Medical Device ASIA, March-April 2016

Vol.8 No.2 | March-April 2016 | New Delhi

A Checklist for Depression

Show Report!

MEDICAL FAIR INDIA

Stress

MANAGEMENT! WOMEN HEART DISEASE! Treatment!

HighBlood PRESSURE

Lose Weight FASTER & SAFELY About STOMACHACHES!

Diabetes Prevention HKTDC HONG KONG INTERNATIONAL MEDICAL DEVICES AND SUPPLIES FAIR

Program

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highlights Medical Devices & Equipment | Healthcare | Pharmaceutical Journal

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HKTDC HONG KONG INTERNATIONAL MEDICAL DEVICES AND SUPPLIES FAIR

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MEDICAL FAIR INDIA 2016 in Mumbai

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Wound Healing 2016

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The Pulmonary Arterial Hypertension (PAH) therapeutics market

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NAYATI MULTI-SUPER-SPECIALTY HOSPITAL

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EOLIS air manager, 1st intelligent air filtration system to be launched in India

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Robotics Lasik Launched in Gurgaon

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Aspirin Both Triggers And Treats An Often-Missed Disease

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The smart way of providing affordable health care

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9 Tips to Practice Yoga at Home

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Diabetes Prevention Program under the Affordable Care Act is working

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How to Lose Weight Faster, But Safely

Vol.8 No.2 |March-April 2016 | Annual Subscription: India : Rs.2000 / Overseas: US$ 250

Managing Editor Sarvjit

Associate Editor & Public Relations Director Reny

Joint Editors Vishwapreet Amrita

Production Rakesh

Marketing & Communications Lovleen

Web Editor Ravindar

Circulation Surekha

Secretary & Legal Advisor Surinder

Editorial Advisory Board Alex & Lilly - Netherlands

alex@vanbienen.net Andy McCourt - Australia

UK Representative Mike Steele, MJ Marketing

20, Spencer Bridge Road Northampton NN5 5EZ Tel: +44-1604 756 100 Fax: +44-1604-750 910 For advertising, subscribing or to submit a press release, write to : D-182, PR House, Anand Vihar, New Delhi - India.

Tel : +91 11 22141542 / 4309 4482 Fax: +91 11 22160635 Email: info@medicaldeviceasia.in Published, printed, & owned by World-Wide Publications at D-182, Anand Vihar, Delhi-110092 and printed by him at Chandu Press, 63, Patparganj, Delhi-110092. Editor: Sarvjit Kanwar

China Correspondents Ying Wei / Adrian Liu

The publisher does not necessarily agree with the views expressed by the contributors, in this issue, nor do accept any responsibility for any errors or interpretation in the publication.

Global Healthcare Mobility Solutions Market 2016

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he global healthcare mobility solutions market was evaluated at US$20.19 billion in year 2014 and it is predicted to touch the revenue of US$110 billion US dollars by the end of year 2022.

Today, mobility has evolved as a main technology for healthcare sector, as it helps the medical community to accept a patient centered approach, reducing healthcare expenses and the implications of the deficiency of nursing as well as healthcare experts. Growing penetration of modernized network techniques like personal digital assistants, smart phones and tablets in healthcare services & systems combined with the emerging concentration on patient centric mobility uses and applications is stimulating the growth and expansion of healthcare mobility solutions market globally.

Further, lack of skilled healthcare experts, high quality of healthcare services, best cost efficacy of mobility services, increased acceptance of mobility services by healthcare experts, shortage of nursing staff, and increasing market penetration of wireless network techniques like 3G and 4G are predicted to propel the growth and expansion of the healthcare mobility solutions market universally. However, the privacy and data security issues

and interoperability threats related with the healthcare mobility services has limited the broad acceptance of healthcare mobility solutions. Also short life of battery of mobiles & computers, lack of standardized protocols of communication, fluctuating compensatory polices, price issues and issues of infrastructure can pose a major threat to the growth and expansion of the healthcare mobility solutions market worldwide.

The worldwide healthcare mobility solutions market was divided by products & services, by applications, by end users and by geographical locations. The global healthcare mobility solutions market by products & services includes enterprise mobility podiums, mobile equipments and mobile applications. Mobile equipments comprises of barcode scanners, mobile computers, RFID scanners and others.

Key companies profiled in this market report includes McKesson Corporation, Koninklijke Philips N.V., Airstrip Technologies Incorporation, Oracle Corporation, Cisco Systems Incorporation, SAP SE, Cerner Corporation, AT&T Incorporation, Philips Healthcare, Zebra Technologies Corporation and Omron Corporation.

Medical Device ASIA | March-April 2016 | 3

HKTDC HONG KONG INTERNATIONAL MEDICAL DEVICES AND SUPPLIES FAIR Present Leading-edge Products and Explore Medical Industry’s Advancements

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he 7th edition of the HKTDC Hong Kong International Medical Devices and Supplies Fair will take place from 3 – 5 May, 2016, at the Hong Kong Convention and Exhibition Centre, with more than 250 exhibitors from 11 countries and regions participating in this year’s fair.

regions include Sweden, exhibitors of which will bring along medical devices in the field of Otolaryngology; Vietnam will showcase a variety of products, including diapers that are specially designed for adults; Pakistan will present a wide range of surgical instruments, including sections of the scalpel.

The fair is divided into 15 specific product zones, including Rehabilitation and Elderly Care Zone, Hospital Equipment Zone, and Tech Exchange, showcasing latest remediation and therapeutic products. Nonetheless, the popular zone Physiotherapy Zone will display the latest physiotherapy equipment, instruments and related services and products, including braces, rollers, exercise paraphernalia, sports equipment and more.

Institutional Medical Devices and Supplies

This year the pavilions include Hong Kong Medical & Healthcare Device Industries Association Limited (HKMHDIA) Pavilion and Shenzhen Association of Medical Devices (SAMD) Pavilion, as well as the new participation of Pakistan Pavilion.

Newly participating countries and

Illies East Asia Limited from Hong Kong designs and develops its own AliveCor Mobile ECG which is a "mobile electrocardiograph" that looks like a normal smart phone case. As long as the application is installed in users’ compatible smartphone or tablet, users can keep record of their electrocardiogram and heart rate easily. The atrial fibrillation detector of this product has passed FDA authentication.

Healthcare Technology International Limited’s Firefly Wireless Medical Camera Series includes Otoscope and Dermatoscope. The small and lightweight cameras can capture medical imaging or video and instantly transmit to the

computer for further use, like for diagnostic and education purpose.

It has been widely applied in otolaryngology, audiology, dermatology as well as veterinary diagnosis, and is suitable for use in hospitals and clinics.

In addition, patients with back injuries may need to use pillow as support for fixing their body, or seek help from family members for turning side to side at midnight. Just Med Limited presents “SYSTAM 30° Positioning Wedge”. The ergonomic stabilization supporter can maintain user’s body in 30° properly, which helps to minimize pressure from sacrum.

Doses of Insights with the Latest Market Trends Alongside a great array of innovative products, the fair also presents seminars and networking opportunities. Different representatives were invited to the fair, including Nano and Advanced Materials Institute Limited, Hong Kong Productivity Council and Hong Kong Science and Technology Parks Corporation,

to explain the latest technology and market trends in the medical and healthcare device industry. Ir Bryan So, Executive Deputy Secretary General, Asian Harmonization Working Party will share his insights into the latest updates for medical device regulations. The fair also features workshops and talks coorganized with Hong Kong Doctors Union and Hong Kong Health Care Federation respectively, so as to exchange information with industry players.

Organized by the Hong Kong Hospital Authority, the annual signature event in the medical industry “Hospital Authority Convention 2016" will be held concurrently on the first two days of the Medical Fair in the same venue.

Over 90 overseas and local speakers will share their expertise and experience with the industry.

Besides, “Asia Biotech Invest” conference will also be held concurrently on the last day of the fair, providing biotech companies in the Asia-Pacific region a platform for cooperation and exchanging information.

For more fair details, please visit: www.hktdc.com/hkmedicalfair Enquiries: exhibitions@hktdc.org Tel: (852) 1830 668

ILLIES EAST ASIA LIMITED (Hong Kong) Booth no.: 3G-B20 Product Zone: Household Medical Products

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HEALTHCARE TECHNOLOGY INTERNATIONAL LIMITED (Hong Kong) Booth No: 3F-G24 Product Zone: HKMHDIA Pavilion

JUST MED LIMITED (Hong Kong) Booth no.: 3G-A07 Product Zone: Rehabilitation and Elderly Care

Multiple Pump Technologies

Global Sales & Manufacturing

Broad Application Range

India: Manoj +91 9004282345 manoj.ahire@gardnerdenver.com | SE Asia: Michelle + 852 9170 0693 michelle.wu@gardnerdenver.com Australia: Keri +61 (0) 402 275 962 keri.mcneill@gardnerdenver.com | Korea: Eddie +82 10 7720 2584 eddie.lee@gardnerdenver.com Japan: Shiko +81 90 8051 5394 shiko.iwai@gardnerdenver.com | China: Mark +86-135-0170-935 mark.lou@gardnerdenver.com

305, A-wing 215 Atrium, Andheri – Kurla Road, Chakala, Andheri (E), Mumbai – 400 093. Tel: +91 (022) 658 12345 / +91 (022) 61274541 - 44

Gardner Denver Engineered Products India Pvt. Ltd

Oil-Less Operation

Global Solutions for Medical OEMs

OEM Compressors, Vacuum and Liquid Pumps

MEDICAL FAIR INDIA 2016 in Mumbai: number of visitors exceeds expectations MEDICAL TRADE FAIR REPORTS A 34% INCREASE IN VISITORS.

conditions.

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Horst Giesen, Global Portfolio Director for the `World of MEDICA´ of the Messe Düsseldorf Group, gave a positive summary of the 22nd MEDICAL FAIR INDIA: "We did not expect such a volume of visitors up to the last day of the trade fair. The new products, many of them from the high-tech sector, found a very positive echo from professional visitors. Given extraordinary growth in the medical sector in one of the most populous countries in the world, we also expect a strong trade-fair business in future that can also benefit our European exhibitors. MEDICAL FAIR INDIA and the globally leading trade fair MEDICA complement each other".

he MEDICAL FAIR INDIA 2016, India's No. 1 Trade Fair for Hospitals, Health Centres and Clinics, has continued its successful development in the growth market India in impressive fashion. Over 10,700 professional visitors made their way to the Bombay Convention & Exhibition Centre in Mumbai during three intensive days of the trade fair. This corresponds to record growth of 34% compared to the previous event in Mumbai.

The exhibitor figures also benefited once again from the strong economic situation in the industry: 512 exhibitors from 16 countries presented their product innovations from the fields of medical technology and health management over an exhibition area of approx. 6,000 square metres, and unanimously praised a successful trade fair.

All relevant Indian companies were represented in Mumbai, including numerous market leaders from Asia.

298 exhibitors from other countries bear witness to the growing internationality of the event.

In addition to India, the largest exhibitor nations included China, Malaysia and Taiwan; Germany, France, Great Britain, Italy, Japan, Korea, Turkey, the UAE as well as the USA also took part in the trade fair.

On the initiative of the Spectaris and ZVEI associations, Messe Düsseldorf organised an official joint company stand as part of the International Trade Fair Programme of the Federal Republic of Germany (AMP); this significantly facilitated participation in the trade fair for exhibitors, and offered both an optical as well as a price benefit through an attractive uniform image and favourable

The MEDICAL FAIR INDIA was accompanied by an extensive supporting programme. A highcalibre professional conference with the focal themes "Healthcare Branding, Marketing & Business Development" as well as "Innovating India with Healthcare Technology" offered decision makers from the clinic sector, medical professionals, dealers and players from industry and health management an ideal forum at which to obtain information on trends and to establish contacts.

Afzal Kamal, National Head of the leading professional journal for medical personnel in India, Medgate Today, again honoured particularly outstanding companies, hospitals and medical professionals during the 22nd MEDICAL FAIR INDIA. The renowned MT India Healthcare Award was presented to 32 participating Indian companies and personalities from various categories. For example, awards went to the best doctors in Cardiac Surgery, Surgery, Gynaecology and Oncology, as well as to personnel from

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the Healthcare sector (the Healthcare Personality of the Year), and to renowned companies such as Hindustan Medical Devices, Ribbel International Ltd. or Spencer India Technologies Ltd. Visitors to the trade fair included numerous top decision makers from healthcare as well as renowned personalities such as Prof Dr Wali, Personal Doctor to the Indian President, Secretary General Anjan Bose and Dr Jitendar Sharma, Director NHRC & Advisor to Chief Minister Andrah Pradesh.

The next MEDICAL FAIR INDIA will be held from 6 to 8 April 2017 in New Delhi in line with the scheduled rotation.

The MEDICAL FAIR INDIA is part of the `World of MEDICA´ and is one of the long-established international medical trade fairs of the Messe Düsseldorf Group – organised in close cooperation with the world's largest medical trade fair MEDICA at the Düsseldorf location.

Exhibitor Response to MEDICAL FAIR INDIA 2016 Björn Kallmeyer, Managing director of Kallmeyer Medizintechnik GmbH & Co. KG (Germany): “For the first time our local partner Easycare, presented ERKA products. And with great success. With this we were able to greatly improve our name recognition in Mumbai und Delhi. For future expansion we are looking for additional local partners in other regions of the large Indian market.”

Anand Singh, CEO of Thea Tex Healthcare (India) Pvt. Ltd.: “An excellent show.

We have launched a new product and booked several orders. Very

professional expo. We were busy for all three days. We will certainly book for 2017!”

Anjali Gaur, Manager Sales & Marketing of Medico Electrodes International Ltd.: “Medical Fair India has always been a good experience. Response was good. Surely, we would like to book a stand next year also.”

Devanshu Patel, Executive Director of Zeal Medical Pvt. Ltd.: “Proud to be associated with Medical Fair India since the very start. It’s always been an upward graph and definitely will reach better heights.”

Satya S. Gupta, Director of Galaxy India: “We are thankful to Messe Düsseldorf India for giving us an excellent platform and audience.

The show was organised in a professional way with great services.

We got the maximum target audience.”

Aditya Sarabhai, Managing Director of AV Consumables: “Medical Fair India is a great place to make new contacts, meet up with existing clients and also one of the best places to know the pulse of the medical industry.

Nikunj Kedia, Director of Bellcross Industries: It’s a pleasure to be associated with a reputable brand in exhibition industry. As a brand Messe Düsseldorf is such that people fly from all over India to attend and participate in the Medical Fair India.For other exhibitions, Medical Fair India is the benchmark of how to do it. Every year we get new clients as well as new products.”

For more information, please contact: http://www.medicalfair-india.com

TURKEY PHARMA INDUSTRY ONE OF THE PRIMARY INDUSTRIES IN THE GOALS OF THE COUNTRY FOR THE YEAR 2023 Turkish and Global giant pharma companies come together under one roof in CPhI Istanbul 2016...

The largest pharma exhibition in Eurasia, CPhI Istanbul 2016 is preparing to welcome over 4,500 visitors from more than 40 countries in Istanbul Congress Center between June 1st and 3rd. More than 200 exhibitors from over 25 countries will take part in the event where local and international purchasing directors and suppliers will come together.

Moreover, the Turkey Pharma Industry Report which CPhI Istanbul initiated three years ago in order to shed light on the industry and which it will organize with collaboration of Fortune Turkey Magazine this year will first be revealed in CPhI Istanbul 2016.

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urkey pharma industry is among the primary industries that will make significant contribution to reaching the goals of our country for the year 2023 with its deep-rooted history, long years of culture of production, a structure based on high added value and advanced technology as well as experienced workforce and export potential. The Turkish pharma industry plays a significant role in the Turkish economy with over

11,000 products, 65 manufacturing facilities that make production in accordance with international standards, 11 raw material production facilities, over 300 institutions and 30,000 employees. Having 13 accredited R&D centers, the industry makes export to 170 countries, particularly to USA, EU, Commonwealth of Independent States and MENA countries.

to reducing current deficit. Turkey pharma market achieved 15.5% increase in economic value in 2016 and reached 16.87 billion TL. 6.7% increase has been observed in the box scale and production reached 1.95 billion boxes.

Turkish pharma industry's export increased by 9.8% in 2015 and reached 939 million US Dollars, whereas pharma import diminished by 2.6% and reached 4.6 billion US Dollars. This way the export / import coverage ratio realized as 20.3%, reaching the highest in the 20102015 period and the pharma industry made positive contribution

Bringing together three social security systems implemented in Turkey under a single roof, the Health Transformation Program has completed its 12th year. Following the program, hospital visits have almost been multiplied by 3 times since 2004 and this caused increase in pharmaceuticals usage. Accordingly, health spending in Turkey is

Health spending per capita in Turkey is expected to reach 2,000 dollars until 2023

Medical Device ASIA | March-April 2016 | 7

expected to continue to grow by 5.6% until the end of 2017. This growth rate exceeds the growth in the largest health markets in the world. Considering the changing demographical structure, increase in the frequency of occurrence in chronic diseases, continued expansion of health system in the country and works conducted for making Turkey a center of medical tourism, health spending per capita in Turkey is expected to increase by 23.1% Compound Annual Growth Rate until 2023 and to be multiplied by three times, reaching 2,000 dollars.

CPhI Istanbul 2016 quickly became the common and major meeting point for the pharma industry in the Eurasia region Having realized one of the most prestigious meetings in the world, CPhI Istanbul is preparing to bring together the largest pharma companies in Eurasia for the 3rd time on June 1st - 3rd. Creating major opportunities for its exhibitors and visitors in order to access the pharma industry in Turkey, MENA, Middle Asia and Caucasia, CPhI Istanbul 2016 has quickly become the common and major meeting point for the pharma industry in the region.

Chief Operating Officer of Turkey in UBM EMEA (Istanbul), Haluk Balci said: "We organize 450 exhibitions a year with over 5,500 employees in 40 countries and we aim to improve the exhibition business. We are equipping our experience and knowledge from the decades with capabilities and facilities which no exhibition company can accomplish worldwide and we are using these to serve the pharma industry and our geography. Accordingly, CPhI Istanbul was awarded the "Best Trade Fair Launch" award in the Excellence Awards of International Association of Event Organizers

right at its first year."

Stating that Turkey owns 9.1 billion dollars market per year in the pharma industry alone and this is expected to reach about 20 billion dollars in 2023 with the investments to be made, Chief Operating Officer of Turkey in UBM EMEA (Istanbul), Haluk Balci said: "About 400 million dollars' worth of 33 investment projects are planned for establishing new and pharma industries and modernizing the existing ones in the target markets.

As UBM EMEA (Istanbul), we identify our clients' needs before they do and we enable them to reach new markets constantly."

The firsts and innovations will appear in CPhI Istanbul 2016 Pharma Exhibition Mentioning that Turkey Pharma Industry Report 2016 which is prepared with the collaboration of Fortune Turkey, one of the most prestigious economy magazines in the world will be announced in CPhI Istanbul 2016 for the first time, Haluk Balci said: "Fingers are crossed for Turkey Pharma Industry Report 2016 as the report keeps its finger on the pulse of the pharma industry and steers its development. Our report contains findings regarding Turkey's pharma industry and data to guide and offer solutions for every kind of needs of local and foreign players who would like to take part in this large market."

CPhI Istanbul 2016 opens the gates to its exhibitors and visitors for new markets by organizing meetings titled 'Investment and Business Opportunities in the Target Countries' in Turkey for the first time and provides them with the principles and strategies applicable for these markets. Stating that UBM EMEA (Istanbul) continues to change the traditional order of the exhibition business model and

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offers a special vision for its exhibitors and visitors, Haluk Balci said: "We have designated the countries that will take part in the workshops we scheduled for this year with commissions of 3-4 persons as Jordan, United Arab Emirates, Morocco, Israel, Iran, Lebanon, Saudi Arabia, Egypt, Algeria and Turkey. We will accept our exhibitors and visitors to our meetings titled 'Investment and Business Opportunities in Target Countries' to be held in the form of half an hour sessions in groups of 10 persons and we will provide them with strategic consultation services, particularly on market conditions."

common presentations.

Highlighted topics in the conference program are "Positioning Turkey as the Global Pharma Production Center

by Building It On Entrepreneurship, Innovation and R&D Operations", "Evaluation of Changing Dynamics in the Market: How to Be Strong Against the Main Issues We Are Facing in the Pharma Industry Today?", "Becoming Stronger in the MENA Region Using Investment Strategies and Effective Growth: Project and Portfolio Management", "Middle East and North Africa as the Hot Domain of the Large Pharma Industry: New Production Facilities that Rivet the Developing Market Status in the Region".

Having the privilege of being Eurasia's largest pharma event, CPhI Istanbul 2016 addresses major topics in the industry such as investment and business opportunities, legal regulations and policies, production, R&D, new technologies and supply chain and focuses further on new markets and the business potential therein with a conference within the organization.

It is expected that top level executives from leading players of the countries in the region, scientists and academicians from university communities, senior representatives from state organizations and institutions, officials from industryspecific associations and foundations as well as investment experts, analysts and consultants will attend the conferences as speakers and share their opinions via case study evaluations, panel discussions and

CPhI Istanbul 2016 is organized by UBM EMEA (Istanbul) with the support of the Turkish Republic Ministry of Health, Turkish Drug and Medical Device Agency (TITCK) and Small and Medium Enterprises Development Organization (KOSGEB) in official partnership with the Pharmaceuticals Manufacturers Association of Turkey (IEIS). Also, DEVA Holding assumed the diamond sponsorship, Nobel Ilaรง the platinum sponsorship, Helba Ilaรง, BD Medical Pharma and CCCMPHIE the gold sponsorship, Koรงak Farma, Pharmactive, Vem Ilaรง and Infa Group the silver sponsorship, Analitik Kimya, Mustafa Nevzat, Sanli Ilaรง, BD Medical Pharma and Infoset, Harman Finochem, Nosch Labs PVT, Pharma Action, Softi Gel Procaps, Symbiotica and Promo Pharma assumed the other sponsorships.

ABOUT UBM EMEA (ISTANBUL): Headquartered in London, UBM is a London-listed global leading fair organization business with offices in more than 40 countries and over 5,500 employees. It is the world's second largest pure play event organizer. It is a member of the FTSE 250 index with over 450 events a year.

In addition to traditional exhibition business, the company attaches great importance to technology and content and is a leading company that ensures each exhibition raises the bar in the industry each year.

For detailed information: ubmistanbul.com/tr/

STARLED7 NX LED lamp for operating room STARLED7 NX is the operating lamp granting the best working conditions to surgeons and medical staff.

The new NX series of our STARLED lamps meets the highest quality standard requirements. STARLED7 NX produces a perfect IR-free light, with an excellent colour temperature and low consumption suitable for every situation.

The Made in Italy design grants visual comfort, practicality of use and compatibility with laminar flows. STARLED7 NX boasts an excellent light quality. The special optics of its LEDs, realized by ACEM, generates a shadowless, clear and homogeneous light assuring visual comfort and best working conditions both for the surgeon and for the medical staff.

Thanks to its next generation LEDs, the lamp can produce a perfect illumination under every condition generating a IR-free light, an excellent colour temperature and a practically endless life cycle at low consumptions.

The lamp is composed by 57 next generation LEDs circularly placed and splitted into 7 reflectors (with 7 LEDs each one) and other 8 LEDs radially positioned around the handle.

STARLED7 NX produces a high illumination level of 160.000 lux. The colour rendering index of 95 and the colour temperature of 4.500 °K allow to reproduce the exact chromatic scale of the colours of the human body. The lamp is provided with ACRIS, the innovative system realized by ACEM that ensures, by the use of a microprocessor, the control of electrical curves typical of LEDs to remain unaltered over the time but maintaining a long life cycle (about 50.000 hours).

STARLED7 NX assures: • High quality illumination level for each kind of surgery • Colour temperature representing the contrast of the surgical area perfectly • Colour rendering index of 95 (CRI) • Clear luminosity at 160.000 lux • Colour temperature of 4.500 °K • Ergonomics for an extraordinary simplicity of use and easy positioning for the medical team • Exceptional duration with easier management and low consumptions STARLED7 NX is provided with: • ACRIS, a smart system created by ACEM • A special system to adjust the light field dimension without mechanical parts through an optical-electronic management • A revolutionary I – SENSE® control system • An innovative LIGHT – UP system that, thanks to the special light beams coming from the upper part of the lamp, assures adjustable illumination levels according to the different use and particularly suitable for minimal invasive surgery.

FOCUSED AND AMBIENT LIGHT

In order to achieve a correct illumination according to the different needs STARLED7 NX can produce a FOCUSED and AMBIENT light.

Thanks to the special optics realized by ACEM, the light field focusing system adjusts the light spot diameter accurately assuring an excellent sharpness of details in the operating area. The light field dimension adjustment without

mechanical parts is possible through an optical-electronic management that grants a steady, homogeneous, shadowless and reliable illumination of the operating field in every situation particularly suitable for deep cavities.

AMBIENT light is managed by the LIGHT-UP system, a technology created by ACEM that produces adaptable and adjustable illumination levels according to the different uses thanks to the special light beams coming from the upper part of the lamp. This light allows to visualize the operating field as well as the surrounding environment clearly and is particularly suitable for minimal invasive surgery and for the preparation and treatment during the operation, monitoring of the patient and microscope operations.

Ergonomic, practical and functional design

Comfortable and light to move, thanks to its central handle, STARLED7 NX is practical also for the medical team who can move it from the lateral handles assuring stability and constant illumination even during the movement.

STARLED7 NX has been manufactured with a smooth and resistant material that makes cleaning quick, easy and complete. On demand, the removable and sterilizable central handle can house a video camera shooting the surgical operations accurately (the video camera can be placed on a separate arm alternatively). The lamp shape assures visual comfort and is particularly suitable for laminar flows in the operating room.

The design is practical, functional and ergonomic. Thanks to AVSM system (Acem – Video – System – Management) STARLED7 NX is compatible with all the cameras and monitors offered by ACEM. STARLED7 NX functions are managed by the handy, digital and easy-toread I–SENSE® control panel positioned on the cardanic structure and adjusting: • ON/OFF function • Light intensity • SIZE - Light spot diameter dimension (light beam focusing) • ENDO - Light for endoscopy • DOF - Depth of field – for a full visualization of the operating field and deep cavities • SYNC – (optional) Mode to synchronize controls among the combined lamps: STARLED7 NX double (twin dome configuration) and STARLED7 NX with STARLED5 NX or STARLED3 NX. The SYNC mode grants simplicity of use saving time and giving the possibility of being managed by a single operator. The precise and easy-to-read I–SENSE® system is functional, simple and easy to clean.

The optional remote control is useful to manage all the functions of the lamp from a remote position offering the end-user better efficacy and practicity..

For more information: ACEM SpA, Medical Company Division, Via della Tecnica 29 - 40050 Argelato, Bologna – ITALY, Ph. +39 051 721844 Fax +39 051 721855, info@ acem.it www.acem.it Medical Device ASIA | March-April 2016 | 9

ALCHEM INTERNATIONAL LAUNCHES THIRD GENERATION PHYTOMEDICINE TO COMBAT COUGH, COLD AND FLU

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n international clinical trials, PhytoRelief-CC’s patented formulation has proven to be very effective for conditions like cold and flu symptoms, upper respiratory tract infections, and mucosal lesions of the mouth and throat Alchem International launches the third generation phytomedicine called PhytoRelief-CC to combat symptoms of cough, cold and flu.

PhytoRelief-CC comes in the form of chewable sugar-free lozenges which contain concentrated and purified molecular extracts of turmeric (haridra), ginger (zingiber officinale), and pomegranate (dantabija). The synergistic effect of these nature-derived ingredients offers a host of benefits to quickly and naturally cure symptoms of cough, cold and flu. PhytoRelief-CC has very potent anti-viral, antibacterial, immune-modulatory, antiinflammatory, anti-allergic and antioxidant properties. It has been developed using AlchemLife’s proprietary Phytoplex™ technology based on cutting-edge science to deliver unsurpassed efficacy without any side effects. Phytoplex™

technology is Alchem’s proprietary extraction process which isolates active plant molecules in a way that preserves the `natural balance’ and ‘synergistic effects’ present in the original plant material. Raman Mehta, Founder, Alchem International, said, “PhytoRelief-CC provides quick and effective relief naturally, combining the power of traditional medicinal herbs with cutting-edge science and research. We expect a very encouraging response as there is presently no natural offering in the market that is backed by clinically proven results for the prevention and treatment of symptoms of cold, cough and flu.”

In European clinical studies published in prestigious peerreviewed international journals like Minerva Gastroenterol Dietol and Minerva Medica, PhytoRelief-CC has proven to be very effective for conditions like cold and flu symptoms, upper respiratory tract infections, and mucosal lesions of the mouth and throat (associated with Bechet’s disease). Compared to the placebo, PhytoRelief-CC led to reduction of signs and symptoms of cold and flu within 2weeks, 83 %

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reduction in bacterial load within 3 days, and effective anti-viral activity against various strains of influenza.

Tests have also shown significant improvements in treating disorders of the mouth, throat and upper respiratory tract infections within just 4-5 days. Priced at Rs199 for a strip of 10 lozenges, PhytoRelief-CC will be distributed in phases across the country at all retail and pharmacy outlets.

Sudhir Mehra, Senior Vice President, Alchem International, said, “The product will first be made available across North India and subsequently register its presence in other parts of India.”

About Alchem International Alchem International develops and markets Third Generation Phytomedicines – i.e. phytomedicines which undergo international clinical trials for efficacy and safety - under the master brand AlchemLife. Third Generation Phytomedicines are more efficacious than regular phytomedicines and have no side effects because of Alchem International’s proprietary extraction Phytoplex™ Technology.

Third Generation Phytomedicines have been developed by applying modern science to traditional systems of medicine from across the world including Chinese, African, South American, European and Indian. Third Generation Phytomedicines are ideally suited for long term treatment of ailments as they have no side effects. They can be used for primary therapy, or as adjuncts to primary therapy, that deliver long-term results with no side effects.

Alchem International has over 75 years of experience in manufacturing phytochemical-based Active Pharmaceutical Ingredients (APIs). Its phytochemicals plant, the biggest in India, is certified by the US FDA, WHO-GMP and AFSSAPS (The French Agency for the Safety of Health Products) and vendor validated by companies across the world. 80% of its revenues are generated from global exports.

The top selling Third Generation Phytomedicine brands under AlchemLife include Liverubin (Liver care), Flexiqule (Joint care), Miraqule C 100 ( Cardio care), ProstaQuil (Prostate care) and PhytoRelief CC (Flu care).

B-CELL NON-HODGKIN’S LYMPHOMA TREATMENT MARKET WILL STUTTER TO $5.45 BILLION BY 2024 • The Non-Hodgkin’s Lymphoma (NHL) market is forecast to experience only limited growth, rising from $4.38 billion in 2014 to $5.45 billion by 2024 • The NHL treatment arena will be prevented from experiencing any substantial growth by the entrance of biosimilars and generics through to 2024, says analyst lymphoma settings, while the developers of Arzerra, copanlisib, and duvelisib are focusing on indolent NHL.” GlobalData believes that while new players entering the NHL treatment market must overcome various obstacles, opportunities remain within this segment.

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he B-cell Non-Hodgkin’s Lymphoma (NHL) treatment market is set to rise slowly in value from $4.38 billion in 2014 to reach $5.45 billion by 2024, representing a very modest Compound Annual Growth Rate (CAGR) of 1%, according to research and consulting firm GlobalData.

The company’s latest report* states that such limited growth, which will occur across the seven major markets (7MM) of the US, France, Germany, Italy, Spain, the UK, and Japan, will be hindered by the entry of biosimilars and generics during the forecast period, combined with a weak pipeline.

Cai Xuan, Ph.D., GlobalData’s Analyst covering Oncology, says: “The launch of biosimilar rituximab across the 7MM in 2018 will have a significant negative impact on branded drug growth. Also significant will be the impact that generic bendamustine and lenalidomide will have on the treatment space as they are released

at various intervals in each region during the forecast period.

“Furthermore, no late-stage drugs in the NHL pipeline are expected to achieve blockbuster status, as rituximab-based chemotherapy regimens are gold-standard therapies that dominate the NHL treatment algorithms across both indolent and aggressive forms of the disease.”

The analyst adds that the high clinical efficacy and established reputation of these immunochemotherapies makes developing a replacement therapy in the first-line setting exceedingly difficult.

Xuan continues: “Despite this, there is potential for some of the current pipeline agents to be incorporated into the NHL treatment algorithms across indolent and aggressive lymphomas and in various lines of therapy.

“For example, Roche’s Gazyva is being evaluated across the follicular lymphoma and diffuse large B-cell

12 | March-April 2016 | Medical Device ASIA

Xuan concludes: “The NHL market is in need of more cost-effective therapeutics, improved consolidation/maintenance therapies for follicular NHL patients, and the development of novel drugs for NHL patients, all of which present significant opportunities for development within this treatment space.” *OpportunityAnalyzer: B-Cell NonHodgkin’s Lymphoma (NHL) – Opportunity Analysis and Forecasts to 2024 This report provides analysis of the Non-Hodgkin’s Lymphoma (NHL) treatment space across the seven major countries of the US, France, Italy, Germany, Spain, the UK, and Japan, including annualized market data from 2014 and forecast to

2024. It discusses market characterization, unmet needs, opportunities, and research and development strategies for the NHL market.

This report was built using data and information sourced from proprietary databases, primary and secondary research, and in-house analysis conducted by GlobalData’s team of industry experts.

For guidelines on how to cite GlobalData, please see: http:// www.globaldata.com/ QuotingGlobalData.aspx ABOUT GLOBALDATA GlobalData is a leading global research and consulting firm offering advanced analytics to help clients make better, more informed decisions every day. Our research and analysis is based on the expert knowledge of over 700 qualified business analysts and 25,000 interviews conducted with industry insiders every year, enabling us to offer the most relevant, reliable and actionable strategic business intelligence available for a wide range of industries.

For more information, please contact our Press Office on +44 (0)161 359 5822 or at pr@globaldata.com.

Wound Healing 2016: The Inaugural Event held at London, UK last January 26-28

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ound Healing 2016 run

by Euroscicon Ltd was an open forum event that tackled the processes that are involved in wound healing. The event also discussed the related therapies to wound infection and healing. In addition to this, Wound Healing 2016 used an international setting, inter-specialty and multiprofessional approach that offers huge numbers of opportunities for debate and discussion that is set in an informal atmosphere.

According to researchers at this week’s event, 40 million cases of non-healing chronic wounds are evident globally with ten million reported in Europe alone. In Europe, wound management accounts for 2-4% of the healthcare budgets. Aside from this, the problematic biofilms in chronic wounds have been demonstrated to have a role to play in delaying wound healing and were also considered to increase the risk of a wound developing an infection.

the patient and a significant financial burden to health services worldwide. In conjunction with the need for new antibiotics, as highlighted by the Chief Medical Officer of Cupron Inc Professor Sally Davies, the development of innovative antibiofilm agents is also urgently required.

According to Professor Steven Percival from The University of Liverpool, “New research findings were shared at Wound Healing 2016, which will further advance our fundamental understanding of this complicated and dynamic process.”

The event also tackled that adding microscopic copper oxide particles in wound dressings enhances wound healing especially in hard to heal chronic wounds. The molecular mechanisms of the enhanced wound healing were also discussed.

Dr Narendra Kumar, Associate Professor of pharmaceutical sciences, at the Texas A&M Irma Lerma Rangel College of Pharmacy, USA, proposed to developed new ways to completely protect and secure the gut lining from wounds.

But, available options for the treatment of non-healing chronic wounds are limited when biofilms are evident, as biofilms are inherently recalcitrance to presently available antimicrobial interventions. Biofilms that are present in chronic wounds represent a serious clinical issue for 14 | March-April 2016 | Medical Device ASIA

A new pulseless disposable pump running on Masterflex L/S Drives has been launched

by Swissinnov Product

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cycles to ensure a constant flow delivery. The “NaoStedi” pump delivers pulseless flow without a need for a calibration or flow sensor.

The “NaoStedi” pump delivers outstanding performances in dosing accuracy, flow control and is a new and fairly easy to use alternative to traditional peristaltic, diaphragm and syringe pumps. “NaoStedi” pump head can be sterilized and integrated as OEM component in any devices using pump system.

The “NaoStedi” pump functions with reciprocating pistons driven independently over the pumping

For an immediate evaluation of the “NaoStedi”, a starter Kit comprising of a pump holder mounted in 5 minutes on the Masterflex L/S drives and 3 pump heads is available online at www.naopump.com.

The Starter Kit is designed for a comprehensive testing of the “NaoStedi” on existing systems running Masterflex L/S drives. Any specific requirements can be reviewed by Swissinnov Product.

Swissinnov Product provides consulting services for custom designs and personalized solution.

Swissinnov Product has long track record in developing innovative

wissinnov Product a special ized firm in innovative pump system recently launched a pulseless dosing pump compatible with Masterflex L/S drives, the “NaoStedi”. This unique pump serves multiple applications in pharmaceutical, medical, laboratory, chemical and industrial markets.

pumping system and solving complex fluidic problems. Its team of experts works constantly to provide new and unique pumping systems for demanding applications.

Further information is available at: www.naopump.com Swissinnov Product sàrl, Rue Etraz 1, CH – 1196 Gland Tel + 41 22 575 23 60 | Fax + 41 22 364 13 37

Medical Device ASIA | March-April 2016 | 15

The Pulmonary Arterial Hypertension (PAH) therapeutics market • Pulmonary arterial hypertension therapeutics market to rise gradually from $3.45 billion in 2014 to $4.75 billion by 2024, driven by new drug launches • Growth will be modest due to the inability of new drugs to address underlying disease mechanisms, and the enduring search for a cure, says analyst

clinical development.

Dharmarajan continues: “The more promising of the two late-stage pipeline PAH drugs is Actelion’s Uptravi, a first-in-class prostacyclin IP receptor agonist with a favorable clinical efficacy and safety profile.

Uptravi was recently launched in the US in January 2016 and is estimated to be the highest revenue generator of the PAH market at the end of the forecast period, recording nearblockbuster sales of $996 million in 2024.

Despite Unmet Needs, Pulmonary Arterial Hypertension Therapy Market Will Hit $4.75 Billion by 2024, says GlobalData The Pulmonary Arterial Hypertension (PAH) therapeutics market will experience modest growth from $3.45 billion in 2014 to $4.75 billion by 2024, representing a Compound Annual Growth Rate (CAGR) of 3.2%, according to research and consulting firm GlobalData.

The company’s latest report* states that the increase in PAH treatment sales, which will occur across the seven major markets of the US, France, Germany, Italy, Spain, the UK, and Japan, will be driven by new drug launches, the increased use of double and triple combination therapies, and patient assistance programs by manufacturers.

Lakshmi Dharmarajan, Ph.D., GlobalData’s Senior Analyst covering Cardiovascular and Metabolic Disorders, says that despite these developments and growth in the PAH arena, significant unmet needs will remain by 2024, the most crucial of which is to find a cure for the fatal

disease.

Dharmarajan explains: “While there are currently 12 marketed PAH therapies available, they only serve to slow disease progression. There is no marketed drug that addresses the underlying disease mechanism and targets to cure patients.

“The main challenges in developing curative or stabilizing therapies come from a lack of understanding of the disease mechanism. This is not helped by the fact that most companies in the field are focusing their attention on reformulating existing PAH drugs and enhancing patient convenience, rather than improving efficacy.”

The analyst adds that there is a great need to develop biomarkers and assays that could be used to predict patient response upfront and make treatment more personalized.

However, there are no ongoing efforts to address this need in the PAH therapeutics market.

In terms of what the PAH treatment pipeline does have to offer, there are only two drugs in late-stage

16 | March-April 2016 | Medical Device ASIA

“The other Phase III candidate, Beraprost sodium 314d, does not demonstrate as much potential due to its lack of clinical superiority over other existing prostacyclin-based therapies.”

seven major countries of the US, France, Germany, Italy, Spain, the UK, and Japan, including annualized market data from 2014 and forecast to 2024. It discusses market characterization, unmet needs, clinical trial mapping and implications for the PAH treatment arena.

This report was built using data and information sourced from proprietary databases, primary and secondary research, and in-house analysis conducted by GlobalData’s team of industry experts.

For guidelines on how to cite GlobalData, please see: http:// www.globaldata.com/ QuotingGlobalData.aspx

GlobalData believes that pharmaceutical companies should address unmet needs by focusing their attention on PAH-specific mechanisms which, although wrought with a high risk of failure, could potentially lead to innovative and effective disease-modifying treatments. *OpportunityAnalyzer: Pulmonary Arterial Hypertension – Opportunity Analysis and Forecast to 2024

-ABOUT GLOBALDATAGlobalData is a leading global research and consulting firm offering advanced analytics to help clients make better, more informed decisions every day. Our research and analysis is based on the expert knowledge of over 700 qualified business analysts and 25,000 interviews conducted with industry insiders every year, enabling us to offer the most relevant, reliable and actionable strategic business intelligence available for a wide range of industries.

This report provides analysis of the Pulmonary Arterial Hypertension (PAH) therapeutics space across the

For more information, please contact our Press Office on +44 (0)161 359 5822 or at pr@globaldata.com.

LemnaTec OS software screens parasites at Zoetis

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oetis, previously a subsidiary of Pfizer, the largest animal health company in the world has selected LemnaTec to provide the software and hardware for its latest research into developing treatments for parasites.

At its global R&D headquarters in Kalamazoo, Michigan, Zoetis develops effective treatments for

internal and external parasites in companion and production animals by using in vitro models.

Senior Scientist Scott Timmins comments, “We were working with internal parasites, using a 384 well format, checking by eye for a reduction in motility.

This was hugely labour intensive and we realised that it would take many years to complete the programme without some kind of automation.”

Following a visit to see a LemnaTec machine at BASF in Germany, we drew up a specification for an automated phenotyping system

that could use the 384 well format with backlight and dark field functionality. The machine, a customized HTS Scanalyzer fitted with a robotic arm to position the plates, was delivered by LemnaTec the following year.

“We configured two cameras so we could scan an entire 96 well plate but also individual wells in 96 and 384 well plates”, says Scott. “We also introduced heat and carbon dioxide to stimulate model organisms that would otherwise be immotile is the absence of the stimulus.”

Having capacity for high throughput screening that can deliver a quantitative output greatly increases productivity and accuracy when compared to manual observation under a microscope. One problem

the industry faces is that parasites eventually become resistant to products. The Scanalyzer is used to detect which treatments are effective against these resistant parasites.

“We use barcoded plates to track compounds and we record well coordinates plus the degree of movement of the sample. The Scanalyzer data is exported in CSV file format to a statistics package from which we analyse the data. This gives us a quick and easy way to interpret results from one to many thousands of samples” concludes Scott.

The company provides a diverse portfolio of animal medicines and vaccines to meet the needs of veterinarians, pet owners and livestock farmers in more than 120 countries.

Medical Device ASIA | March-April 2016 | 17

Peripheral Vascular Interventions Market Will Climb to $3.4 Billion by 2022

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he global market for peripheral vascular interventions, including lower extremity stents, percutaneous transluminal angioplasty (PTA) balloons, PTA drug-eluting balloons (DEB), carotid stents, and renal stents, will rise from $2.1 billion in 2015 to $3.4 billion by 2022, says research and consulting firm GlobalData.

According to the company’s latest report*, this expansion, which will occur at a compound annual growth rate of 6.8%, will be driven by an increased demand for minimally invasive endovascular procedures, greater availability of improved solutions for femoropopliteal artery revascularization, and the rising prevalence of peripheral artery disease (PAD).

Premdharan Meyyan, GlobalData’s Analyst covering Medical Devices, explains that the prevalence of PAD is rising worldwide due to an increase in risk factors such as diabetes, hypertension, obesity, and tobacco use, resulting in a greater demand for minimally invasive treatments. An increasing number of physicians trained in endovascular techniques will help to address this.

moving forward, as this will improve long-term efficacy.”

The current key players within the large and dynamic peripheral interventions market are Abbott Vascular, Boston Scientific, C.R. Bard, Cook Medical, Cordis, Medtronic, and W.L. Gore.

Meyyan continues: “Recent highprofile acquisitions, such as Medtronic’s acquisition of Covidien and Cardinal Health’s acquisition of Cordis, will significantly impact the competitive landscape moving forward.

“Companies such as Biotronik, B. Braun, Maquet, and Eurocor are also strong potential competitors which are poised for growth due to investment in innovative technologies within this space, including DEB and polytetrafluoroethylene (PTFE)covered stents.”

Meyyan comments: “Drug-eluting devices, including DEB and drugeluting stents, are expected to significantly impact the treatment paradigm of PAD during the forecast period, particularly for complex femoropopliteal and infrapopliteal artery lesions where bare-metal stents and standard balloon angioplasty have not been as effective as long-term treatments.

“The development of more efficient drug delivery systems that maintain drug concentration in the vessel wall for longer periods of time will be a significant market opportunity 18 | March-April 2016 | Medical Device ASIA

NAYATI MULTI-SUPER-SPECIALTY HOSPITAL MATHURA ANNOUNCES COMMENCEMENT OF SERVICES AT THE CENTRE FOR RENAL SCIENCES (NEPHROLOGY & UROLOGY) Comprehensive kidney care through a full range of diagnostic, management and operative services Dialysis services commences from March 14 Right to Left- Dr. Krishna Mohan Sahu(Director, Nephrology & Kidney Transplant) & Dr. Tapan Agrawal, (Associate Consultant, Urology) at Nayati Hospital, Mathura

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his World Kidney Day, Nayati Healthcare announced the commencement of full services at the cenre for Renal Sciences (Nephrology & Urology).

This new-age centre is a first-of-its kind in the region providing comprehensive kidney care to the patients through a full range of diagnostic, management and operative services.

Niira Radia, Chairperson, Nayati Healthcare said “The Centre has brought together the finest medical professionals, state-of-the-art infrastructure and the highest standards of clinical excellence and patient safety. Our commitment is to get care to the patients doorstep and thereby reduce the social, emotional and economic burden of treatment and this is yet another step in that direction.” Dr. R K Mani, CEO Medical, Nayati Healthcare stated

“The burden of kidney related diseases is very high in all states of India and equally if not more in Uttar Pradesh. Kidney disease is termed as “silent” disease because it is often unnoticed by most as few specific symptoms appear in the beginning before it gets diagnosed. Hence detection is at a late stage, compromising the outcomes. In Western Uttar Pradesh, there is a gaping lack of infrastructure and expertise in treating kidney disease. Till now patients have had to travel to Delhi NCR or other big cities for the purpose. Now patients do not have to travel long distance for evaluation, diagnosis, treatment or dialysis. The Centre will work as a cohesive team with interdisciplinary interactions between nephrologists, urologists, critical care specialists, cardiac science specialists, oncologists and others.

Dr. Krishna Sahu, Director & Head of

the Department of Nephrology & Kidney Transplant stated “Our centre is well equipped to treat patients with acute and chronic kidney failure, hemodialysis and peritoneal dialysis, kidney transplant, nephrotic and nephritic syndrome, kidney and bladder stone, prostate and urinary incontinence and kidney cancer patients among others. It also involves comprehensive care for kidney diseases associated with other illnesses and conditions, such as diabetes and hypertension. We have dialysis facility and we will starting kidney transplant surgeries soon. At Nayati, we are committed to provide precise & timely medical treatment to the people of the region at affordable costs.”

The state of art dialysis unit will cater to routine as well as special dialysis for very sick patients. The dialysis unit is supported by the latest water

processing plant to produce ultra pure water for safe and smooth dialysis of the patients. For special dialysis of critically ill patients in ICU, the centre is equipped with latest generation SLED and CRRT machines.

The unit is also supported by world class operation theaters to take care of all kinds of kidney & urology related surgeries.

About Nayati Healthcare & Research Pvt. Ltd., taking treatment to the patient: Nayati Healthcare & Research is India’s first Multi SuperSpecialty healthcare organisation offering premium tertiary care to TierII & Tier-III cities. It offers world class patient care services aided by stateof-the-art medical technology and advanced treatment facilities. The aim of the organisation is to provide cost effective and easily accessible healthcare.

About Nayati Multi Super Specialty Hospital, Mathura: Nayati Multi Super Specialty Hospital, Mathura once operational will be the first hospital in the region to provide integrated, comprehensive and high quality healthcare through our Centres of Excellence. These centres will be supported by advanced Intensive Care units comprising of: MICU, CCU, SICU, NICU and PICU. The upcoming hospital in Mathura will also cater to Vrindavan, Agra, Palwal, Firozabad, Mainpuri, Kasganj, Etawah, Etah, Hathras, Agra and surrounding areas.

Medical Device ASIA | March-April 2016 | 19

EOLIS air manager, 1st intelligent air filtration system to be launched in India Thanks to the ACTIV mode, EOLIS is a smart unit automatically adapted to your environment. It includes a monitoring system easy to use thanks to a three user control interface: touch screen panel, computer or smartphone. Because each product is unique and get a specific ID number, we can see how it works and when you need maintenance and filters to be replaced.

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atéoSanté, a French company specialising in air quality treatment, is about to launch EOLIS, the first intelligent air filtration system especially conceived for the Indian market.

Manufactured in France, EOLIS is intended to be made in India later this year, at EOLANE industrial plant in Bangalore. EOLIS will be on sale in India from May 2016 and distributed thought our Indian Partners.

EOLIS air manager has been conceived from the initial idea to provide an air filtration system combining high performances and simplicity of use. Tailored for professionals in home appliances, hospitality and heath/medical sectors, EOLIS will incorporate a filter system composed of a medical grade filter HEPA H13 or ULPA U15 and a high density active carbon filter able to treat an area of either 60 or 120 m² (two versions will be proposed). Nateosanté air filtration systems are equipped with the most efficient filters on the market. In order to ensure 99.9% purification, our units are silent, reliable, easy to use, adapted to your needs and energy efficient. Natéosanté is very

EOLIS air manager will be available in India from May 2016 and distributed thought our Indian Partners.

Available in two versions depending on the area surface to be treated (60 or 120m²), it is the first intelligent air filtration system to be marked with CE certifications. successful in Asia, with several trusted references (Renault, PSA, Mutualité Française, Miele …).

The Indian market is extremely promising as declared by Mr. Stéphane Monnier, International Business Development Manager: “India is a strategic market for our company and we want to provide Indian professionals with the best equipment to treat air pollution.

Some of the cities in India like New Delhi are facing huge challenges due to very heavy levels of concentration of fine and ultrafine particles in the air, and NateoSante wants to work with Indian professionals with products like EOLIS that have a proven track record for improving quality of air and quality of life.”

EOLIS is more an AIR MANAGER than an Air Purifier.

20 | March-April 2016 | Medical Device ASIA

About NATEOSANTE: NatéoSanté is a French company created 7 years ago and specialising in quality of indoor air. The company has already provided thousands of families and professionals in France and in Asia. Our product line has been built and improved day after day, through concrete feedback from our customers, enabling us to become a reference on the market.

Our experts know the problems which may be faced by our customers, we work every day to offer them solutions by taking full account of the specificities of each

environment.

For further information, please visit: http://www.nateosante-pro.fr/ About Business France: Business France is the national agency supporting the international development of the French economy, responsible for fostering export growth by French businesses, as well as promoting and facilitating international investment in France. It promotes France’s companies, business image and nationwide attractiveness as an investment location, and also runs the V.I.E international internship program. Business France has 1,500 personnel, both in France and in 70 countries throughout the world, who work with a network of publicand private-sector partners. For further information, please visit: www.businessfrance.fr and youbuyfrance.com.in.

Company contact: Mr. Stéphane MONNIER NATEOSANTE International Business Development Manager Tel: (+33) 2 85 52 06 75 / @: stephane@nateosante.fr Press contact: Mr. Thomas ILHE Business France, French Trade

Eminox set to reduce air pollution in China Eminox Announces Cooperation with Chinese distributor treatment systems.” Air pollution in China is a growing problem and accounts for around 1.6 million premature deaths every year, equivalent to killing nearly 4,400 people every day. Air pollution alone accounts for 17 per cent of all the country's deaths. Motor vehicles in China emit around 52.27 million tonnes (2010 figures) of pollutants each year and the number of vehicles registered is growing at 10% annually.

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ainsborough-based Eminox, a leader in the manufacturer of exhaust after-treatment technology for heavy duty diesel vehicles, and Calan Environmental Technology, a specialist automotive distributor, have signed a distribution venture agreement to supply Diesel Particulate Filter solutions in China.

The cooperation will involve Eminox providing its market-leading Diesel Particulate Filter (DPF) technologies, which have been developed and refined over the last 20 years. The DPF range, including CRT® and FBC®, have shown in real world tests to reduce particulate matter by both mass and number, including ultra-fine particles that are most damaging to health.

“The signing of the agreement by Nick Lyons, Deputy Managing Director of Eminox and Zhaohan Ding, CEO of Calan Environmental

Technology, coincided with the recent “UK-China Leadership Forum” attended by All Party Parliamentary China Group Chairman Richard Graham MP.” Air pollution is a major environmental challenge in China; in order to curb emissions an increasing number of provinces are introducing retrofit schemes. These tough, new emission standards have already been introduced in Shandong province where Calan Environmental Technology is based.

Shandong Province aims to reduce air pollution by 50 per cent in 2020 and Eminox’s technology will now play a part in achieving this target as its DPF technology has been proven to remove more than 90% of particulate matter.

“As a leader in exhaust after treatment systems, Eminox is reinforcing its market presence

globally, and this Joint Venture with Calan creates a strong foothold in the Chinese heavy duty diesel vehicle retrofit market,” said Nick Lyons, Deputy Managing Director of Eminox. “We are confident that our alliance will enable us to further develop opportunities across the region. By leveraging the expertise of both companies, we have the scope to make a real difference to air quality in the most polluted parts of China.”

Zhaohan Ding, Managing Director of Calan Environmental Technology Ltd., said: “We are looking forward to working with Eminox in our new enterprise.

The Joint Venture will strengthen Calan’s current market presence as well as play a key role in enhancing our proposition to existing and new customers. It brings together both companies' expertise in automotive distribution and exhaust after-

Eminox’s CRT® system is the world's leading retrofit diesel particulate filter (DPF) with around 60,000 systems installed on buses and trucks worldwide. It enables vehicles as old as China III to be upgraded to the particulate matter (PM) standards of a China VI vehicle.

The CRT® system contains a specially formulated catalyst and a wall-flow ceramic filter. This technology captures particulate matter within the wall flow filter and then continuously oxidises it, at typical exhaust gas temperatures, into harmless gas using patented chemical technology.

The FBC System (Fuel Borne Catalyst) provides an alternative diesel particulate filter solution for vehicles which operate with higher sulphur diesel.

To find out more about the new range of Diesel Particulate Filters available for Calan Environmental Technology, go to: www.jialantech.com For more information on the full range of Eminox exhaust aftertreatment technology, visit: www.eminox.com or call: 00 44 (0)1427 810088.

Medical Device ASIA | March-April 2016 | 21

MENB VACCINE BEXSERO MIGHT SEE PRIVATE UPTAKE IN THE UK WITH APPROPRIATE INCENTIVES even if provided to the National Health Service (NHS) for less than £1 per dose. However, costeffectiveness should not be viewed as the main determining factor for the broad application of a vaccine against a rare disease, as many vaccines might not pass this threshold, given low enough disease prevalence.

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he UK Department of Health’s rejection of an 800,000signature public petition to expand the routine administration of the only approved vaccine to offer protection against invasive meningococcal disease (IMD) caused by serogroup B (MenB), may lead to parents and physicians to consider purchasing the vaccine themselves, according to an analyst with research and consulting firm GlobalData.

The decision to keep free access to GlaxoSmithKline’s MenB vaccine, Bexsero, limited to infants rather than vaccinating children up to 11 years of age, as requested in the petition, is a significant setback for the advocacy groups and parents aiming for expanded vaccine administration. Mirco Junker, Ph.D., GlobalData’s Analyst covering

Infectious Diseases, explains: “Even though IMD cases caused by serogroups B and C are most prevalent, the majority of European countries only routinely administer meningococcal vaccines against serogroup C, which provide excellent safety and efficacy profiles in combination with relatively low price points. MenB vaccines, on the other hand, are relatively new and expensive, and there is only limited clinical data demonstrating their long-term effectiveness.

“This uncertainty regarding the longterm efficacy - together with studies indicating low cost-effectiveness of MenB vaccines - also highlights the general conflicts rare diseases like IMD bring up when medical needs are pitted against the commercial viability of vaccines. Indeed, vaccinating entire populations

22 | March-April 2016 | Medical Device ASIA

against rare diseases can be extremely challenging to rationalize from a pharmacoeconomic perspective.”

In fact, in 2014, a study using the analysis of quality-adjusted life-years indicated that the new MenB vaccine would not be cost-effective

Junker continues: “While the Department of Health’s decision is a disappointment for parents worried about their children developing IMD, GlobalData believes it is understandable from the perspective of the NHS, as healthcare costs continue to rise and governmental agencies have to balance the restraints of a limited budget with society’s medical needs. “A reasonable compromise could be to provide individual families concerned about IMD to purchase vaccines out-ofpocket without having to face the list price of the vaccine. As such, it might be in the interest of the pharmaceutical industry to provide incentives to make the vaccine available to individuals not covered under the NHS guidelines.”

Robotics Lasik Launched in Gurgaon

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edanta-The Medicity brings the revolutionary FemtoLASIK, the latest and safest in bladeless refractive LASIK treatment to the city Medanta – The Medicity, one of India's largest multi-super specialty institutes located in Gurgaon today announced the launch of FemtoLASIK, a revolutionary technology and the most advanced LASIK treatment available in the world that enables bladeless refractive treatment.

Speaking on the launch, Dr. Naresh Trehan, Chairman and Founder, Medanta said, “At Medanta, it is our constant endeavour to bring the latest medical technologies in the world to Gurgaon and provide the best cure to every patient. The launch of FemtoLASIK showcases our commitment to strengthen our ophthalmology division at the Medicity and provide all encompassing medical treatment under one roof.”

“FemtoLASIK is bladeless and allows the creation of flaps with diameter and thickness of a wide range. It creates very precise, perfect and smooth corneal flaps to ensure accurate treatment with minimum risk. This is the safest LASIK technology available in the world today.”

“With this launch, the Institute of Ophthalmology at Medanta is at par with other renowned medical institutions globally.” Dr. Pakrasi added.

institutes located in Gurgaon, a bustling town in the National Capital Region.

Founded by eminent cardiac surgeon, Dr. Naresh Trehan, the institution has been envisioned with the aim of bringing to India the highest standards of medical care along with clinical research, education and training. Medanta is governed under the guiding principles of providing medical services to patients with care, compassion, commitment.

Spread across 43 acres, the institute includes a research center, medical and nursing school. It has 1250 beds and over 350 critical care beds with 45 operation theatres catering to over 20 specialties. Medanta houses six centers of excellence which will provide medical intelligentsia, cutting-edge technology and state- of-the-art infrastructure with a well-integrated and comprehensive information system.

About Medanta: Medanta – The Medicity is one of India's largest multi-super specialty

FemtoLASIK technology is the most advanced procedure aimed at improving patient’s quality of life by reducing the dependence on glasses. This world renowned LASIK technology is the current state-ofthe-art in refractive surgery. It works by altering the shape of the cornea to treat nearsightedness, farsightedness and astigmatism.

Dr. Sudipto Pakrasi, Chairman, Institute of Ophthalmology at Medanta - The Medicity said,

Dr. Sudipto Pakrasi at the LASIK Launch event, Medanta The Medicity Medical Device ASIA | March-April 2016 | 23

Asthma Therapeutics Market in Asia-Pacific Region to Hit $5.6 Billion by 2021 • Asthma therapeutics market in Asia-Pacific (APAC) region will expand from $3.5 billion in 2014 to $5.6 billion by 2021, as disease prevalence rates rise • Six costly new biologics will enter the APAC asthma treatment space in the near future, led by GlaxoSmithKline's mepolizumab, says analyst

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he asthma therapeutics market in the Asia-Pacific (APAC) region will grow from $3.5 billion in 2014 to $5.6 billion by 2021, at a strong Compound Annual Growth Rate (CAGR) of 7.2%, according to business intelligence provider GBI Research.

The company’s latest report* states that the primary driver of this considerable rise is the prevalence of asthma across the APAC countries, which include China, India, Australia, South Korea, and Japan. The condition is burgeoning due to aging populations and increases in air pollution, dust and pollen levels, which both cause and exacerbate asthma in children.

Aswini Nath, Analyst for GBI

Research, says: “As well as the increasing incidence of the disease, six costly biologics are set to enter the APAC asthma market, which will push its value up considerably.

These consist of GlaxoSmithKline’s mepolizumab, Teva’s reslizumab, Chugai/Roche’s lebrikizumab, Sanofi/ Regeneron’s dupilumab, and AstraZeneca’s tralokinumab and benralizumab.

“The most advanced of these drugs is mepolizumab, which is currently at the Pre-registration stage in Japan, while the other five monoclonal antibodies (mAbs) are in Phase III development in the APAC region.

As the cost of these treatments is likely to be high in comparison with more established drugs, strong uptake could well increase the cost

24 | March-April 2016 | Medical Device ASIA

of treatment for asthma patients.” In terms of disease prevalence trends within the five APAC countries, India has the highest number of asthma sufferers. In 2014, 53.6 million people were estimated to be living with the disease, which is approximately 52.4% of the total assessed Asia-Pacific prevalence.

therapy in comparison with the other assessed countries."

Nath elaborates: “Lack of knowledge of the condition among the public, an increasing aging population, and increasing air and dust pollution will mean the prevalence rate will continue to rise over the period, resulting in 57 million sufferers by 2021.

“As Japan is ranked only third of the five countries in terms of disease prevalence, this reflects the relatively high cost of drugs, and the country’s readiness to adopt promising new molecules such as the IL-targeting mAbs,” the analyst concludes. Asthma Therapeutics in Asia-Pacific Markets to 2021 – High Prevalence and Launch of Late-Stage Biologics will Drive the Market in Spite of Affordability Concerns

“Despite this, India only represented 12.2% of the APAC asthma market in 2014, which reflects the low cost of

Japan, by contrast, was the largest market of the five APAC countries in 2014 at $1.8 billion, and will continue its lead to 2021, growing to $3 billion at a CAGR of 7.1%, according to GBI Research.

NAYATI MULTI SUPER SPECIALTY HOSPITAL ORGANISES FREE GYNECOLOGY HEALTH CHECKUP FOR WOMEN Healthy women Healthy family Specialty Hospital, Mathura: Nayati Multi Super Specialty Hospital, Mathura once operational will be the first hospital in the region to provide integrated, comprehensive and high quality healthcare through our Centres of Excellence. These centres will be supported by advanced Intensive Care units comprising of: MICU, CCU, SICU, NICU and PICU. The upcoming hospital in Mathura will also cater to Vrindavan, Agra, Palwal, Firozabad, Mainpuri, Kasganj, Etawah, Etah, Hathras, Agra and surrounding areas.

About Nayati Center for Excellence in Oncology (Cancer): The Center has three divisions: medical, surgical and radiation oncology, which will provide end to end treatment for cancer. The centre is concerned with screening, early detection, grading and management of cancer and has high end radiation therapy, isolation rooms, critical care, bone marrow transplantation, palliative care, plastic and reconstructive surgery, pain clinics and counselling services will also be available.

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ayati multi super specialty hospital today organised a free health checkup camp for women to mark International Women’s day. The checkup includes, free consultation by the gynaecologist, free HB and Random Blood Sugar (RBS) test. In addition, the hospital will offer a special 50% discount to all women on Ultrasound. The camp will be operational from 9 am – 3 pm.

Talking about the special initiative Nayati Healthcare Chairperson Niira Radia said “We have launched a special initiative “Dharini” for the welfare of Women’s health. To raise health awareness and highlight the importance of regular health checkups, we are organizing a free Gynecology Health Check-up and

special discounts on certain investigative tests for women under this special initiative Dharini.

Through this initiative we intend to increase awareness about women health issues that usually remain the last in the list of priorities in a family.

A Woman with a healthy mind and body can nurture a healthy and fit family. A Woman is responsible for the health condition of her entire family therefore the first in her to do list should be to look after and nourish her own health. ” Dr. Varna Rao, Head of the Department Obstetrics & Gynaecology stated “Anemia continues to be a major public health problem worldwide particularly among females and more so among females of reproductive age and

Uttar Pradesh is no different. The Maternal Mortality Rate in Uttar Pradesh is one of the highest. It is imperative that all women take charge of their health. Women must focus on the health of their mind and body in terms of healthy eating and adequate exercising”.

About Nayati Healthcare & Research Pvt. Ltd., taking treatment to the patient: Nayati Healthcare & Research is India’s first Multi SuperSpecialty healthcare organisation offering premium tertiary care to TierII & Tier-III cities. It offers world class patient care services aided by stateof-the-art medical technology and advanced treatment facilities. The aim of the organisation is to provide cost effective and easily accessible healthcare. About Nayati Multi Super

The services at Nayati Center for Excellence in Oncology include evaluation for solid tumours and blood cancers, along with treatment planning and coordination of all modalities. Minimal access and open surgical interventions will be available for cancer of the head and neck, brain, spinal cord, lungs, pleura, thorax, thyroid, breast, oesophagus, stomach, liver, gall bladder, pancreas, intestine, rectum, gynecological, lymph nodes, kidney, bladder, prostrate and pediatric cancers.

For further information please contact: Shivani Sharma / Neha Singh 91 9871741891 / 91 9910638881 shivani.sharma@nayatihealthcare.com / neha.singh@nayatihealthcare.com

Medical Device ASIA | March-April 2016 | 25

Merck Finishes Record Year 2015 Stronger  Net sales (+13.0%) and EBITDA pre exceptionals (+7.1%) reach new record levels  All three business sectors deliver organic growth  Asia-Pacific region drives Group sales growth  Merck meets targets for 2015  Proposed dividend to increase to • 1.05 (+5%)

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erck, a leading science and technology company, reported record results for 2015, emerging stronger from the transformation process that started in 2007. Net sales and EBITDA pre exceptionals were higher than ever before in Merck’s history of nearly 350 years.

“2015 was not only an eventful, but above all a very

26 | March-April 2016 | Medical Device ASIA

successful year for Merck. We again achieved profitable growth. By acquiring Sigma-Aldrich, we successfully completed the portfolio realignment of recent years. In immuno-oncology, we initiated six pivotal clinical trials.

Research advances and futureoriented investments form the foundation for future success. And our new bold and vibrant branding shows what makes Merck unique,” said Karl-Ludwig Kley, Chairman of the Executive Board.

declined in 2015 by –3.7% to • 1.1 billion (2014: • 1.2 billion). This was attributable to one-time expenses in connection with the Sigma-Aldrich takeover and integration as well as higher interest expenses to finance the acquisition.

Net sales of the Merck Group rose sharply by 13.0% to • 12.8 billion in 2015 (2014: • 11.4 billion). The acquisitions of AZ Electronic Materials (AZ) and Sigma-Aldrich were responsible for 4.3% of the sales growth. Organically, Merck increased sales by 2.6% over 2014.

Favorable exchange rate effects, primarily thanks to the strength of the U.S. dollar, contributed 6.2% to sales growth.

Merck was thus able to meet or exceed its forecast for 2015 with respect to sales, EBITDA pre exceptionals and earnings per share pre exceptionals.

Although Merck had meanwhile built up a net cash position by mid-2015, net financial debt rapidly increased as expected to • 12.7 billion at the end of 2015 (December 31, 2014: • 559 million) owing to the purchase price payment for Sigma-Aldrich. As was the case following major acquisitions in the past, Merck aims to use its strong internal financing power to quickly reduce its debt.

As of December 31, 2015, Merck had 49,613 employees worldwide (December 31, 2014: 39,639). The increase in the Merck headcount by around 10,000 people compared with 2014 was mainly due to the successful completion of the SigmaAldrich acquisition.

The operating result (EBIT) rose by 4.6% to • 1.8 billion (2014: • 1.8 billion). EBITDA pre exceptionals, the key financial indicator used to steer operating business, climbed significantly by 7.1% to • 3.6 billion (2014: • 3.4 billion) thanks to the Life Science and Performance Materials business sectors.

Net income, i.e. profit after tax attributable to Merck shareholders,

Earnings per share pre exceptionals increased by 5.9% to • 4.87 (2014: • 4.60). The proposal to the Annual General Meeting on April 29, 2016 will be to increase the dividend by • 0.05 to • 1.05 per share.

Fourth quarter of 2015: Life Science drives Group growth In the fourth quarter of 2015, Merck generated net sales of • 3.5 billion, representing an increase of 15.5% (Q4 2014: • 3.0 billion). Apart from organic growth, this was primarily due to the strong acquisition-related sales increase in Life Science. The 6.3% increase in EBITDA pre exceptionals to • 933 million in the fourth quarter of 2015 (Q4 2014: • 878 million) was also driven by Life Science. At • 1.13, earnings per share pre exceptionals remained stable in the fourth quarter of 2015 (Q4 2014: • 1.14).

Healthcare: robust business and investments in growth markets Net sales of the Healthcare business sector increased in 2015 by 4.7% to • 6.9 billion (2014: • 6.6 billion).

This was attributable to organic growth of 1.6% and exchange rate effects of 3.1%. Above all, the AsiaPacific region fueled organic growth.

business sector in 2015 remained at the previous year’s level (2014: • 2.0 billion). This mainly reflected the loss of royalty and license income as of mid-2014 as well as marketing and selling expenses, which were significantly higher than in 2014 due to ongoing investments in growth markets as well as currency effects.

Life Science becomes Merck’s growth engine in 2015 Amid growing profitability, net sales by the Life Science business sector soared in 2015 by 25.1% to • 3.4 billion (2014: • 2.7 billion). This was attributable not only to strong organic growth of 6.5% and favorable exchange rate effects of 8.4%, but mainly to acquisitionrelated increases of 10.2% resulting from the purchase of Sigma-Aldrich.

Sales of Rebif, which is used to treat relapsing forms of multiple sclerosis, declined organically by –10.7% in 2015 owing to continued competitive pressure from oral formulations.

Amid currency tailwinds of 8.5%, Rebif sales amounted to • 1.8 billion (2014: • 1.8 billion). At • 899 million, Group sales of the oncology drug Erbitux in 2015 were stable (2014: • 904 million). The slight organic sales decline of –1.5% was partly offset by positive exchange rate effects of 0.9%. With Gonal-f, the leading recombinant hormone used in the treatment of infertility, Merck achieved organic sales growth of 3.7% in 2015. Including positive currency effects, sales rose to • 685 million (2014: • 628 million).

The Process Solutions business area, which markets products and services for the entire pharmaceutical production value chain, generated organic sales growth of 11.6%. The increase was mainly fueled by higher demand for products used in biopharmaceutical production in Europe and the United States. With its broad range of products for researchers and scientific laboratories, the Lab Solutions business area delivered organic sales growth of 3.1%. The Bioscience business area, which provides products and services to support research for pharmaceutical, biotechnological and academic research laboratories, reported a slight organic sales increase of 0.7%.

The first-time consolidation of Sigma-Aldrich on November 18, 2015 boosted Life Science sales by • 279 million, accounting for 8% of the business sector’s net sales in 2015.

At • 2.0 billion, EBITDA pre exceptionals of the Healthcare

In 2015, the Life Science business sector reported a sharp 30% rise in

EBITDA pre exceptionals to • 856 million (2014: • 659 million), which was attributable to good operating performance in all businesses as well as the contribution from SigmaAldrich.

“With the acquisition of SigmaAldrich, the biggest takeover in our corporate history, Merck has become one of the leading players in the global life science industry,” said Karl-Ludwig Kley. “We can now offer our customers a broader product portfolio than before.

Additionally, we now have the leading e-commerce platform in the sector.”

Performance Materials benefits from business with innovative products In 2015, net sales of the Performance Materials business sector rose sharply by 24.1% to • 2.6 billion (2014: • 2.1 billion).

Apart from a significantly positive currency effect of 13.1%, revenues from acquired businesses also contributed considerably to sales growth, accounting for 10.4% of the increase.

These acquisition-related sales effects were largely attributable to the integration of AZ, which was acquired in 2014. In addition, the first-time consolidation in midNovember of the SAFC Hitech business of Sigma-Aldrich contributed around • 10 million to the sales increase in the Performance Materials business sector. Organically, net sales were at the previous year’s level, with growth of 0.6%.

The Display Materials business unit, which was established at the beginning of 2015, saw a strong increase in sales driven by currency and acquisitions and solidified its global market leadership position.

The increases in sales volumes of innovative technologies overcompensated for the decline in sales volumes for older liquid crystal technologies. For the Pigments & Functional Materials business unit, 2015 was a stable business year with sales at the previous year’s level. The Integrated Circuit Materials business unit, which includes the former AZ business with materials used to manufacture integrated circuits as well as the Sigma-Aldrich Hitech business acquired in November 2015, recorded slight organic sales growth. Within the Performance Materials business sector, the highest growth rates were achieved by the Advanced Technologies business unit. Its emerging OLED materials business showed a particularly dynamic development. In June 2015, Merck laid the cornerstone for a new OLED materials production unit in Darmstadt, involving an investment of around • 30 million.

EBITDA pre exceptionals of Performance Materials soared by 26.5% to • 1.1 billion (2014: • 0.9 billion), driven by currency effects, the integration of AZ, as well as good volume developments.

2016 guidance: Merck expects slight organic sales growth and a low double-digit increase in EBITDA pre exceptionals In 2016, Merck expects slight organic sales growth. Additionally, owing to the acquisition of SigmaAldrich, the company expects a positive portfolio effect on sales in the low double-digit percentage range. For 2016, owing to the expected operating performance and the acquisition of SigmaAldrich, Merck forecasts a low double-digit percentage increase in EBITDA pre exceptionals over 2015.

Medical Device ASIA | March-April 2016 | 27

TOSHIBA TO SELL ITS MEDICAL IMAGING BUSINESS TO CANON FOR $6B AMID DEEPENING ACCOUNTING SCANDAL

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nfinix-i X-ray angiography system-Courtesy of Toshiba Toshiba agreed to sell its medical imaging unit to Canon ($CAJ) for ¥666.5 billion ($5.97 billion) as it seeks to recover from an everworsening accounting scandal.

The price tag and buyer were as expected, for the process was drawn out. But the importance of the cash lifeline was heightened by news that the U.S. Securities and Exchange Commission is investigating the company for hiding $1.3 billion in losses at its nuclear power business, according to Bloomberg.

Toshiba's stock fell 8% on the revelation. It's down 64% since its 2014 peak due to various other accounting mishaps, which have led to the need for the conglomerate to

slim down.

With earnings of ¥23.9 billion ($210 million) on net sales of ¥412.5 billion ($3.69 billion), Toshiba Medical Systems is a bright spot for the struggling company. It garnered interest from multiple companies and private equity firms, as well as competing bids from fellow Japanese titans Fujifilm Holdings and Konica Minolta.

Initial estimates were that the sale of the entire unit would fetch around $4 billion.

Toshiba Medical Systems consists of imaging devices for CT scans, MRIs, ultrasounds and X-rays, according to the company website. It leads the Japanese imaging market with a 30% share, and is fourth worldwide, with

28 | March-April 2016 | Medical Device ASIA

a global market share of 10%, Nikkei Asian Review previously reported.

Although most famous for its cameras, Canon's medical device offerings include radiography devices, mobile X-ray machines, fluoroscopy devices and optical coherence tomography equipment for eye care, according to the company website.

It was chosen as the exclusive negotiator for Toshiba Medical Systems earlier this month over Fujifilm Holdings. Following the deal's announcement FujiFilm sent a letter to Toshiba inquiring about the sale over concerns it was rushed so that the transaction can be completed by the end of the company's fiscal year, which ends in March. "We are left with an impression that the

deal went through a process that was exceedingly tricky and aimed at buying time," Fujifilm spokesman Takao Aoki told Bloomberg. "If this is to be accepted, this raises concerns that competition laws are just a facade."

The deal also calls for Toshiba Medical Systems to pay ¥22.5 billion ($200 million) to Toshiba's U.S. holding company for the rights to Toshiba America Medical Systems.

Toshiba also said it has come a preliminary agreement to sell its consumer electronics business to China's Midea Group as it narrows its focus to nuclear power plants and flash memory chips. It expects to post a net loss of ¥710 billion ($6.36 billion) for the fiscal year ending in March.

Aspirin Both Triggers And Treats An Often-Missed Disease to see what would happen.

"Forty-five minutes later," Fite says, "I'm coughing, sweating, my heart is beating out of my body, and they're like 'OK, stop. She has the disease.' " After years of seeing doctor after doctor trying to understand why she was always sick, she finally knew the reason.

"It felt so good to have the diagnosis. I started tearing up in the doctor's office in Bangkok like midhorrible reaction," Fite says.

But there was one problem. Fite needed a treatment called aspirin desensitization. That's when a doctor overloads a patient with a large dose of aspirin. And Fite's doctor had never done it before.

W

hen Allison Fite was 16, she couldn't stop falling asleep in class. Doctors told her it was from a severe sinus infection, but it never really went away. For the next decade she struggled with infection after infection, taking antibiotics and decongestants. "Having these sinus problems and not being able to breathe was debilitating," she says.

Fite, now 27, couldn't figure out why this kept happening. Neither could any of her doctors. They told her she had allergies, but "then the tests would come back and they'd be like, 'Huh. You don't have allergies,' " she says.

But a few unusual symptoms helped Fite eventually figure out that she had a little-known disease shared by 1 to 1.5 million Americans. She has asthma, a loss of smell and taste, and a strong, adverse reaction to alcohol. "Before I could finish [a

drink], I started to get these really bad headaches," she says. "I really am allergic to fun."

And she had nasal polyps, which are benign growths in the sinus cavities. When she was 20, she had them surgically removed for the first time. At age 25, she flew back from where she was living in Thailand to the U.S. for a second operation. But this time the polyps reappeared even faster, a mere eight weeks after the surgery.

Allison Fite was living in Thailand when she was diagnosed with aspirin-exacerbated respiratory disease.i Allison Fite was living in Thailand when she was diagnosed with aspirin-exacerbated respiratory disease.

"I was seeing a doctor in Bangkok at this point," she says. "He was like, 'This is not normal.' " But the doctor

mentioned that aspirin can cause nasal polyps. This was Fite's first real clue about her illness. It's called aspirin-exacerbated respiratory disease, or AERD. It was first described in the early 1900s, says Dr. Tanya Laidlaw, an immunologist at Brigham and Women's Hospital in Boston who studies the disease. It's seen in "patients who had this triad of asthma, nasal polyps and very idiosyncratic reactions to medications like aspirin," Laidlaw says.

Things started clicking into place.

Fite's mother found one of Laidlaw's presentations on the illness online and sent it to her daughter. Fite knew she had nasal polyps and asthma but she didn't know if she had the third symptom — a potentially lifethreatening reaction to painkillers like aspirin or ibuprofen. So her doctor in Thailand decided to test her. He gave her a fifth of a pill of aspirin, just

"He was like, 'I don't feel comfortable doing it, and I don't think you'll find a doctor in Asia who is.' " Fite says.

So Fite left Thailand again and went to Tanya Laidlaw's clinic in Boston to get the procedure. Laidlaw says nobody knows why the treatment works, but it desensitizes the patient to aspirin and helps alleviate the symptoms. Laidlaw says she's frustrated by the lack of awareness of AERD. She estimates at least 20 percent of people who have it go undiagnosed. "It's really frustrating," she says.

It probably gets missed a lot by clinicians, particularly primary care providers who don't specialize in immunology or ear, nose and throat medicine, says Dr. Ana Broyles, an immunologist at Boston Children's Hospital. And there's a severe lack of science around the illness. When Laidlaw began studying it 10 years ago, she says barely any basic research had been done in the last century.

Medical Device ASIA | March-April 2016 | 29

Ayala expands healthcare portfolio

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onglomerate Ayala Corp. is seeking to expand its foothold in healthcare and education and hopes to seal more deals this year.

Ayala group head for Corporate Strategy and Development Paolo Borromeo said the conglomerate wants to increase investments in human capital through healthcare and education.

“We are looking for investments in healthcare and education. There are a number of opportunities that we are evaluating in (the two sectors),” Borromeo said.

Borromeo declined to confirm whether there are ongoing talks with some parties but said the group hopes to seal some deals soon.

“Hopefully, (we can do it soon).

Possibly, we’d like to do that this year,” Borromeo said.

He said social infrastructure is very important for the group.

“People tend to neglect social infrastructure and are focused on hard infrastructure but (social infrastructure) is equally important,” he said.

The country’s oldest conglomerate has its own line of communitybased clinics, FamilyDoc, which Ayala put up through its healthrelated subsidiary, Ayala Healthcare Holdings.

The group has two communitybased clinics, in Las Piñas and in Imus, which started in December.

The so-called community-based clinics, with a size of around 100 square meters, have five staff at any given time including one doctor and two nurses.

With a consultation fee of P350 and clinic hours from 7 a.m. to 9 p.m.,

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the clinic is equipped with an X-ray, an ultrasound as well as first-aid response equipment.

Bello and businessman Teodoro Ferrer co-founded the drugstore chain.

It is seen complementing the government-run health centers and other community-based clinics.

Established in 2003, Generika promotes the use of generic drugs in the country. Its first outlet opened in May 2004 in Montillano, Muntinlupa.

Depending on the success of the first two pilot clinics, Ayala may put up more of these community-based clinics.

In July last year, Ayala Corp. also announced its venture in healthcare through the acquisition of a 50 percent stake in drugstore chain Generika Group.

Its wholly owned subsidiary Ayala Healthcare Holdings signed the agreement with the family of cofounder Julien Bello.

Generika is among the pioneers in the retail distribution of quality generic medicines in the country with over 500 stores nationwide.

In the area of education, Ayala, in partnership with the Pearson Group, has APEC Schools, which is a lowcost high school chain.

The smart way of providing affordable health care

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s India’s masses increase in affluence and awareness, they are demanding access to better health care. But the supply of conventionally-delivered health care services cannot hope to keep up with the ever-increasing demand.

The clamour for specialists able to address issues beyond what often poorly-trained general practitioners can handle is getting especially loud.

To understand the scope of the issue, here are the statistics for selected health care specialists in India vs the US. The US is widely considered to have a shortage of specialists, as well as a shortage of primary care physicians in rural areas. It has suffered from such shortages for decades. By comparison, India has a supershortage of specialists, with less than 1 specialist per 1 lakh people.

The US vs India ratio in this case ranges from 5x to 25x. While these per capita gaps will narrow over time, it will take many years.

So how are the crores of Indians, who have no access to a specialist, going to get help in the next 10 years? Providing new means of affordable access is no small task.

We see five factors that must be addressed: First, services of specialists must not only accessible, but also affordable to both urban and rural India. Indians have a high willingness to pay for quality health care diagnostics that are reasonably affordable. There is growing health care consumer awareness in India, so demand will continue to grow if care is affordable and accessible.

Second, services must be from a trustworthy source. Because of all the quacks and healers here, Indians

are generally sceptical unless they can find genuine medical credentials. This is even true of “branded” health care services. People want “board certified” or the equivalent along with references.

Third, convenience is a major factor for consumers. People lead busy lives. If you want to visit a specialist, appointments are hard to get and then you end up waiting in a queue.

For many people, this means complicated logistics with family, cost of transport to a specialist facility, and lost income. Getting treated for the simplest of maladies, too, is an expensive investment.

Fourth, providing consultation needs to be convenient for specialists. Most specialists are busy, so to take on new clients, they need a solution which enables them to get more services done in

the same time, and/or to make better use of their time when they are between patients or in transit.

Fifth, specialists need to earn money. While motivations vary for specialists, it is fair and right that they get paid for additional services delivered based on the time invested. Ensuring fair remuneration also helps ensure that they pay attention to quality. It must also be reasonably easy for a specialist to reliably receive payment.

Enter the new smart mobile platforms, which are soon going to be ubiquitous. The cost of a basic Android smartphone is now Rs 2,500 and falling. In not too many years, it won’t be possible to purchase a new mobile phone that isn’t a smartphone. India has the cheapest mobile services on the planet. 3G is already available across

Medical Device ASIA | March-April 2016 | 31

much of India; there will continue to be a ferocious price war to capitalise on the 3G and 4G spectrum purchased by the mobile carriers. This is all good news for consumers and health care providers. Why? Because, the combo of ubiquitous smartphones and 3G data creates a massive lowcost platform for delivering health care services–the foundation of Telemedicine 3.0.

Mobile platforms are changing the game for diagnostics, creating opportunities for Telemedicine 3.0.

Here’s the formula for the future of diagnostics by many specialists: Smartphones, tablets and laptops (bring your own) at health clinic.

Connected non-invasive diagnostic devices capture diagnostic and patient info. Phones/tablets connect securely via 3G/4G data to cloudbased apps. Cloud services connect to a network of specialists

using smartphones/tablets, ready to provide fast responses.

Here are some of the diagnostic services ready for disruptive growth: Ophthalmology: Eye screening for disease and refraction issues can now be done by a technician using new low-cost devices such as Forus’ 3netra, routed via mobile networks to ophthalmologists working in their homes, in the back seat of a taxi, or waiting for a flight and diagnosed with a tap on their smartphone. In fact, one of our portfolio companies does exactly this.

Radiology: CT scans, X-rays, ultrasounds can be captured by a technician. The remote radiologists can then view these images along with other relevant patient data wherever they are on their smartphones, tablets or laptops and provide diagnosis. Numerous

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companies provide this technology today in developed markets, and numerous startups are looking to create low-cost versions of the same in India.

Cardiac care: Today, ECG monitoring devices are primarily sold to health facilities that have a cardiologist in near proximity. If you could easily transmit an ECG image via a smartphone to a group of ondemand cardiologists, you could suddenly put ECG devices in a 100 more places.

Dermatology: Eighty-five percent of skin issues can be fully diagnosed by a dermatologist with a photo taken by a smartphone. From the embarrassing STDs and acne to rashes that don’t go away and other skin issues, there is a huge efficiency to the consumer and the doctor in managing the interactions through a mobile platform.

“Diagnostics as a service”: Disrupting and serving In the next few years, the traditional model of selling diagnostic devices is going to be replaced with selling “diagnostics as a service”. Rather than paying for a diagnostic device upfront, a health centre will get a noor-low-cost device installed and a technician trained. This device will be integrated through 3G/4G with a group of quality specialists who can deliver opinions on patient diagnostics within minutes. And the business model will be revenue sharing.

This “diagnostics as a service” has the potential to increase the diagnostic device market size in India in magnitude, connect underutilised specialists with previouslyneglected populations, and usher in a much-needed realisation of the long-held vision of telemedicine.

How to Lose Weight: The best ways ever...

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ou know the drill when it comes to losing weight: take in fewer calories, burn more calories. But you also know that most diets and quick weight-loss plans don't work as promised. If you're trying to drop a few pounds fast, these expert tips will make it easy for you to lose the weight quickly.

1. Write down what you eat for one week and you will lose weight.

Studies found that people who keep food diaries wind up eating about 15 percent less food than those who don’t. Watch out for weekends: A University of North Carolina study found people tend to consume an extra 115 calories per weekend day, primarily from alcohol and fat.

Then cut out or down calories from spreads, dressings, sauces, condiments, drinks, and snacks; they could make the difference between weight gain and loss.

2. Add 10 percent to the amount of daily calories you think you’re eating.

If you think you’re consuming 1,700 calories a day and don’t understand why you’re not losing weight, add another 170 calories to your guesstimate. Chances are, the new number is more accurate. Adjust your eating habits accordingly.

do them. Instead (whether you believe it or not) repeat positive thoughts to yourself. “I can lose weight.” “I will get out for my walk today.” “I know I can resist the pastry cart after dinner.” Repeat these phrases and before too long, they will become true for you.

3. Get an online weight loss buddy to lose more weight. A University of Vermont study found that online weight-loss buddies help you keep the weight off. The researchers followed volunteers for 18 months.

Those assigned to an Internet-based weight maintenance program sustained their weight loss better than those who met face-to-face in a support group.

5. After breakfast, stick to water.

At breakfast, go ahead and drink orange juice. But throughout the rest of the day, focus on water instead of juice or soda. The average American consumes an extra 245 calories a day from soft drinks. That’s nearly 90,000 calories a year—or 25 pounds! And research shows that despite the calories, sugary drinks don’t trigger a sense of fullness the way that food does.

4. Get a mantra.

You’ve heard of a self-fulfilling prophecy? If you keep focusing on things you can’t do, like resisting junk food or getting out the door for a daily walk, chances are you won’t

6. Eat three fewer bites of your meal, one less treat a day, or one less glass of orange juice. Doing any of these can save you about 100 calories a day, and that alone is enough to prevent you from gaining

the two pounds most people mindlessly pack on each year.

7. Watch one less hour of TV. A study of 76 undergraduate students found the more they watched television, the more often they ate and the more they ate overall. Sacrifice one program (there’s probably one you don’t really want to watch anyway) and go for a walk instead.

8. Wash something thoroughly once a week.

Whether that’s a floor, a couple of windows, the shower stall, bathroom tile, or your car, a 150pound person will burn about four calories for every minute spent cleaning. Scrub for 30 minutes and you could work off approximately 120 calories, the same number in a half-cup of vanilla frozen yogurt.

9. Wait until your stomach rumbles before you reach for food.

It’s stunning how often we eat out

Medical Device ASIA | March-April 2016 | 33

of boredom, nervousness, habit, or frustration—so often, in fact, that many of us have actually forgotten what physical hunger feels like. If you’re hankering for a specific food, it’s probably a craving, not hunger. If you’d eat anything you could get your hands on, chances are you’re truly hungry. Find ways other than eating to express love, tame stress, and relieve boredom.

10. Sniff a banana, an apple, or a peppermint when you feel hungry.

You might feel silly, but it works.

When Alan R. Hirsch, M.D., neurological director of the Smell & Taste Treatment and Research Foundation in Chicago, tried this with 3,000 volunteers, he found that the more frequently people sniffed, the less hungry they were and the more weight they lost—an average of 30 pounds each. One theory is that sniffing the food tricks the brain into thinking you’re actually eating it.

11. Stare at the color blue.

There’s a good reason you won’t see many fast-food restaurants decorated in blue: it functions as an appetite suppressant. So serve up dinner on blue plates, dress in blue while you eat, and cover your table with a blue tablecloth. Conversely, avoid red, yellow, and orange in

your dining areas. Studies find they encourage eating.

12. Eat in front of mirrors and you’ll lose weight.

One study found that eating in front of mirrors slashed the amount people ate by nearly one-third.

Having to look yourself in the eye reflects back some of your own inner standards and goals, and reminds you of why you’re trying to lose weight in the first place.

13. Spend 10 minutes a day walking up and down stairs.

The Centers for Disease Control says that’s all it takes to help you shed as much as 10 pounds a year (assuming you don’t start eating more).

14. Walk five minutes for at least every two hours.

Stuck at a desk all day? A brisk fiveminute walk every two hours will parlay into an extra 20-minute walk by the end of the day. And getting a break will make you less likely to reach for snacks out of antsiness.

15. You’ll lose weight and fat if you walk 45 minutes a day, not 30.

The reason we’re suggesting 45 minutes instead of the typical 30 is that a Duke University study found

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that while 30 minutes of daily walking is enough to prevent weight gain in most relatively sedentary people, exercise beyond 30 minutes results in weight and fat loss. Burning an additional 300 calories a day with three miles of brisk walking (45 minutes should do it) could help you lose 30 pounds in a year without even changing how much you’re eating.

16. Don’t buy any prepared food that lists sugar, fructose, or corn syrup among the first four ingredients on the label. You should be able to find a lower-sugar version of the same type of food. If you can’t, grab a piece of fruit instead! Look for sugar-free varieties of foods such as ketchup, mayonnaise, and salad dressing. Also, avoid partially hydrogenated foods, and look for more than two grams of fiber per 100 calories in all grain products.

Finally, a short ingredient list means fewer flavor enhancers and empty calories.

17. Put your fork or spoon down between every bite.

At the table, sip water frequently.

Intersperse your eating with stories for your dining partner of the amusing things that happened during your day. Your brain lags your

stomach by about 20 minutes when it comes to satiety (fullness) signals.

If you eat slowly enough, your brain will catch up to tell you that you are no longer in need of food.

18. Throw out your “fat” clothes for good.

Once you’ve started losing weight, throw out or give away every piece of clothing that doesn’t fit. The idea of having to buy a whole new wardrobe if you gain the weight back will serve as a strong incentive to stay fit.

19. Close the kitchen for 12 hours.

After dinner, wash all the dishes, wipe down the counters, turn out the light, and, if necessary, tape closed the cabinets and refrigerator.

Late-evening eating significantly increases the overall number of calories you eat, a University of Texas study found. Stopping late-night snacking can save 300 or more calories a day, or 31 pounds a year.

20. Walk before dinner and you’ll cut calories AND your appetite.

In a study of 10 obese women conducted at the University of Glasgow in Scotland, 20 minutes of walking reduced appetite and increased sensations of fullness as effectively as a light meal.

9 Tips to Practice Yoga at Home

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aily yoga practice at home can help you stay healthy, more productive, calm and happy all day. Besides, these benefits are not just for you to enjoy. Doing these practices at home will not only keep you happy but your family members too will be able to feel the positive energy and happiness around. What’s more, you get a chance to practice them right in the comfort of your home, any time you wish.

Once you have learned yoga techniques properly from a Art of Living Yoga teacher, and are comfortable, you can start practicing them on your own. Here are a few tips to keep in mind as you prepare yourself for a fun yoga practice at home.

1: Choose a convenient time Practicing yoga in the morning is generally considered to be the best as it keeps energy levels high during the day. Yet, if it doesn’t happen, don’t let it be an excuse to skip your practice. You may choose a time slot which seems most convenient.

It could be late mornings, before

lunch, or evenings. Yoga at these times can also be a good way to refresh the mind and release stress collected during the day.

2: Choose a comfortable place It would be best to have a small, private room in your house for daily yoga practice. Over time, your practices will create positive vibrations in the room, providing healing, strength and comfort to you and others at home. However, in case it is not possible, you may choose a quiet space anywhere at home, which is large enough to roll out your yoga mat and where you know you are not likely to be disturbed for a while. All you need to ensure is that your yoga space is clean, well-ventilated, and away from furniture or sharp objects (learn more about a yogis home).

3: Practice on a relatively empty stomach Yoga postures are always best practiced on a light or empty stomach. You can practice yoga poses and meditate about 2-3 hours after your meal.

4: Keep your yoga wear simple Go for loose, comfortable clothing – you wouldn’t want tight bodyhugging outfits coming in the way of doing some wide stretches! Also, keep aside any excessive jewelry that you are wearing and avoid heavy makeup.

5: Warm up before doing intense yoga postures This is an absolute must, else you may be at risk of straining your muscles. Start by warming up your body and do a few body stretches to bring flexibility, before moving on to more intense yoga postures.

6: It is your own body; be gentle on it Respect your body and do yoga poses gently with a smile. Doing them increasingly fast or going beyond what your body can take will not bring faster results. It will only make the practice more difficult and painful.

7: Be consistent It is very important to be regular with your yoga practice – make it a part of your daily schedule (as men-

tioned above, find a time slot where you can comfortably fit yoga in) and then it would be easier to make it a habit. Krishan Verma, senior Art of Living Yoga teacher says, "Twenty minutes of daily yoga practice is more likely to show positive results sooner than two hours of occasional practice."

8: Make yoga time as ‘family fun time’ When you practice alone, it might get boring after a while or you may simply become lazy. Try doing it with family or friends and see the difference! Practicing yoga at home can be a great way for a family gettogether. Learn more about how you can enrich your family time with yoga.

9: Include a variety of yoga techniques Practice a variety of yoga poses and breathing techniques, or if you are crunched for time, you may fix a set of practices to be done daily and then treat your body with the complete package on a Sunday!

Also, be sure to end your yoga pose practice with Yoga Nidra.

Medical Device ASIA | March-April 2016 | 35

Yoga tips for weight loss: Five ways to slim down your tummy and thighs!

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oga is considered as one of the the best and simplest ways for weight loss. The best thing about yoga is that it can be practised by people of any age as it is equally good for any age group.

Even pregnant women are recommended to do Yoga because it can be healthful during the period as long as they take certain precautions.

Stress has been linked to many health problems including gaining weight. Yoga, which is believed to be a good stress buster, will not only help you stay in shape, but will also reduce your risk of getting certain diseases. Losing weight and staying fit can help boost a person's self-esteem and decrease stress levels.

Below are a few yoga poses that will promote weight loss if one practices it regularly: Bridge poseBridge pose (Chakrasan): This is a powerful yoga pose for flattening your tummy by

toning and strengthening the abdominal muscles along with the hip flexors and spine.

Lie down on your back, bend your knees and keep your feet flat on the floor hip distance apart.

Move your hands alongside the body with the palms facing down and make sure that your fingertips are lightly touching the heels.

You can clasp your hands together and now lift your body in the upward. Hold this pose for 30 seconds to 1 minute.

Release and roll slowly back to the floor. Repeat 5 more times.

Cobra poseCobra pose (Bhujangasan): This yoga pose is usually done to firm the buttocks and tone the abs. It is also a great exercise for people with back aches.

Lie face down on the floor.

Place your hands under your shoulders, palms flat and fingers spread apart.

Stretch your legs with the tops of

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your feet flat on the floor.

Press your palms into the floor and lifting your head and chest upward.

Push back your shoulders while keeping your hips, legs and feet planted on the floor.

Bow poseBow pose (Dhanurasan): This yoga pose may take more energy to do, but it really helps you burn fat and tone difficult parts of the body. Bow also helps relieve menstrual and constipation problems.

Lie down on your belly and reach your back with your hands to grab your feet as in bow pose.

Now, pull in your stomach and lift up your chest while squeezing your shoulders towards each other.

Your feet should be folded towards the hip region with the hands holding the toes.

Hold this pose for several breathes and then slowly release.

Seated forward bend poseSeated forward bend pose (Paschimottanasana): This is one of the simplest yoga exercises to

reduce the unwanted fat surrounding your belly while keeping you fit and healthy.

Sit down on the floor with both your legs keeping straight in front of you.

Bend your head and body forward and try to touch your toes without bending your knees.

Try to touch your knees with your nose or forehead.

Exhale and holding out your breath, try to stay in this posture for a few seconds and then slowly return to your starting position.

Repeat this for 4-5 times.

Grinding poseGrinding Pose (Chakki Chalanasana): This is a very effective asana to reduce belly fat.

Sit comfortably on the floor with your legs spreading straight in front of you.

Make sure that both your legs touch each other.

Now, clasp both your hands together and move it in a circular motion without bending your knees.

Do it 10 times in clockwise position.

NIH AND ONC ANNOUNCE SYNC FOR SCIENCE TO ENABLE PATIENTS TO DONATE DATA TO PRECISION MEDICINE INITIATIVE

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HR makers including Allscripts, athenahealth, Cerner, drchrono, Epic and McKesson said they will embrace open specs including S4S APIs and FHIR to connect research apps to electronic health records software.

The National Institutes of Health and the Office of the National Coordinator for Health IT have launched Sync for Science, a pilot to allow individuals to send their health data to researchers with the Precision Medicine Initiative.

The S4S pilot – coordinated by NIH and ONC alongside the Harvard Medical School Department of Biomedical Informatics – will be key to helping the Precision Medicine

Initiative Cohort Program reach its goal of including one million U.S. participants. Key to S4S' success, meanwhile, will be the electronic health record vendors taking part in the project: Allscripts, athenahealth, Cerner, drchrono, Epic and McKesson.

The vendors will implement a "consistent, standards-based workflow," building on open specifications such as OAuth and HL7's FHIR protocol, according to a blog post co-written by Deputy National Coordinator Jon White, MD; Josephine Briggs MD, interim director of the PMI Cohort Program; and Josh Mandel MD, research scientist at Harvard Medical School.

"Once developed and imple-

mented, this functionality will allow individuals to connect a research app to their electronic health data, facilitating individual data donation for research and leveraging patients’ access rights under HIPAA," they wrote. "The pilots will also collect information on individual participant preferences on alternative approaches for data donation."

S4S pilot has two goals: Make it easier for patients to share clinical data with the PMI Cohort in a structured electronic format, and build up a national ecosystem for patient-mediated data access through APIs. Stage 3 meaningful use requires APIs, for instance, and White said the S4S pilot offers insight into how that requirement

could play out across the market.

ONC and NIH are hoping that the APIs developed as part of the S4S Pilot will offer research participants easier ways of sharing medical records; researchers an easier path to receive basic clinical data; providers a way to improve patient engagement, and vendors new ways to help their customers meet meaningful use requirements for for API-based patient access.

ONC said EHR vendors should join Argonaut’s free, open Implementation Program to get involved in S4S. The agency also encouraged providers whose vendors are participating in S4S to offer to serve as a pilot site.

Medical Device ASIA | March-April 2016 | 37

At the MEDICA 2016, the “T5 Career Forum” is going to start

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he trend can no longer be overlooked. Many employers in the field of medical technology complain of a lack of experts and managers in the case of engineers, scientists, and IT specialists. There is a lack of candidates with and without professional experience. At the same time, more than 20,000 of the total 130,000 visitors to the MEDICA 2015 already stated that they also visited the world’s largest medical trade fair (recently featuring almost 5,000 exhibitors from 70 countries) to gain career perspectives.

Based on this development, from this year on, the MEDICA will include the “T5 Career Forum” to cover the

topics of recruiting and career planning. The forum will be planned and implemented in close cooperation with the T5 KarrierePortal – as a platform for employers as well as experts and managers. “In the first year, as a joint effort, we would like to test how large the true need really is for employers as well as candidates and what other topics might be of interest,” explained Klaus Peter Kaas from the T5 KarrierePortal.

The cooperation between the MEDICA and the T5 KarrierePortal also stretches into the online area, reciprocally linking an electronic job market with the portals at “MEDICA.de” and “T5karriereportal.de” (Link: http://

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www.medica-tradefair.com/tcf2).

The MEDICA 2016 will be held from 14 to 17 November in Düsseldorf, running, as in the previous year, from Monday to Thursday. In parallel to the MEDICA 2016, the COMPAMED 2016 will be taking place, the internationally leading specialist trade fair for suppliers of the medical technology industry (in 2015: 779 exhibitors from 37 countries).

BIG DATA: BOLD PROMISE? OR THE HARDEST PART OF POPULATION HEALTH, PRECISION MEDICINE AND BETTER PATIENT EXPERIENCE?

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eading providers are already thinking about how to transform themselves from data-driven to information-driven organizations, able to offer drastically improved patient experience akin to Amazon and Google. But it's not easy.

Seattle Children's Chief Data Officer Eugene Kolker offered up a confession: "I'm a little bit nervous right now about what's happening in our industry. People are moving from one extreme to another."

His main concern? Healthcare providers and payers that are focusing on cost above all else.

With changing payment models, shared savings and risk and patients empowered by everyday technologies, Kolker said, this new age

requires providers to concentrate on so much more than the bottom line.

Brigham and Women’s.

Healthcare doesn't have big data — yet

"We have to drastically improve experience for our customers,” he added. “In the next five years we'll have really different customers.

They'll have a Google- or Amazonlike experience to compare providers by outcomes and expense, and they'll be able to do that conveniently with phones they have right now."

Despite all the buzz around big data, a smaller reality persists.

Addressing that demand is going to require putting big data and analytics to work in new ways — and leading health institutions are already thinking about how to transform data into information. In addition to Seattle Children’s, some of the first-movers include Advocate Healthcare and

"I haven’t seen healthcare big data.

I've only seen healthcare little data," said Sriram Vishwanath, a professor of electrical and computer engineering at the University of Texas, Austin.

"Healthcare data science is fundamentally different than every other domain. Healthcare is exponentially harder."

One reason: Within a population of tens of millions of patients, Vishwanath explained, it's typical that only a few hundred thousand are ultimately driving cost and treatment patterns.

What's more, privacy concerns are inhibiting healthcare organizations from easily linking information to patients, according to Kenneth Mandl, MD, a professor of Pediatrics at Harvard Medical School and the Boston Children's Hospital Chair in Biomedical Informatics and Population Health.

"There's a reason we don't have much data linked to the patient: privacy," Mandl added. "One issue in healthcare is that the data doesn't link very easily."

Those are among the reasons that, according to Deloitte, only 16 percent of healthcare organizations are doing anything beyond dabbling — some analytics pilots, perhaps, or proofs-of-concept.

Medical Device ASIA | March-April 2016 | 39

"Most organizations are only able to tap into retrospective views; they're not ready to use analytics to provide more advanced insights into the business," said Ryan Renner, principal of Deloitte's Strategy and Operations analytics leader.

From data-driven to informationdriven The next step to enhancing the patient experience en route to population health management and precision medicine practices is transforming data into information?The difference between data and information is more than a nuance or naming convention. And with population health, genomics, precision medicine all on the horizon, there are some emerging success stories of providers running analytics against data sets to glean actionable information.

David Bates, MD, chief innovation officer at Brigham and Women's, for instance, rattled off high-cost patients, readmissions, triage, decompensation, adverse events, diseases that affect multiple organ systems as areas where he has

already seen early demonstrable progress.

could be pressed into use are huge," Mandl said. "There are ways to make big data sing and dance if we align with workflows."

"It's not just about the data — data is not the most key aspect anymore," said Tina Esposito, vice president of the Center of Health Information Services at Advocate Healthcare. "It's how you turn it into information."

That won't be easy. As the digital world moves toward IDC's projected 44 zettabytes by 2020, in fact, the challenge of examining all that data is finding employees with the right skill sets, engaging leadership to ensure projects succeed, having clean processes to communicate with customers and having a tight, iterative development cycle, according to Jonathan Greenberg, director of Fast Analytics at the University of Michigan Health System.

Taking that a step further, Chris Keaton, director of information and analytical advancement at HealthNow New York, said his intention is no longer to be a datadriven organization.

"I want to strive to be an informationdriven organization. That's my goal," Keaton explained. To which Seattle Children's Kolker added: "We're trying to get from data to execution."

In the future data will be big Advocate's Esposito said that providers will be looking to explore ways of tying information together to better understand characteristics of patients and populations than we do today.

"The number of data sources that

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"Now a lot of data are collected electronically but it does take a lot of work to get all the data out the back – we’re working to make that a sustainable core feature of healthcare," Mandl explained. "We can get the data out now, and do studies at scale. But how do we influence at the point of care itself?"

Carolinas HealthCare boosts patient safety with palm-vein biometrics

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IO Craig Richardville said Carolinas has reduced its duplicate medical records error rate from 2.9 percent to 0.01 percent using the ID and authentication technology in conjunction with its master patient index.

Carolinas HealthCare System has reduced its duplicate medical records error rate from 2.9 percent to 0.01 percent using ID and authentication technology. That improvement, in turn, has helped bolster the health system’s patient safety initiatives, which CIO Craig Richardville called the ultimate return on investment for the technology.

“We were looking at it to uniquely identify patients, especially in an electronic health records environment, where problems with duplication of medical records, error rates, incorrectly combining records, and finding a perfect patient match get accentuated,” Richardville said.

“In a manual world, you can pull

information out and combine records fairly easily. In an electronic world, incorrect data potentially can get integrated.”

Additionally, Carolinas uses clinical decision support technology along with its EHRs, and if patient information getting pumped into the decision support system is incorrect, that can lead to improper guidance for providers, Richardville said.

So Carolinas went with Imprivata’s palm-vein biometrics to complement its enterprise master patient index. When being admitted into any facility, a patient age 13 or older places his or her hand atop the palm-vein scanner, which on the first scan identifies the unique vein pattern underneath the skin and assigns that pattern an algorithm and unique identification number within the enterprise master patient index.

After that, no matter the Carolinas location that patient enters, the palm

scan will link registrars and caregivers to that patient’s proper and complete records.

Richardville said that 97 percent of patients have accepted the technology and agreed to palm-vein scans.

“We still have 3 percent or so who do not want to use it, which may be over privacy concerns, a religious concern having to do with the palm, or a lack of understanding of this one additional thing we’re looking to capture from them,” he explained.

Richardville said Carolinas did consider other biometrics technologies.

looked at fingerprint, which was less expensive, but there were many false positives. That error rate was too high, and we thought we were hitting a better rate even with manual than with fingerprint, so it did not gain us a significant advantage.

When we did our pilots, people felt most comfortable with palm-vein scans.”

In addition to reducing the duplicate medical record error rate, the biometrics technology has helped identify unconscious trauma patients in emergency rooms and has helped the health system avoid some cases of insurance fraud, Richardville added.

“We looked at iris recognition, but it was more expensive and to some patients it felt intrusive to have something looking into your eye, even though it’s just a camera taking a picture,” Richardville said. “We Medical Device ASIA | March-April 2016 | 41

Diabetes Prevention Program under the Affordable Care Act is working Tested at YMCA, this marks the first time a CMS Innovation Center preventative service has become eligible for expansion in Medicare.

Chalk up a big win for diabetes prevention. Health and Human Services Secretary Sylvia Burwell announced Wednesday that a preventive model of care for people with diabetes is indeed working.

And now the Centers for Medicare and Medicaid Services is considering how it would expand this model broadly throughout the Medicare program.

This is the first time a preventive service model from the CMS Innovation Center has become eligible for expansion into the Medicare program.

YMCA of USA used $11.8 million in funding, under the Affordable Care Act, to test the Diabetes Prevention Program model. YMCA enrolled eligible Medicare beneficiaries at high risk for diabetes in a lifestyle coach program focused on

improving diet and increasing physical activity. The target was a 5 percent weight loss.

The proof is in the results: Medicare beneficiaries enrolled in the program lost about 5 percent of their body weight, and more than 80 percent of participants attended at least four weekly sessions. Also, when compared with similar beneficiaries not it the program, Medicare estimated savings of $2,650 for each enrollee over a 15-month period, more than enough to cover the cost of the program, according to CMS actuaries.

"This program has been shown to reduce healthcare costs and help prevent diabetes,� Burwell said in a statement. “Medicare, employers and private insurers can use [the model] to help 86 million Americans live healthier.�

About 30 million Americans have type 2 diabetes, resulting in two deaths every five minutes across the country. Moreover, 86 million

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Americans have a high risk of developing diabetes, because one in every three adults has prediabetes, according to the Centers for Disease Control and Prevention. Many people with prediabetes develop type 2 diabetes within 10 years, according to the CDC.

Why Children Get Carsick—and What to Do

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Carsickness isn't really about the car.

It's about the brain's ability to interpret a message based on what it senses. Normally, the eyes, ears, and joints all send signals to the brain, and the signals are similar, according to the American Academy of Pediatrics. If you're traveling in a car, most body parts tell the brain: "We're moving forward."

horizon or the child is looking down and reading at the same time, his brain is getting different messages.

The part of the ear that controls balance and motion says, "We're moving," but the message from the eyes says, "We're sitting still and looking at a book!" This leads to a sensory mismatch that overloads and confuses the brain, and nausea results. This can be a problem if your child is not looking out the windshield. If your children are too young to express themselves, you can suspect carsickness if they become bad-tempered, sweaty, and pale, are restless, or begin to yawn frequently.

But if the child is sitting too low to see through the window to the

Here are several tips to prevent carsickness: Stop frequently and at

otion sickness is common, especially in children. But what causes it is only partly understood, and why some children have it and others do not is unknown.

the first sign of symptoms. Before leaving home, give your child some crackers or other light snack. Avoid smoking or carrying any strongsmelling foods in the car.

Elevate your children (with approved child safety seats or booster seats) so that they can see the horizon through the windshield.

Remember, though, that children under 2 years old need to be in rear-facing car seats (unless they have reached the highest weight or height allowed by the car seat manufacturer).

Entertain young children with activities that keep them from looking down. Instead of using books, try CDs they like to listen to.

If your children get carsick, stop immediately and have them lie down until the dizziness passes. If they have vomited, offer cool water and a light snack when the nausea passes.

If carsickness is a regular problem, talk to your child's health care provider. If your child is older than 2, your health care provider may suggest an over-the-counter travelsickness medication. Be sure to use the proper dosage for the child's age. Some of these medications cause sleepiness or even agitation.

Always get advice from your health care provider and be careful when using them. Do not use a motion sickness patch because it contains too high a dosage for children.

Medical Device ASIA | March-April 2016 | 43

A Checklist for Depression

What's the difference between a bad case of the blues and the painful mental disorder known as depression? According to the experts, impaired functioning is usually a clear-cut indication of a major depression.

Here's a quick checklist of depression symptoms. If the list sounds familiar, you may want to see a counselor or a psychiatrist.

Depressive mood. Do you suffer from feelings of worthlessness, helplessness, or pessimism for days at a time?

Sleep disturbance. Do you have trouble falling asleep at night or trouble staying asleep—waking up in the middle of the night or too early in the morning? Are you sleeping too much?

depression.

Appetite disturbance. Are you eating far less than usual—or far more?

Severe and continuing appetite disturbance is often an indication of depression.

Inability to concentrate. If you can't seem to focus on even routine tasks, it's probably time to get some help.

Dependence on mood-altering substances. If you depend on alcohol or other drugs to make it through the day, you may be suffering from depression. Often, the substance abuse causes symptoms that mimic the appearance of clinical depression, but are, in fact, due wholly to the drug use.

Chronically fatigued. Do you frequently feel tired or lack energy?

Feeling a sense of inappropriate guilt Isolation. Have you stopped meeting with family or friends? Increasing isolation and diminished interest or pleasure in activities are major signs of

Recurrent thoughts of death or suicide or a suicide attempt

A Safer Way to Get Out of Bed Something as simple as getting out of bed properly can help to ease strain on your back and prevent injury. Follow these steps to protect your back when you get out of bed: Move yourself close to the edge of the bed while still lying on your back. Bend your knees upward and flatten your feet on the bed. Roll onto your side closest to the edge of the bed, keeping your knees together. Keep your shoulders in line with your hips — don't twist your spine as you roll.

Once you're on your side, use both hands to push yourself up into a sitting position. Let the weight of your legs swinging to the floor help you move. When you're sitting up, take a moment to rest and take deep breaths, if needed, particularly if you're feeling lightheaded. When you're ready to stand up, lean forward. Use your legs and arms to push yourself up to a standing position. Tighten your stomach muscles to help keep your back straight.

Once you're standing, straighten both of your legs at the same time.

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A Simple Way to Keep the Flu Away on which droplets have landed also infects many people. You can spread the virus to others before you feel sick yourself. The CDC says you are contagious a day before symptoms begin and up to 5 days afterward.

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ou can avoid the flu this season by taking 1 simple step: Get a flu shot.

You can protect yourself against the flu by doing simple things like washing your hands before eating and not putting your hands near your face or in your mouth. You don't need special cleansers when washing your hands. Washing for at least 20 seconds with ordinary soap works fine. If someone in your family has the flu, you can keep surfaces clean of the virus by wiping them with a solution of 1 part bleach to 10 parts water.

Unfortunately, some people think that getting a flu immunization is too much trouble or costs too much.

Or, they are sure that a flu immunization will make them sick or make them more likely to catch the flu or even colds.

contains live, weakened flu viruses that can't cause the flu. This form is approved for healthy people ages 2 to 49 years. Exceptions are those who are pregnant or have diabetes, a weakened immune system, heart problems, or chronic respiratory disorders like asthma. Check with your health care provider to see if the nasal-spray vaccine is right for you.

Even if you don't fall into 1 of the above groups, you can still get the vaccine if you want to avoid the flu.

Talk with your health care provider first

Seasonal influenza — the flu — is caused by 1 of several strains of influenza viruses (type A or B) that infect the nose, throat, and lungs.

The flu makes life miserable for a week or 2 for many people — and deadly for some. Flu season can begin as early as October and peak anywhere from late December to early April, according to the CDC.

A flu immunization is most important for children 6 months to 59 months and adults ages 50 and older. It is also important for anyone with a chronic disease, anyone who lives in a nursing home or other long-term care site, health care workers, and people who are often in contact with elderly adults or the chronically ill.

You have a severe allergy — like an anaphylactic reaction — to chicken eggs.

Immunization facts

The CDC says children between ages 6 months and 8 years who were never immunized or received only 1 dose of vaccine in the previous year should get 2 full doses of vaccine, 1 month apart.

Your best defense against the flu is to get immunized. Depending on your age, you can do that in 1 of 2 ways:

Some people shouldn't be immunized for the flu before talking with their health care provider, the CDC says. These are reasons to talk with your health care provider:

You had previously developed Guillian-Barré syndrome in the 6 weeks after getting a flu shot.

You currently have an illness with a fever. Wait until symptoms improve before getting the vaccine.

Children younger than 6 months of age should not be immunized against the flu. Flu vaccines haven't been approved for that age group.

Other prevention steps

With a flu shot, given with a needle.

This form of the vaccine contains killed virus and is approved for all people older than 6 months of age.

With a nasal-spray vaccine. This form

Health care providers also suggest flu shots for women who plan to be pregnant during flu season. The CDC says flu shots are OK for breastfeeding mothers.

Flu viruses are spread by contact with droplets sneezed or coughed from an infected person. Inhaling the droplets is the most common route to getting the flu. Touching objects

The other effective means of flu prevention is humidity. The flu bug exists in higher quantities in dry nasal and oral passages, which is 1 reason why flu epidemics occur in dry winter months. Raise the humidity in your workplace and at home to keep your nasal passages and mouth moist. Your body will then be better able to flush out the flu bug.

Rooting out rumors Don't believe the rumor that a flu shot can give you even a mild case of influenza. It's impossible. Neither form of the vaccine — by injection or nasal spray — contains a form of the flu virus that can give you the flu.

The injected form of the vaccine is made from pieces of dead flu virus cells. The nasal spray contains live viruses that have been damaged so they can't cause a major infection.

When you are injected with the flu vaccine, your body reacts as if it has been infected with the actual living virus and makes antibodies that provide immunity against the real virus. These antibodies remain at high levels for only 6 months to 9 months. These disappearing antibody levels are 1 reason why you need to be revaccinated each year.

Medical Device ASIA | March-April 2016 | 45

A Woman's Guide to Beating Heart Disease

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urveys show that few women think heart disease is their greatest health threat.

Unfortunately, it's the nation's number one killer, and women are its prime target. Over one-third of the women who die in the U.S. each year die of heart disease. In fact, more women die of heart disease each year than breast cancer.

The risk of heart attack and stroke increases with age. That’s especially true after menopause. But you should start protecting yourself from heart disease early. The buildup of plaque in your arteries—called atherosclerosis—can lead to heart attacks and strokes. It can begin as early as your teens and 20s.

Triglycerides, another form of fat in the blood But your cholesterol is only part of it.

Your health care provider will look at your medical history. He or she will also ask about your family history of heart disease.

This information will help assess your personal risk for the disease. He or she may decide you need medication to lower your cholesterol. Or your health care provider may want you to make lifestyle changes before prescribing medication.

Quit smoking

Fatty meats

Smokers have more than twice the risk for heart attack than do nonsmokers. The chemicals in cigarette smoke can shrink coronary arteries, making it tough for blood to circulate. Smoking can also cause the lining of blood vessels to become stickier. As a result, blood clots are more likely, which can cause stroke.

Palm oil

Get active

For some women, heart disease is preventable. The following lifestyle changes can help women lower their risk for it.

Strive for at least 30 minutes of moderate-to-vigorous physical activity 5 days a week. Exercise can reduce your risk of heart disease. It can raise your good cholesterol and lower your bad cholesterol.

Check your risk

Maintain a healthy weight

Change your fats

Talk with your health care provider about your cholesterol and blood pressure. Have both checked. The higher either of them is, the greater your risk for heart disease or heart attack. A blood test done after a 9to 12-hour fast can measure the fats in your blood. It can tell you:

Being overweight can raise your blood pressure, cholesterol, and triglyceride levels. It also puts you at risk for type 2 diabetes. This condition can also raise your risk for clogged arteries and heart attack.

Change the fats in your diet. Avoid butter and other saturated fats.

Instead use liquid margarine, tub margarine, olive oil, and canola oil.

But use them sparingly because all fats are high in calories. Each type of fat contains roughly 100 calories per tablespoon. Too much dietary fat of any kind can lead to weight gain.

Your total cholesterol LDL ("bad") cholesterol HDL ("good") cholesterol

By losing weight, you'll lower your cholesterol and blood pressure.

You’ll also be less likely to develop diabetes. Even losing 5% to 10% of your body weight can make a difference. Talk with your health care provider about your weight.

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Also limit the following: Full-fat dairy products

Partially hydrogenated vegetable oils Convenience or other prepared foods high in fat Eat your fruits and veggies Eat plenty of produce. A moderately active woman should eat at least 3 cups of vegetables and 2 cups of fruits daily. Studies link diets high in fruits and vegetables with lower blood pressure and a reduced risk for heart disease.

Fiber up Soluble fiber helps reduce LDL cholesterol. Oatmeal, whole-grain bread, and other whole-grain foods are excellent sources of this nutrient.

Adults should have 6 to 9 ounces of grains per day. Half of this amount should be whole grains.

Drink alcohol only in moderation Women should limit alcohol to no more than 1 drink per day. That’s equivalent to 12 ounces of beer, 4 to 5 ounces of wine, or 1-1/2 ounces of 80-proof spirits.

About Stomachaches

M

ost stomachaches are nothing more than indigestion or gas. But stomach pain also could be appendicitis, gallstones, a tubal pregnancy, or other serious conditions. The features of the pain and its severity, location, and duration are clues to its cause.

Whether you have shortness of breath, dizziness, or a fever

constipation. The pain usually moves to the belly's lower right side.

The usual suspects

Diverticulitis can feel like appendicitis, except the pain is in the lower left side of the belly. The pain is usually severe and comes on suddenly.

Gastroesophageal reflux disease (GERD), a cause of indigestion and heartburn, and inflammation in the stomach are the most common causes of stomach problems.

What to ask These are questions to consider when describing the pain to your health care provider: Where is the pain? Is it in the upper, middle, or lower abdomen? Is it on one side only or on both sides?

Does the pain stay in one spot or does it seem to travel?

Is it related to eating or going to the bathroom?

Does it come and go or stay the same?

Does anything make it worse or better?

Other important things to tell your health care provider: Whether you have vomited or have diarrhea If you had blood in the vomit, diarrhea, or urine

A stomach viral infection, also known as gastroenteritis, can cause symptoms that include nausea, vomiting, cramps, diarrhea, and fever. It usually goes away without medical treatment.

Food poisoning causes nausea, vomiting, stomach cramps, and diarrhea. Symptoms can occur within 30 minutes or up to 2 days after eating contaminated food.

Gallstones can cause steady pain in the upper belly that increases rapidly and lasts from 30 minutes to several hours. Other signs include bloating, gas, and indigestion.

Ectopic or tubal pregnancy symptoms include belly or pelvic pain. It can be sudden, constant, and severe but also may be mild. If a fallopian tube has burst, which is a medical emergency, there also may be signs of shock like a weak, racing pulse; pale, clammy skin; and dizziness or fainting.

Ovarian cancer symptoms can include periodic pelvic and abdominal pain. Other symptoms include more frequent urination and a more frequent urge to urinate; increased belly pain or bloating; and a feeling of fullness.

The following guidelines can help you determine how to respond to stomach pain: Self-treat if the pain is mild.

See your health care provider if the pain is mild to moderate and happens again over time.

Go to the emergency room if your pain is severe, if you have a fever, if you have blood in your vomit, or if you have bowel movements that look like runny, black tar.

A health care provider should evaluate any pain that’s severe or interferes with your ability to go about your usual routine.

Treatment decisions

Irritable bowel syndrome is one of the most common disorders diagnosed by health care providers.

Belly pain, bloating, and discomfort are the main symptoms.

Appendicitis requires immediate medical attention. The symptoms typically start with a loss of appetite, mild fever, pain around the bellybutton, vomiting, diarrhea, or Medical Device ASIA | March-April 2016 | 47

Ability to Concentrate Isn't What It Used to Be

W

hen you are rolled into the operating room at the hospital, you want to know that the surgeon is ready to concentrate on your procedure.

When you board a jetliner for your next vacation destination, you want to know that the tower crew is rested and ready to direct the pilot through dense airport traffic.

but too much stress leads to burn out, accidents, or illness. Think of your life today. Stress? That's your middle name, right? Hurry here, hurry there, with never enough time in the day.

Concentration is vital in some professions. Even in our everyday lives, though, we all need to concentrate — to avoid traffic accidents, to get the job finished, to remember important information.

But with today's world filled with flashing images on TV, quick news reports, and fast-food restaurants on every corner, are we capable of concentrating as well as we used to?

One reason people have trouble concentrating may be too much television. When a brain is battered by so much stimulation, it's hard to concentrate on just 1 thing. Some experts have pointed out that a child's attention span is now about 7 minutes — the length of time a program runs before a commercial break. In Europe, by contrast, attention spans seem to be longer.

Perhaps that is because there are

longer gaps between commercials.

A concentration tune-up To help tune up your concentration skills, practice these tips: Cut back on the amount of television you watch, or your children watch.

So, with all this stress and a culture that thrives on short takes, can we concentrate?

Before we answer that question, let's take a closer look at concentration, and its sibling, attention.

Attention is a global term. It is used to describe a state in which you are interested in everything going on around you. Concentration focuses that attention on 1 specific thing.

Staying in focus Attention and concentration developed in humans as defense mechanisms. Early humans had to be constantly alert or be eaten. But it's difficult to keep up a high level of attention for long periods of time without getting stressed out.

Stress is good in small quantities,

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Get enough sleep. The CDC recommends 7 hours to 9 hours of sleep for teens and adults, 10 hours to 11 hours for school kids, and even more for preschoolers and toddlers.

Avoid drinks that contain stimulants. Although caffeine or nicotine can give you a quick boost, it lasts only a short time.

Pay attention to what you eat. A high-fat meal can leave you feeling sluggish.

This is not because the body needs the extra blood to help digest the food.

Research has shown that you feel sleepy after eating a meal high in fat or refined sugar because these foods change the makeup of the amino acids entering the brain. Try to stay calm and relaxed. Take a short break of a few seconds to a minute every hour or so at work to break the tension cycle.

Just taking a moment to breathe deeply and slowly can help you re-center yourself.

The Biliary System: Anatomy and Functions

Anatomy of the biliary system The biliary system consists of the organs and ducts (bile ducts, gallbladder, and associated structures) that are involved in the production and transportation of bile.

The transportation of bile follows this sequence: When the liver cells secrete bile, it is collected by a system of ducts that flow from the liver through the right and left hepatic ducts.

to the duodenum (the first section of the small intestine).

However, not all bile runs directly into the duodenum. About 50 percent of the bile produced by the liver is first stored in the gallbladder, a pear-shaped organ located directly below the liver.

Then, when food is eaten, the gallbladder contracts and releases stored bile into the duodenum to help break down the fats.

Functions of the biliary system

These ducts ultimately drain into the common hepatic duct.

The biliary system's main function includes the following:

The common hepatic duct then joins with the cystic duct from the gallbladder to form the common bile duct, which runs from the liver

To drain waste products from the liver into the duodenum

controlled release of bile Bile is the greenish-yellow fluid (consisting of waste products, cholesterol, and bile salts) that is secreted by the liver cells to perform two primary functions: To carry away waste To break down fats during digestion Bile salt is the actual component which helps break down and absorb fats. Bile, which is excreted from the body in the form of feces, is what gives feces its dark brown color.

To help in digestion with the Medical Device ASIA | March-April 2016 | 49

How to Lose Weight Faster, But Safely

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he trouble with dieting, I hear many women say, "is that it takes too long. If I want to look good for my anniversary next month, I should've started losing weight way back in February. Now that I'm finally focused, it's too late." Well, yes and no. Taking the long-term approach to weight loss is wise because it means you'll lose pounds slowly and steadily -- making it more likely that you'll keep them off. But there are ways to rev up your metabolism so you burn calories and lose weight more quickly.

Check out my favorite no-fail jump starts.

Watch Your Fluids 1. Drink green tea. Get this: When a recent study compared the metabolic effect of green tea (in extract) with that of a placebo, researchers found that the green-tea drinkers burned about 70 additional calories in a 24-hour period. If you can believe it, those 70 calories a day add up to a total of 7.3 pounds of fat a year! It's not magic, it's science: Researchers believe the

difference is caused by metabolismenhancing antioxidants known as catechins, which are found in green tea.

2. Avoid calories in a glass.

Scientists now know that the body does not register liquid calories in the same way it does solid calories.

Drinking a grande caffe mocha, for instance, won't make you feel satiated the way eating a bowl of pasta will. Which means that although the caffe mocha actually has a greater number of calories than the pasta, you're still more likely to want a second cup from Starbucks than another plate of linguine. So monitor your intake of juice, soda, coffee drinks and wine. If you consume one of each of those beverages during the day, you'll have taken in at least 800 extra calories by nighttime — and you'll still be hungry. (Incidentally, alcohol may suppress the metabolism of fat, making it tougher for you to burn those calories.)

Start Lifting 3. Buy a set of five-pound weights.

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It's a onetime investment you'll never regret. Here's why: Strength training builds lean muscle tissue, which burns more calories — at work or at rest — 24 hours a day, seven days a week. The more lean muscle you have, the faster you'll slim down.

How do you start strength training?

Try some push-ups or a few squats or lunges. Use your free weights to perform simple biceps curls or triceps pulls right in your home or office. Do these exercises three to four times per week, and you'll soon see a rapid improvement in your physique.

4. Lose the salt. Sodium contributes to water retention, making you look and feel bloated. Do you eat too much salt? Probably — the daily value suggests no more than 2,400 milligrams of sodium each day (or about one teaspoon), but most of us are getting more than twice that amount. So keep an eye on your sodium intake, and that doesn't just mean ditching the saltshaker. Hidden sources include soups, canned foods and drinks (did you know a serving of regular V8 juice has 800

mg of sodium?), salty snacks such as chips and pretzels and many prepackaged foods.

Heat Things Up 5. Spice it up. Angelo Tremblay, Ph.D., director of the division of kinesiology at Laval University, in Canada, found that eating hot peppers can boost a person's basal metabolism (the total calories the body burns at rest). The reason?

Capsaicin, a compound found in jalapeno and cayenne peppers, may increase your body's release of stress hormones such as adrenaline, which can speed up your metabolism and your ability to burn calories.

What's more, eating hot peppers may reduce your appetite, Tremblay says, helping to curb your cravings.

So spice up your stir-fried veggies, eat low-calorie chili or salsa (try them on salads and baked potatoes), and watch the pounds come off faster.

6. Get some sleep. As funny as it sounds, sleep deprivation may make you fat — and not just because you're susceptible to cases of the

late-night munchies (although there's that too). Women who get less than four hours of sleep per night have a slower metabolism than those who snooze for a full eight hours, according to researchers at the University of Chicago. So don't skimp on your zzz's, and you'll be rewarded with an extra edge when it comes to shedding pounds quickly.

Move Around 7. Go for an evening walk. Don't get me wrong — exercising at any time is good for you. But evening activity may be particularly beneficial because many people's metabolism slows down toward the end of the day. Thirty minutes of aerobic activity before dinner increases your metabolic rate and may keep it elevated for another two or three hours, even after you've stopped moving. What that means for you: Those dinner calories have less of a chance to take up permanent residence on your hips.

8. Eat every meal. Listen up: Skipping meals will not make you lose weight faster. That strategy backfires because your body thinks food is in short supply, so it slows your metabolism in order to conserve energy. Over time, the result is that when you do eat — even if you consume the same foods as always — your body will be slower to use the calories as fuel, thus creating a backlog of unwanted pounds. If a hectic day makes a sit-down meal impossible, stash an energy bar or a piece of fruit in your purse or briefcase -- anything that will keep you from going hungry.

9. Add 20 minutes of exercise per day. If you're on a diet, you're probably

already working out a couple of times a week. (No? Well, you should start!)

But whether you exercise or not, you can get a leg up on all those other weight-loss wannabes by doing a little something extra each day. Take the stairs instead of the elevator; walk to the bus, train, or all the way to the office; window-shop with your best friend rather than sit over coffee. Taking the dog out, gardening and even housecleaning all increase the number of calories you expend. You don't have to go for a jog (although that would help!) to speed up weight loss. Twenty minutes of moderate exercise a day means you'll burn approximately 700 calories.

Drink Up! 10. H20, H20, H20. You've heard it before, and you'll hear it again. That's because drinking 64 ounces of water daily is one of the easiest ways to speed up weight loss. Your body needs water in order to efficiently metabolize stored fat. When you shortchange your supply, you're likely to slow down that process, meaning it's more difficult for you to burn calories.

An easy eight glasses a day (at least!) will keep your system running smoothly.

11. Don't go for the gimmicks. At any given time, there are dozens of weight-loss hypes in the marketplace that claim to have the ability to take off 10 pounds in 10 days, or whatever. Desperation can tempt us to try anything, but you and I both know these schemes don't work. Save your money, but more importantly, save yourself from the emotional pain when these gimmicks fail. Be realistic. Jump-start your weight-loss program in ways that make sense, and not only will you be thinner, you'll be happier too.

Medical Device ASIA | March-April 2016 | 51

Mammograms: Another way to screen for heart disease?

C

alcium in the arteries of the breast predicts early buildup of plaque in the heart's arteries, and may improve risk assessment in many women, especially young women Routine mammography--widely recommended for breast cancer screening--may also be a useful tool to identify women at risk for heart disease, potentially allowing for earlier intervention, according to a study scheduled for presentation at the American College of Cardiology's 65th Annual Scientific Session.

Data from this study show for the first time a link between the amount of calcium in the arteries of the breast--readily visible on digital mammography--and the level of calcium buildup in the coronary

arteries. Coronary arterial calcification, or CAC, is considered a very early sign of cardiovascular disease.

Importantly, the presence of breast arterial calcification also appears to be an equivalent or stronger risk factor for CAC than other wellestablished cardiovascular risk factors such as high cholesterol, high blood pressure and diabetes.

Earlier research had shown a link between breast arterial calcification and atherosclerotic disease--even heart attack, stroke and other cardiovascular disease events, but researchers said these data provide a more direct relationship between the extent of calcified plaque in the mammary and coronary arteries, as well as a comparison to standard risk evaluation.

"Many women, especially young women, don't know the health of

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their coronary arteries. Based on our data, if a mammogram shows breast arterial calcifications it can be a red flag--an 'aha' moment--that there is a strong possibility she also has plaque in her coronary arteries," said Harvey Hecht, M.D., professor at the Icahn School of Medicine and director of cardiovascular imaging at Mount Sinai St. Luke's hospital, and lead author of the study.

All told, 70 percent of the women who had evidence of breast arterial calcification on their mammogram were also found to have CAC as shown on a noncontrast CT scan of the chest. For women under 60 years of age with CAC, half also had breast arterial calcification--an important finding as very few would be thinking about or considered for early signs of heart disease. There were even fewer false positives among younger patients; research-

ers said that if a younger woman had breast arterial calcification, there was an 83 percent chance she also had CAC. Notably, breast arterial calcification also appeared to be as strong a predictor for cardiovascular risk as standard risk scores such as the Framingham Risk Score, which underestimates women's risk, and the 2013 Cholesterol Guidelines Pooled Cohort Equations, which tends to overestimate risk, Hecht said. When researchers added 33 asymptomatic women with established CAD, breast arterial calcification was more powerful than both risk assessment formulas, which suggests the presence of subclinical atherosclerosis may be a more important indicator of heart disease than other risk factors. "This information is available on every

mammogram, with no additional cost or radiation exposure, and our research suggests breast arterial calcification is as good as the standard risk factor-based estimate for predicting risk," Hecht said.

"Using this information would allow at-risk women to be referred for standard CAC scoring and to be able to start focusing on prevention-perhaps even taking a statin when it can make the most difference."

breast arterial calcification, to routinely report not just the presence or absence of breast arterial calcifications but also to estimate and note the amount.

Multivariate analysis showed that early signs of a buildup of plaque in the coronary arteries were most strongly related to breast arterial calcification. While CAC was about two times as likely with advancing age or high blood pressure, it was three times more likely with breast arterial calcification.

A total of 292 women who had digital mammography and noncontrast CT scans within one year were included in the study. Of these, 124, or 42.5 percent, were found to have evidence of breast arterial calcification. Mammograms were reviewed by a second radiologist who was blinded to the CAC results. Women with breast arterial calcification were more likely to be older, have high blood pressure and chronic kidney disease, and less likely smokers.

Women with established cardiovascular diseases were excluded.

Breast arterial calcification was evaluated on a scale from zero to 12

"The message is if a woman is getting a mammogram, look for breast arterial calcification. It's a freebie and provides critical information that could be lifesaving for some women," Hecht said, adding he hopes these findings will prompt clinicians, who rarely report

"The more breast arterial calcification a women has, the more likely she is to have calcium in her heart's arteries as well. If all it requires is to take a closer look at the images, how can we ignore it?," he said.

by increasing severity, and CAC was measured on the CT using a validated 0-12 severity score. The overall accuracy of breast arterial calcification for the presence of CAC was 70 percent, and 63 percent of those with CAC also had breast arterial calcification.

other year for women 50-75 years old and women at high risk for breast cancer by the U.S. Preventive Service Task Force. Digital mammography is more sensitive to the presence of calcifications and is now available in 96 percent of mammography units in the U.S.

To date, there is no consensus on using CAC as a screening test, though a very large outcome study of 39,000 subjects is underway in the Netherlands. Mammography, however, is widely used and accepted and, as Hecht said, may provide an opportunity to risk stratify asymptomatic women by breast arterial calcification who might have calcium in the coronary arteries and ordinarily would not have been readily considered for cardiovascular screening. Heart disease is the leading cause of death among women, yet breast cancer is often the most feared. Roughly 37 million mammograms are performed annually in the U.S. Mammography is recommended annually for women over 40 years of age by the American Cancer Society and every

Another intriguing point that deserves additional study, according to the researchers, is that the nature of the atherosclerosis is different in breast arterial calcification and CAC, making it unclear why one should be related to the other.

Hecht stresses that these findings warrant further evaluation and validation in larger studies. Future prospective trials are needed to see what the prognostic significance of breast arterial calcification might be.

Because the study involved women who received both mammography and CT scan for clinical indications, these women may have been more likely than the average woman to have coexisting conditions, although Hecht said these were unrelated to heart disease.

Medical Device ASIA | March-April 2016 | 53

Adding stress management to cardiac rehab cuts new incidents in half management training during their cardiac rehabilitation had subsequent cardiovascular trouble -about half the rate of the other group.

Both sets of patients who went to rehab fared better still than recovering heart patients who elected not to attend rehab; 47 percent of this group later died or had another cardiovascular incident, according to the article.

Reducing stress may seem like an obvious part of any plan for improving heart health, said lead author James Blumenthal, Ph.D., a clinical psychologist and professor in psychiatry and behavioral sciences at Duke.

P

atients recovering from heart attacks or other heart trouble could cut their risk of another heart incident by half if they incorporate stress management into their treatment, according to research from Duke Health.

The findings, published March 21, 2016 in the American Heart Association journal Circulation, are the result of a randomized clinical trial of 151 outpatients with coronary heart disease who were enrolled in cardiac rehabilitation due to heart blockages, chest pain, heart attacks or bypass surgery. They ranged in age from 36 to 84 years old.

About half of the patients participated in three months of traditional

cardiac rehabilitation, which included exercise, a heart-healthy diet and drugs to manage cholesterol and high blood pressure.

The other half went to cardiac rehab and also attended weekly, 90minute stress management groups that combined support, cognitive behavior therapy, muscle relaxation and other techniques to reduce stress. Patients were followed for an average of three years after rehab.

Thirty-three percent of patients who received only cardiac rehabilitation had another cardiovascular event such as a heart attack, bypass surgery, stroke, hospitalization for chest pain or death from any cause.

By comparison, 18 percent of the patients who participated in stress-

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"Over the past 20 to 30 years, there has been an accumulation of evidence that stress is associated with worse health outcomes," Blumenthal said. "If you ask patients what was responsible for their heart attacks, most patients will indicate that stress was a contributing factor."

But stress management is typically not part of most cardiac rehabilitation programs, he said.

"I think part of the issue is that stress is hard to define, and there's no universally accepted way of measuring it or treating it," Blumenthal said. "The data we provide indicate that by reducing stress, patients can improve clinical outcomes, even beyond the benefits that we know exercise already has on reducing stress and improving cardiovascular

health." For the trial, patients' stress levels were measured using five standard instruments on which participants self-reported their levels of depression, anxiety, anger and perceived stress. Overall, those who participated in stress management reported reductions in anxiety, distress and their overall level of perceived stress.

Both groups that participated in cardiac rehabilitation saw similar and significant physical improvements in their cholesterol levels and proteins that indicate heart disease-related inflammation, as well as their exercise capacity.

"We have known for some time that participation in a supervised exercise program is beneficial in patients with coronary heart disease," said Alan Hinderliter, M.D., cardiologist with UNC Health Care and co-investigator on the trial.

"The results of this study suggest that stress management is also a very important element of a comprehensive cardiac rehabilitation program.

The intervention was clearly helpful in reducing stress levels, but we need additional research to confirm the benefits of stress management in improving cardiovascular outcomes."

Although death rates from heart disease have improved, it remains the No. 1 cause of death in the U.S. and is growing worldwide, according to the American Heart Association.

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