2020

Graduate

  • THE TEAM

    Student Team: Brooke Hayley, Niranjanaa Jeeva, Disha Mankodi, Natsuha Omori, Shayan Roychoudhury, Noah Yang

    Advisors:Kunal Parikh, PhD; Soumyadipta Acharya, MD, PhD; R. D. Ravindran, DO; R. Kim, DO; Chitaranjan Misra, DO; Pradeep Ramulu, MD, PhD; David Green; Namratha Potharaj

    ABSTRACT

    Around the world, the prevalence of diabetes is increasing at staggering rates. Over 422 million individuals are struggling with this condition and its comorbidities globally, and this number is projected to increase to 642 million by 2040. The burden of diabetes disproportionately affects low and middle-income countries (LMIC) because of major challenges in healthcare infrastructure. In India, there are over 70 million diabetic patients and this number is rapidly increasing.  One manifestation of diabetes is diabetic macular edema (DME), the fluid build-up in the back of the eye caused by the leakage of highly permeable retinal blood vessels characteristic of diabetic patients. This condition causes visual impairment in 31 million people worldwide. Many patients with DME are prescribed monthly intravitreal injections. However, while visiting Aravind Eye Hospital, the world’s largest high-volume eye care system, our team saw that on average patients were only receiving two injections per eye per year. Many patients are not able to receive the prescribed monthly injections because of the recurring cost of the medication and travel required. Thus, patients need an effective, long-lasting treatment for diabetic macular edema in order to impede disease progression and prevent vision loss. Oculy meets this need with our device, an ocular implant that slowly releases medication to the back of the eye over an extended period of time, thus improving clinical outcomes for patients who cannot visit the hospital as frequently. Oculy reduces preventable blindness by increasing access to treatment for chronic eye diseases globally.

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  • THE TEAM

    Student Team: Brooke Hayley, Niranjanaa Jeeva, Disha Makodi, Natsuha Omori, Shayan Roychoudhury, Noah Yang

    Advisors: Clifford R. Weiss, MD; Youseph Yazdi, PhD; Ami Kumordzie, MiKaela Olsen

    ABSTRACT

    Over five million central venous catheters (CVC) are inserted in the United States every year, to allow direct delivery of medication into the blood. Up to 15% of these catheters can become occluded, often due to blood clots clogging the lumen of the catheter. Once occlusions are detected, they must be cleared immediately to prevent downstream complications. These clots can delay treatment and become an incubator for bacteria, increasing the risk for Central Line-Associated Bloodstream Infection (CLABSI), which leads to 28,000 deaths in the US per year. Patients with occluded catheters are nearly three times more likely to develop CLABSI. In the hospital, inpatients with occlusions are treated with time-consuming and expensive declotting agents If the occlusion is not treatable with the agent, patients must have their CVC replaced, increasing their length of stay at the hospital. To prevent catheters from getting occluded, the gold standard as stated in the Infusion Nurse Society policy is to flush the catheter with saline using a start-stop method, where 10 short boluses of 1 mL are delivered with a syringe, interrupted by brief pauses. Several studies have shown that pulsatile flushing is at least twice as effective in clearing the inside of the catheter. However, interviews and observations at the Johns Hopkins Medical Institute have revealed that nurse compliance with pulsatile flushing is as low as 6%. Therefore, nurses need an easier and quicker way to introduce pulsatile flow in lines in order to prevent thrombotic occlusion of central venous catheters. RevIVe presents PulseFlush, a disposable syringe that makes sure that the gold standard of flushing is met, regardless of how busy or experienced the nurse is. Nurses can push the syringe continuously, while the device creates the pulsatile flow profile. Consistent pulsatile flushing will break up any debris inside the catheter, preventing clots from forming and bacteria from growing inside. Nurses no longer have to actively push and pause the plunger of the syringe, making it easier for them to comply with the standard of care.

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  • THE TEAM

    Student Team: Alina Andrews, David Maher, Elizabeth Russo, Madeline Wartan, David Zarrin

    Advisors: David Hackam, MD; May Chen, MD; Mark Kovler, MD; Emily Dunn, MD; Youseph Yazdi, PhD; Soumyadipta Acharya, PhD; Aditya Polsani, MS; Joshua de Souza, MSE; Medtronic, Minimally Invasive Therapies Group (Boulder, CO)

    ABSTRACT

    Necrotizing Enterocolitis (NEC) is an inflammatory disease that causes bowel necrosis in premature infants. It is the number one cause of death in infants weighing less than 1500 grams and the number one surgical emergency among all patients in the Neonatal Intensive Care Unit (NICU). 380,000 infants are born prematurely annually, with over 90,000 at elevated risk for developing NEC. This disease can onset acutely and severely, causing seemingly healthy infants to undergo surgery within 24 to 48 hours. Current diagnostic methods, which include physical examinations and abdominal X-rays, are not sensitive and specific enough to facilitate early detection of NEC. Physical examinations consist of manual abdominal girth measurements and auscultation. These assessments are both subjective and infrequent, as they occur every three to four hours. X-ray, the diagnostic gold standard, is only effective at diagnosing late-stage NEC. These limitations result in a large percentage of the 5,400 infants diagnosed with definite NEC each year to require surgical intervention since medical treatment was initiated too late. Surgical intervention carries a 30% mortality rate that results in over 800 infants dying each year. Our solution for earlier NEC detection is a novel four-quadrant abdominal patch sending output data to an algorithm that is capable of objectively and continuously monitoring the earliest physiological and clinical indicators of the disease: reduced bowel sounds and altered gut perfusion. This proprietary algorithm will continuously isolate bowel sounds from ambient and environmental noise in neonatal critical care settings to estimate gastrointestinal motility levels. A separate algorithm will analyze temporal perfusion changes by trending regional oxygen saturation (rSO2) values in real-time. In combination, these objective metrics of gut perfusion and gastrointestinal motility will guide medical management of neonates. Integrating NEC Check into the current standard of care for this patient population can quickly alert providers of changes in abdominal health.

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  • THE TEAM

    Student Team: Alina Andrews, David Maher, Elizabeth Russo, Madeline Wartan, David Zarrin

    Advisors: Jake Abernathy, MD; Akbar Herekar, MD; Sarah Coppola, PhD; Prashanth Reddy, MBBS; Naresh Pagidimarry, MS; Youseph Yazdi, PhD; Soumyadipta Acharya, PhD; Aditya Polsani, MS; Joshua de Souza, MSE; Medtronic, Minimally Invasive Therapies Group (Boulder, CO)

    ABSTRACT

    In a study of global access to surgical care, the Lancet Commission found that more than 4.8 billion people in the world do not have access to surgery. In India, this results in 90% of the population lacking access to safe surgical care. In order to achieve safe, affordable, and timely surgical care, patients also need access to reliable anesthesia care. Urban hospitals in India often deal with high patient volume which limits the amount of attention each anesthetist can reasonably give each patient. Accordingly, physician attention is a limited resource in these clinical settings. Maintaining a patent airway is essential for adequate oxygenation and remains a significant demand for the attention of the anesthesia team on a daily basis. Failure to maintain a patent airway can be life-threatening to patients. Glossoptosis is the downward displacement of the tongue that is often caused by loss of muscle tone. This complication often presents when escalating sedatives are administered to comfort patients during cases using regional anesthesia and can lead to complete obstruction of the upper airway. The primary clinical response involves three, two-handed maneuvers performed by the anesthetist: head elevation, chin lift, and jaw thrust. Although this approach effectively maintains the patency of the airway, it does not allow the provider to attend to other responsibilities until the risk of airway compromise is alleviated. In some cases, after five to 10 minutes of performing the jaw thrust, anesthetists will elect to intubate the patient and transfer to general anesthesia. Our solution to relieve this burden on anesthesia providers is a medical device that can keep the patient in the jaw thrust position. Although competitors in this space focus on replicating one of the three maneuvers performed by the anesthetist, Safe-T aims to prevent upper airway obstruction by designing a device that mimics all three of these maneuvers.

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  • THE TEAM

    Student Team: Ryan Bell, Brielle Cenci, Kaveri Das, Grace Weyand, Hannah Sennik, Sneha Shivkumar

    Advisors: Soumyadipta Acharya, PhD; Azadeh Farzin, MD; Christopher Golden, MD; Alain Labrique, PhD; Youseph Yazdi, PhD; Aditya Polsani

    ABSTRACT

    Approximately 2.7 million newborns die each year. 99% of these deaths occur in low-resource settings, and 75% of these deaths occur during the first week of life. In Uganda, community health workers, or CHWs, visit the homes of newborns to assess their health during the first week of life. The CHWs check for seven danger signs that have been established by the World Health Organization (WHO). There are four qualitative signs: difficulty feeding, convulsions, chest indrawing, and movement only when stimulated; and three quantitative signs: respiratory rate > 60bpm, and temperature > 37.5°C or < 35.5°C. Identification of even one of these danger signs is indicative of severe neonatal illness, which means that the neonate should be taken to a health facility. The problem is that there are not enough CHWs to visit every newborn, which means that many neonatal illnesses go unnoticed until it is too late. Our solution is the NeMo (neonatal monitoring) system, which empowers mothers to assess their own baby’s health at home. This system aims to reduce the number of preventable neonatal deaths by improving the frequency and quality of neonatal health assessments during the first week of life. The NeMo system consists of an audiobook that guides the mother in checking for the qualitative danger signs and a wearable sensor that checks for the qualitative danger signs. The mother will use the system every day of the newborn’s first week of life, allowing for more frequent assessment of the neonate compared to the current standard of care.

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  • THE TEAM

    Student Team: Ryan Bell, Brielle Cenci, Kaveri Das, Grace Weyand, Hannah Sennik, Sneha Shivkumar

    Advisors: Chirag Parikh, MD; John Sperati, MD; Ashish Nimgaonkar, MD; Suzanne Przybyla; Pradeep Mehra, MD; Aditya Polsani; Youseph Yazdi, PhD; Soumyadipta Acharya, PhD

    ABSTRACT

    Osmo is focused on reducing fluid overload (FO), which is defined as excess fluid in the blood, for patients diagnosed with end stage renal disease (ESRD). Patients with ESRD have limited to no kidney function and must receive renal replacement therapy (RRT). The most common therapy is in-center hemodialysis (ICHD) where patients visit a clinic three times a week for a machine to filter the blood of toxins and excess fluid. Healthy kidneys are constantly filtering blood, so the shift to a three-time per week filtration schedule has a severe impact on toxin and fluid clearance efficiencies. Fluid levels in the body fluctuate depending on fluid intake and output, and most patients diagnosed with ESRD have limited to no ability to eliminate these fluids through urination. The average patient on ICHD has 1.5L of excess fluid on their body between dialysis sessions. The symptoms of excess fluid manifest as difficulty breathing, high blood pressure, and swollen extremities. Severe cases, or patients presenting with FO above 1.3L, result in a significant increase in risk of cardiovascular mortality. Of the nearly 450,000 patients on ICHD in the United States, there are about 320,000 hospitalizations due to FO each year.  The Osmo team has developed both a hydrogel-based solution and an intra-abdominal implant solution to alleviate the buildup of fluid between ICHD sessions.

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  • THE TEAM

    Student Team: Ebenezer Armah, Zack Buono, Sophia Diaz, Karina Frank, Kiley Gersch, Monet Slinowsky

    Advisors: Bashar Safar, MD; Chady Atallah, MD

    ABSTRACT

    SubTract Medical aims to develop a novel, device-based approach to treating complex perianal fistulas. Perianal fistulas are a debilitating physical condition that affects 140,000 individuals annually in the U.S. alone. This condition presents in patients as a chronic inflammatory tract between the anal canal or rectum and the surrounding perianal skin. This condition can result in devastating symptoms such as constant drainage, chronic pain, psychological and social distress, and the inability to sit. If left untreated, fistulas can dramatically worsen, putting patients at risk of fecal incontinence or sepsis. Anorectal fistulas are classified as either simple or complex based on their anatomy and/or patient comorbidities. Factors that can cause a fistula to be deemed complex include its involvement of a significant portion of the anal sphincter muscle, comorbidities such as Inflammatory Bowel Disease, or the existence of multiple branches and/or openings. Simple fistulas are relatively easy to treat, but complex perianal fistulas pose a greater clinical challenge, with current solutions succeeding only 40-70% of the time. Our solution aims to deskill a technically challenging procedure that can be used to repair complex perianal fistulas which has shown promising results when performed in the hands of skilled surgeons. By closing the internal opening of the fistula simply and effectively without compromising the anal sphincter muscles, our solutions support the body’s natural healing process while simultaneously preserving patients’ fecal continence. By deskilling a prohibitively complex procedure, our device makes complex perianal fistula repair achievable to surgeons of all skill levels, thus making the solution accessible to a wider and more complex patient population.

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  • THE TEAM

    Student Team: Ebenezer Armah, Zack Buono, Sophia Diaz, Karina Frank, Kiley Gersch, Monet Slinowsk

    Advisors: Jennifer Stevenson, PhD; Yvonne Linton, PhD; Mohamed Bayoh, PhD

    ABSTRACT

    ByteSight Technologies aims to decrease the global malaria burden via an innovative computer vision tool that rapidly identifies the dangerous mosquitoes that carry and transmit malaria. Malaria is one of the most devastating vector-borne diseases, resulting in approximately 228 million cases and 405,000 deaths per year. The most effective way to reduce malaria cases is to prevent them before they occur. Vector control programs can accomplish this task by identifying and eliminating the malaria-transmitting mosquitoes before they can spread disease. Effective vector control operation is dependent on accurate and timely vector surveillance, or the monitoring of the density and distribution of these dangerous mosquitoes. Although the thousands of mosquito species in existence may look the same to the naked eye, only 40 of these are capable of actually transmitting malaria. All vector control implementation decisions depend on knowing the type, location, density, and behaviors of these vectors. Therefore, in order to effectively deploy the correct interventions directed at mosquito populations in specific locations, these programs must have accurate, species-specific mosquito demographic data. Current vector surveillance practices are time- and labor-intensive, requiring highly trained entomologists to visually identify individual specimens manually. Entomologists’ average identification rate is approximately one mosquito per 20 minutes, with an average identification accuracy of ~66%. Our computer vision-based technology addresses the current gap in surveillance by improving identification accuracy to well over 90%, and by identifying individual specimens on the order of seconds, thereby increasing the availability of key vector surveillance data needed for effective vector control.

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The Johns Hopkins Center for Bioengineering Innovation & Design