TAG: "Innovation"

NIH awards high-risk, high-reward research grants


UC researchers receive 17 of 85 awards aimed at innovative approaches to biomed research.

UC Berkeley's Michi Taga, one of 16 UC recipients of NIH High Risk, High Reward program grants, plans to use her grant to develop methods to selectively kill disease-causing bacteria.

The National Institutes of Health awarded 85 grants under its High Risk-High Reward program, of which 17 will go to University of California researchers. The awards support scientists proposing highly innovative approaches to major contemporary challenges in biomedical research.

UC researchers received 11 of 50 New Innovator awards, which support projects by early-career biomedical researchers with the potential to transform scientific fields and accelerate the translation of research into new ways to improve human health.

UC scientists also received:

  • One of 10 Pioneer awards for groundbreaking approaches that have the potential to make an unusually high impact on a broad area of biomedical or behavioral research;
  • Two of eight Transformative Research awards for cross-cutting interdisciplinary approaches that could potentially create or challenge existing paradigms; and
  • Three of 17 Early Independence awards that provide an opportunity for exceptional junior scientists to skip traditional postdoctoral training and move immediately into independent research positions.

“Supporting innovative investigators with the potential to transform scientific fields is a critical element of our mission,”’ said NIH Director Francis S. Collins. “This program allows researchers to propose highly creative research projects across a broad range of biomedical and behavioral research areas that involve inherent risk but have the potential to lead to dramatic breakthroughs.”

The total funding for the 85 grants is approximately $141 million.

UC recipients include:

UC Berkeley

  • Nicholas Ingolia (New Innovator)
  • Michi Taga (New Innovator)
  • Roberto Zoncu (New Innovator)

UC Davis

  • Lin Tian (New Innovator)

UC Irvine

  • Weian Zhao (New Innovator)

UCLA

  • Reza Ardehali (New Innovator)
  • Elissa Hallem (New Innovator)
  • Sriram Kosuri (New Innovator)
  • Lili Yang (New Innovator)

UC San Francisco

  • Adam Abate (New Innovator)
  • Robert Judson (Early Independence)
  • Wendell Lim (Transformative Research)
  • Michael McManus (Transformative Research)
  • Michael Rosenblum (New Innovator)
  • Glenn-Milo Santos (Early Independence)

UC Santa Barbara

  • Denise Montell (Pioneer)

Lawrence Livermore National Laboratory

  • Amanda Randles (Early Independence)

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UC receives nearly a quarter of NIH brain research grants


14 projects are led by researchers from six UC campuses.

The National Institutes of Health awarded UC researchers nearly a quarter of the $46 million in grants announced today (Sept. 30) in support of President Barack Obama’s BRAIN Initiative.

UC scientists have long been at the frontline of efforts to understand the brain’s inner workings — a pre-eminence reflected by the grants: Of the 58 NIH awards, 14 are projects led by researchers from UC Berkeley, UC Davis, UC Irvine, UCLA, UC San Diego and UC San Francisco.

Collectively, UC researchers will receive more than $10 million of the $46 million that the NIH is awarding for 2014.

“The human brain is the most complicated biological structure in the known universe. We’ve only just scratched the surface in understanding how it works — or, unfortunately, doesn’t quite work when disorders and disease occur,” said NIH Director Dr. Francis S. Collins in a statement. “There’s a big gap between what we want to do in brain research and the technologies available to make exploration possible.”

The BRAIN Initiative was launched last year by Obama as a large-scale federal effort to help scientists develop new tools and technologies to gain a deeper understanding of how the brain functions and to accelerate the creation of new treatments for neurological disorders.

“These initial awards are part of a 12-year scientific plan focused on developing the tools and technologies needed to make the next leap in understanding the brain,” Collins said. “This is just the beginning of an ambitious journey and we’re excited about the possibilities.”

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UC innovation grants produce healthy returns


Report finds return on investment of more than 5 to 1.

UC San Diego Dr. Greg Maynard leads a five-campus UC project to reduce dangerous blood clots (venous thromboembolism, or VTE), which prevented an estimated 140 VTE occurrences in 2013 for an annual savings of $1.45 million.

By Alec Rosenberg

A University of California center that fosters health care innovation at UC’s five medical centers is proving to be a boon to both patient health and the bottom line.

A report assessing the impact of grants made by the Center for Health Quality and Innovation (CHQI) found that UC’s investment is paying off with improvements such as fewer blood clots and improved post-surgery care at UC hospitals. Based on current cost savings, revenues and additional funds received, the projected net financial gain in 2016 of the center’s grants will be about $40 million from a $7.3 million allocation from UC medical centers — a return on investment of more than 5 to 1.

“The investment has been a good one,” said Dr. John Stobo, UC Health senior vice president and CHQI chairman. “The innovation center has done a lot of good in terms of improving quality and saving costs.”

CHQI was established in 2010 to foster innovations developed at UC medical center campuses and hospitals in order to improve quality, access and value in the delivery of health care. To date, the center has issued a total of 50 grants. In addition to funding from UC’s five medical centers, CHQI also has awarded $7.7 million it received from the UC Office of Risk Services for grants designed to reduce the risk of clinical harm to UC patients.

“We’ve been able to support innovative projects that produce better outcomes for patients, reduce costs and are being expanded across the UC Health system,” said CHQI Executive Director Karyn DiGiorgio. “This report helps quantify our impact.”

Examples include:

  • A five-campus project led by UC San Diego’s Greg Maynard to reduce dangerous blood clots (venous thromboembolism, or VTE) prevented an estimated 140 VTE occurrences in 2013 for an annual savings of $1.45 million.
  • A project at UC Irvine reduced the median length of stay for high-risk abdominal surgery patients by two days, resulting in fewer complications and projected annual savings of $816,000 (Maxime Cannesson).
  • The 2012 UC San Diego colorectal postoperative program reduced length of stay by 4.5 days for high-risk surgical patients and 0.9 days for moderate-risk patients, resulting in projected annual savings of $553,000 (Elisabeth McLemore).
  • A 2012 UCSF palliative care intervention resulted in 45 additional palliative care consults in the intensive care unit, generating $167,000 in annual savings from reduced ICU bed-days (Wendy Anderson).
  • A 2012 UC Davis specialty pharmacy initiative led to contracts that generated $18,000 in revenue at UC Davis and $1.36 million in revenue at UCSF during a CHQI fellowship (John Grubbs).
  • The 2012 UCLA elective surgery discharge program increased net revenues through a discharge pharmacy program for surgical services by $639,000 during a CHQI fellowship (Michael Yeh).

The report projects at least $25 million in grant-generated cost savings and revenues by the end of 2016. Also, seven project teams have received an additional $16 million in external funding based on their CHQI work, including a UCSF-led radiation safety project (Rebecca Smith-Bindman), a UC Davis pediatric telehealth project (James Marcin) and a UCSF-led eConsult project (Nathaniel Gleason).

In addition, 16 papers in national journals have been published based on work funded by CHQI.

The report did not assess the center’s other activities, such as hosting three systemwide colloquiums and convening multicampus collaboratives to develop and implement evidence-based practices.

The report was prepared by the center’s Innovation Evaluation Committee, which includes Michael Ong of UCLA, Patrick Romano of UC Davis, Andrew Auerbach of UCSF, Sheldon Greenfield of UC Irvine, Theodore Ganiats of UC San Diego and Stephen Shortell of UC Berkeley, and Karyn DiGiorgio, executive director of the center. CHQI plans to issue a yearly update, and by 2016 expects to present an in-depth review of the overall impact of the programs funded by the center.

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Engineers develop prototype of low-cost, disposable lung infection detector


NSF grant supports UC Irvine’s efforts to improve manufacturing process for nanodevices.

Imagine a low-cost, disposable breath analysis device that a person with cystic fibrosis could use at home along with a smartphone to immediately detect a lung infection, much like the device police use to gauge a driver’s blood alcohol level.

Timely knowledge of a lung infection would let people with CF or other inflammatory respiratory conditions seek immediate treatment and thereby prevent life-shortening permanent damage to their already vulnerable airways.

Thanks to a nearly $1.3 million grant from the National Science Foundation, UC Irvine engineers can continue developing this type of nanotechnology device – and potentially many others – using a more wide-scale manufacturing process.

Materials scientist Regina Ragan and electrical engineer Filippo Capolino have created a nano-optical sensor that can detect trace levels of infection in a small sample of breath. They made the sensor in the laboratory but would like to see it become commercially available. In addition to diagnosing medical conditions, the device could be modified to monitor environmental conditions – for instance, identifying harmful airborne agents produced through automotive or chemical industry practices.

Nanotechnologies such as this sensor depend on extremely small, nanometer-scale building blocks. A nanometer is about 100,000 times smaller than the width of a human hair. Fabricating on this tiny scale poses huge challenges, since most of the current methods that achieve a high level of precision are too costly and slow to be viable for manufacturing.

“With support from the NSF and input from industry, our goal is to help nanoscale manufacturing processes leave the laboratory – where they’ve been confined – and become usable in widespread commercial applications,” said Ragan, associate professor of chemical engineering & materials science and principal investigator on the project.

This grant highlights the strength of our faculty in both nanosciences and advanced manufacturing,” said Gregory Washington, dean of The Henry Samueli School of Engineering. “The Samueli School is poised to move forward as a force in this area.”

Co-principal investigators are Capolino, associate professor of electrical engineering & computer science; Ozdal Boyraz, associate professor of electrical engineering & computer science; and Marc Madou, Chancellor’s Professor of mechanical & aerospace engineering.

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UCLA hosting 24-hour invention competition to meet health care needs


Inventathon encourages teams of young inventors to develop innovative solutions.

A team of UCLA students working on their project during the 2013 Inventathon competition. (Photo by Samantha Le, UCLA)

Just a stone’s throw from Silicon Beach — the epicenter of technology in Los Angeles — the Business of Science Center at UCLA, with support from the Center for Advanced Surgical and Interventional Technology and Center for Digital Behavior, is spurring innovation as the organizer of the second-annual Inventathon.

This event is a unique 24-hour competition designed to develop solutions for pressing health care needs using the latest device technology and mobile applications.

Watches that track more than time and augmented reality glasses worn like conventional glasses, but that also house a tiny computer, are just the latest examples of wearable devices. Inventathon is designed to help young inventors harness similar technologies for use in the healthcare field.

Inventathon kicks off Oct. 15 with the announcement of the health care need to be addressed. Teams then have a couple of days to assemble before the actual competition starts on Oct. 17. Once the competition begins the teams will work around the clock to develop and eventually present their ideas to a panel of judges. The product could be a mobile app, conceptual drawing or embedded or wearable device. Mentors from UCLA and industry will be available during the entire process, which is designed to help participants hone their research and entrepreneurial skills.

The 24-hour inventing marathon serves as the concluding event of UCLA Innovation Week, organized by Bruincubate, a collection of 14 different groups at UCLA dedicated to promoting entrepreneurship. Bruincubate is hosted by the UCLA Office of Intellectual Property and Industry Sponsored Research. Innovation Week brings together UCLA’s entrepreneurial organizations to help students, faculty, and staff explore and grow their ideas into tangible products. In addition to the Inventathon, events include talks, a career fair and mixers.

The Inventathon competition will take place at the UCLA California NanoSystems Institute. “This event supports future inventors and entrepreneurs,” said Shyam Natarajan, a Business of Science program director and a Center for Advanced Surgical and Interventional Technology researcher, who helped launch the event last year. “We are excited to see raw science talent paired with business and design expertise to develop and jumpstart ideas.”

Medical technology inventors of all levels, from undergraduates and graduate students from UCLA and other universities are welcome. Organizers encourage the teams, consisting of three to five participants, to include a wide range of skills from the medical field, engineering, art, design and business.

During the 24-hour competition, the teams will have access to tools such as 3-D printers, augmented reality glasses that can be used to help design and test applications for wearable devices, and special boards to help make mini computer chips, which are the brains behind the applications.

“Competitions like Inventathon get students to think there are no walls that will inhibit them,” said Roy Doumani, a professor at the David Geffen School of Medicine at UCLA and executive director of the Business of Science Center. “The experience is invaluable in developing the skill set needed to succeed in developing and pitching a product. Participants are mentored throughout the competition and we want to thank our mentors for their extremely valuable support and time.”

Additional programs on UCLA’s campus help students even after the competition. The Business of Science Center offers a course called Advancing Bioengineering Innovations designed to teach medical device design and to develop practical solutions for unmet medical needs. The program is a collaboration among the Department of Bioengineering in the UCLA Henry Samueli School of Engineering and Applied Science, the David Geffen School of Medicine at UCLA and the UCLA Anderson School of Management.

“There is huge potential for the latest remote monitoring applications and devices to support and track health care needs,” said Sean Young, assistant professor of family medicine and executive director of the Center for Digital Behavior at UCLA. The center brings together academic researchers and private sector companies to study how social media and mobile technologies can be used to predict and change behaviors that impact health. “Events like Inventathon are a great resource and learning opportunity for students.”

The second annual Inventathon will start on Wednesday, Oct. 15, with a kickoff event to announce the type of health need to be solved and to start assembling teams. Competition begins at 4 p.m. on Friday, Oct. 17 and the competition concludes Saturday, Oct. 18 at 6 p.m.

The public is invited to watch the final pitches to the judges and the announcement of the winners, which will take place from 4 to 6 p.m. on Saturday.

The UCLA Clinical Translational Science Institute is a collaborator on the event. This project received support from the following NIH/NCATS grant to the UCLA Clinical Translational Science Institute: UL1TR000124.

Inventathon sponsors include: Option3 LLC; Cardiovascular Systems; Epson America; SparkFun Electronics; UCLA Blum Center for Poverty and Health in Latin America; KARL STORZ Endoscopy-America; Hitachi Aloka Medical America; UCLA Center for World Health; Lob; California NanoSystems Institute, UCLA AIDS Institute and UCLA Health.

For more information about Inventathon and sponsorship opportunities, please visit www.UCLAideas.com.

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Brain Innovation Group funded for brain tumor tool


National Cancer Institute grant boosts development of optical wand technology.

Laura Marcu, UC Davis

The UC Davis Comprehensive Cancer Center’s Brain Innovation Group has received a grant from the National Cancer Institute (NCI) to improve brain cancer surgery and treatment using UC Davis-developed biophotonic technology.

The $400,000 grant is the first for the cancer center’s eight cancer research innovation groups, which link scientists, oncologists, surgeons, engineers and other experts in discussions about patient care needs and potential innovations.

“The groups were started to fulfill a big part of our mission as a comprehensive cancer center by enhancing clinical and translational cancer research,” said cancer center director Ralph de Vere White. “This grant is a clear example of the success of this endeavor.”

UC Davis researchers will use the funding to adapt state-of-the-art optical biopsy technology, the Multispectral Scanning-Time Resolved Fluorescence Spectroscopy, to help neurosurgeons distinguish between radiation necrosis and cancer recurrence during brain cancer surgery. The technology was developed by Laura Marcu, professor of biomedical engineering and neurological surgery and principal investigator on the project.

The collaborative Brain Innovation Group includes specialists from adult and pediatric oncology, neurology, neurosurgery, neuroradiology, radiation oncology, biomedical engineering and biophotonics, hematology and biochemistry. They meet once a month in an open forum to present their projects and look for ways to combine and translate their work into high-impact clinical trials.

“This NCI grant demonstrates the benefit of having experts with different backgrounds work together to find new ways to better diagnose and treat cancer,” said Marcu, adding that the idea to apply the novel photonic technology in distinguishing between brain tumor recurrence and radiation necrosis was sparked during an innovation meeting.

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UCLA Health System, Anthem join others to launch Vivity


Unique product created by insurer and seven health systems aligns care for SoCal members.

The UCLA Health System and six other top hospital systems in Los Angeles and Orange counties have partnered with Anthem Blue Cross to offer Anthem Blue Cross Vivity, an integrated health system. This partnership — the first in the nation between an insurer and competing hospital systems — will help the medical centers enhance the health of all Anthem Blue Cross Vivity members and enable them to share financial risk and gain.

The six other hospital systems — all of which have hospitals ranked among Los Angeles County’s top 30 by U.S. News and World Report — are Cedars-Sinai, Good Samaritan Hospital, Huntington Memorial Hospital, MemorialCare Health System, PIH Health and Torrance Memorial Medical Center.

“Vivity will create economies of scale, allowing us to provide the highest quality and affordable health care to thousands of Californians,” said Dr. David Feinberg, president of the UCLA Health System and CEO of the UCLA Hospital System. “UCLA is proud to join Anthem Blue Cross and its hospital partners at the vanguard of health care delivery in the U.S.”

Vivity continues the move away from traditional fee-for-service reimbursements that may create incentive for providers to increase the volume of medical procedures they perform, and it continues the trend toward a structure that financially rewards activities that keep patients healthy.

“This is an exciting and historic time,” said Pam Kehaly, west region president for Anthem Blue Cross. “This innovative venture will create a foundation to significantly advance the medical delivery system, simplifying the care experience and creating a structure with aligned incentives to eliminate waste and redundancy and improve overall health.”

This is just the first step in aligning the delivery system. Longer term, value will come from future improvements in efficiency and effectiveness enabled by such things as a common electronic medical records system, shared care management systems, joint wellness resources and other enhancements.

Anthem Blue Cross Vivity will provide members with more predictable costs, a simpler experience and convenient access to some of the best primary care doctors, specialists and hospitals in the region. For doctor visits, medical procedures or prescriptions, Vivity members only pay a co-pay; they don’t have to worry about meeting deductibles or deciphering complicated medical bills. The seven hospital systems and their affiliated medical groups have built a network of doctors that provides both quality care and affordable prices to Vivity members in Los Angeles and Orange counties.

CalPERS, the nation’s second largest purchaser of health benefits and an early adopter of health care system innovations, has already agreed to use Vivity network doctors and hospitals within its Select HMO network in Los Angeles and Orange counties. Large group brokers can start requesting proposals on Oct. 1, with coverage beginning on Jan. 1, 2015.

The name Vivity captures a fresh perspective on health care. Coined from vivify, meaning “to enliven or animate,” the name speaks to the energized team of providers coming together to deliver a uniquely people-centric offering.

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Diaper detective


Students develop inexpensive, versatile pad to detect medical problems in infants.

A team of UC Riverside Bourns College of Engineering students created an inexpensive pad that can be inserted into diapers to detect dehydration and bacterial infections in infants.

The product, which recently won an award that included a $10,000 prize at a national engineering design contest, operates much like a home pregnancy test or urine test strip. Chemical indicators change color when they come in contact with urine from an infant who is suffering from dehydration or a bacterial infection.

The pad, which is 2.5 inches by 5 inches and called “The Diaper Detective,” is attractive for numerous reasons. It costs 34 cents to make. It doesn’t require electricity, cold storage or an advanced education to interpret. It’s customizable so that other chemical indicators can be added to test for other medical conditions. And it could be adapted to be used in adult diapers.

“We created this to fulfill a need for a versatile, inexpensive, non-invasive method of urine collection in developing countries and elsewhere,” said Veronica Boulos, one of the team members. “The beauty of this is that it solves a huge problem with simplicity.”

Strike against infant mortality

The Diaper Detective addresses the worldwide problem of infant mortality in developing nations. Of the estimated 3.9 million annual neonatal deaths, 98 percent occur in developing countries and could be prevented with access to low cost, point-of-care diagnostics.

In developing countries, the students hope the Diaper Detective will be distributed via relief organizations. In the United States, the students believe the pad would qualify for reimbursement through medical insurance, making it an inexpensive option for low-income users.

The uniqueness of the diaper insert comes from the use of lateral flow channels that guide the user’s urine to the reactive regions where the color change takes place. The lateral flow channels were originally created using Crayola crayons and are now created by paraffin wax and a laser printer.

The students won a third place award at the National Institute of Biomedical Imaging and Engineering Design by Biomedical Undergraduate Teams Challenge. They have also submitted the product to the National Collegiate Inventors and Innovators Alliance BMEStart competition.

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Five wearable health gadgets on the horizon


UCSF collaborations helping develop next generation of digital health devices.

We’ve all seen ads for Fitbits, Jawbones, Gearfits – perhaps even tracked our own health with a specialized home glucometer or blood pressure cuff.

These devices can help collect data that can help motivate an individual and track progress, but they don’t tell us much beyond that. The next wave of wearable health technology has far more advanced biosensors that can collect new data, teach us what data is most valuable – and maybe even change the way we practice medicine.

Wearable health devices are just one niche in the rapidly growing field of digital health. Future wearable biosensors may be as small as a patch worn on the skin or an ear bud or even a tiny fiber sewn into clothing – and these tools can gather new data in real-time with patients in the real world, tracking things we couldn’t accurately measure outside a hospital until now.

This data not only will provide useful information for the patient and his or her doctor, but could also lead to huge gains in precision medicine, an emerging field that aims to integrate data from molecular, clinical, population and other research to create treatments that are more predictive, preventive and precise.

“We need to get to a world where individuals are using digital health devices to collect accurate, detailed data about themselves and that data is available for clinical trials as well as to their clinicians for helping them maintain wellness or managing disease,” says Michael Blum, M.D., director of UCSF’s Center for Digital Health Innovation, which collaborates across health care and industry to create, implement and validate digital health technologies. One of its biggest collaborations is with Samsung, a partnership that’s launched the UCSF-Samsung Digital Health Innovation Lab at Mission Bay.

Blum, who also serves as chief medical information officer of the UCSF Medical Center, says the goal is for wearables being developed now to someday be able to seamlessly “provide patient data into larger databases that can be accessed for clinical care and that multiple researchers can have access to in order to create new understandings.

“When we have access to these large, rich data sources, we will likely see new patterns and relationships that will lead to the development of new, non-traditional ‘vital signs.’”

For all of the wearable health devices being developed, Blum says, it’s vital that they are validated: Do the sensors accurately measure the things they’re designed to measure? Does wearing the device and knowing this information lead to changes in treatment or behavior?  Does it generate better outcomes for the patients? Did we uncover new health data points that could be more important to measure for a certain disease?

For example, Aenor Sawyer, M.D., an orthopedic surgeon and associate director of CDHI, says one key area where monitoring could really help inform doctors – and patients – is when a patient is released from the ICU or after a serious surgery.

“Imagine a patient who’s been closely monitored, then when he’s discharged, we don’t have any oversight, and we don’t have any vital signs being taken. These patients might benefit from some closer scrutiny. We know that certain things can happen in those windows that would be nice to have some way to track it,” says Sawyer.

A number of wearable health devices being developed now could help close that critical loophole. And the data that future wearables gather will teach us new key indicators for health we haven’t even thought of yet, Sawyer says.

Here are five exciting new wearable health gadgets on the horizon:

Track what gets you stressed

The next generation of wristbands will have far more accurate biosensors that can measure specific health indicators such as blood pressure, heart rate, oxygen saturation and body temperature. The devices will be able to send data to your doctor, and could help researchers measure how different medicines or behavior changes are affecting patient health. For example, Samsung has partnered with UCSF to develop the Simband, which will measure heart rate, blood pressure, temperature, oxygen level and even signs of stress. Simband is also a reference platform that allows other companies to develop sensors that will integrate into it, allowing for a community of developers to create the ecosystem of sensors and products that will be critical to this nascent market.

Take part in a sleep study – in the comfort of your own bed

In the sleep lab, researchers hook patients up to complex machines and sensors to measure motion, heart rate and rhythm, respiratory rate and rhythm, and oxygen and carbon dioxide saturation.

Soon tiny, non-invasive biosensors could gather this data while you sleep in your own bed and transmit the information to a central database.

Know how your elderly mother is doing from hundreds of miles away

A combination of biosensors can measure movement and heart and respiration rates. They could be calibrated to an individual’s patterns to alert caretakers when something is amiss. Knowing that an elderly relative is not going to the refrigerator, leaving the house, or calling friends and family could provide early clues to a brewing illness that could be easily managed with early intervention, but might be devastating if left unchecked.

Let the doctor monitor your heart in real time 

For anyone who has worn a holter monitor to check for irregular heart rhythms, a Vital Connect patch is a big upgrade. Instead of having to go in to the doctor’s office to pick up a cumbersome device, wear it for weeks, then go back to the doctor’s office to return it and wait for it to be analyzed, the data from the patch is uploaded to the cloud-based system via the Internet, and the doctor can be alerted if there are any signs of danger.

Measure your vitals while listening to music

The ear is an excellent spot on the body to measure physical signals such as motion, heart rate and blood pressure.  Several companies are exploring making a new high-tech ear bud that can measure heart rate, temperature and respiration rate using photoplethysmography, or PPG, which measures changes in blood flow by shining a light on the skin and measuring how it scatters off blood vessels (this is often done in hospitals with a device that fits over your fingertip).

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Monitoring a new vital sign


Biosensor may help doctors determine which patients should be fed following surgery.

AbStats, developed by a team at UCLA, is a non-invasive acoustic gastrointestinal surveillance biosensor that monitors gut sounds.

A disposable plastic listening device that attaches to the abdomen may help doctors definitively determine which post-operative patients should be fed and which should not, an invention that may improve outcomes, decrease health care costs and shorten hospital stays, according to a UCLA study.

Some patients who undergo surgery develop a condition called post-operative ileus, a malfunction of the intestines. The condition causes patients to become ill if they eat too soon, which can lengthen an affected patient’s hospital stay by two to three days. Until now, there was no way to monitor for post-operative ileus other than listening to the belly for short periods with a stethoscope, said study first author Dr. Brennan Spiegel, a professor of medicine at the David Geffen School of Medicine at UCLA and the UCLA Fielding School of Public Health.

If proven successful, the device, a non-invasive acoustic gastrointestinal surveillance biosensor called AbStats, could also be used to help diagnose irritable bowel syndrome and inflammatory bowel disease as well as helping obese people learn by the sounds from their gut when they should or shouldn’t eat, which could help them lose weight.

Spiegel and his team worked with researchers at the UCLA Wireless Health Institute at the Henry Samueli School of Engineering and Applied Science to develop the sensor, which resembles a small plastic cap and has a tiny microphone inside to monitor digestion.

“We think what we’ve invented is a way to monitor a new vital sign, one to go along with heart rate, blood pressure and respiration. This new vital sign, intestinal rate, could prove to be important in diagnosing and treating patients,” Spiegel said. “The role of wearable sensors in healthcare has reached mainstream consciousness and has the capacity to transform how we monitor and deliver care.

“Yet, there are very few biosensors that are supported by any peer-reviewed evidence,” Spiegel continued. “This study represents peer-reviewed evidence supporting use of a biosensor, a device born and bred out of UCLA multidisciplinary research.”

The study appears in the early online edition of the peer-reviewed Journal of Gastrointestinal Surgery.

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Innovation center names executive director


Karyn DiGiorgio to lead systemwide center.

Karyn DiGiorgio

Karyn DiGiorgio, M.S.N., R.N., has been appointed executive director of the UC Center for Health Quality and Innovation (CHQI).

The center, based at the UC Office of the President, is a systemwide effort launched in 2010 to support innovative grants and spread best practices that aim to improve quality, increase efficiencies and reduce costs at UC medical centers.

DiGiorgio joined UCOP in 2013 as the associate director of CHQI, after working for the Gordon and Betty Moore Foundation, where she was a program officer in the Betty Irene Moore Nursing Initiative.

“Karyn brings a wealth of experience to this position, having served as associate director since 2013,” said Dr. John Stobo, UC Health senior vice president. “Karyn also served as interim director since March of 2014 following the retirement of Terry Leach, and has helped to enhance the scope of the center’s mission, collaborating with UCOP and medical center leadership to develop and implement a variety of patient care and revenue models as well as systemwide reimbursement models that will support UC Health’s Leveraging Scale for Value initiative.”

UC Health launched its Leveraging Scale for Value initiative in March to collaborate as a system to reduce costs and enhance revenue at UC medical centers.

At the Moore Foundation, DiGiorgio developed and managed multiple systemwide health care grants in the Bay Area and greater Sacramento regions — many of which resulted in significant reductions in patient morbidity and mortality and led to improvements in patient care. Previously, she worked as the R.N. discharge coordinator and a staff/charge nurse in the emergency department at UCSF Medical Center. She is a graduate of Georgetown University and holds an M.S.N. in health policy from UC San Francisco and an M.S. from Drexel University in Philadelphia.

The Center for Health Quality and Innovation is governed by a board composed of the six UC medical school deans, five UC medical center CEOs and chaired by the UC Health senior vice president.

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Providing a medical home for HIV patients


UC San Diego transforms HIV care as part of DSRIP pay-for-performance initiative.

UC San Diego Dr. Amy Sitapati (left) directs the Owen Clinic, which has become a model medical home for HIV patients.

By Rebecca Vesely, Special to UC Newsroom

Though incurable, HIV today is a manageable, chronic condition. With advances in drug therapy, those infected with HIV in North America can expect to live into their early 70s — almost as long as the general population.

However, HIV is a chronic illness that typically requires a complex treatment regimen and has the added layer of social stigma.

At UC San Diego Health System, providers have implemented a novel multidisciplinary approach to HIV care management that is improving outcomes for patients. This approach could be a model for chronic care management in other populations.

UC San Diego’s HIV care delivery transformation began under the California HIV/AIDS Research Program and was implemented as a special Delivery System Reform Incentive Program (DSRIP). DSRIP is a novel, pay-for-performance initiative in which California’s 21 designated public hospitals receive Medicaid dollars in exchange for meeting pre-set milestones.

California’s public hospitals had the option of participating in a fifth DSRIP category focused on HIV care. UC San Diego is one of the state’s 10 public hospitals working in this category.

UC San Diego, through DSRIP Category 5, was able to overhaul its outpatient care delivery for HIV/AIDS patients into a medical home model.

‘Truly transformative’

“This is what the ‘triple aim’ is all about,” said Dr. Angela Scioscia, chief medical officer at UC San Diego Health System. “This project has been truly transformative. We took a clinic that had lost its way in terms of structure and turned it into a model for care delivery.”

Also known as the Owen Clinic, the UC San Diego HIV/AIDS outpatient center is located on the third floor of a medical office building across the street from UC San Diego Medical Center at Hillcrest. The clinic treats about 3,500 patients annually. Last year, 500 new patients joined, with the demand for services growing by approximately 40 percent in the past five years, said Dr. Amy Sitapati, Owen Clinic director.

About 70 percent of patients served at the clinic are in Medi-Cal managed care plans. DSRIP support enabled the clinic to hire more staff, with a total of 60 personnel, both full- and part-time.

Team-based approach

The clinic uses a team-based approach, with four teams, each led by a primary care physician. Two of the teams have Spanish-language fluency.

Each morning, the teams meet in “huddles” and review the patient panel for that day. A computer printout shows patient names, ages and reasons for the visit, status on preventative screenings and viral loads. The printouts also show each patient’s Veterans Aging Cohort Study (VACS) score, an evidence-based score that assesses HIV patient risk of mortality. The Owen Clinic may be the only outpatient clinic in the country using patient VACS scores in daily huddles.

Knowing a patient’s risk of mortality helps to frame the office visit because providers understand before the patient walks through the door his or her need for additional support services, Sitapati said. A patient with a high VACS score might need more time in the clinic to meet with a staff pharmacist or psychiatrist or social worker, for instance.

Comprehensive, coordinated services are available to all patients. Because of the complexity of many of these patients’ treatment regimens (patients take on average seven medications each day), the staff aims to make each visit as productive as possible. For instance, staff pharmacists on site work together with physicians to educate patients about their prescriptions, help them find affordable options, get adequate reimbursement from payers and avoid adverse reactions to drugs.

Eight to 10 drugs are commonly used in HIV treatment, meaning there are between 30 and 50 total drug combinations. Finding the right balance for patients can be a challenge, especially with myriad side effects, co-payments and insurance pre-authorization requirements to fill a prescription.

“There are a lot of barriers to patients taking the right medications,” Sitapati said.

Incorporating health information technology

Access to health information technology resources has been crucial to the clinic’s transformation. UC San Diego assigned a four-person team of health IT specialists — including a physician informaticist, a data analyst, a programmer analyst and a Master of Public Health team member — to work on the clinic’s patient-centered medical home innovation projects. Having a clinical informatics team that understands the patient population, is invested in the clinic’s success and is aligned with the project’s vision and goals has been absolutely critical, Sitapati said.

Ongoing communication with patients is an important component to care. Patients at the clinic are avid adopters of MyUCSDChart, a Web portal that sends reminders for appointments and preventative screenings.

In 2013, there were an average of 1,003 MyUCSDChart patient encounters per month, up from 288 MyUCSDChart encounters in 2012. These patient portal interactions are on par with in-person and phone visits in 2013, which averaged 1,135 office visits and 1,455 average phone calls per month in 2013.

Perhaps one of the most valuable clinic informatics tools is SmartSet — an electronic medical record tool that allows clinicians to order lab tests in batches for patients who haven’t received recent laboratory screenings. The Centers for Disease Control and Prevention recommends annual screening for sexually transmitted diseases (STDs) in HIV-positive individuals. The SmartSet allows clinicians to quickly identify patients due for screenings and then order tests without manually ordering each lab for each patient, increasing clinic efficiencies and productivity.

Focusing on care transitions

The Owen Clinic focuses on care transitions for its patients. The clinic has a dedicated “nurse transition specialist” skilled in HIV/AIDS care to assist patients moving between inpatient care and the Owen Clinic. The nurse transition specialist program is part of another DSRIP project at UC San Diego.

These proactive, integrated approaches are garnering results. Viral load monitoring rose from a baseline of 63 percent in 2011 to 81.9 percent for the period of January through December 2013. Screening for both chlamydia and gonorrhea increased from 57.4 percent in 2011 to 84.2 percent for the period of January 2013 through December 2013. Wrap-around services for HIV care — including nutrition, substance abuse counseling, pharmacy, psychiatry and case management — increased 34 percent.

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