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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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Johnson & Johnson Ireland moves to 100pc renewable electricity

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The move comes following a power purchase agreement between Johnson & Johnson and Ørsted, which has windfarm sites in Clare and Kerry.

Johnson & Johnson has revealed plans to move to 100pc renewable electricity across its Irish operations.

The company has entered into an eight-year corporate power purchase agreement in Ireland with Danish company Ørsted. The agreement will help to ensure that the company’s entire Irish operations will be powered by electricity from 100pc renewable sources from now on.

Ørsted will supply the company with more than 1TWh of renewable energy during this period from two windfarms located in Kerry and Clare. The agreement will also help Ørsted as it invests in its strategy to construct more renewable generation in the future.

Taoiseach Micheál Martin, TD, praised the move in the context of Ireland’s climate action plans.

“Johnson & Johnson has embraced its environmental responsibilities globally, but also here in Ireland, and this agreement will help the company to achieve its wider climate goals. We are at a crucial point in the global fight against climate change and initiatives like this should become the benchmark for all companies to aspire to,” he said.

Towards net zero

Last year, Johnson & Johnson’s worldwide VP of environmental health, safety and sustainability, Paulette Frank, spoke at Silicon Republic’s Future Human event about the company’s “bold” climate goals. From her base in the US, Frank told attendees of the virtual event that her colleagues viewed the pandemic as “inspiration to propel” its climate action “further faster.”

Sourcing electricity from 100pc renewable sources is a goal the company set to achieve by 2025. By 2030, it wants to achieve carbon neutrality in its global operations.

John Lynch, plant leader at Johnson & Johnson Vision Care Ireland, said the company was proud to have met its targets in its Irish operations.

“Across our 10 sites and workforce of more than 5,000 here in Ireland, we are committed to supporting Johnson & Johnson’s climate action goals. In the last decade we have invested more than €60m in over 80 carbon footprint reduction projects.

“Today is a major landmark on our journey in Ireland to achieve net zero carbon emissions by 2030 and underlines our commitment to ensuring a better, healthier world.”

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‘At once intolerable and addictive’: five wellbeing courses and apps, road-tested | Health & wellbeing

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Australians are the world’s biggest consumers of health and wellness apps, punching well above our per capita weight in our quest for peak physical and mental condition, according to research from telecommunications company Uswitch. In recent years we have also been making them – with everyone from fitness influencers to mental health advocacy groups launching digital products.

I’m partial to a bit of mobile-based movement and mindfulness myself, but I have a complex relationship with wellness. While I love green juices, pilates and my “ness” being “well”, I can’t abide many contemporary uses of the word. In the diet, fitness, fashion and other industries, “wellness” can feel like a barely repackaged “weight loss”, while “healthy” has replaced “slim” as companies respond superficially to the body positivity movement without really changing their ways.

Despite wholesome beginnings in the 1950s, wellness is often framed as a goal for the financially and genetically privileged – and don’t get me started on the pseudoscience.

So I choose cautious cynicism when engaging with wellness and wellbeing products – but I’ve also been alone in my house for the greater part of two years, so I’ll try pretty much anything.

Sweat

Cost: $19.99 a month

Screen shot of the Sweat app from Kayla Itsines.

Sweat is a women’s health app co-founded by Australian fitness influencer Kayla Itsines, who boasts a worldwide social media following of more than 40 million. It offers over 30 programs for training at home or the gym, including high-intensity interval training (Hiit), low-intensity training, yoga and barre.

I did sessions from the PWR Zero Equipment program and it was all easy to follow and very doable. Audio and written instructions and onscreen demonstrations are clear, and self-accountability is super easy. It’s perfect for lockdown and for busy people cramming in exercise wherever and whenever they can. Plus, I can report that burpees are still the merciless work of Satan herself.

Itsines has created an app that exists in the wellness space with little of the self-congratulatory, quasi-spiritual hoopla other influencers lean so heavily into. Sweat isn’t pretending to be something it’s not. It’s a workout app, you do workouts on it. Yes, there are recipes and lifestyle tips but they aren’t offered as miracle pathways to a higher plane of being.

Is it my preferred mode of exercise? No. But it’s convenient and flexible and I can see myself using it when I travel. If that’s a thing that ever happens again.

Worry Time

Cost: Free

ReachOut’s WorryTime app
ReachOut’s WorryTime app. Photograph: Reach Out

ReachOut’s WorryTime is an anxiety management app from the online youth mental health service that uses cognitive behavioural therapy (CBT) techniques to disrupt and manage repetitive thinking.

I am by no definition a youth, but I have mild anxiety and WorryTime’s methodology appealed to me. You nominate a daily time to do all your worrying and when you feel anxious, you note why in the app; every day at the designated time, you worry about what’s still plaguing you and delete what’s not. Easy!

I used WorryTime diligently for a while, noting my fears, my troubles and doubts and reassessing them every 24 hours. All was going well until I got busy with work, stressed about work and scared I’d stop getting work. Where the app had been a welcome task, it became a bugbear.

I was trying not to think about things that made me anxious and knowing the app contained a list of them created a classic avoidance paradigm. I skipped a day. And the next day. And the day after that. Soon the WorryTime alarm was causing me the very anxiety it was engaged to minimise. After a few weeks of this mental chicken-egg dance, I deleted the app. I may have been in the foetal position at the time.

I’m not advocating against WorryTime. It could be a great tool for others. There are no one-size-fits-all mental health salves. It would be nice if there were though.

Bibliotherapy with State Library Victoria

Cost: Free

Dr Susan McLaine, host of State Library Victoria’s Bibliotherapy podcast
Dr Susan McLaine, host of State Library Victoria’s Bibliotherapy podcast. Photograph: Supplied

My favourite discovery from this whole exercise is bibliotherapy or book therapy, an age-old practice that uses literature to support better mental health and wellbeing. Basically, you read or are read aloud a prescribed text, specifically chosen to raise questions, uncover truths and encourage healing. It’s also fun to say.

In response to the pandemic, a new podcast called Bibliotherapy with State Library Victoria was launched. Hosted by bibliotherapy practitioner Dr Susan McLaine, it offers to help people “stay calmer in this fragile time”. In each episode, McLaine reads a short story and a poem and poses questions for listeners. Texts range from emerging and obscure writers to Tolstoy, Donne and Kipling.

I love this podcast. There’s something so intimate and soothing about being read to, no doubt embedded in childhood nostalgia. McLaine’s voice takes some getting used to, though to be fair I find this with most podcast hosts, but her choice of texts is excellent and she reads everything slowly and deliberately, “savouring every word and offering space between words”. It’s the closest thing to a hug I’ve had in months.

The only bad thing about it is that there are only two short seasons. After a brief search for similarly soporific, story-based podcasts and apps, I found the excellent Dreamy podcast, a collection of beautiful sleep stories by First Nations storytellers like Jazz Money and Aurora Liddle-Christie. Bringing tens of thousands of years of oral tradition into the digital world, Dreamy is “helping people of all walks of life to quiet their minds, drift into dreams, and disconnect from their devices”.

I also found Sleep Stories on the Calm app ($14.99 a month). It’s full of grown-up tales and mindful nonsense to soothe or bore you into slumber. There are even equally terrible and amazing celebrity cameos: Matthew McConaughey, Cillian Murphy and the hot duke from Bridgerton will read to you like you’re a child. Last night Harry Styles read me the worst poem I’ve ever heard – for 40 minutes. Five stars. Would listen again.

The Resilience Project

Price: $4.49 one time fee

The Resilience Project Wellbeing App.
Photograph: Supplied

The Resilience Project app is a “daily wellbeing journal” for all ages from a Melbourne-based organisation of the same name, providing evidence-based mental health strategies and “sharing the benefits of gratitude, empathy and mindfulness” to schools, sports clubs and businesses.

Users are encouraged to log on every day, note how they feel, record who or what they’re grateful for, perform acts of kindness and do a short guided meditation. This nice daily ritual only takes a few minutes but proves a small antidote to the current news cycle.

I don’t see myself using it long-term, because of repetitiveness and the world’s shortest attention span, but during this lockdown I’ve appreciated the nightly reminder to acknowledge my blessings and privilege and to reach out to friends.

Though it can’t do the heavy lifting where mental health is concerned, I’ll put it in my arsenal of chronic depression coping mechanisms, and try to use it in bad times. It won’t soothe what only drugs and Great British Bake Off can, but it might provide a few minutes respite.

The Class

Cost: $40 a month

The Class Digital Studio is a mat-based exercise program, with elements of yoga, pilates, cardio, free-style dance, expansion, and release.
The Class Digital Studio is a mat-based exercise program, with elements of yoga, pilates, cardio, free-style dance, expansion, and release. Photograph: The Class Digital Studio

The Class is an American exercise methodology-slash-mindfulness practice with semi-cult vibes, taught by a host of ridiculously hot and relentlessly cool twentysomethings who can pull off white Lycra and blend in on a Girls set.

In fortuitous timing, founder Taryn Toomey launched online classes in late 2019, taking the Class into locked down homes around the world from 2020. Australians can access a wide selection of on-demand and live online classes, and there’s even an Australian teacher. Timezone differences narrow live options quite a bit, but most live classes become on-demand classes, so it doesn’t really matter.

Frequented by celebrities including Alicia Keys, Naomi Watts and Emma Stone, the Class is a mat-based, music-driven “cathartic workout experience” designed to “strengthen the body and balance the mind”. It’s yoga meets Les Mills meets clubbing. Movements are simple, repetition is key and loud exhales are encouraged. You may do squats for a whole song, free dance for another and star jumps for the next. In between, there’s stillness.

Teachers speak a kind of motivational psychobabble that is at once intolerable and addictive. It verges on the spiritual and flirts with cultural appropriation but remains just secular enough that I don’t turn it off. “Be in your power”; “You are enough”; “Softness is your birthright” and so on. Many teachers end their sessions with “I love you” which I somehow don’t hate.

At first, I struggled to put aside my prejudices against self-indulgent, pseudo-mystical wellness fads and find peace with beautiful women telling me to accept myself while making me do burpees. But the more I did it, the more I was able to just let go and roll with the theatre. Plus, it’s actually a very good workout.

I am now willingly paying for the Class. Let’s never speak of this again. I love you.

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NFTs not annoying enough? Now they come with wallet-emptying malware • The Register

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In brief Whether or not non-fungible tokens are a flash in the pan or forever, malware operators have been keen to weaponise the technology.

An investigation was triggered after a number of cryptowallets belonging to customers of the largest NFT exchange OpenSea got mysteriously emptied. Researchers at security shop Check Point found a nasty form of NFT was in circulation, one that came with its own malware package.

People were receiving free NFTs from an unknown benefactor, but when they accepted the gift the attackers got access to their wallet information in OpenSea’s storage systems. The code generated a pop-up, that if clicked, allowed wallets to be emptied.

After disclosing the issue Opensea had a fix sorted within an hour – we wish others took such prompt action – and the platform appears to be secured. But beware of “free” gifts, particularly where money is involved.

Crime doesn’t pay? really?

A US Treasury report has said that in the last three years ransomware operators using over 60 different variants have siphoned off $5.3bn in Bitcoin payments.

The Financial Crimes Enforcement Network report [PDF], first spotted by The Record, said that the ransoms taken in the the first six months of this year amounted to $590m, up from $416m for 2020, and the problem is getting worse, according to ten years of 2,184 Suspicious Activity Reports (SARs) analysed by the agency.

“If current trends continue, SARs filed in 2021 are projected to have a higher ransomware-related transaction value than SARs filed in the previous 10 years combined, which would represent a continuing trend of substantial increases in reported year-over-year ransomware activity,” the Treasury team warned.

Arming robots with sniper rifles, not worrying at all

US-based Ghost Robotics showed off an unusual new gadget this week at a meeting of the Association of the United States Army – a sniper rifle robot.

The robotics firm already has unarmed robot dogs acting as sentries at Tyndall Air Force Base but mounted a 6.5mm sniper rifle with a range of up to 1,200 meters (3937 feet) with both day and night vision cameras. The manufacturers were at pains to point out that this is not autonomous in any way and a human always controls the trigger, the robot just gets into position to keep its human operator safe.

The robot caused something of a storm, and Ghost Robotics CEO Jiren Parikh attributed this to the emotional connection robot dogs evoke and decades of movies about killer robots.

US warns critical water systems under attack

American online watchdogs at the Cybersecurity and Infrastructure Security Agency has issued a security advisory following a spate of attacks against water and waste management facilities.

Since 2019 CISA said it had recorded five attacks against water systems, mostly ransomware but also aa former employee at Kansas-based water company who tried to tamper with drink water quality using credentials that should have been revoked when they left the biz.

For ransomware operators such businesses are tempting targets. Since water is such an essential service, it’s no-doubt thought that they’d be more likely to pay up rather than cause widespread disruption and panic.

Ukrainian cops cuff botnet suspect

The Security Service of Ukraine announced this week that they had arrested a man accused of running a massive botnet and charging for its use.

The man, a resident of Ivano-Frankivsk region in the west of the country, is said to have been running a botnet made up of over 100,000 infected systems. His opsec wasn’t great, he used telegram to tout for customers and, police say, made use of “electronic payment systems banned in Ukraine.”

A search of the suspect’s premises revealed computer equipment used to operate the botnet, and data stolen from botnet participants. Police say the suspect was also a representative of legitimate Russian payment service Webmoney, which is however under sanctions from the Ukrainian government.

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