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Knitted knee wearable may prevent or delay joint decline

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A more sensitive, less bulky, knitted circuit-embedded knee wearable for wireless sensing of joint movement in real-time has been developed which could highlight early mobility issues – potentially preventing or delaying functional decline.

The stretchable knee wearable has been designed by a team from the Singapore University of Technology and Design, and if commercialised could have a massive impact on how age-related joint changes are dealt with both by medics and older patients.

Our bodies become stiffer and more inflexible as we age because we make less synovial lubricating fluid, which acts like oil to keep our joints moving smoothly. Our cartilage also becomes thinner and ligaments shorten and lose elasticity.

Mobility limitation – which is an early sign of functional decline – can manifest as muscle weakness, loss of balance, an unsteady gait, and joint pain. This in turn can lead to reduced physical activity, possible weight gain, decreased balance and coordination, and social and psychological effects.

It has long been known that long-term and continuous monitoring of joint motion may prevent or delay this decline by allowing the early diagnosis, prognosis, and management of mobility-related conditions.

This is usually made possible through either wearable or non-wearable engineered devices.

Non-wearable systems are reliable, but need a laboratory environment and trained individuals to use, monitor and interpret them, so are impractical for daily use.  On the other hand, wearable systems are portable, cheaper, and much easier to use.

But typical wearable sensors tend to be inflexible and bulky.

A relatively new player are wearables made from soft, lightweight, malleable and non-invasive conductive fabric. They are comfortable to wear and can be used for long-term monitoring.

However, most conductive fabric-based wearables are prone to flagging up errors if they are removed from their intended location, and because they are attached externally to users’ clothing can also be cumbersome and restrictive.

 

The SUTD’s model boasts fewer external components, has more sensitive sensors, and because it’s made from a single section of highly stretchable fabric, allows the wearer more freedom.

The knee wearable has been developed by associate professor Low Hong Yee and her colleagues at the SUTD in collaboration with Dr Tan Ngiap Chuan of SingHealth Polyclinics. Their research has been published in the journal Advanced Healthcare Materials.

Professor Low said the team chose to concentrate on a wearable for the knee joint because of its importance for lower limb mobility.

But the team – which via the SUTD has filed patents related to the knee brace – is already looking to build on its work. The hope is to study the effect of sweat and humidity on sensor signals and to extend the research to include subjects from healthy and unhealthy populations in the future.

Professor Low said: “We have started working on extending the wearable to special user groups and to monitor other body joints, such as the shoulder. We’re also looking at securing an incubation fund to explore the commercialisation potential of the wearable.”

To develop the single-fabric circuit on the knee wearable, the team mechanically coupled an electrically conductive yarn with a dielectric thread of high elasticity in various stitch patterns.

Dimensions were customised according to the subject’s leg. The functional components – sensors, interconnects, and resistors – formed a stretchable circuit on the fully knitted wearable that allowed real-time data to be obtained.

However, putting together sensors, interconnects, and resistors in a single stretchable knit is difficult, as professor Low explained. “The synergy of yarns with different electrical and mechanical properties to achieve high signal sensitivity and high stretchability” was challenging, she said, as the desired properties for each component were vastly different.

Sensors need to produce a large change in resistance for enhanced sensitivity, while interconnects and resistors need fixed resistances of the highest and lowest values, respectively.

When worn, the knee brace converts changes in the knee joint to electrical signals, enabling the wireless and continuous real-time sensing of joint motion. Image: SUTD

As such, the researchers optimised yarn composition and stitch type for each component before connecting the functional circuit to a circuit board contained in a pocket of the wearable, allowing for wireless transmission of real-time data.

With a soft knee wearable developed, its components functional, and data transmission possible, it was time to test the performance of the wearable.

The team assessed the wearable through extension-flexion, walking, jogging, and staircase activities.

Subjects wore the knee wearable together with reflective markers that were detected by a motion capture system, allowing the comparison between sensor data and actual joint movement.

The sensor response time was less than 90 milliseconds for a step input, which is fast enough to monitor the human movements included in the study.

Additionally, the smallest change in joint angle that the sensors could detect was 0.12 degrees.

The research team say the potential impact of such a device in the medical field is huge.

Often, people ignore the early signs of mobility decline as they are not deemed serious enough to seek help. But wearable technology solves this problem by assessing a user’s mobility directly in real-time.

The team believe embedding a user-friendly sensor circuit into a soft and comfortable fabric may increase the public’s adoption of wearable technology – especially among the elderly.

Data can be gathered in real-time and translated into indicators that can detect mobility decline. When signs of mobility decline are found, preventive care, prognosis, and management of the healthcare condition can be given.

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Europe: Improving access to early-stage lung cancer care

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Europe: Improving access to early-stage lung cancer care

Researchers from Amsterdam UMC Cancer Center Amsterdam have looked at inequalities in access to early-stage lung cancer care in Europe.

Early-stage lung cancer has stark differences between European countries regarding access and reimbursement.

There are also differences in reimbursement times and indications between the European Medicines Agency (EMA) and the US Food and Drug Administration (FDA).

Researchers from Amsterdam UMC Cancer Center Amsterdam analysed the landscape, publishing their results in The Lancet Regional Health Europe as part of a series on the latest developments in the treatment of this lung cancer.

“Tackling inequalities in access to care must be a common European priority,” says Amsterdam UMC pulmonologist Idris Bahce. In collaboration with colleagues from seven European countries, Bahce used a literature review to map out the latest developments and analyse access to these new treatments from a European perspective.

“The existing differences in healthcare systems and reimbursement structures between European countries threaten to exacerbate healthcare inequalities at both European and national level. We therefore call for a collective European approach to reduce these inequalities,” says Bahce.

He suggests measures such as more international cooperation between the EMA and other registration authorities, harmonising cost-effectiveness procedures in European countries, a more critical evaluation of reimbursement criteria and improving multidisciplinary collaborations around the patient.

The standard treatment for fit patients with early-stage lung cancer has always been surgery, sometimes combined with pre- or post-operative chemotherapy. Recently, the EMA has approved new treatments such as immunotherapy, which appear to significantly improve survival rates after surgery. More approvals of innovative treatments are expected, potentially further exacerbating existing inequalities within Europe.

In addition to the Dutch hospitals Amsterdam UMC and Erasmus MC, colleagues from Spain, France, Germany, England, Italy and Poland also contributed to this international study as well as a Review and a Viewpoint in The Lancet Regional Health Europe.

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Study looks at link between adversity and cognitive decline

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A new paper has examined the relationship between childhood adversity and psychiatric decline, as well as adult adversity and psychiatric and cognitive decline. 

The findings revealed just one instance of adversity in childhood can increase cases of mental illness later in life. It also revealed that adverse events in adults can lead to a greater chance of both mental illness and cognitive decline later in life. 

The paper has been published by Saint Louis University associate professor of health management and policy in the College for Public Health and Social Justice, SangNam Ahn, Ph.D., in Journal of Clinical Psychology.

Ahn stated: “Life is very complicated, very dynamic. I really wanted to highlight the importance of looking into the lasting health effect of adversity, not only childhood but also adulthood adversity on health outcomes, especially physical health and psychiatric and cognitive health. 

“There have been other studies before, but this is one of the first that looks into these issues comprehensively.” 

Ahn, along with his team of researchers, examined data from nearly 3500 individuals over the course of 24 years. The group took the longitudinal data and evaluated it using a list of lifetime potential traumatic events.

The research team included childhood adversity events such as moving due to financial difficulties, family requiring financial help, a parent experiencing unemployment, trouble with law enforcement before the age of 18, repeating school, physical abuse and parental abuse of drugs or alcohol. 

Adulthood adversity events included the death of a child, the death of a spouse, experiencing a natural disaster after age 17, firing a weapon in combat, a partner abusing drugs or alcohol, being a victim of a physical attack after age 17, a spouse or child battling a serious illness, receiving Medicaid or food stamps and experiencing unemployment. 

The study determined that nearly 40% of all individuals experienced a form of childhood adversity, while that number climbed to nearly 80% for adulthood adversity. Those who experienced childhood adversity were also 17% more likely to experience adulthood adversity. Only 13% of individuals sampled reported two or more forms of childhood adversity, while 52% of adults experienced two or more forms of adult adversity. 

In cases of either childhood adversity or adulthood adversity, researchers found individuals who experienced adversity were also more likely to experience anxiety and depression later in life, and in the case of adulthood adversity, were also more likely to experience cognitive decline later in life. 

Individuals with one childhood adversity experience saw a 5% higher chance of suffering from anxiety, and those with two or more childhood adversity experiences had 26% and 10% higher chances of depression and anxiety, respectively. Individuals who experienced two adulthood adversities had a 24% higher chance of depression, while also experiencing a 3% cognitive decline later in life. 

While most of the results were expected or unsurprising, one area that stood out to Ahn was education. Those individuals studied who reported higher levels of education saw a reduction in the number of adversity experiences. Ahn hopes to study this avenue more to learn how education may be able to mitigate or prevent these declines. 

“Before including education, there was a significant association between childhood adversity and cognitive impairment,” Ahn said. 

“But when including education as a covariate, that significant association disappeared. Interesting. So there were important implications here. Education and attending school, people could be better off even if they were exposed to childhood adversity. They’re likely to learn positive coping mechanisms, which may help avoid  relying on unhealthy coping mechanisms, such as smoking or excessive drinking or drug use.

“Education is quite important in terms of health outcomes. If I am educated, I’m likely to get a better job, have a higher income, and live in areas with less crime. I’m likely to buy gym membership or regularly exercise. I’m likely to shop at Whole Foods and get proper nutrition. All of which help combat these adversities we hinted at in the study. So the education and health outcomes are already closely related, and that is what we saw in our study.”

Ahn also encourages clinicians and everyday people alike to discuss their stress. Clinicians can learn more about their patients and have a better approach when it comes to their physical and mental health, while others could potentially relate to shared experiences. But through awareness and recognition, these adverse experiences could potentially have less serious, lasting effects. 

“Public health is very interested in stress,” Ahn said. “But we’re still examining how daily stress impacts our long term health outcomes. So to see the effects here in the study, I want people to pay attention to their stress and proactively address it. Clinicians should have deep discussions with their patients about their stress and mental state. And those topics can be approached in other areas too, like the classroom or the dining room table. The more we are aware of stress and discuss our stress, the better we can handle any adversities we find in life.”

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New tool to explore mechanisms of age-related diseases

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New tool to explore mechanisms of age-related diseases

A new screening tool has been developed that will investigate the mechanisms behind conditions such as cancer, arthritis, neurodegeneration and cardiovascular disease.

Wellcome Sanger Institute researchers and their collaborators at Open Targets and EMBL’s European Bioinformatics Institute (EMBL-EBI) have developed the screening tool called scSNV-seq.

The tool has been designed to uncover how genetic changes affect gene activity that can lead to diseases such as cancer, autoimmunity, cardiovascular disease and neurodegenerative diseases such as Alzheimer’s and Parkinson’s. 

The tool enables the investigation of thousands of DNA mutations identified by genetic studies in one experiment, and will help to guide the development of advanced diagnostics and treatments.

scSNV-seq allows the rapid assessment of the impact of thousands of genetic changes in cells that have never been screened before, directly connecting these changes to how those same cells operate. 

This technique helps researchers to pinpoint mutations that contribute to disease, which will offer crucial insights for developing targeted therapies.

In a new study, published in Genome Biology, the team applied scSNV-seq to the blood cancer gene, JAK1, accurately assessing the impact of JAK1 mutations.

The assessment revealed for the first time that certain mutations caused a “halfway house” phenotype cycling between different states which was not possible under previous approaches.

The technique is designed to demonstrate versatility across cell types, including hard-to-culture primary cells like T cells and stem-cell derived neurons, as well as various editing methods such as base editing and prime editing. 

Applied on a large scale, scSNV-seq could transform understanding of the genetic changes driving cancer and decoding genetic risk for Alzheimer’s, arthritis, diabetes and other complex diseases.

Dr Sarah Cooper, first author of the study at the Wellcome Sanger Institute, stated: “In an era where the rate of genetic variant discovery outpaces our ability to interpret their effects, scSNV-seq fills a major gap for studying challenging cells like T cells and neurons. 

“We are already using it to shed light on the impact of Alzheimer’s and Parkinson’s risk variants on brain cells.”

Dr Andrew Bassett, senior author of the study at the Wellcome Sanger Institute, said: “Our technique is able to directly connect effects of mutations to how a cell behaves, revealing downstream impacts that previous technologies alone cannot deliver. 

“The technique speeds up the identification of causal genetic mutations, which will allow better diagnosis and deepens our molecular understanding of diseases, paving the way for more targeted and effective treatments.”

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