2013
Global Health Innovations
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The Team
Student team: Ting-Yu Lai, Adam Lightman, David Shin, and QX Yee
Clinical Advisors: John Sampson, MD, Department of Anesthesiology and Critical Care Medicine; Dr. Lynn Kanyuuru, Jhpiego Kenya and Dr. Kusum Thapa, Jhpiego Nepal
Sponsor: Jhpiego
Abstract
Oxygen is a critical, life saving medicine. It is used to manage childhood pneumonia, COPD, obstetric emergencies and is necessary for performing surgeries. Despite these facts, oxygen is generally not available below the district hospital level in the developing world. There are multiple technologies available for supplying patients with oxygen in the developing world, yet no technology has proven to be a sustainable solution for resource starved clinics.
Our team has analyzed oxygen delivery from the perspectives of technological solutions, business model innovations, and policy level efforts. Using this knowledge, we have devised a sustainable business model to improve the availability of concentrated oxygen in lower-level facilities in developing countries. In this model, local entrepreneurs purchase kits of affordable oxygen concentrators and bottling equipment and sell filled oxygen cylinders to health facilities within a catchment area. The model incentivizes equipment maintenance and simplifies distribution, common pitfalls of previous attempts to provide concentrated oxygen to lower-level facilities. When combined with a parallel effort by NGOs to promote oxygen demand, we project our model to create a sustainable enterprise while dramatically increasing the availability of oxygen.
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The Team
Student Team: Stephen Dria, Kaitlyn Harfmann, Christopher Lee, David Narrow
Clinical Advisors: Janine Bullard, MD, Department of Neonatology, JHU
Other Advisors: Helge Myklebust, Harshad Sanghvi, MD
Sponsors: Day of Birth Alliance (CBID, Jhpiego & Laerdal Global Health)
Abstract
Annually, there are over 4 million global neonatal deaths primarily occurring in resource-constrained environments. This accounts for over 38% of deaths in children under the age of five. When performed properly, neonatal resuscitation is an effective means to revive newborns that are unable to properly breathe. Statistics indicate that birth asphyxia accounts for 23% of all neonatal deaths. Additionally, another one million newborns suffer from permanent disabilities due to insufficient oxygen at time of birth. Effective newborn resuscitation alone can prevent millions of newborn deaths. Neonatal resuscitation requires the use of a ‘bag-valve-mask’ or BVM. The BVM channels ambient air from the atmosphere into a one-way valve, when the user compresses the bag-component. Gas is then expelled through the mask and into the trachea, bronchus and lungs of the infant. Due to the technical difficulties associated with the procedure, newborns that otherwise would have been resuscitated die because of ineffective equipment operation and improper technique—a function of the burden of training and skill retention. Thus, it is critical to reduce the amount of skill required for providing an effective and consistent resuscitation, especially in peripheral health care centers of the developing world.
Failed resuscitations are attributed to poor head positioning and an inadequate seal between the mask and the baby’s mouth. However, air is forcibly pushed into the lungs through ventilation only ;when proper mask seal and head positioning are addressed together. After significant research, chest rise is a variable that is most cost-effective to quantify successful resuscitation instantaneously. Thus, a tool to quantify lung expansion would be revolutionary to the resuscitation protocol, providing low-skilled health workers real-time feedback throughout the procedure. Our innovation will mitigate existing inadequacies attributed to constrained resources, diminished skill retention over time and difficulty using devices associated with resuscitation. Our technical solution quantifies chest expansion and guides the user through a proper resuscitation, improving the results of attempted resuscitations and successfully managing birth asphyxia.
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The Team
Sponsor: Jhpeigo and US AID/Saving Lives at Birth
Student Team: Dana Schultz, Hina Shah, James Su, Michelle Zwernemann, Vaishakhi Mayya
Abstract
Moderate to severe anemia is a major public health concern, particularly dangerous during pregnancy for both the mother and the baby. 100,000 maternal deaths and 600,000 neonatal deaths worldwide are attributable to anemia each year. The prevalence of anemia in the developing world is staggering, with estimates by the WHO of up to 50% among pregnant women and 65% among children.
There is a need for a device that can be used to widely and cheaply to screen for anemia. This device should enable identification of those at the highest risk, especially those with moderate-severe anemia in late gestation, in order to bring them “out of the cold” and into existing healthcare structures. Moreover, a device that is able to track patient data geographically and over time would facilitate macro-scale public health policy by enabling the targeting of health care initiatives to areas in need and by providing feedback on interventions. Such a device would have to be non-invasive and affordable.
Hemoglobe is a non-invasive anemia screening device that leverages the existing cell phone technology to provide a cost effective method for screening for anemia, while providing real time surveillance data about the status of the pregnant woman.
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The Team
Sponsors: Center for Tuberculosis Research Laboratory & Jhpiego
Clinical Advisors: Gyanu Lammichane, PhD & Yukari Manabe, MD – Center for TB Research; Stacie Stender, RN – Jhpiego
Student Team: Anjana Sinha, Hiren Mistry, Anmol Chopra, Hector Neira, Devin O’Brien-Coon
Abstract
Globally, only 60,000 of the estimated 310,000 new cases of Multi-Drug Resistant Tuberculosis (MDR- TB) are diagnosed. The situation is even more dismal in the 27 nations that account for 80% of MDR-TB cases, where less than 5% of patients receive an official diagnosis. MDR-TB diagnostics are typically available only at reference level facilities, two or three level above where patients actually seek treatment. Clinicians are therefore forced to “treat” these patients with highly ineffective drugs for at least six months, prior to modifying treatment. In the meantime, patients are likely to become increasingly resistant to treatment, and able to spread this airborne infection within their community. Progression of MDR-TB cases into extensively drug resistant (XDR-TB) cases is a major public health concern because XDR-TB strains are virtually untreatable. Our team is developing a self-contained assay comprising effective, yet inexpensive components, to bring the gold standard of care, culture-based diagnosis, to rural healthcare facilities. User-centric design is being employed to assure the final system enables minimally trained personnel to conduct MDR-TB testing safely, without sophisticated laboratory equipment. Expanding availability of MDR-TB diagnostics to rural health facilities will lead to adequate treatment for patients, while they are still responsive to available drugs.
U.S. Healthcare Innovations
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The Team
Student Team: Kaitlyn Harfmann, Ting-Yu Lai, Adam Lightman, David Narrow & Dr. Devin Coon
Clinical Advisers: Seth Goldstein and Ying-Wei Lum JHU SOM, Department of Surgery; Gedge Rosson, JHU SOM, Department of Plastic Surgery; Eduardo Rodriguez, University of Maryland/R. Adams Cowley Shock Trauma Center, Division of Plastic Surgery; Emad Boctor, JHU SOM, Department of Radiology; Jerry Prince, JHU Whiting, Department of Electrical and Computer Engineering
Technical Advisers: Drs. Soumyadipta Acharya, Emad Boctor, Jerry Prince & Youseph Yazdi
Abstract
Each year 50,000 patients in the U.S. alone will undergo free flap reconstruction, about 15% of whom will experience non-preventable vascular complications. These surgeries have the power to restore patients’ lives, yet too often they result in failure. If signs of a vascular flow problem are detected early, surgeons can repair the vessels before it is too late − thus, monitoring is pivotal to the success of these cases. However, half of these patients suffer from costly and morbid total flap failure due to inherent flaws in current monitoring devices, despite the fact that hospitals are paying hundreds to thousands of dollars to monitor each patient after surgery.
EchoSure has developed a novel monitoring technology with the power to prevent thousands of surgical failures and avoid unnecessary and expensive re-operations, while saving hospitals over $2,200 per surgery. Current competitors have high false positive rates, non-definitive outputs, and significant time delays to identify a problem; these factors lead to decreased surgical success, unnecessary procedures, and clinical frustrations. Our unique, clinically driven insight was that Doppler ultrasound was the ideal technology for monitoring — if it could be de-skilled so front-line clinicians could use it. The result was EchoSure, a dual-component system comprised of EchoMark and EchoFind. EchoMark is an implantable, resorbable marker placed beneath the vessels of interest, which acts as a homing beacon for nurses tasked with monitoring post-operative patients. EchoFind, a software application, is used to help guide users to the ideal position with the ultrasound at which point critical information about the vessel health is gathered and used to assess the patient. This technology will help save hospitals over $180M annually while decreasing unnecessary procedures and improving outcomes.
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The Team
Student Team: Christopher Lee, Dana Schultz, David Shin & Michelle Zwernemann
Clinical Advisors: Alan Schwartz, MD, Philip L. Smith, MD, Jason Kirkness, PhD and Hartmut Schneider, MD, PhD (Johns Hopkins Sleep Disorders Center)
Other Advisors: Susheel Patil, MD, PhD, JHU Sleep Disorders Center, Soumyadipta Acharya, MD, PhD
Abstract
39 million Americans suffer from sleep apnea (SA), a serious medical condition that causes people to periodically stop breathing during sleep. Established medical research has conclusively linked SA to many downstream clinical diseases such as heart disease, stroke, and cognitive atrophy. Economic analysts have estimated undiagnosed and untreated SA has an annual cost of $45–80 billion in medical costs and up to $165 billion in total downstream economic costs in the United States. Despite these serious consequences, approximately 2 out of 3 Americans with SA remain undiagnosed. SA diagnosis requires an overnight sleep study in a fully equipped and staffed sleep center. These studies comprehensively diagnose SA by monitoring up to 10 modes of physiologic data. However, this is not only expensive and uncomfortable for patients, but current sleep clinic infrastructure is unable to meet high patient demand. As a result, 26 million Americans suffering with SA remain undiagnosed.
To overcome the diagnostic bottleneck imposed by limited clinic test infrastructure, at-home sleep monitors have been introduced that allow patients to be screened from their own bedrooms. However, no home system exists that can be self-applied by patients to record all 10 necessary physiologic signals needed for a comprehensive diagnosis. As a result, home monitors have gained limited clinical adoption and represent only 2.5%. Our team is developing The Lyra, the first sleep apnea diagnosis system that effectively transitions sleep apnea diagnosis to the home setting. The Lyra integrates traditional sleep diagnostic technology and novel dry electrodes into comfortable, sleep-friendly form factors, a headset and chest strap, which record a complete dataset equivalent to an in-clinic sleep study.
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The Team
Student Team: Anjana Sinha, Hector Neira, Qing Xiang Yee, Vaishakhi Mayya
Clinical Advisors: James Shin and Ashley Cimino-Mathews, MD. Dept of Pathology Melissa Suzzane Camp, MD MPH, Johns Hopkins Breast Center
Abstract
Patients undergoing Breast Conserving Surgery (BCS) have a one in five chance of requiring a reoperation because surgeons cannot determine if the entire tumor has been removed. Surgeons rely on pathologists to assess margins through histological evaluation. Due to the inherent mechanical properties of breast tissue, this cannot be done before the surgery ends. ClearView allows pathologists to produce high-quality histology slides within minutes, enabling intra-operative assessment of tumor margins. This could prevent up to 66,000 unnecessary BCS procedures in the U.S. annually.
Using ClearView, a typical surgery will require $120 of disposables, covered by insurance companies under existing reimbursement codes. According to FDA regulations, ClearView is a Class I device, the lowest-risk device category. This affords a quick time to market, with minimal testing and regulatory requirements. Our team is collaborating closely with leading clinicians from the Johns Hopkins Breast Center, who are excited about our initial results.
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The Team
Student Team: Anmol Chopra, Hiren Mistry, Michael Batista, Hina Shah, James Su, Stephen Dria
Advisors: Inder Makin MD PhD, John Sperati MD, Robert Fitzgerald MD, Youseph Yazdi Ph.D MBA.,Ying-Wei Lum MD
Abstract
Hypertension, or high blood pressure, affects one-third of all Americans, increases the risk for heart disease, stroke and renal disease, and is directly associated with 350,000 American deaths annually. In the US, the annual cost attributable to hypertension is $250 billion in medical expenses. Currently, antihypertensive drugs are the only treatment. However, these therapies fail for 20% of hypertensive Americans that cannot control their blood pressure even when using multiple antihypertensive medications. These patients have a condition known as resistant hypertension. Two experimental device-based treatments have shown promise, but are currently in clinical trials: renal denervation (RDN) and baroreceptor stimulation (CBS). However, RDN excludes one third of patients and may damage the renal artery. Meanwhile, CBS requires the invasive implantation of a device and has failed safety endpoints due to severe procedural complications. Therefore, there is a need for a novel device-based treatment to help the millions with resistant hypertension.
The proportion of hypertensive Americans continues to grow and the market for device-based therapies for hypertension continues to expand. SympSolutions has developed AccuRIGHT, a novel device to treat resistant hypertension within a clinician’s office. The device utilizes the well established technology of high intensity focused ultrasound to noninvasively eliminate the carotid body, a central contributor to hypertension, without an operating room. In past animal and human trials, surgical removal of the carotid body has proven both safe and effective, creating reductions in pressure sufficient to restore normal blood pressure values in patients. In terms of development, initial feasibility animal trials have begun, ultrasound simulations have been performed to evaluate initial safety profiles, and a therapeutic ultrasound setup has been proven to generate lesions sufficient to eliminate the carotid body.
As this novel device avoids the shortcomings of other device-based treatments, patients will see improved health outcomes, health care providers will gain a new source of revenue, and the cost burden to the healthcare system will be reduced.
