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The ‘all hands on deck’ approach to medical device research at Cúram

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Sam Cox shines a spotlight on Cúram, the Science Foundation Ireland research centre developing life-changing medical devices.

Across scientific research, ‘transdisciplinarity’ has become a buzzword. It is no longer enough to remain statically in a single academic area without linking in with your peers and seeing how other systems interact.

This is particularly prominent in medicine. The human body is an interlinked series of systems, organs and mechanisms. Some of these interplays are well-understood. Our interventions for when they go wrong are often straightforward and effective. Other interactions still elude us.

This is what Cúram, the Science Foundation Ireland research centre for medical devices, tries to remedy. Hosted by NUI Galway, their smart medical device technologies aim to find creative solutions to complicated problems.

Life-altering decisions

Take, for instance, diabetes. One of the key problems with type 2 diabetes is hesitancy to take insulin injections. Dislike of needles, stigma around medication for life and fear of the unknown often lead people to delay taking insulin injections, impacting the severity of ultimate health outcomes. It is problems like these that Cúram tackles.

By reimagining delivery systems, such as slow-release tablets for oral ingestion, there is a concentrated effort at making real differences through clever technology. To do this, disciplines as diverse as engineering, materials science, biochemistry, medicine, and social science converge with academics, industry and clinicians. Creating solutions means advancement not only within these sectors, but for medical innovation.

Choosing which solution to pursue is a magnified Sophie’s choice in medicine. Some work is short-term with little doubt of its requirement. During the early stages of the Covid-19 pandemic, researchers were involved in optimising ventilators to allow more patients to be treated with the same number of devices. Other projects are longer-term. In its previous research cycle, the Galway-based Cúram centre was a panoply of cutting-edge ideas and solutions, with 244 separate potentially breakthrough projects on the go. Of these, 16 have been carried forward – those with the most chance of realising life-altering technologies.

To carry these projects out, teams of engineers, clinicians, patients and researchers are assembled. Academics and industry come together. All of these assets are co-ordinated to address specific problems, all with the goal of melding outside systems into the factory of the human body.

Prof Abhay Pandit, director of Cúram, explains that careful criteria were developed, and an external world-renowned board of clinicians, academics and industry was set up to evaluate “How can we get concepts to the patient and what can we do to facilitate that?”

To get to the patient, Cúram needs support from industry, as its ultimate goal is to make technologies widely available. While Cúram deals with a variety of medical ailments, it has divided its next stage of research into three broad domains: soft tissue, musculoskeletal-neural, and renal-cardiovascular-metabolic. But when the crux of the objective is to improve quality of life, how can projects be compared?

What can be compared is what stage the research is at. Pandit describes one project centred around a gel to alleviate pathological symptoms after a heart attack. While this is a blue-sky project that is four to six years from fruition, the studies conducted are very advanced – a metric that puts them at the front for funding.

Moving from project to prototype is the aim of the centre in its next funding phase, and a central motivation for the increased transdisciplinarity. It’s an all hands on deck approach to get results in the immediate future.

The balancing act

In the left atrium of the heart there is a sac called the left atrial appendage. “It has no anatomical function – it’s just an evolutionary hangover,” said Dr Martin O’Halloran, whose research tackles atrial fibrillation.

For some patients, the heart pumps inefficiently and blood gets trapped in this sac. If blood sits, it clots, and can get back into the bloodstream. If it travels to the brain, it can cause a stroke. Currently, patients undergo two open-heart surgeries to fix the problem – three hours to fix the electrical issue and a second three hours to fix the mechanical problem by putting in a plug. O’Halloran and industry partners are working on developing a device that can be implanted alongside the electrical fix to achieve both surgeries in one go, effectively halving the time undergoing high-risk surgery.

Another Cúram project involves using thermal therapy to treat high blood pressure (hypertension). Affecting more than 1bn people worldwide, 12 to 18pc of cases are caused by abnormal hormone-secreting tumours on the adrenal glands. Currently, the most effective cure is to take the gland out with surgery – a solution that works when one gland is affected, but not when it’s both. These patients require a drug that often carries nasty side effects while lacking the same effectiveness. O’Halloran and his team want to burn these tumours off, saving the healthy tissue and solving the problem.

‘This is for societal good, even if the commercial case isn’t fully there yet’
– DR MARTIN O’HALLORAN

After a few years working in academia as an engineer for medical devices, O’Halloran had become frustrated at the lack of research making its way to the clinic.

“I looked at groups nationally and internationally who were developing devices that made it to the clinic and the common denominator was in the groups where the project lead was a clinician, or groups that were physically located in a hospital,” he said.

This spurred the move of his engineering laboratory to the hospital, where the focus is always patient impact.

O’Halloran feels the strength of the Cúram is in allowing industry to come to the research centre with a problem, gaining access to a network of researchers that can tackle every aspect of that problem. Rather than trying to recruit a jack of all trades and master of none, Cúram has created a network where everyone knows the right person to go to. If industry can get access to universities, they get access to resources – and that’s when innovation becomes feasible.

According to O’Halloran, more than 90pc of the research is making incremental changes. It’s very hard to do disruptive research. “If you talk to medtech investors, you want a balanced portfolio. You want some incremental low-risk guaranteed to deliver, but you also want high-risk high-gain. In a way, I think the academic sector needs to do that. In my lab, if we went to a funder with a 10-year project, it’s a big ask to ask for funding. But if you prove yourself through smaller projects, you get a lot of credence and then they trust you on the more ambitious projects,” he said.

“We’re doing a project for blood pressure, and if you were to look at the commercial case, it’s not there yet. Loads of the pieces of the jigsaw are missing, because it is, at best, 10 years to fruition. But I love that, as an academic institution, we can look at that. This is for societal good, even if the commercial case isn’t fully there yet.”

This is where Cúram draws its strengths – not only from the interdisciplinarity of the fields within the centre, but its balance between industry and academia. Having worked in both, O’Halloran talks of the ‘rent-a-brain’ nature of consultancy work and being mined to solve a particular problem. Equally, academia often lacks the funding, or the practical applications needed to realise its conceptual ideas. He is clearly thriving in the balance.

Teaching new postdocs to navigate this borderline isn’t easy. “They’re used to answering questions thoroughly. You don’t give an answer until you know within a certain confidence interval that you’re correct,” said O’Halloran. Industry, on the other hand, wants the best guess at the present moment in time. It is about working on enough information to make the best next decision and having confidence that you will learn more and adjust accordingly as you go on. “Understanding that tension is really important,” added O’Halloran.

With more than 200 researchers trained within Cúram’s first research cycle, and 13 Innovative Training Networks specifically set up for its next phase, the centre is aiming to teach this interdisciplinarity as a language and navigate accordingly.

A blonde woman with wavy hair pictured against a dappled grey background.

Dr Karen Doyle. Image: Cúram/NUI Galway

Getting straight to the heart of the matter

In terms of a worldwide collaboration spanning countries and continents, we look to Dr Karen Doyle, who is at the epicentre of research into the cause of stroke.

Doyle is aiming to understand stroke at the level of composition. Blood clots can cause a blockage in the brain, leading to an ischemic stroke (versus a haemorrhagic stroke, which is caused by a rupture or tear in the blood vessel). Blockages can be caused by clots of all compositions. Yellow ones. Stringy ones. Ones filled with platelets or ones made of mainly red blood cells. Ones that can be removed in one go during a process called a thrombectomy, or ones that take repeated attempts. Some thrombectomies involve putting a stent retriever in and grabbing the clot, while others are sucked out through an aspiration device. There’s even recent evidence that some clots are caused specifically by Covid-19.

While strokes are distressingly common, affecting one in six men and one in five women globally, Doyle highlights how few forms of intervention have existed up until recently. Before the late 1990s, doctors were largely limited to providing care for the patient rather than any treatment. Then a drug called tissue plasminogen activator (tPA) was approved and some clots could be broken down, but only when they are fibrin-based (a tough, non-globular protein found in the blood).

With the advent of better imaging technology, it became increasingly possible to look into the brain and see what was going on in those suffering from strokes. In the mid-2000s, radiologists were able to see the vasculature of the brain and developed stent technology to reach clots. In fact, in 2015, Doyle explained, five seminal studies showed “without a shadow of a doubt” that feeding a medical device through the heart to reach the site of the clot and physically remove it is “hugely beneficial”.

These removed clots are now the samples that Doyle is collecting to build databases of clots in all their shapes and sizes from around the world. “When the clot is removed, we provide formalin pots to the hospital to collect the clot. We then courier the clots to our lab,” said Doyle. “The first thing we do is take a photograph. It’s amazing – even just studying the clots at that level, they look so different.”

After that, the clots are embedded into wax which gives them a stability to cut into thin slices of three micrometres, and tests are performed. Histology is first, where a stain called Martius Scarlet Blue is applied to reveal the microsocopic anatomy of the clot. Next is immunohistochemistry where an antibody is applied to selectively identify antigens in the cells, and in particular to look for the components that are related to aetiology. Finally, they use mass spectrometry to glean whatever further information is possible.

“For the Restore registry, we have Beaumont [Hospital in Dublin], but we also get clots sent to us from Gothenburg in Sweden, Budapest in Hungary and Athens in Greece,” she said. “We’re seeing similar findings to North American clots. However, Japan is an interesting new development. There is evidence that there is difference in an Asian population. Their diet is considerably different.”

Where O’Halloran focused on what Cúram could provide industry partners, Doyle highlights the close relationship with clinicians. In her case, the surgeons and doctors who are removing the clots and sending them samples. With more than 1,000 patients sampled, her team hopes to provide the groundwork that will eventually lead to industry design and, more immediately, a clinical understanding for their procedural approach. While they have industry partners, their publications and conference speakers make their discoveries known to all in the scientific community.

Doyle hammers home what Pandit had also made clear: that for all of Cúram’s projects, the central message is ‘we are ready to work with you on this’ and to tie all of the strands together for the sake of the patient.

This is what transdisciplinarity means for Cúram. Realising change for those affected when the interplay of bodily systems goes awry.

By Sam Cox

Sam Cox was named the science and technology winner in the 2020 National Student Media Awards (Smedias). This award category is sponsored by Science Foundation Ireland and includes a €1,000 bursary to support and encourage up-and-coming science and technology journalism.

The 2021 Smedias are now open for entries. The deadline for applications is 15 April 2021.

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UK mulls making MSPs subject to mandatory security standards • The Register

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Small and medium-sized managed service providers (MSPs) could find themselves subject to the Network and Information Systems Regulations under government plans to tighten cybersecurity laws – and have got three months to object to the tax hikes that will follow.

Plans to amend the EU-derived Network and Information Systems Regulations (NIS) are more likely than ever to see SMEs brought into scope, as The Register reported last year when these plans were first floated.

NIS is the main law controlling security practices in the UK today. Currently a straight copy of the EU NIS Directive, one of the benefits of Brexit leapt upon by the Department for Digital, Culture, Media and Sport (DCMS) is the new ability to amend NIS’s reporting thresholds.

Bringing MSPs under NIS “would provide a baseline for expected cybersecurity provision and better protect the UK economy and critical national infrastructure from cyber security threats,” as UK.gov said in a consultation document issued on Wednesday. Its plans are for MSPs, currently not subject to NIS, to be brought into the fold. This includes defining what an MSP does, legally, and possibly ending NIS’ existing exemption on SMEs.

“The government recognises the strong need to minimise regulatory burden on small and micro-businesses particularly in a rapidly evolving industry such as this. However, recent incidents have highlighted the scale of risk that can be associated with managed service providers – regardless of their size,” said the consultation document.

In essence, if an “operator of essential services” or a critical national infrastructure business outsources something to your MSP, prepare for NIS compliance.

And the flip side: money

Enforcement of NIS is carried out by the ICO, which is getting a funding bonus if Parliament nods through the NIS amendments. Initially coming from general taxation, in time DCMS wants to “extend the existing cost recovery provisions to allow regulators (for example, Ofcom, Ofgem, and the ICO) to recover the entirety of reasonable implementation costs from the companies that they regulate.”

SMEs across the whole British economy are already familiar with this kind of “cost recovery” activity through stealth taxes such as the ICO’s data protection registration fee.

Andy Kays, chief exec of a managed detection and response firm in London called Socura, agreed that “further market intervention is required to help raise the bar to protect the UK economy.”

“However,” he added, “I do believe that interventions like Cyber Essentials, GDPR and NIS have raised the profile of cyber and data security in the UK, and have improved understanding and investment where they are applicable among businesses.”

Jake Moore, global cybersecurity advisor with Slovakian infosec firm ESET, also agreed, saying in a statement: “Essential services are desperately in need of better protection so these new laws will help direct businesses into a more secure offering with the help and direction required. Laws often may seem like they do not go far enough but digital crime is fast paced and the goal posts constantly move making such plans difficult to project or even become out of date by the time they land.”

The consultation closes on 22 April. As well as questions about money, DCMS is also asking about whether the regs should be extended to SMEs and how detailed they ought to be. Have your say via theses 66 pre-formatted questions. ®

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7 early-stage start-ups NDRC is accelerating in 2022

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The first cohort of the NDRC accelerator by Dogpatch Labs has four female co-founded start-ups and two international ones.

After taking over the NDRC accelerator from the Government in 2020, Dogpatch Labs gave it a makeover and launched its first cohort of 11 early-stage start-ups last year.

This year, they are running two accelerators with two separate cohorts and increasing the total number of participating start-ups from 11 to 14. The first cohort, H1, has a total of seven start-ups – four of which have female co-founders.

Announced yesterday (19 January), the first cohort also has two regional start-ups and two international start-ups co-founded by Irish CEOs who graduated from top international talent accelerators Antler and Entrepreneur First.

Here we list NDRC’s first cohort of seven early-stage start-ups in 2022 representing the next generation of Ireland’s start-up ecosystem who are gearing up for Demo Day on 7 April.

Image: Dogpatch Labs

Filter

This start-up helps patients with breathing difficulties such as asthma or chronic obstructive pulmonary disease (COPD) to monitor their health. A device called Filter can be used by patients in conjunction with an AI-powered digital health coach called Kos to track their respiratory health and get alerts when something’s wrong.

Filter was founded in 2020 by Andrew Gallagher and Stephen Keenan, both University College Dublin alums. Gallagher, who is the chief technology officer, is an engineer by profession, while Keenan has a background in both law and computer science.

GreyScout

GreyScout offers a business tool for companies that want to protect their brand against intellectual property (IP) infringements and counterfeits. The start-up’s product scans across online domains including marketplaces, search engines, websites, social media channels and web forums to identify and remove policy violations and unauthorised content, alerting clients in real time.

On a mission to ‘democratise IP protection’, GreyScout was founded in 2019 by chief executive John Killian and chief technology officer Chris McCauley.

Herd

This start-up has built a novel social platform for sports fans to discuss live matches with friends and make predictions on the outcome. In a game-like interface, users have to compete against each other in guessing next moves of sports payers and the winning side – enriching the virtual live entertainment experience.

Herd was co-founded by Jack Cantillon, who is the chief executive, and Robert Minford, who is the chief technology officer. A qualified lawyer in New York, Ireland and the UK, Cantillon was featured in Sports for Business 30 Under 30 in 2020.

Jama AI

Jama is a start-up that uses natural language processing to help B2B sales reps with communication intelligence and analytics. The platform is a one-stop-shop for all the messaging channels used by sales reps, such as WhatsApp, WeChat and Line, to make customer relationship management simpler and win more deals.

It was co-founded by Kerry-based Aisling Hayes, who is the chief executive of Jama with prior experience in founding and running start-ups in Ireland. Jama graduated from the global accelerator by Antler, an early-stage VC firm based in Singapore.

Öogo

This Dublin-founded start-up connects people who need childcare with those who are looking to provide it. Childcare providers called Minders who can be booked to offer a wide range of services including online tutoring, baby-sitting and maternity nursing.

With changes in the nature of work for many parents because of remote and hybrid work, Öogo hopes to act as a Tinder for childcare, making it simple. It was founded in 2019 by Kate Clark, who worked in sales in New York for five years before starting the business.

Squid

Squid aims to promote customer loyalty towards businesses by incentivising buy from them through loyalty cards. By partnering with Squid, brands can ask their customers to download the Squid app and get rewards for purchases. And additional business portal helps brands get customer insights and track customer loyalty.

The start-up also helps businesses get discovered on their app through a marketplace where they can advertise special offer and sell vouchers to their community. Squid was co-founded by Katie Farrell and Matthew Coffey

Upskill Marketplace

This online platform helps the HR and learning & development teams of businesses to connect with soft skills trainers and professional coaches. It aims to make the process of finding trainers simpler through its online portal that has all details, including pricing, listed upfront. Trainers with Upskill go through a selection process before listing, and user reviews help businesses determine who to book.

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Microsoft’s Activision merger faces real-world barriers to metaverse mission | Microsoft

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If the world of Call of Duty seems fraught enough when you are playing it, try being in it. That could be the consequence of Microsoft’s proposed $68.7bn (£50.4bn) acquisition of Activision Blizzard, the video games maker behind the shoot ’em up franchise. Announcing the deal, Satya Nadella, Microsoft’s chief executive, said that gaming would “play a key role in the development of metaverse platforms”.

The metaverse is a catch-all term for an immersive experience that blends the physical and digital worlds through a mixture of virtual and augmented reality. This concept is years away from being fully realised, but it is envisaged that participants – using digital representations of themselves, or avatars – will access it through a virtual reality headset, or augmented reality (AR) glasses that put a digital layer over what they see in the real world. In the metaverse they can socialise with friends, carry out their job – or take part in a video game.

John Egan, chief executive of market intelligence firm L’Atelier BNP Paribas, says that with the Activision deal Microsoft has made it “very clear” that gaming will be at the centre of how metaverse concepts work. And it is not just using the games, but also deploying the creative and technical talent behind them to build virtual worlds.

“Imagine Call of Duty. You’d be dropped into a Battle Royale-like environment, on to a planet like the way Fortnite is now, though bigger by a factor of several thousand. You’ve got an entire planet, so your experience can go on for weeks at a time.”

employees with placards
Activision Blizzard employees hold a walkout to call for changes in conditions for women and other groups at the company in Irvine, California in July 2021. Photograph: David McNew/AFP/Getty Images

Egan adds that Call of Duty would work in what he calls a “digi-physical” environment, where AR comes in to play and the game is superimposed on participants’ glasses, or even contact lenses.

“Microsoft could create virtual layers over existing urban infrastructure, within which people can use mixed reality lenses, like glasses or contact lenses, to interact with each other. So imagine something like a skateboard park that becomes a Call of Duty arena. And people use their phones as a gun, and they’ve got their glassware on as the mixed reality infrastructure to do that interaction.”

Of course, not every metaverse world will be like Call of Duty – and not everyone would want to go anywhere near it. Egan says Activision games such as Crash Bandicoot, featuring the antics of an anthropomorphic marsupial, offer a more family-friendly alternative.

Analysts have also pointed to the fact that Activision will immediately bolster Microsoft’s gaming business – it owns the Xbox platform and the Minecraft and Halo franchises – regardless of its metaverse plans. The Bill Gates-founded company will gain access to 390 million monthly users, adding to its Game Pass subscription service, which already has 25 million users.

Dan Ives, a managing director at the US investment firm Wedbush Securities, describes Microsoft’s metaverse vision for the deal as “the cherry on top of the sundae”.

“We believe for Microsoft this was the right deal at the right time to boost its gaming strategy and streaming ambitions. Nadella recognised Microsoft’s consumer business needed a shot in the arm,” he says.

The agreed deal would also need to get past US regulators, who served notice on Tuesday that the tech industry would face a tougher regime. Lina Khan, chair of the Federal Trade Commission, the US competition watchdog, and Jonathan Kanter, head of antitrust at the department of justice, announced a review of merger guidelines – with tech among their areas of concern. Kanter said: “We need to understand why so many industries have too few competitors.”

Fallen heroes of war billboards promote the launch of Activision’s Call of Duty: Vanguard in Shoreditch, London, in November 2021.
Fallen heroes of war billboards promote the launch of Activision’s Call of Duty: Vanguard in Shoreditch, London, in November 2021. Photograph: Neil P Mockford/Getty Images for Activision: Call of Duty

It could be argued that this is a “vertical” deal between two businesses that do not compete directly: Microsoft’s Xbox platform and Activision’s games. But regulators are likely to look at whether Microsoft could shut off Activision titles from rival platforms such as PlayStation. Microsoft said on Tuesday it did not intend to “pull communities away” from PlayStation.

Rebecca Allensworth, professor of law at Vanderbilt University in Nashville, Tennessee, says Khan and Kanter’s review signals a toughening of the environment for tech.

“Generally, there is a lot of muscle right now behind antitrust enforcement in tech,” she says. “Changing the merger guidelines to be harsher against tech mergers is a part of that. The comments on Tuesday highlighted the idea that the guidelines need to be able to recognise competitive harm from mergers that are vertical or mixed vertical. That’s the merger between Activision and Microsoft.” Nonetheless, she says that it is “still very hard to challenge vertical mergers” and the deal may go through.

However, L’Atelier’s Egan added that even if the deal got past the FTC and justice department, there was also the question of integration. On Monday Activision said it had fired or pushed out more than three dozen employees and disciplined another 40 since July, to address allegations of sexual harassment and other misconduct at the company, which has nearly 10,000 employees to Microsoft’s 190,000.

“Microsoft has an extraordinarily high level of employee satisfaction,” says Egan. “It’s a really good company. You wonder if one of the biggest threats of this is Microsoft kind of letting the wolf in the door. How are Microsoft going to assimilate an organisation with a culture that is beset by issues to do with misogyny, diversity and harassment over the last number of years which they have failed utterly to remedy? How are Microsoft going to resolve that?”

Should the deal go through, Microsoft will have real-world concerns too.

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