Smart glasses follow our eyes, focus automatically

Though it may not have the sting of death and taxes, presbyopia is another of life’s guarantees. This vision defect plagues most of us starting about age 45, as the lenses in our eyes lose the elasticity needed to focus on nearby objects. For some people reading glasses suffice to overcome the difficulty, but for many people the only fix, short of surgery, is to wear progressive lenses.

“More than a billion people have presbyopia and we’ve created a pair of autofocal lenses that might one day correct their vision far more effectively than traditional glasses,” said Stanford electrical engineer Gordon Wetzstein. For now, the prototype looks like virtual reality goggles but the team hopes to streamline later versions.

Wetzstein’s prototype glasses — dubbed autofocals — are intended to solve the main problem with today’s progressive lenses: These traditional glasses require the wearer to align their head to focus properly. Imagine driving a car and looking in a side mirror to change lanes. With progressive lenses, there’s little or no peripheral focus. The driver must switch from looking at the road ahead through the top of the glasses, then turn almost 90 degrees to see the nearby mirror through the lower part of the lens.

This visual shift can also make it difficult to navigate the world. “People wearing progressive lenses have a higher risk of falling and injuring themselves,” said graduate student Robert Konrad, a co-author on a paper describing the autofocal glasses published June 28 in the journal Science Advances.

The Stanford prototype works much like the lens of the eye, with fluid-filled lenses that bulge and thin as the field of vision changes. It also includes eye-tracking sensors that triangulate where a person is looking and determine the precise distance to the object of interest. The team did not invent these lenses or eye-trackers, but they did develop the software system that harnesses this eye-tracking data to keep the fluid-filled lenses in constant and perfect focus.

Nitish Padmanaban, a graduate student and first author on the paper, said other teams had previously tried to apply autofocus lenses to presbyopia. But without guidance from the eye-tracking hardware and system software, those earlier efforts were no better than wearing traditional progressive lenses.

To validate its approach, the Stanford team tested the prototype on 56 people with presbyopia. Test subjects said the autofocus lenses performed better and faster at reading and other tasks. Wearers also tended to prefer the autofocal glasses to the experience of progressive lenses — bulk and weight aside.

If the approach sounds a bit like virtual reality, that isn’t far off. Wetzstein’s lab is at the forefront of vision systems for virtual and augmented reality. It was in the course of such work that the researchers became aware of the new autofocus lenses and eye-trackers and had the insight to combine these elements to create a potentially transformative product.

The next step will be to downsize the technology. Wetzstein thinks it may take a few years to develop autofocal glasses that are lightweight, energy efficient and stylish. But he is convinced that autofocals are the future of vision correction.

“This technology could affect billions of people’s lives in a meaningful way that most techno-gadgets never will,” he said.

This research was funded in part by Intel Corporation, NVIDIA, an Okawa Research Grant, a Sloan Fellowship and the National Science Foundation.

---

Story Source:

Materials provided by Stanford University. Note: Content may be edited for style and length.

---

Journal Reference:

1. Nitish Padmanaban, Robert Konrad, Gordon Wetzstein. Autofocals: Evaluating gaze-contingent eyeglasses for presbyopes. Science Advances, 2019; 5 (6): eaav6187 DOI: 10.1126/sciadv.aav6187

https://www.sciencedaily.com/releases/2019/07/190701144250.htm

Kaiser, Centene and Molina must pay big risk-adjustment charges

Kaiser Permanente, Centene Corp. and Molina Healthcare are among the health insurers that racked up massive charges under an Affordable Care Act program meant to steady the premiums in the individual insurance market and discourage insurers from cherry-picking healthy, less costly plan members.

According to Modern Healthcare’s analysis of data released by the CMS late last week, Kaiser Permanente, which is integrated with Kaiser Foundation Health Plan, must pay $891.7 million into the ACA risk-adjustment program for the individual market for 2018, which will be transferred to insurers who enrolled riskier patients. Kaiser must pay another $414.3 million into the risk-adjustment program for the small-group market. Modern Healthcare excluded catastrophic plans and high-risk pools from the analysis.

St. Louis-based Centene Corp., which is the dominant ACA marketplace insurerwith nearly 2 million exchange enrollees, racked up charges of $629.7 million in the individual market. Molina Healthcare must pay $373.2 million for individual market risk-adjustment purposes.

Most of the companies set to receive the biggest payments from the risk-adjustment program were Blue Cross and Blue Shield affiliates, as has been the case in previous years. Combined, the Blues companies, including Anthem, will get $2.5 billion in risk-adjustment payments for the individual market and another $567.4 million for the small-group market.

ACA risk-adjustment is a permanent program that shuffles money from plans that enroll relatively healthy members to plans with sicker, riskier patients. The zero-sum program is based on a patient’s risk score. Payments and charges are calculated by comparing each health plan’s average patient risk score to the average premium in the state. In 2018, 572 health insurers participated in the program and transfers between them totaled $10.4 billion.

Various factors can contribute to whether a plan receives payments or must pay into the program, but, “At the end of the day, it comes down to the risk of your membership and the premiums you’re charging,” said Deep Banerjee, insurance analyst at S&P Global.

Larger health insurers that have been serving their populations long enough that they have a wealth of data on their members and understand and can code them accurately are more likely to receive risk-adjustment payments, which explains why the Blues companies tend to receive funds, Banerjee explained.

The three insurers set to receive the largest payments included Blue Shield of California, whose payments tallied $784.8 million in the individual market; Health Care Service Corp., which will receive $574.7 million; and Blue Cross and Blue Shield of Florida, with payments of $512.3 million. Those insurers will each receive smaller risk-adjustment payments for the small-group market as well.

Other insurers that have expanded rapidly into new markets where they don’t have a lot of information on their patients’ health conditions are more likely to pay into the program, as are smaller or younger insurers.

That might explain why Oscar Health, a smaller insurer that expanded in five states in 2018, must pay $201.9 million to the individual market’s risk-adjustment program.

But there are other more technical factors. David Anderson, a research associate at Duke University’s Margolis Center for Health Policy, explained that in Tennessee, for example, new-to-the-area Oscar enrolled a bunch of members in a bronze plan in 2018. Meanwhile, its competitor Blue Cross and Blue Shield of Tennessee enrolled most members in silver and gold plans. Silver and gold plans have higher risk scores under the risk-adjustment methodology, while bronze plans, which tend to attract young and healthier than average members, have a lower risk score, Anderson said.

By concentrating on selling bronze plans, Oscar was already going to have risk-adjustment charges. But with a membership heavy in silver and gold plans, Blue Cross and Blue Shield of Tennessee pushed the statewide average risk higher, making Oscar’s membership look even healthier.

For Centene and Molina, the big charges are a product of the patients covered and the insurers’ narrow networks and low premiums, Anderson said.

Centene prices its health plans to capture low-income patients who don’t anticipate having a lot of health problems; Molina does something similar, he said. Their plan designs help them avoid patients with high cost conditions who are more likely to go to sign up with an insurer with a broader network. Centene and Molina end up with healthier populations and so, pay into the risk-adjustment program.

Anderson noted that risk-adjustment charges and payments are not necessarily indicators of profitability. Centene has turned a profit on the exchanges and its business as a whole despite having big charges under the program.

The risk-adjustment program is a controversial one. Small health plans and ACA co-ops have long argued that the formula used to calculate payments favors large plans with more claims experience. In early 2018, insurance co-op New Mexico Health Connections won a partial victory in a lawsuit challenging the program. In response, the Trump administration froze payments to insurers for the 2017 benefit year but then restored the program not long after. Litigation in the case is ongoing.

https://www.modernhealthcare.com/insurance/kaiser-centene-and-molina-must-pay-big-risk-adjustment-charges

Evercore boosts Dova Pharmaceuticals to Outperform

Evercore ISI has upgraded Dova Pharmaceuticals (NASDAQ:DOVA) to Outperform, from In-Line.

That joins a mostly bullish set of covering analysts.

Sell-side analysts rate the stock an Outperform on average, while it has a Quant Rating of Neutral.

At last check shares were up 2.1% postmarket.

https://seekingalpha.com/news/3475150-evercore-boosts-dova-pharmaceuticals-outperform

More effective flu vaccine begins clinical trials across the U.S.

A more effective seasonal flu vaccine is about to be tested in clinical trials across the US.

The flu shot was working well early in the season with effectiveness around 47% in February. But this decreased substantially during a second wave of a tougher flu strain, with effectiveness at just 9%, as reported by the U.S. Centers for Disease Control and Prevention.

Dr Nikolai Petrovsky, Flinders University Professor and Research Director of Vaxine Pty Ltd , says current flu vaccines do provide some protection, but his team have demonstrated a lot can be done to improve their effectiveness.

“Despite currently available vaccines, flu remains a very major global health problem,”

“During the 2017-18 Northern hemisphere flu season, the Centers for Disease Control and Prevention estimated that the US had 49 million cases of flu, 960,000 hospitalizations due to influenza complications and 79,000 deaths.”

Dr Petrovsky developed the technology behind this vaccine using adjuvants- substances which act as a turbocharger to enhance their ability to protect against infection.

The technology behind this improved flu shot is believed to be the first human drug in the world to be completely designed by artificial intelligence (AI).

This represents the start of a new era where artificial intelligence is going to play an increasingly dominant role in drug discovery and design. ”

Professor Nikolai Petrovsky, Flinders University

Although computers have been used in the past to help in drug design, this vaccine technology was independently designed by an AI program called SAM (Search Algorithm for Ligands), created by the Flinders-based team.

Associate Professor Dr Dimitar Sajkov, says a number of influenza patients seen this year had received the 2019 vaccine, highlighting the need to develop a better flu shot

“It is tremendous to see such a promising vaccine that we developed with the very first human trials being done at Flinders, progressing onto the world stage,”

“In 2009 the team at Flinders were the first in the world to develop a new swine flu vaccine to combat the 2009 pandemic. The Flinders trials confirmed both the effectiveness and speed with which this new vaccine could be delivered, resulting in many awards including the AMP National Innovation Award at the Telstra Business Awards.

The US clinical trial will take about 12 months to complete and aims to recruit 240 healthy volunteers.

The trial is sponsored by the National Institute of Allergy and Infectious Diseases, part of the US National Institutes of Health.

Dr Petrovsky expressed gratitude to the US government for providing long term funding for research that led to this breakthrough.

“It takes decades to develop a new human vaccine and this is extremely hard to achieve under Australian funding models which tend to be short term.”

https://www.news-medical.net/news/20190701/More-effective-flu-vaccine-begins-clinical-trials-across-the-US.aspx

Celyad to advance CYAD-02 into the clinic

Celyad (NASDAQ:CYAD) announces that the FDA has signed off on its IND for its next-generation CAR-T candidate CYAD-02 clearing the way for clinical trials in relapsed/refractory acute myeloid leukemia (AML). Enrollment in a Phase 1 dose-escalation study should commence in early 2020. The company says CYAD-02 is based on licensor Horizon Discovery’s optimized shRNA SMARTvector technology.

In a Phase 1 trial, first-generation CYAD-01 showed “preliminary anti-leukemic activity” in 46% (n=6/13) of AML patients. Preliminary data from cohort 4 should be available by year-end.

Management will host a conference call tomorrow, July 2, at 8:00 am ET to discuss its plans.

https://seekingalpha.com/news/3475111-celyad-advance-cyadminus-02-clinic

States explore importing drugs. Will it catch on?

Seeking a solution to the soaring costs of drugs, Colorado, Florida and Vermont are making plans to import medications from Canada, where prescriptions are cheaper.

President Donald Trump has offered his support, marking the first time drug importation has won a presidential endorsement.

The states’ plans are in their infancy. But they signal how frustration among consumers—especially those shouldering greater portions of their healthcare bills through high-deductible health plans—is putting pressure on federal and state officials.

Because so many details are still being hashed out, it’s not yet clear who would be helped by the states’ efforts or if the plans can ultimately gain federal approval and withstand likely court challenges.

In the early 2000s, attempts by a few states, led by Illinois, to allow drug importation fizzled, and any new plan faces stiff regulatory and legal hurdles. But drug prices are at an all-time high. The increasing popularity of high-deductible plans means a growing number of patients are spending more money on healthcare. And Trump’s endorsement and current consumer demand for lowering drug prices could yield a different result this time around.

“Everyone is eager to get going into uncharted territory,” said Trish Riley, executive director of the National Academy for State Health Policy, a nonpartisan group of state health officials, which has been working with Vermont on its importation plan.

Gabriel Levitt, president of PharmacyChecker.com, which verifies online foreign pharmacies for customers, said the high prices for drugs make the efforts worth pursuing.

“It certainly will be helpful to reduce costs for some in the states that go ahead, and that’s a great start,” he said. Plus, he added, Trump’s support “puts the wind at the sails of importation.”

Tempering expectations

The 2003 Medicare Modernization Act allows states to import cheaper drugs from Canada, but only the Health and Human Services secretary verifies their safety. Previous attempts by states to allow importation failed because the secretary opposed them.

Vermont, Florida and Colorado plan to work together to set up a program to buy drugs from Canada, said Riley. That coalition of states—with governors from the center, right and left—shows how powerful the issue of high-priced drugs is with voters.

The same medicines are often cheaper in other countries than in the U.S. since most developed countries negotiate with drugmakers to set prices.

RELATED: Pelosi aims for feds to negotiate drug prices, even for private insurers

State officials said they expect that the effect of their programs would be modest to start, generally first permitting the importation of only certain types of high-priced drugs and for specific populations.

For example, infusion medicines used for cancer or autoimmune diseases that are administered in medical offices would not be available to import from Canada under the programs the states are setting up. Nor would drugs such as insulin, which needs to be refrigerated. Prices for these types of drugs have come under fire in the U.S., with patients calling them unaffordable.

“It’s a few states and a few drugs,” Riley said.

No tampering with safety

Vermont, which passed legislation to start planning the program a year ago, is still trying to find a way to ensure the safety of imported drugs and so far has identified only 17 medicines that would save enough money to be worth bringing over the border. Those drugs include treatments for conditions including diabetes, hepatitis C, cancer and HIV/AIDS.

After a review, officials decided it was not worth importing drugs for Medicaid enrollees because the state already receives hefty rebates on those medications from U.S. manufacturers and patients do not have copayments. So Vermont’s program is being designed to help residents who have commercial insurance.

Florida’s legislature authorized a blueprint this spring with a strong endorsement from Republican Gov. Ron DeSantis. The program aims to help bring down drug costs for the Medicaid program, which covers the more than 4 million enrollees in the state, prisoners and patients at free health clinics. The legislature also authorized a separate program that would provide drugs for individual Florida residents.

DeSantis signed the bill June 11 and called on federal officials to “get this done.”

Colorado approved its legislation in May, but state officials said they do not yet have details on what it might cover.

Officials in all three states have high hopes that the programs will succeed in ways not possible the last time around.

Between 2004 and 2009, Illinois, Kansas, Missouri, Rhode Island and Vermont defied the federal government and allowed residents to import from a Canadian retail pharmacy under a joint program, which flopped. Just 5,000 people participated, far fewer than the millions predicted, partially because the federal government declared the program violated federal law and warned against using the drugs. Also, in 2006, it established a Medicare drug benefit to help those 65 and older, further weakening demand.

Besides, after several years, the Canadian health minister threatened to prohibit pharmacies from participating over concerns that the program might cause shortages, and the main Canadian supplier pulled out due to lack of demand.

In 2014, Maine briefly allowed residents and employers to buy foreign drugs. Under that law, some employers, including the city government of Portland, established a program for workers to use CanaRx, a Canadian company that connects customers with brick-and-mortar pharmacies in Canada, Great Britain and Australia.

After pharmaceutical manufacturers and pharmacists sued, a federal judge overturned the law in early 2015, citing its conflict with federal law.

Then and now, opponents of importation say sending drugs over the border will increase the chances Americans get counterfeit medications, a claim often boosted by the drug industry. Levitt noted that states now intend to work directly with and inspect Canadian wholesalers, which should make Americans more comfortable about drug safety.

With prices so high, individual Americans are more open to buying drugs from Canada, anyway—some have for decades been driving over the border, using online pharmacies or going into storefronts that connect buyers to pharmacies in Canada and other countries. Although these strategies are technically illegal, the government does not prosecute individual offenders. Nor has it moved to stop the dozens of cities, counties and school districts across the United States that have programs for employees to buy drugs from Canada and other countries.

Canadian health officials are watching the debate and said they are weighing the effect a robust importation program would have on Canadian consumers.

“Collaborative efforts among implicated parties would be important in addressing any potential adverse impacts on the drug supply in Canada that may arise from increased cross-border trade,” said Eric Morrissette, a spokesman for Health Canada, the government agency responsible for public health.

https://www.fiercehealthcare.com/regulatory/trump-has-blessed-states-exploration-importing-drugs-will-it-catch

Carpal Tunnel Syndrome: ‘Red Flag’ for Subsequent ATTR, Heart Failure

Carpal tunnel syndrome may be an early warning sign of amyloidosis and heart failure, a Danish study showed.

Matched by age and sex to the general population, people who got carpal tunnel surgery had higher risks of developing amyloidosis (0.10% vs 0.006%, adjusted HR 12.12, 95% CI 4.37-33.60) and heart failure over the next 10 years (5.3% vs 3.2%, adjusted HR 1.54, 95% CI 1.45-1.64).

These patients also experienced significantly more of other adverse cardiovascular outcomes — such as atrial fibrillation, atrioventricular heart block, and pacemaker implantation — according to a group led by Emil Fosbøl, MD, PhD, of the University Hospital of Copenhagen, Rigshospitalet, reporting in the July 9 issue of the Journal of the American College of Cardiology.

Given that the absolute incidence of diagnosed amyloidosis was still low for either group, carpal tunnel syndrome by itself “may not merit direct referral for further evaluation for amyloidosis, but could rather be considered a red flag and an opportunity for early disease detection,” Fosbøl and colleagues said.

“Transthyretin cardiac amyloidosis is still usually found too late, when severe left ventricular thickening, restrictive cardiomyopathy, and depressed systolic function can lead to orthostasis, hypotension, conduction disease, dyspnea, and death. To improve outcomes and start drugs when they can be of benefit, early diagnosis of transthyretin cardiac amyloidosis is imperative,” commented Van-Khue Ton, MD, PhD, and colleagues, all from the University of Maryland School of Medicine in Baltimore, in an accompanying editorial.

Study investigators also found that the subgroup with heart failure and a history of carpal tunnel syndrome showed lower short-term but higher long-term mortality risk than peers with heart failure but not the latter — consistent with the development of wild-type transthyretin cardiac amyloidosis, they said.

Their study was based on Danish registry data spanning from 1996 to 2012 (total of 56,032 patients). Median age was 53.9 years and 67.9% of the cohort were women.

Carpal tunnel syndrome is known to be common in transthyretin amyloidosis (ATTR), and the two may be linked by systemic amyloid accumulation. On top of that, ATTR has been found to be one of the causes of heart failure with preserved ejection fraction (HFpEF), according to the authors.

“It would be highly interesting to determine the importance of HFrEF [heart failure with reduced ejection fraction] versus HFpEF in the current study, but unfortunately, these data were not available in the registry,” Fosbøl’s group acknowledged. “It is crucial that future studies phenotype the HF syndrome associated with CTS [carpal tunnel syndrome].”

Other limitations of the study include its observational nature and the lack of certain clinical variables in the files (for example, hereditary amyloid cardiomyopathy and wild-type ATTR could not be distinguished from the dataset).

Moreover, people who got surgery for carpal tunnel syndrome had more comorbidities than controls and were on more medications, especially anti-inflammatory drugs, at baseline.

“[C]arpal tunnel syndrome often predates clinical amyloidosis by decades. Thus, a 10-year study, while admirable, might still miss many patients with amyloidosis. Furthermore, amyloidosis is still underdiagnosed, and true rates might be much higher,” Ton and colleagues added.

ATTR cardiomyopathy also presents more commonly in men and non-Caucasians, suggesting that the Danish population may not be the best group in which to study this, the editorialists wrote.

With such low absolute event rates in patients with carpal tunnel syndrome in the present study, the question is whether it would only predict relatively few amyloidosis patients, the editorialists said.

Nevertheless, they agreed that carpal tunnel syndrome could be considered a “red flag” of possible amyloidosis down the road.

Fosbøl and Ton disclosed no conflicts of interest.

• Primary Source

  Journal of the American College of Cardiology

  Source Reference: Fosbøl EL, et al “Association of carpal tunnel syndrome with amyloidosis, heart failure, and adverse cardiovascular outcomes” J Am Coll Cardiol 2019; DOI: 10.1016/j.jacc.2019.04.054.

• Secondary Source

  Journal of the American College of Cardiology

  Source Reference: Ton V, et al “Carpal tunnel syndrome and future amyloidosis: time to heed the warning sign” J Am Coll Cardiol 2019; DOI: 10.1016/j.jacc.2019.04.055.

https://www.medpagetoday.com/cardiology/chf/80785