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Public Access to Drugs Meets Health Needs, Cuts Costs

Pills on table

(e-Magine Art/Flickr)

28 February 2017. A study shows adding universal access to essential drugs as part of Canada’s health care system would meet much of that country’s pharmaceutical needs and save billions of dollars. The analysis by a team from University of British Columbia and University of Toronto appears in the 27 February issue of Canadian Medical Association Journal.

In a related study in the same journal, Nav Persaud, a family physician at St. Michael’s Hospital in Toronto, and colleagues compiled a list of 125 essential prescription drugs for Canadians, based on World Health Organization’s model list of essential medicines developed in 2013 and clinical practice in Canada. Persaud is a participant in and co-author of the universal access study led by UBC public health professor Steven Morgan.

The UBC-Toronto team seeks to gauge the impact on public health outcomes and government budgets if the Canadian government purchased in bulk and insured access to prescription drugs most needed by its citizens. While Canada has a single-payer health care system, the country’s prescription drugs are offered in a hybrid program that mixes public coverage with private plans. An analysis of survey data from 2014 by Morgan and colleagues shows some 8 percent of Canadians age 55 and over skipped filling their prescriptions due to the drugs’ costs, second only to the U.S. with 17 percent among 11 high-income countries.

The researchers compiled a list of 117 drugs considered essential to Canadians similar to the list collected by Persaud’s team based on the WHO initiative, known as CLEAN Meds, short for carefully selected and easily accessible at no-charge medications. The 117 drugs include those prescribed for primary health care needs, such as antibiotics, insulin, heart medications, and anti-depressants. The list also has treatments for public health priorities such as oral contraceptives, HIV, hepatitis, and some inflammatory conditions. The 117 medications account for 44 percent of all prescriptions written in Canada and 30 percent of the country’s prescription drug costs in 2015.

The team ran simulations to calculate the effects of bulk purchases on Canadian drug spending, from administrative and market research data of prescription drugs filled in Canada, as well as pricing models of single-payer systems from Sweden and New Zealand, as well as the Veterans Administration in the U.S. The team found on average, generic drug costs are 47 to 84 percent lower under these single-payer plans, while brand-name drugs are on average 43 percent lower in the V.A., than those paid by Canadians.

The researchers estimate Canadians filled 568 million prescriptions in 2015 at a total cost of $26.2 billion, with the 378 million publicly-paid prescriptions costing some $10.8 billion that year. Having the Canadian government purchase and provide the essential medications would reduce the total annual expenditure for prescription drugs in the country by $3.1 billion. Savings to consumers and private drug plans are calculated at $4.3 billion per year, an average of 28 percent. The Stockholm region in Sweden experienced a similar 28 percent savings when it introduced its Wise List formulary for essential drugs. The Canadian government would have to pay an additional $1.2 billion per year to purchase the drugs. (All estimates are in Canadian dollars, equal to $US 0.75.)

“A program of this kind is a feasible way of improving the overall health of Canadians while dramatically lowering drug costs,” says Morgan in a UBC statement. “We show that adding universal public coverage of essential medicines to the existing system of drug coverage in Canada is a significant and feasible step in the right direction.”

Morgan and Persaud tell more about the study in the following video.

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Mastering The Mail For Business

– Contributed content –

28 February 2017. Being good at business also means being good at organizing in some way, shape or form. Whether it’s organizing your work diary to get the most out of your day, or organizing your business shipping to get products out to customers faster. Some part of running is a business is always going to have a rather hefty focus on organization.

If you’re a business that is into the making and selling of physical products, getting that product out to customers is possibly the most important stage of business for your company. If you can master mail — that is responding, shipping and delivering — then your business shouldn’t encounter many issues. Running a good business is about nailing the basics, rather than excelling in weird niche areas.

Box cartoon

(Public domain)

Business goes more and more global each and every day. Your products could certainly end up in any corner of the world and it’s your duty to make sure they get there. This costs money, though, so keep an eye out for any trends in purchases to make sure you can save your remote customers some money on high costs of shipping. If there is a certain country that has a high demand for your products, you might want to consolidate and organize deliveries with a local postage company in that area for monthly shipping orders that can break your deliveries down and save money for all parties. This is a great way of rewarding your customers.

It’s worth knowing your postage rates as well and offering this information to customers. Many customers might feel burnt by high postage fees and you can prevent this by being honest and open with postage rates. You should also be able to inform your customers of delivery times as well, to keep them in the know regarding their ordered products.

Another way to master the mail is to keep organized with your physical correspondence. Mailbox forwarding can help you with this, and it’s easy to ignore incoming mail in the age of the instant message. Compare mailbox forwarding companies to find the best value for your business. Ignoring physical mail which could contain customer queries is one way many businesses fail. Mailbox forwarding is a great way to manage your mail online and post things out from a central hub.

U.S. mailbox

(Wikimedia Commons)

Look for patterns in shipping. Certain products might be ordered more at certain times, and it’s up to you to spot these trends and patterns. Organizing the right shipping methods in line with trends can ensure your business is on the ball.

Also, make sure you offer your customers plenty of delivery options. One good way to line in with the spotted trends is to offer subscription services to customers who order in certain patterns, making sure you can pack items in advance. Subscriptions will also help with your budgeting, as you can count on a monthly order or so if you agree on a subscription package with a customer.

If you’ve got a product to ship, you need to ship it well otherwise you might just turn off your valued customers!

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Test of Nasal Skin Cells Found to Detect Lung Cancer

Lungs illustration

(National Cancer Institute)

27 February 2017. A diagnostic test analyzing the genes in skin cells from nasal passages can detect lung cancer, and the absence of cancer, as accurately as more invasive samples from the airways. Results of this study testing a technology by diagnostics company Veracyte Inc. appear in today’s issue of the Journal of the National Cancer Institute (paid subscription required).

The study assesses the technology behind Veracyte’s Percepta bronchial genomic classifier, a device that normally evaluates cell samples taken from the airways of individuals suspected of having lung cancer, but in this case also with cells taken from nasal passages. Airway cell samples are collected for the test during a bronchoscopy, where a cancer specialist can view the condition of a person’s airways and lungs with a miniature camera on a flexible tube inserted through the windpipe, from the nose or mouth, as well as take tiny biopsy samples. Although bronchoscopies are considered minimally invasive, patients may need to be sedated or given a local anesthetic, or even a general anesthetic.

Veracyte’s Percepta test analyzes samples taken with a bronchoscopy for biomarkers, or molecular indicators of tumors, from 23 genes expressed in the airways to supplement the physician’s visual observations. Clinical evidence offered by the company says Percepta tests improve the accuracy of bronchoscopies, to not only diagnose lung cancer earlier, when treatment can be more effective, but also more accurately identify benign tumors and reduce by half unnecessary lung surgeries.

The researchers, led by Boston University medical and bioinformatics professor Avrum Spira, guessed that nasal passages of smokers, a group more likely to contract lung cancer, would express similar damage, and thus similar biomarkers, as their airways. Thus, if skin cell samples from nasal passages could be used to detect lung cancer as accurately as cells from airways, lung cancer could be detected easier and sooner, as well as reduce uncertainties and distress of people without cancer.

Spira and colleagues enrolled 505 individuals already taking part in two lung cancer clinical trials, who were undergoing bronchoscopies as part of the trials. These same individuals offered nasal swabs from which the researchers tested for biomarkers and compared the results to the bronchoscopies. Participants were also tracked for 1 year after giving their initial nasal swab samples.

The study team found nasal samples offer biomarkers expressed from 30 genes indicating either the presence or absence of cancer, which when combined with clinical factors such as age and smoking history, can predict future lung cancer cases. The researchers likewise found similar biomarker expressions in the nasal passages and airways of participants in the studies, both those developing and not developing tumors. In addition, after 1 year, the genes in the nasal swab samples of participants could accurately predict individuals more likely to develop cancerous lung tumors and those with benign conditions.

The authors conclude that the so-called field of injury for lung cancer extends to nasal passages, with the results demonstrating the potential of nasal swabs as a less invasive method for lung cancer screening. “This discovery,” says Spira in a Veracyte statement, “could offer a method to further reduce the uncertainty, risk, and cost associated with the early detection of lung cancer.”

Spira is an entrepreneur as well as a physician-scientist, and holds a professorship in health care entrepreneurship at Boston University, as well as his other faculty posts. He is one of the founders of the company Allegro Diagnostics in Maynard, Massachusetts which, as reported by Science & Enterprise, first developed a commercial test of biomarkers in the airways. In September 2014, Veracyte, in South San Francisco, California acquired Allegro Diagnostics and Spira’s technology.

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Duchenne Gene-Editing Company Launched, Raising $5M

DNA illustration

(National Heart, Lung, and Blood Institute, NIH)

27 February 2017. A biotechnology start-up is applying a process for editing-out disease-causing mutations to correct the inherited disorder Duchenne muscular dystrophy. Exonics Therapeutics Inc. is being formed in Boston by the venture division of CureDuchenne, a research funding and advocacy organization seeking remedies for the disease, and raising $5 million in seed capital.

Duchenne muscular dystrophy is a rare genetic disease resulting in progressive muscle degeneration and weakness, primarily in the shoulders, arms, hips, and thighs. The condition affects mainly boys starting at age 3 to 5, and caused by a defective gene that fails to produce the protein dystrophin for strengthening muscle fiber and protecting muscles from injury. While life expectancy can vary, people with Duchenne muscular dystrophy do not often survive past their 20s or 30s, with death caused by respiratory or cardiac failure.

Exonics Therapeutics is licensing research applying the genome-editing technology Crispr to remove the defective DNA responsible for Duchenne muscular dystrophy. Crispr, short for clustered regularly interspaced short palindromic repeats, is a technique based on bacterial defense mechanisms that harnesses RNA to identify and monitor precise locations in DNA. The actual editing of genomes with Crispr uses an enzyme known as Crispr-associated protein 9 or Cas9. With this approach to Crispr, RNA molecules guide Cas9 proteins to specific genes needing repair, making it possible to address root causes of many diseases.

For Duchenne muscular dystrophy, Exonics is licensing Crispr-Cas9 technology developed by molecular biologist Eric Olson at University of Texas Southwestern Medical Center in Dallas, and scientific founder of the company. Techniques devised by Olson’s lab employ adeno-associated viruses to deliver the RNA molecules with Cas9 proteins to correct mutations in the gene producing dystrophin. Adeno-associated viruses are benign and naturally occurring microbes that can infect cells, but do not integrate with the cell’s genome or cause disease, other than at most mild reactions in humans.

In preclinical tests, Olson and colleagues used Crispr-Cas9 to edit out the faulty exons, or protein-coding parts of the DMD gene responsible for low or non-production of dystrophin. In a study published last year in the journal Science, the researchers edited out the suspect exons in young mice, from 1 to 18 days old, induced with Duchenne muscular dystrophy. The edits resulted in restored production of dystrophin in skeletal and heart muscles, as well as stronger gripping abilities after 4 weeks.

The authors note that the edits took place in mice’s genomes after birth, and not in the embryo. Section 749 of the U.S. Consolidated Appropriations Act of 2016 prohibits FDA review of “a drug or biological product in research in which a human embryo is intentionally created or modified to include a heritable genetic modification.” Voluntary guidelines developed by scientists and bioethicists allow for research on conditions in non-heritable or somatic cells, but only rarely with inheritable or germline cells.

Exonics is raising $5 million in seed capital, with half of that amount provided by CureDuchenne Ventures, a division of the research funding and advocacy group CureDuchenne in Newport Beach, California. CureDuchenne Ventures provides grants, loans, and in this case equity financing to support development of treatments and diagnostics for the disease. Exonics is one of two enterprises founded with CureDuchenne Ventures backing.

Olson says gene-editing therapies can correct as many as 80 percent of Duchenne muscular dystrophy cases. He tells more about the technology in the following video.

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Genome Editing Builds Viral Disease Resistance in Pigs

Piglets

(Laura Dow, Roslin Institute)

24 February 2017. Veterinary researchers used Crispr-Cas9, an emerging genome editing technique, to produce pigs with cells resistant to a common viral disease affecting commercial herds. The team from Roslin Institute at University of Edinburgh in Scotland and Pirbright Institute in Woking, U.K., and the livestock breeding company Genus plc in Basingstoke, U.K. published its findings in the 23 February issue of the journal PLoS Pathogens.

The researchers led by Roslin Institute geneticist Alan Archibald are seeking solutions to porcine reproductive and respiratory syndrome, or PRRS, a viral disease that began affecting pig herds in Europe and North America in the late 1980s. Infections from the virus cause lesions in the lungs of young pigs and severe respiratory distress, with fatalities at this age as high as 80 percent. Among pregnant sows, infections can cause stillbirths of entire litters and early terminations of pregnancies. The authors cite data showing pork producers in the U.S. suffering annual losses of $650 million from PRRS, and more than €1.5 billion in Europe.

The PRRS virus infects macrophages, white blood cells in the immune system that normally attack and absorb invading pathogens. In this case, the virus attacks the macrophage itself, seeking out and binding to a receptor protein known as CD163, often found in the lung macrophages of pigs. That protein has a molecular structure resembling a string of pearls, where the fifth “pearl”  or region in the sequence interacts with the PRRS virus, enabling infections to occur.

Archibald and colleagues investigated the genome editing technique known as Crispr, short for clustered regularly interspaced short palindromic repeats, as a technique for changing the gene in pigs that produces CD163. Crispr is based on bacterial defense mechanisms that use RNA to identify and monitor precise locations in DNA. The actual editing of genomes with Crispr uses an enzyme known as Crispr-associated protein 9 or Cas9. With this approach to Crispr, RNA molecules guide Cas9 proteins to specific genes needing repair, making it possible to address root causes of many diseases.

The researchers identified the gene and specific exons, or parts of the gene, in pigs that direct the RNA code for producing CD163 proteins. Using Crispr-Cas9, the team deleted only the precise exon in pig zygotes with the code for the fifth region in CD163 proteins. The zygotes were then implanted in sows and proceeded to birth. The team reports the pigs experienced normal births and were raised under standard care and conditions, with no adverse effects and normal blood counts.

Lab tests of macrophages from the lungs of the gene-edited pigs show normal functioning of CD163 proteins on the macrophage surface, even with the fifth coding region removed. The researchers then exposed the pigs’ macrophages to various types of PRRS viruses and found that the cells resisted infections, resulting from the lack of receptor protein normally found in pigs’ macrophages, but edited out with Crispr-Cas9.

“Genome-editing offers opportunities to boost food security,” says Archibald in a joint statement, “by reducing waste and losses from infectious diseases, as well as improving animal welfare by reducing the burden of disease. Our results take us closer to realizing these benefits and specifically address the most important infectious disease problem for the pig industry worldwide.”

The next stage in the research is to test the resistance of pigs with edited genomes to infections from PRRS viruses, not just the macrophage cells.

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Nuclear Cancer Therapy Company Launches, Raises $25M

Radio isotope shipment

(Centre for Probe Development and Commercialization)

23 February 2017. A new company developing cancer therapies combining nuclear radiation and synthetic antibodies is starting up in Hamilton, Ontario. Fusion Pharmaceuticals Inc., a spin-off enterprise from from the Centre for Probe Development and Commercialization at McMaster University in Hamilton, is raising $US 25 million in its first venture funding round.

Fusion Pharmaceuticals aims to create treatments for cancer that join together the cancer-killing capabilities of radiation therapy with the precise targeting of monoclonal antibodies, synthetic proteins that target specific proteins uniquely found in cancer cells. The therapies developed by Fusion will emit alpha particles from radioactive elements directed at tumor cells expressing specific biomarkers as targets.

The company’s lead product, code-named FPX-01,  is designed to deliver radiation from actinium-225, an isotope or radiation-emitting form of actinium that kills tumor cells. Fusion is also developing synthetic proteins called centryrins for targeting the tumor cells. Centryrins have been shown to deliver engineered antibodies for immunotherapies to treat blood-related cancers, such as multiple myeloma and leukemia.

Fusion Pharmaceuticals is a spin-off company from the Centre for Probe Development and Commercialization, a government-supported research institute at McMaster University studying radiopharmaceuticals destined for the marketplace. The center says it has more than 50 radiopharmaceutical programs in various stages of discovery, development, or manufacturing, with more than 12 of these therapies in clinical trials.

The company is raising $US 25 million in its first venture financing round. Johnson & Johnson Innovation, a division of the pharmaceutical company backing new enterprises with investment and incubation, is leading the funding round. Taking part in the financing are health care and life science investors HealthCap, TPG Biotech, and Genesys Capital, along with Fight Against Cancer Innovation Trust, or Facit, the science commercialization arm of the Ontario Institute for Cancer Research, Facit is a founding seed-stage investor in the company.

Fusion is licensing its centyrin protein targeting platform from Janssen Biotech, also a division of Johnson & Johnson. In addition, HealthCap brings experience in radiopharmaceuticals with investments in two similar companies.

“Targeted delivery of medical isotopes that emit alpha particles,” says John Valliant, Fusion’s CEO in a company statement,  “can be used to kill tumor cells with remarkable precision and unprecedented potency, and it has the added potential of having complementary effects with treatments which activate the immune system.” Valliant is Fusion’s founder, as well as founder and CEO of Centre for Probe Development and Commercialization, and professor of chemistry at McMaster.

More from Science & Enterprise:

Disclosure: The author owns shares in Johnson & Johnson.

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Handheld Surgical Assist Device in Development

FlexDex prototype

FlexDex prototype (Michigan Creative, Hilary Robinson)

23 February 2017. A handheld mechanical device that promises to reduce the cost and ease the work of minimally invasive surgery is being created by a spin-off company from University of Michigan. The device is a product of FlexDex Surgical LLC in Brighton, Michigan, and supported by a $1.4 million Small Business Innovation Research or SBIR grant from National Science Foundation.

FlexDex’s device is a needle driver for laparoscopic, or minimally-invasive surgery, where surgeons make and work through tiny incisions. Laparoscopic is less expensive and traumatic with shorter recovery times for patients, but requires extra skills for the surgeon and often expensive robotic equipment for hospitals. The company cites data showing some 1.5 million laparoscopic procedures are performed in the U.S. each year across most surgical specialties, but even wider adoption is limited by the high cost of surgical robots, extra training needed for these sophisticated instruments, and complexity of some minimally invasive procedures.

In addition, says FlexDex, current lower-cost mechanical, non-robotic devices to aid minimally-invasive surgery are either difficult to learn or lack the dexterity needed by surgeons. The company says its technology is designed to fill the need for an easy-to-use device to aid laparoscopic surgery that is also affordable for smaller clinics and hospitals.

The FlexDex device is designed to supplement the work of a skilled surgeon. The device is worn on the surgeon’s hand, wrist, and forearm, and reacts to fine movements of the surgeon’s hand, thus acting as an extension of the surgeon. And because the device is driven by the mechanical actions of the surgeon, it does not require sensors, actuators, or computer-controls, keeping its cost low.

FlexDex Surgical is a start-up company spun-off from the lab of mechanical engineering professor Shorya Awtar and pediatric surgery professor James Geiger at University of Michigan in Ann Arbor. Awtar’s lab studies dynamics and controls of flexible systems that mimic or parallel physical actions, as well as models for new kinds of machines and instruments used in manufacturing and health care, such as the FlexDex device.

Awtar and Geiger founded FlexDex Surgical with entrepreneur Greg Bowles who serves as the company’s chief marketing officer. Awtar and Geiger are FlexDex’s chief technology and medical officers, respectively. FlexDex received an early-stage SBIR grant in 2013 to prove the technical and commercial feasibility of the device. The current second-phase award supports completion of the device’s development, verification, regulatory clearance, and commercial launch. The four-year grant extends through November 2018.

“For decades,” says Awtar in an NSF statement, “surgeons and hospital staff assumed there was a trade-off for minimally invasive instruments. If you want affordability, you get traditional hand-held instruments. If you want functionality, you need to pay a higher price for a robotic surgery system. I was convinced there was a better solution.”

“Dozens of companies have tried this and they have failed,” adds Geiger, “because their solutions were not based in scientific discovery.”

Awtar tells more and demonstrates the device in the following video.

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An Inspiring Company Needs Aspiring Employees

– Contributed content –

22 February 2017. It’s hard to keep employees productive in the business world, whatever your industry. Repeating the same tasks day in and out, which ends up happening no matter how “unique” or “fun” the style of business may be, is enough to drive anyone insane. At the end of the day, whilst your employees are the workforce which keeps your business ticking over nicely, they’re not lifeless, robotic machines who can always operate like clockwork. Sometimes productivity may slip.

Of course, the last thing you should do in such an incident is belittle employees or demonstrate frustration, as this will merely have the effect of further agitating them and decreasing their motivation or productivity. The key to lifting the spirits of your workforce and ensuring they are all treated like people with wants and needs is to get to the bottom of what’s affecting their productivity, which could be different for each worker. Here are some steps to help your employees aspire towards success once more and help lift the image of your inspiring company at the same time.

Office workers at window

(Pexels.com)

Challenge your workers.

Maybe this is the opposite solution to anything you were expecting, but it makes total sense. People aren’t always lazy. They don’t always want the easy route. We might think we do until we’re faced with a dull and monotonous job which requires no real thinking power and no real opportunity to challenge our skill set or potential to grow and improve. It’s your job as the employer to put challenges in the road for your employees and reignite that spark behind their eyes once more. Simply asking your employees to take on new projects or invent a new marketing strategy for the company could be enough to jolt them into action and convince them that the job role doesn’t just require mundane, repetitive tasks day in and out. Give them a challenge, and watch as they start to work hard again.

Office worker at desk

(Pexels.com)

Ease their workload.

You might be overworking your employees. Whilst I mentioned that it is important to challenge your workers, there’s a breaking point for everyone, and we all need to take a break and recover at some point. As I said, nobody is a machine. For example, your company could consider IT support to help relieve the workload of some employees who are putting in endless additional hours to keep company data secure. You might be putting people in way over their heads, and they didn’t want to say anything because they felt they should meet your expectation as the employer.

On top of that, you shouldn’t be turning your employees into workaholics because, ironically, workaholics don’t always work as well. If you drain every new employee of all their potential and eagerness, they’ll quickly tire of your company. Encourage real breaks, and build a more social atmosphere around the office. Even installing a pool table in the break room could be enough to remind employees that they are valued as people and allowed a little free time to recharge here and there.

Value employees for their work.

This is another big one. Much as I mentioned earlier, employees become stagnant and uninspired when they feel their job role entering a rut. You need to be reminding them that their work is important because people want to make a difference; they don’t always want to merge in with the crowd and simply pick up their paycheck at the end of the day. You’ve employed people with real potential, and you should be valuing them when they show it. Additionally, inspiring your best workers to grow and improve with the promise of a promotion won’t only improve their work, but the work of other employees who crave that promotion.

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Biofeedback Device Reduces Panic Attacks in Trial

Fear in scrabble

(Wokandapix, Pixabay)

22 February 2017. A medical device that provides people with panic disorder feedback on their abnormal breathing is shown in a clinical trial to reduce panic severity 12 months after treatment. The test of the Freespira device made by Palo Alto Health Sciences in Danville, California is reported in the 13 February issue of the journal Applied Psychophysiology and Biofeedback.

The Freespira device provides people with panic disorder feedback on the carbon dioxide content of their breathing, to enable people with the condition to adjust their breathing and relieve panic symptoms. Panic disorder is marked by panic or anxiety attacks, periods of intense fear which can occur unexpectedly, even when asleep. Anxiety and Depression Association of America estimates 6 million adults in the U.S. suffer from panic disorder, which generally develops in early adulthood and affects twice as many women as men.

The Freespira device, cleared by FDA in 2013 for use in the U.S., provides objective feedback on carbon dioxide or CO2 content of exhaled breath to people with panic disorder. When in a panic attack, individuals often start hyperventilating, with rapid deep breaths that reduce the CO2 content of exhaled air, and often results in dizziness, abnormal heart beats, shortness of breath, and sweating that adds to feelings of fear and helplessness.

Freespira has a sensor that measures CO2 concentrations and respiration rate in exhaled breath, known as end-tidal CO2, with readings displayed on a tablet app. Software in the app provides guidance to the user with visual cues to change their breathing. These instructions are designed to bring CO2 content back to more normal levels, and thus reduce the symptoms contributing to the individual’s feelings of panic. Freespira can be used at home, after training with a clinician. The normal course of Freespira treatment is 2 sessions a day, each 17 minutes, for 4 weeks.

The intermediate-stage clinical trial enrolled 69 participants at 4 sites in the U.S., led by David Tolin, a psychiatrist with Institute of Living in Hartford, Connecticut and adjunct professor at Yale University. All participants were trained in the Freespira device; the study had no control or comparison group, but readings and scores were measured to baseline levels before the treatments. The study team looked primarily at scores on a standard self-reporting rating scale of panic attack severity, which were taken at 2 and 12 months following the treatments. Participants uploaded their device readings and panic severity scores to a collection site in the cloud.

Of the 69 individuals that started the trial, 56 completed the study. Among those who completed the treatments after 2 months, more than half (53%) were in remission with large decreases in panic attack severity scores. After 12 months, the remission rate increased to 7 in 10 (70%), with large decreases in severity scores. At both times, 7 to 8 in 10 individuals who completed the treatments reported no panic attacks in the previous week. CO2 concentration measures and respiratory rate measures also returned closer to normal ranges at 2 and 12 months following the treatments. Adverse events were rare, and limited to light-headedness and mild dizziness at training sessions.

The authors note that earlier trials were conducted in academic settings, while this trial tested the device with patients at home. The authors also note economic factors supporting Freespira. The device is relatively low in cost compared to pharmaceuticals, and patients can upload data to remote servers, making it possible for clinicians to treat more individuals with panic disorder than in traditional settings.

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Smart Watch Data Reveal Epilepsy Triggers

Smart watch

(Oliur Rahman, Paxels)

(22 February 2017). Data collected with Apple smart watches show stress and missed sleep tend to trigger more seizures among people with epilepsy than other causes. These findings were among results reported today by a team from Johns Hopkins University at the annual meeting of American Academy of Neurology.

The Johns Hopkins researchers, led by neurology professor Gregory Krauss, provided their first results from a project that began in October 2015. Krauss and colleagues are seeking better ways of recording events and activities of people with epilepsy as their episodes occur, with an app called EpiWatch configured to work with the Apple Watch and iPhone. EpiWatch was designed with Apple’s ResearchKit that provides modules for tracking activity, conducting surveys, and gaining user consent.

Epilepsy is a neurological disorder where nerve cell activity in the brain is disturbed, causing seizures with symptoms ranging from blank stares to tingling sensations to loss of consciousness. World Health Organization estimates some 50 million people worldwide have epilepsy, where in many cultures people with the condition face stigma and discrimination. While epilepsy can be treated in most cases, WHO says as many as 30 percent of episodes do not respond to treatment.

Participants in the study, people with epilepsy and an Apple Watch, are asked to open the app when they first encounter an aura, or warning episode. EpiWatch then records the person’s heart rate and movements for 10 minutes, and asks participants to perform simple tasks to test their responsiveness. Participants complete a brief survey following the episode to describe the seizure, any loss of awareness, and possible triggers.

The Johns Hopkins team reports 598 individuals signed up as participants in the study, with 40 percent of the group recording 1,485 seizures for 10 months. Some 177 individuals reported on triggers for their episodes, with nearly 4 in 10 (37%) attributing their seizures to stress. Among those reporting stress as a trigger, individuals working full time are more likely to report this cause for their seizures (35%) than participants working part-time, unemployed, or disabled — 29 percent or less.

The other main seizure triggers reported are missed sleep (18%), menstruation (12%), and overexertion (11%). Diet, missed medications, and fever or infections were reported by less than 10 percent of participants. While missed medications account for a small percentage of triggers, participants age 25 and under are somewhat more likely to report this cause than older individuals.

“The data collected will help researchers better understand epilepsy, while helping people with epilepsy keep a more complete history of their seizures,” says Krauss in an American Academy of Neurology statement. “The app also provides helpful tracking of seizures, prescription medication use and drug side effects — activities that are important in helping people manage their condition.”

The authors conclude that mobile technology offers opportunities to collect clinical data like these in near real time, and provide better insights for patient care. “Our eventual goal,” adds Krauss, “is to be able to use wearable technology to predict an oncoming seizure. This could potentially save lives as well as give people with epilepsy more freedom.”

Krauss and colleague Nathan Crone tell more about EpiWatch and the study in the following video.

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