks, patients given nivolumab reported that they were doing better than their counterparts on other treatments for a range of symptoms, including pain, sensory problems, appetite loss, tiredness and breathing problems.
After 15 weeks, the list of beneficial effects was even longer, with patients taking nivolumab being less badly affected by nausea, insomnia and weight loss.

Institute of Cancer Research
www.icr.ac.uk/news-archive/immunotherapy-kinder-than-chemotherapy-for-patients-with-head-and-neck-cancer

Chemists at the University of Alabama at Birmingham have designed triple-threat cancer-fighting polymer capsules that bring the promise of guided drug delivery closer to preclinical testing.

These multilayer capsules show three traits that have been difficult to achieve in a single entity. They have good imaging contrast that allows detection with low-power ultrasound, they can stably and efficiently encapsulate the cancer drug doxorubicin, and both a low- and higher-power dose of ultrasound can trigger the release of that cargo.

These three features create a guided drug delivery system to target solid tumours. Therapeutic efficacy can be further improved through surface modifications to boost targeting capabilities. Diagnostic low-power ultrasound then could visualize the nanocapsules as they concentrated in a tumour, and therapeutic higher-dose ultrasound would release the drug at ground zero, sparing the rest of the body from dose-limiting toxicity.

This precise control of when and where doxorubicin or other cancer drugs are released could offer a non-invasive alternative to cancer surgery or systemic chemotherapy, the UAB researchers report.

‘We envision an entirely different approach to treating solid human tumours of numerous pathologic subtypes, including common metastatic malignancies such as breast, melanoma, colon, prostate and lung, utilizing these capsules as a delivery platform,’ said Eugenia Kharlampieva, Ph.D., an associate professor in the Department of Chemistry, UAB College of Arts and Sciences. ‘These capsules can protect encapsulated therapeutics from degradation or clearance prior to reaching the target and have ultrasound contrast as a means of visualizing the drug release. They can release their encapsulated drug cargo in specific locations via externally applied ultrasound exposure.’

Kharlampieva – who creates her novel ‘smart’ particles while working at the intersection of polymer chemistry, nanotechnology and biomedical science – says there is an urgent, and so far unmet, need for such an easily fabricated, guided drug delivery system.

University of Alabama at Birmingham www.uab.edu/news/innovation/item/8162-uab-creates-triple-threat-cancer-fighting-polymer-capsules-for-guided-drug-delivery

A recent study, affiliated with UNIST has proposed the possibility of in situ human health monitoring simply by wearing a contact lens with built-in wireless smart sensors.

This study has been jointly conducted by Professor Jang-Ung Park of Materials Science and Engineering, Professor Chang Young Lee of Life Science, and Professor Franklin Bien of Electrical and Computer Engineering at UNIST in collaboration with Professor Hong Kyun Kim of Ophthalmology and Professor Kwi-Hyun Bae of Internal Medicine at Kyungpook National University (KNU).

In the study, the research team unveiled a smart contact lens sensor that could help monitor biomarkers for intraocular pressure (IOP), diabetes mellitus, and other health conditions. The research team expects that this research breakthrough could lead to the development of biosensors capable of detecting and treating various human diseases, and used as a component of next-generation smart contact lens-related electronic devices.

Diabetes is the most common cause of high blood sugar levels. Hyperglycaemia is a condition in which an excessive amount of glucose circulates in the blood plasma. If this condition persists for more than two hours, a patient will be diagnosed with diabetes.

Since blood sugar can be measured with tears, many attempts have been made to monitor diabetes with contact lenses. Despite numerous studies in the last several decades, the biggest drawback with conventional smart contact lenses was thought to be poor wearability. The electrodes used in existing smart contact lenses are opaque, and therefore obscure the view when wearing it. Moreover, because they lens-shaped firm plastic material, many people complain of comfort issues with contact lens wear which made wearing them impossible.

Professor Park and his research team solved these issues by developing a sensor based on transparent and flexible materials. Their new smart contact lens sensors use electrodes made of highly stretchable and transparent graphene sheets and metal nanowires.

Using this sensor, patients with diabetes and glaucoma may one day be able to self-monitor blood glucose levels and eye pressure. Through the embedded wireless antenna in the contact lens sensor, patients can also transmit their health information, which allows real-time monitoring of their health conditions, as well. In addition, because the system uses wireless antenna to read sensor information, no separate power source, like battery is required for the smart contact lens sensors.

Intraocular pressure measurement can be achieved using the dielectric layers. The dielectric layer is an electrically non-conductive layer, characterized by polarity that divides both positive and negative charges. The thickness of this layer changes from thinning as the intraocular pressure increases, to thickening as the intraocular pressure decreases. The IOP sensor, embedded in the contact lenses senses this and transmits the information to the wireless antenna.

According to the research team, their newly-developed smart lenses with built-in pressure-sensing and glucose-monitoring sensors could still detect blood glucose and IOP despite the deformation of the contact lenses. The sensor characteristics were also maintained even when exposed to various substances in human tears.

UNIST news.unist.ac.kr/smart-contact-lens-sensor-for-diabetic-and-glaucoma-diagnosis/

Hospitals that spend more on initial care following patient emergencies have better outcomes than hospitals that spend less at first and rely more on additional forms of long-term care, according to a new study co-authored by MIT economists.
More specifically, hospitals that invest more in inpatient care yield better results, per dollar spent, than those that assign relatively more patients to skilled nursing facilities upon discharge. Other things being equal, allocating a higher percentage of overall health care expenses to a hospital’s inpatient treatment is consistent with lower mortality rates among elderly Medicare recipients.
“We find that patients who go to hospitals that rely more on skilled nursing facilities after discharge, as opposed to getting them healthy enough to return home, are substantially less likely to survive over the following year,” says Joseph Doyle, the Erwin H. Schell Professor of Management at the MIT Sloan School of Management and co-author of a paper detailing the study.
Conversely, Doyle adds: “What types of hospitals are low-cost and have good outcomes? They spend a lot when you’re there, initially, but a lot less [after] you leave the hospital.”
The co-authors are Doyle; John A. Graves, an assistant professor at Vanderbilt University; and Jonathan Gruber, the Ford Professor of Economics at MIT.
The study aims, in part, to address the fact that the U.S. spends about 40 percent more on health care per capita than the next highest-spending country in the Organisation for Economic Co-operation and Development (OECD), a group of 35 major nations — a figure that leads many to wonder whether there are significant ineffeciencies in U.S. health care spending.
In devising their experiment, the researchers took advantage of ambulance company practices that essentially provided a randomized group of patients to study, making it possible to compare outcomes at different hospitals.
The study uses Medicare claims data for hospital admissions from 2002 to 2011, focusing on patients who were at least 66 years old, and tracking their one-year mortality statistics. The study’s final database comprised 1,575,273 patients.
In many parts of the U.S., multiple ambulance companies cover a given area, and their assignment to patients is essentially random; the first available company will take a patient. However, ambulance companies often have agreements or preferences concerning which hospitals they deliver patients to. That means the ambulance companies are essentially delivering a randomized set of people to certain hospitals.
For this reason, the study avoids a basic problem in comparing hospital outcomes — that patients admitted to one hospital may be significantly less healthy, on average, than the patients admitted to another. All told, there are about 2,500 ambulance companies and about 3,000 hospitals in the data set.
The average 90-day spending on patients in the study is almost $27,500; for every additional increase in spending of roughly $8,500, the researchers found a reduction in mortality risk of about 2 percentage points. However, the study finds about a 5 percentage-point increase in mortality at hospitals that have relatively high rates of spending on “downstream” nursing facilities.
“We see this as a potentially novel quality measure for hospitals,” Doyle says. “Hospitals that have that profile where they send patients to skilled nursing facilities have higher spending downstream, and they have worse outcomes.”
The paper is one of a series of studies by Doyle and his colleagues which use the random assignment of patients to hospitals, due to ambulance-dispatch practices, in order to evaluate hospital effectiveness. In a previous study more strictly focused on the intensity of emergency care treatments, Doyle also found that higher spending leads to better outcomes.

MIT
news.mit.edu/2017/hospitals-spend-more-emergency-care-yield-better-outcomes-0710