middle east hospital magazine september 2011

www.middleeasthospital.com

Urology training models with a high degree of realism

MediskillsMediskills

PPPs in the Middle EastInterview with Simon Leary of PwC

Paxman CoolersScalp cooling technology

Focus: UK East MidlandsWhere bioscience thrives

Aesica PharmaMarket leading Formulation Development

Research paper:Accelerated Bio-Ageing

& Socioeconomic Status

World Health Care Congress Middle EastAbu Dhabi 2011 Preview

November:November:

MEDICA 2011 Special Edition

MEH award winners announced

Editor: Guy Rowland

Publisher: Mike Tanousis

Associate Publisher: Chris Silk

MEH Publishing Limited

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Editor: Guy Rowland

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Features Editor: Emrys Baird Tel +44 [email protected]

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Millennium International Group

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Dubai HealthCare City, UAE

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For more information about the

magazine contact the publisher or

editor. Or email MEH at:

[email protected]

Sept/Oct 2011 | 3

Sept/Oct 2011 contents

4. COVER FEATUREMediskills - Urology training models with a high degree

of realism. Mediskills seeks to boost urology education and

training in the Middle East with the latest 100% anatomically

correct Advanced Scope Trainer.

10. EXCLUSIVE INTERVIEW:What is driving the new trend for Public Private Partnerships in

the Middle East?

Middle East Hospital speaks to Simon Leary, Managing

Partner at leading PPP consultants Pricewaterhouse

Cooper with responsibility for Health Industries Middle East.

16. Paxman Coolers - Scalp cooling technology

Paxman is the leading global manufacturer and supplier of

scalp cooling equipment, for the prevention of hair loss during

chemotherapy.

24. UK Regional Focus: East MidlandsNottingham and the East Midlands is one of the leading UK

centres for medical technologies, and is a major hub for

bioscience research and developlment.

32. Preview: World Health Care Congress Middle East

10-13 December 2011, Abu Dhabi

34. Aesica Pharma - Formulation Development specialists.

Aesica is a fast-growing UK company with a global footprint,

expanding into India, the US and Middle East

38. Review: REHACARE 2011A look at the highlights of last month’s show.

42. Research paper: Accelerated Bio-Ageing & Socioeconomic

Status - Accelerated Telomere Attrition Is Associated with

Relative Household Income, Diet and Inflammation in the

pSoBid Cohort.

Editor’s intro

This issue features some excellent

UK companies with proucts with the

potential to make a positive impact

on healthcare in the Middle East.

Mediskills’ urology training models,

Paxman’s scalp cooling system,

and Aesica’s formulation

development services and pharma

products are all UK success stories

that are ready to expand their

global exports, with the Middle

East viewed as an increasingly

important region.

MEH speaks to Simon Leary of

PwC on the growing trend for PPP

hospital builds in the Middle East,

and how these partnerships can

benefit countires as diverse as

Qatar and Egypt. We look at the

bioscience hub of Nottingham in the

UK. A major R&D centre of

excellence driven by global

research expertise based in the

renowned universities of

Nottingham, Loughborough,

Leicester and Nottingham Trent.

The healthcare trade show

season kicked off with

REHACARE last month. We

review the show, and preview the

World Health Care Congress

Middle East. Next month will be

the MEDICA issue, with a preview

of all the best medtech that will be

on display, and we formally

announce the winners of the

2011MEH awards.

Guy Rowland, Editor

Mediskills Models - Designed by Clinicians for Clinicians

Mediskills was founded in 1998by three UK clinicians - aradiologist and two urologists -to develop models for skillstraining in urology, interventionaluroradiology and other minimallyinvasive procedures.

John Kelly acquired the Mediskills

company in 2008 having advised

the founders initially on developing

the business through his own and

still existing consulting company

Moffat Dickson Ltd

[www.moffatdickson.com].

The founders started the

development of the Mediskills

business with the ethos to develop

a range of training models suitable

for their trainees to experience both

anatomically correct models with a

high degree of realism. John with

his Team of model makers has

further developed the Mediskills

models to meet customer

requirements in particular the

Advanced Scope Trainer which has

the capability to re-charge the

stones into both kidneys from

external ports.

Under John’s direction and

innovative approach Mediskills was

presented with a Business Award

2011 from Medilink, a member

organisation, as a Finalist in the

Export Achievement category at

their annual Innovation Day 2011.

Meeting training challengesChallenges facing device and

instrument manufacturers today

include the evaluation of new

instruments and accessories,

training of sales personnel,

demonstrating new products and

physician education. Mediskills can

assist in the conquering of these

challenges by the provision of

lifelike models for evaluation and

training in almost all aspects of

Endourology.

Mr Kelly told MEH, “The long held

philosophy, see one, do one, teach

The Advanced Scope Trainer

Middle East Hospital

Sept/Oct 2011 | 4

Mediskills Models - Designed by Clinicians for Clinicians Training Models with a High Degree of Realism

one, is no longer applicable in the

modern teaching of practical skills.

Learning on the job is unacceptable

to patients and surgeons alike; in

today's cost conscious health

services there is pressure to use

operating lists as efficiently as

possible and therefore time

available for skills teaching is at a

premium.”

Mediskills provide the opportunity to

simulate endoscopic procedures as

well as providing an opportunity for

bench testing new products at the

prototype stage by offering a range

of models for percutaneous access,

percutaneous nephrolithotomy and

ureteroscopy. Unlike animal tissue

models, there are no health and

safety issues, which restrict the use

of medical models. They can be

used in the laboratory, hospital or

commercial exhibition with

complete safety.

Mr Kelly added, “Mediskills is

dedicated to the improvement of

training and the acquisition of endo-

skills by trainees in all aspects of

endourology and interventional

uroradiology. The Mediskills team

has a long experience of running

practical skills courses which has

enabled them to develop the

models. These models possess a

high degree of realism resulting

from extensive discussions with

fellow clinicians. The models, made

in the UK, are developed from hand

crafted moulds and produced from

silicone based plastics. Each model

is individually manufactured and

undergoes rigorous quality control

testing before dispatch to the

customer. It is supplied ready for

use with a complete set of

instructions.”

Benefits for industry andacademic trainingThe Mediskills Models rangecurrently available will enablecompany personnel to becomeproficient in an extensive array ofclinical procedures.


Sept/Oct 2011 | 5


Mediskills sell to all the major

endourology instrument

manufacturers across the globe.

Their largest market is Japan,

with strong sales in Brazil, USA,

Germany, France, India and

Malaysia. In the Middle East the

company sees great potential

for the use of their products by

trainee surgeons in the region’s

hospitals and medical colleges.

Mr Kelly will be attending the

World Health Care Congress

Middle East in Abu Dhabi (10-13

December) where he will be

meeting with senior healthcare

professionals and officials. He

will also be collecting a Middle

East Hospital Health and

Innovation Award for the

Advanced Scope Trainer; as the

best new product for export to

the Middle East in the training

and education category.

Mediskills training productsThe Mediskills advanced

ureteroscopy trainer has been

designed to meet the needs of

basic and advanced training in rigid

and flexible ureteroscopy.

The Advanced Scope Trainer (AST)

utilises a clear acrylic casing more

suited to the actual demonstration

of the properties of a flexible

ureteroscope to potential

customers. It incorporates features

such as distensible bladder, a

realistic ureteric orifice and a ureter,

which follows the same anatomical

course as the adult male, thus

providing a realistic alternative to

training in patients. At the same

time this allows the trainee

ureteroscopist to develop a feel for

the difficulties that may be

encountered during procedures in

patients.

In addition the AST has one

enlarged kidney and a distorted

ureter allowing the trainee

ureteroscopist to develop a feel for

Mr Kelly explained, “Experience

of these procedures will assist

sales and marketing teams as

well as engineers, by enabling

them to appreciate and acquire

the same endoskills used by

clinicians in order to perform

endourological procedures.

Mediskills’ models are powerful

marketing tools which may be

used by your Sales and

Market ing Teams to

demonstrate your products to

best effect ; they can also be

used as par t o f an

educat ional course for the

int roduct ion of new

procedures and dev ices for

endouro log ica l management

of ur inary t ract d isease.”

The Advanced Scope Trainer


Sept/Oct 2011 | 6

100% Anatomically Correct Models

The Perc Trainer

The Standard Scope Trainer

the difficulties that may be

encountered during real-life

procedures in patients. The

Advanced Scope Trainer

provides the operative with the

ability to re-charge each kidney

with stones via the two external

ports when the existing stones

are removed or destroyed.

The Standard Scope Trainer is

designed for multiple uses. The

distendable bladder with an

anatomically correct

ureterovesical junction will

enable ease of access with the

ureteroscope to be assessed.

The reproduction of the lumbar

lordosis enables the performance

of rigid ureteroscopes to be

evaluated along with devices for

stone retrieval and

disintegration.

The carefully designedcollecting system containingboth stones and a papillarytumour together withfluoroscopic properties of themodel enables the performanceand manoeuvrability of flexibleureteroscopes to be assessedand demonstrated. In addition,the placement of a nephroscopethrough a percutaneous trackcan be a very powerful tool fordemonstrating the properties of aflexible ureteroscope to potentialcustomers.

A unique feature of the PercTrainer kidney model is theability to reproduce ultrasoundand fluoroscopic features of thehuman kidney. Re-use islimited, depending on theprocedure practised; but theresealing material allowsrepeated needle puncture in thecollecting system. Howeveronce a tract has been dilated,use is restricted to further tractdilation and endoscopicmanoeuvres.

www.mediskills.com


Sept/Oct 2011 | 7


John Kelly biography

For the last 35 years John has

been involved in the

pharmaceutical industry at Board

and senior management level in

a number of both Japanese and

EU based companies.

Latterly John was President and

Board Member for the major

Japanese conglomerate Kowa

Company Ltd, Tokyo where he

established the European

subsidiary near London to head

up their clinical development

operation and recruited a team of

over 30 staff carrying out clinical

trials in Europe, US, India and

Russia. During this period John

has amassed a network of

contacts particularly in Japan and

South East Asia as well as within

the EU where he has a network

of pharmaceutical and biotech

contacts.

John’s track record of being

involved in two start-up

operations for Japanese

pharmaceutical companies in

Europe in both the commercial

oncology arena launching the

anti-cancer drug Mitomycin-C in

Europe and in research through

the clinical development sector

gives him a valuable insight into

the scientific and business area

as well as the cultural

environment within Japan which

is often a challenge for client

companies reaching out to this

market.

During his career John gained

valuable contacts during this

period internationally with senior

oncologists and urologists and is

listed as a founder member of the

European Organisation for the

Research and Treatment of

Cancer GU Group based in

Brussels (E.O.R.T.C.)

[email protected]


Sept/Oct 2011 | 8

Public Private Partnerships in the Middle East

what is driving the new trend for

Public Private Partnerships in

the Middle East? Middle East

Hospital speaks to Simon Leary,

Managing Partner at leading PPP

consultants Pricewaterhouse

Cooper(PwC), with responsibility

for Health Industries Middle East.

The concept of PPPs has been

enshrined in law in some Middle

Eastern countries for over a

decade. It is only much more

recently, however, the

governmental multi-sector PPP

units and /or specific PPP deals

have emerged as real contenders

to develop infrastructure and social

sector services.

Middle East Hospital (MEH): What

is your role for PwC in the Middle

East?

Simon Leary (SL): The UK has an

increasingly close relationship with

Middle East. Im here to build the

multifunctional health industries

PPP offering that we have in UK in

the 12 countries of the Middle East.

We are advising governments on

setting up national health projects;

for example we are currently

helping to establish a national

health insurance scheme in Doha

which will cover everyone in Qatar,

nationals and non-nationals.

We are also advising on

establishing a national primary care

network in Qatar, and introducing

the concept of an end to end

medical service that starts with

prevention and goes right through

to long term care. Qatar is leading

the charge on this in the region.

We are also helping to set up what

is arguably the first proper PPP in

the region, in Kuwait. This is really

a flagship project for PPP in the

region. We help with performance

improvement, not only cost, but

policy and critical service, through

to supporting other aspects of the

broader health continuum. This is

In essence Public Private

Partnerships are a collection of

models. One such model is the

PFI (Private Finance Initiative)

model in which the private sector

is contracted to rebuild or replace

a public asset and maintain that

asset for 20 to 30 years. However,

PFIs are merely one type of PPP

model. PPPs are defined as a

broader partnership between

private contractors and

government, in which the

common characteristics are that

the public sector contracts

(usually on a long term basis) with

the private sector for the provision

of a public service.

During the 1990s, the United

Kingdom was fertile ground for

PPPs in healthcare since the

government had vastly

underinvested in its National

Health Service (NHS) hospitals.

As a result, nearly every new

hospital – approx. 100 buildings in

12 years – was built as a PPP in

the UK. The concept spread to

other countries, and the PFI

model developed its own cadre of

expertise as bidders and the

public sector improved on the

process.

PPPs were not without criticism

and some well publicised failures

in Australia, Japan, Italy and other

places allowed sceptics to point

out the flaws in the model.

However, important lessons have

been learned from these failures

according to the model’s

advocates, and it has now been

refined and altered.

What is a Public Private Partnership?


Sept/Oct 2011 | 10

(doctors and nurses). This

arrangement makes the project

stand out from other PPPs currently

operating in the Gulf due to the

greater level of private sector

involvement and the risk transfer. It

is therefore a model similar to the

PPP that you would find in the UK.

MEH: What is the attraction of the

PPP model for Middle Eastern

governments?

SL: It’s impossible to generalise

about this region, you really need to

split the market in two. Some

Interview with Simon Leary, Pricewaterhouse Cooper

why we call our department health

“industries” as opposed to health

“care”. We are also looking at

aspects of the pharma market, the

big issue around supply chain, and

also prosthetics; which are very

much in demand due to the high

level of road accidents.

MEH: Who do you work with on

these projects?

SL: This work requires a

multidisciplinary team, so I recruit

people from both inside and outside

the Middle East who have the

requisite skills to tackle these

issues. Our approach is very

country specific due to the big

differences in the healthcare

systems from country to country.

Requirements are very different for

example in Basra than they are in

Doha. Also, there are very different

levels of development between the

Gulf, Levant and North Africa. For

example, we are doing a lot of

public health and primary care

outreach work in Iraq to tackle the

immediate need, while also building

a 500 bed hospital in Kuwait. We

use resources within the region as

much as possible to deliver

projects. That means cutting down

on fly-in resource except where

outside expertise is essential, and

ensuring that the bulk of the work is

done by people living in the region,

if not the actual country.

MEH: How is the flagship Kuwait

hospital project progressing?

SL: The market in Kuwait is

dominated by the public sector, with

some private hospitals. There

hasn’t been a completely new

hospital build in Kuwait for 30

years. The National Rehabilitation

Facility- the only hospital of its kind

in the country- is currently run out

of an army barracks, with 70 beds

to cater for the entire country.

PwC has completed the feasibility

study for the Ministry of Health

and is the project sponsor. Later

this year work will begin on a

PPP scheme to rebuild the

hospital with 500 beds. This will

enable the hospital to meet new

demand, and enable people

currently going overseas for

treatment to stay at home.

The PPP will include the

building, operating and

managing of the hospital by the

private sector on a fixed-term

franchise, with the state

providing the patient-facing staff

Current and projected health spending as percent of GDP in OECD, BRIC nations

Sizing the market: Health spending is expected to increase by 65.5% between

2010 and 2020



Sept/Oct 2011 | 12

countries require the finance and

the expertise- such as Egypt which

has been very active in creating

PPPs across several sectors- while

others need the technical knowhow

and expertise brought from outside

the country. Qatar is a good

example of the latter case, where

the capital is the least important

factor, whereas in North Africa, as

in the West, the finance is the most

important requirement.

MEH: How do you see the future of

healthcare in the Middle East?

SL: The state will continue to play

the major role, both due to the

political nature of healthcare

delivery (and this is true of all

countries not just in the Middle

East), and because most of the

health funding is provided by the

state. Citizens in the region are also

accustomed to the state providing

healthcare and expect to be taken

care of.

I do expect the healthcare

landscape to change over time in

the Gulf. While there is no reason

to believe it will not continue to be

free or heavily subsidised, there are

more efficient ways of delivering

and financing healthcare. Not

necessarily spending less, but

allocating finds more efficiently.

Countries need to look at their

models of care, which tend to be

very inefficient. We are in the early

stages of having that debate in

countries such as Qatar, who

recognise that healthcare as a

whole needs to set up to be

sustainable both financially and

operationally, and not just focused

on trophy projects.

MEH: Will healthcare become more

sustainable in the Gulf?

SL: The healthcare workforce is

increasingly global in nature (eg.

30% of NHS staff not born in UK).

In the Gulf States, where the

majority of the population are not

nationals, the health service reflects

the rest of society. Forward looking

countries are investing in training

more of their own nationals, and we

have recently been consulted on an

endowment programme where

nationals of one country will be sent

abroad to receive medical training,

on the condition that they then

return and spend a certain number

of years working for the health

service of that state. There needs to

be much more of this kind of

programme that contains an

element of repatriation in order to

keep those skilled workers in the

country.



Sept/Oct 2011 | 13


MEH: Can the Middle East avoid

the problems some other countries

have had with PPPs?

SL: It needs to be remembered that

the PPP model in the UK has taken

20 years to develop into its current

level of maturity, while this is still

new in the Middle East. There

will need to be a learning

Simon Leary profileSimon is a partner in

Pricewaterhouse Coopers’

international health industries

advisory practice and is currently

the Managing Partner for our

Health Industries business in the

Middle East. He is also Managing

Partner for PwC’s Health

Research Institute (HRI) across

EMEA and sits on the HRI global

governing council.

From 2002-2005 Simon was

seconded to the UK’s Department

of Health where he undertook a

number of roles, latterly as Head

of the national Strategy Unit. This

role involved providing medium

and long term strategy advice to

the Prime Minister’s Office

(Strategy and Delivery Units),

Health Ministers and senior civil

servants. From 1996-2002 he was

seconded to PwC in South East

Asia where he worked across the

region (initially as director and

then as a partner) to build a

multidisciplinary business focused

across those sectors being funded

by international agencies and

national reconstruction funds.

Simon was educated at

Cambridge University and London

Business School. He is a Fellow

of the Royal Society of Medicine

(UK), an Affiliate Fellow of the

Institute of Chartered Accountants

in England and Wales and a

member of the Royal Institute of

International Affairs.

process over the course of

several years. While lessons

can be learned from the

mistakes of others, the

conditions and economics for

PPP can vary greatly depending

on the country, so blindly

following other national models

that may be inappropriate.


Sept/Oct 2011 | 14


Sept/Oct 2011 | 16

Paxman Coolers

Paxman is the leading globalmanufacturer and supplier ofscalp cooling equipment, for theprevention of hair loss duringchemotherapy.

Hair loss is a well documented side

effect of many chemotherapy

regimes. It is often devastating and

the fear of hair loss has even been

known to cause patients to refuse

treatment. The revolutionary

Paxman hair loss prevention

system is responsible for helping

thousands of people worldwide

keep their hair and their dignity.

Paxman’s innovative system is the

very latest in scalp cooling

technology researched and

developed in the UK over a number

of years, it now has the backing of

leading Oncologists from around

the World.

Company historyPaxman Coolers was formed over

ten years ago after the Managing

Director’s wife lost all her hair

during her cancer treatment. The

family found this very distressing so

using his engineering knowledge,

the resources within his existing

business and the help of his

brother, Glenn Paxman created the

Paxman Scalp Cooler.

Following trials at Huddersfield

Royal Infirmary, the first systems

were sold into hospitals including St

Mary’s Hospital, Portsmouth,

Christies in Manchester and the

Stoke Mandeville Hospital. The

Paxman Scalp Cooler has also

received the Millennium Product

Award for Innovation and has had

much success in many hospitals in

the UK, Europe and other parts of

the World.

How it worksChemotherapy affects the rapidly

dividing cells of the hair follicles and

at any given time, 90 per cent of

hair follicles are in the actively

dividing phase. Cooling the scalp

during selected chemotherapy

regimes has been shown to reduce

or prevent otherwise inevitable total

hair loss by restricting the blood

flow to the hair follicles, thereby

reducing the amount of

chemotherapy chemicals reaching

them. For many of us, one of the

most devastating side-effects of

chemotherapy is the loss of our

hair. However, there is a

revolutionary machine that can help

prevent this – the Paxman Scalp

Cooler. The Paxman Scalp Cooler

is unique - using a lightweight cap

made out of silicone which is

comfortable and provides a snug fit


Sept/Oct 2011 | 17

Scalp Cooling Equipment

to the patient’s head. The caps are

linked to a compact refrigeration

unit which circulates coolant at -6°C

through coolant lines and into the

cooling caps. Temperature sensors

ensure the cap maintains the scalp

at a constant temperature

throughout the treatment.

Consideration and care has gone

into the design of the system in

order to meet the needs of both the

patient and nursing staff. The

Paxman system is simple for

nurses to operate as it has easy-to-

use touch screen displays allowing

instant visual monitoring. The

compact nature of the system

makes it easy to manoeuvre and

ensures an efficient use of space.

As the temperature is maintained

by the system, nursing staff do not

need to stay with patients during

the treatment.

The cap is worn for approximately

30 minutes before chemotherapy

infusion and continues to be worn

during administration of the drugs

and then for a calculated time

afterwards. The cold cap is then

worn for each chemotherapy

session until the course of

treatment is completed. The

average time a patient wears the

cold cap is from two to two and a

half hours, this is dependent upon

the toxicity of the chemo-therapy

drugs being administered.

Success In The Middle EastPaxman Coolers Ltd was delighted

to participate in The 5th Gulf

Federation Cancer Congress

alongside the regional

representative and its new

distributor, Gateway Scientific, held

under patronage of H.H. Sheikah

Jawaher Bint Mohammed Al-

Qassimi, which was officially

opened by Dr. Haneif Hassan,

Prime Minister of Health and held at

Expo Center Sharjah.

The Paxman stand welcomed a

large number of visitors from UAE

and other gulf countries, including

the Prime Minister of Health. The

Friend of Cancer Patient (FOCP)

Society, represented by Miss Amira

Bin Karam and Dr. Sawsan Al-

Madhi committed to donate the

Paxman systems into hospitals in

UAE, thereby enabling more

patients to reap the system’s

benefits.

Dr. Falah Al-khatib, Head of

Scientific Committee, also showed

his interest in the Paxman

technology and plans to utilise it in

his clinical practice at the City

Hospital in Dubai. The President of

Bahrain Cancer Society and


Sept/Oct 2011 | 18

Representatives of Saudi Cancer

Society also attended the stand,

showing great interest and

promising to help hospitals with

donations to purchase Paxman

scalp cooling systems.

At the end of the show Richard

Paxman received an award on

behalf of the company from H.H.

Sheikh Khalid Al-Qassimi for its

excellent participation in the

congress. The company are looking

forward to working with

organisations and hospitals in the

Middle East in the coming months

to enable more patients the

opportunity to receive scalp cooling

as part of their treatment

programme.

Export Achievement Award

In 2010 Paxman won the ‘UK

Trade and Investment Export

Achievement Award,’ at the

Medilink Yorkshire and Humber

Healthcare Business Awards.

Over the past year Paxman has

seen a 66% increase in export

sales, as well as a 65% increase in

new markets. With over 1000 scalp

cooling systems now in use

worldwide, they received the award

as recognition for this success.

Speaking at the event Managing

Director of Medilink Y&H, Kevin

Kiely, said: “Today’s event clearly

highlights the buoyancy of the

Health Technologies sector, and

specifically the continued success

and innovative capacity of Yorkshire

Health Technology companies.”

Richard Paxman, Operations

Director, added: “It has been a very

successful year for us, particularly

in terms of our international

expansion, so it’s fantastic that this

hard work has been recognised.

We hope to continue going from

strength to strength with our export

strategy and remain the world’s

leading provider of scalp coolers.”

Paxman Coolers


Sept/Oct 2011 | 20

Case study: Amy shares herexperiences

“After being diagnosed in

January of this year I started a

course of chemotherapy at a

hospital in Hertfordshire. I had

been given a leaflet about the

Paxman by the cancer care

nurse at the hospital where I was

diagnosed. Initially, I was

sceptical about the treatment

because I had two friends who

had tried the old gel ice caps, one

lost her hair after the first session,

and the other found the treat-

ment so intolerable she gave up

early on.

“The old system uses ice caps of

frozen gel which are taken

straight from the freezer and

placed on your head. They are

unbearably cold at first, then after

about half an hour, just as they

begin to become tolerable, they

thaw and have to be changed. I

had the frozen gel ice cap during

my first session of chemotherapy.

It was really heavy and

uncomfortable. After about half

an hour it warmed up, which was

a relief. As it thawed the cold

water dripped down my neck and

face, then the nurse appeared

with a new ice-cold cap straight

from the freezer and the torture

began all over again!

“The Paxman system which Iused sub-sequently was acompletely different experience.It was a little uncomfortable forthe first ten minutes, then I gotused to it. The Paxman cap ismuch lighter and much easier totolerate than the old gel cap. Ihad lost a lot of hair after my firsttreatment using the old coolingsystem and I began to panic.Thankfully I was able to use thePaxman cooler for my sevensubsequent treatments andwhereas I experienced somethinning, my hair came out instrands rather than handfuls.

“Because I kept my hair it was not

obvious that I was a chemotherapy

patient and this enabled me to keep

my cancer to myself. Thanks to the

Paxman system I felt ‘normal’ and I

was able to continue with a ‘normal’

social life. I would recommend the

Paxman system to every women

going through cancer treatment

who wants to retain her hair and her

anonymity. I wanted to choose who

I told about my illness. The Paxman

enabled me to retain my hair and

keep my secret.’ Amy’s personal

experiences highlight not only how

important it is for women actually

experiencing cancer to retain their

hair, but also that the Paxman

system is effective and essentially

life-changing for these women. The

old system simply does not

compare in terms of ease of use,

comfort and overall effectiveness.”

www.paxman-coolers.co.uk

Paxman Coolers

This summer, several leadingbioscience and healthcarecompanies based in Nottinghamheaded for London as part of amajor campaign to market theMidland city to investors,financiers, businesses andpotential partners.

Gathered in the grand surroundings

of St Pancras International

Renaissance Hotel, were Medilink

East Midlands, the Healthcare and

Bioscience iNet, BioCity

Nottingham and representative

companies such as Monica

Healthcare, Medibord, Sygnature

Chemical Services Limited and

global player Novozymes Limited.

Their presence, and contribution to

the event, left a lasting impression

on those who attended.

Nottingham and the East Midlands

is one of the leading UK centres for

medical technologies, drug

formulation and delivery, with the

University of Nottingham’s School

of Pharmacy rated the highest

school in the UK. The region can

also boast highest number of

people working in drug delivery

companies, ICT and e-health. As a

result, the bioscience,

pharmaceutical, med-tech and

healthcare sectors are among the

most attractive to potential

investors and collaborators.

Driven by global research expertise

based in the renowned universities

of Nottingham, Loughborough,

Leicester and Nottingham Trent, the

commercialisation of new products

and services is generating high-

quality jobs and investment

opportunities. A typical example of

the confidence shown by

Nottingham’s main public-private

partners is the proposed Medipark

complex adjacent to the Queen’s

Medical Centre teaching hospital.

The East Midlands has a long

tradition of excellence in drug

discovery and development, being

home to Alliance Boots,

AstraZeneca and 3M Healthcare.

In a period of rapid investment in

the region’s universities and

research facilities, the life sciences

sector has taken hold and has

attracted some of the brightest

scientific brains. University of

Leicester’s Professor Sir Alec

Jeffreys, the British geneticist who

pioneered DNA fingerprinting and

Regional Focus: UK East Midlands

Orthogem synthetic bone graft


Sept/Oct 2011 | 24

profiling, and Nottingham’s

Research Professor of Chemistry

Martyn Poliakoff are two of the

region’s leading lights who have

maintained their love of the

laboratory and continue to inspire

new generations of scientists.

However, the pipeline of new

discoveries and the

commercialisation of innovative

products which eventually find

themselves in global use take years

to nurture. Without investment in

research, early-stage growth and

significant rounds of funding, most

devices found in hospital use today

or drugs patented for world-wide

application wouldn’t get off the ground.

The significance the East Midlands

in attracting like-minded scientists

and developers can’t be

underestimated. Clusters of high-

tech firms such as those on show in

London stimulate each other; they

co-habit facilities such as BioCity

Nottingham and collaborate in

subtle forms to reach new heights

of commercial success. Middle

East markets are attractive to some

of these new companies who seek

investment partners and business

opportunities to tackle new challenges.

The recognition by the UK

government of the important role of

small and medium-sized

businesses (SMEs) comes at a

crucial time for those in the

healthcare and bioscience sector.

The pharmaceutical industry,

shaken to the core by falling

productivity and looming patent

expiries that will shave billions off its

sales figures, has changed its

research and development model

in recent years.

The largest companies who have

been reducing their internal R&D

capabilities, in part through site

closures, now rely much more

heavily on external partners – often

SMEs and universities – for early

product development. Innovation,

Where Healthcare and Bioscience Thrive


Sept/Oct 2011 | 26

Medibord radiotherapy material

or the successful exploitation of

new ideas, means taking risks, so

external support is usually crucially

important.

East Midlands-based life sciencefirms can draw on the particularexpertise of the Medilink EastMidlands Healthcare andBioscience iNet, an impartialadvisory organisation inspiredby the regional developmentagency and part-funded byEuropean Regional DevelopmentFund. The organisation hashelped more than 500innovative SMEs over the pastthree years.

BioCity Nottingham-based

Orthogem is one of those helped by

the iNet. The company has

developed a novel manufacturing

method for the production of a

highly porous synthetic bone graft

for use in patients with spinal

degeneration and injury.

The advantage of this synthetic

bone is that its exceptionally high

porosity encourages the patient’s

own bone cells to grow into it and

its ability to be completely

reabsorbed by the patient’s own

metabolic processes mean that it is

ultimately being replaced with real

bone. Before the synthetic bone

can be applied, the material may be

blended with an extract of the

patient’s own bone marrow or blood

to create a wet granular mixture.

Orthogem recognised that it could

gain further competitive advantage

by developing an all-in-one sterile

device that blended and delivered

the material to the site of damaged

bone in a single continuous

operation. This would make the

synthetic bone easier to handle and

quicker to use - and help the

surgeon save precious time in the

operating theatre.

As with any novel product entering

a competitive market, the synthetic

bone had to gain clinical

acceptance so it was vital to get

the applicator onto the market

quickly. The iNet adviser helped

the company work through the

options and highlighted possible

sources of funds. Orthogem

decided to apply for an iNet

innovation support grant

because it could be accessed

quickly. As a result, Orthogem

was able to design the

applicator, secure regulatory

approval and launch the

applicator in under a year.

Another company which has

benefited from being part of the

East Midlands ‘cluster’ is Medibord.

Formed in 2009 as a result of a



Sept/Oct 2011 | 28

development project with the

Nottingham University Hospital

Trust City Campus oncology

department, the company has

responded to the increased

requirement for accuracy of

diagnostic imaging to aid

radiotherapy planning for the

treatment of cancerous

tumours. Oncologists need to be

able to fuse both MRI and CT

images to enable them to locate

and track tumours and ensure that

only the affected areas are treated

without damage to surrounding

tissue and organs. Medibord

developed a non-conductive flat

couch top which, together with its

positioning devices, is currently

being used by the NHS in MRI, CT,

LINACS and Tomotherapy

applications. “Our geographical

location has played a major part in

the Medibord success story,” states

Jonathan Richards, founder and CEO;

“our core competence is the

development of sustainable composite

solutions to a number of industrial

sectors, but this was our first entry into

medical devices.

We immediately contacted BioCity in

Nottingham who introduced us to

Medilink East Midlands and the

Healthcare and Bioscience iNet. With

their assistance we were able to

produce prototypes, commission a

detailed market research survey as

well as guiding us through the

legislative issues’.

As a direct a result of this

assistance and support, Medibord

have won the MEH Awards for

Innovation in Export, presented by

Lord Darzi as well as the

prestigious Da Vinci Award. They

have been contacted by and are

working with a number of the

scanner and radiotherapy

manufacturers as well as identifying

resellers and strategic partners

both on a local and global level.

Many other companies like

Orthogem and Medibord in the

healthcare and bioscience sector

have taken advantage of the

Medilink East Midlands sector-

focused workshops, seminars and

lectures as well as networking

events that aim to support

innovation.

The relationships formed between

academic partners, suppliers,

customers and intermediaries such

as professional and trade

associations are particularly

important in developing new

collaborations that have been

demonstrated to improve a

company’s capacity for innovation.

Where Healthcare and Bioscience Thrive


Sept/Oct 2011 | 29

East Midlands Healthcare and Bioscience iNet

Innovation is a key strategic priority for East Midlands Development

Agency (emda). Four sector specific Innovation Networks (iNets) funded

by emda and the European Regional Development Fund, including the

Healthcare and Bioscience iNet, have been established to help turn

innovative ideas in to business opportunities.

The iNet concept was developed by emda and East Midlands Innovation

(the region's innovation council) to bring together businesses, colleges,

universities, public sector representatives and individuals with a shared

interest in a market or the technology that underpins it.

A key aim of iNet is to provide a sector-specific focus that enables

organisations to exchange knowledge and form collaborations to exploit

new ideas. It supports individuals and organisations through the

Innovation, Advice and Guidance and Collaborative Research and

Development initiatives. The support offered includes grants and

funding advice.

The Healthcare and Bioscience iNet is based at BioCity in Nottingham

(its 'iHub'), a renowned life science industry centre of excellence, but it

covers the whole region, and is operated by Medilink East Midlands on

behalf of a consortium of partners.

www.eminnovation.org.uk/health

Much of the work of Medilink East

Midlands and the Healthcare and

Bioscience iNet is directed at

building bridges between

organisations to stimulate

innovation and expanding the

network of support to SMEs with

the long term aim of creating a high-

profile cluster that attracts

investments and people to the East

Midlands.

The companies ment ioned in

th is ar t ic le have commented

on the unexpected leve ls o f

growth achieved wi th the

suppor t o f Medi l ink and i ts

iNet adv isers, and the i r

p ivota l ro le in he lp ing them

to achieve success in global

markets . Middle East

investors would do wel l to

take a look at the growing

levels o f act iv i ty, and

conf idence, in the UK East

Midlands healthcare sector.



Sept/Oct 2011 | 30

Launched in 2010, the WorldHealth Care Congress MiddleEast, is the premier conferenceto feature global health careinnovation. It attracts more than600 senior health care thoughtleaders from all industrysectors, including hospitals,health systems, employers,government agencies, pharma,biotech and industry suppliers.

WHCC Middle East is organized

with sovereign partners the Health

Authority-Abu Dhabi (HAAD) and

the Abu Dhabi Tourism Authority

(ADTA). Additional sponsorship is

currently provided by The Abu

Dhabi Health Services Company

(SEHA) www.seha.ae and

Children’s National Medical Center

www.childrensnational.org.

More than 600 health care

executives representing 25

countries will share their

perspectives on best practices for

health care delivery; with the

Conference to be held at new Abu

Dhabi National Exhibition Centre

(ADNEC) from 11-13 December

2011.

Organized Under the Patronage of

H.H. General Sheikh Mohammed

Bin Zayed Al Nahyan, Crown

Prince of Abu Dhabi and Deputy

Supreme Commander of the

United Arab Emirates’ Armed

Forces and in collaboration with

sovereign partners the Health

Authority-Abu Dhabi (HAAD) and

the Abu Dhabi Tourism Authority

(ADTA), the World Health Care

Congress Middle East is the most

prestigious health care event,

convening global thought leaders

and key decision makers from all

sectors of health care to promote

health care through global best

practices.

Key topics for WHCC Middle East

2011 include: Middle East and

Northern Africa (MENA) Health

Authority Dialogue - Health Care

Strategies for the Future and

Evidence-Informed Health Policies

Hospital/Health System CEO

Debate on Global Health Care

Models; How Provider Systems

and Technology Companies are

Responding to the Implementation

of Electronic Health Records

(EHR) Systems; Building Strategic

Public Private Partnerships

(PPPs); The Promotion of Healthy

Lifestyles.

World Health Care Congress Middle East

World Health Care Congress has announced the return of Al Jazeera

International television host Riz Khan [right] as a featured panel

moderator.

The international TV news veteran will reprise his role from last year’s

WHCC Middle East, leading several panel discussions with global

health care executives. He will join a distinguished roster of 90

presenters from nearly 30 countries.

Mr. Khan served as a presenter and reporter at the BBC for eight years

and was the first mainstream Asian newsreader for the outlet’s

international network. He later worked extensively for CNN. In 2005, he

authored his first book: “Al-Waleed: Businessman Billionaire Prince,”

published by Harper Collins.


Sept/Oct 2011 | 32

The event will also include the 2nd

Annual WHCC Middle East Health

Innovations Poster Exhibit and

Awards Program, which will be on

display throughout the conference.

The poster exhibit is part of the

WHCC Health Innovations

Initiative, a year-round program

that features health care

innovations that improve health

care while reducing costs.

To submit an innovation for

display at the conference and

award consideration, visit

www.worldcongress.com/middlee

ast/posters

www.worldcongress.com/me

World Health Care Congress Middle East 11-13 December 2011, Abu Dhabi

Featured presenters at WHCC Middle East

H.E. Prof. Mohamed Jawad Khalifeh, Minister of Health, Ministry of

Health; President, Arab Health Ministers Council, Beirut, Lebanon

Hanan S. Al Kuwari, PhD, Managing Director, Hamad Medical

Corporation, Doha, Qatar

Rt Hon Prof the Lord Ara Darzi of Denham KBE, Paul Hamlyn Chair of

Surgery; Head, Division of Surgery; Honorary Consultant Surgeon,

Imperial College Hospital NHS Trust and the Royal Marsden Hospital;

Chair, Surgery, Institute of Cancer Research; Chairman, Institute of

Global Health Innovation, United Kingdom

Dr. Manar Al Moneef, Director General, Health Care and Life

Sciences, Saudi Arabian General Investment Authority (SAGIA),

Riyadh, KSA

Zaid Al Siksek, CEO, Health Authority-Abu Dhabi (HAAD), Abu Dhabi,

UAE

Dr. Najeeb Al Shorbaji, Director, Knowledge Management, The World

Health Organization (WHO), Geneva, Switzerland

Dr. Cristian Baeza, Director of Health, Nutrition and Population, The

World Bank, Washington, DC, USA

Prof. Abdallah S. Daar, Professor, Public Health Sciences; Professor,

Surgery, University of Toronto, Canada

Jeff Goldsmith, PhD, President, Health Futures, Inc., Charlottesville,

Virginia, USA

Anne Milton, MP, Parliamentary Under Secretary of State for Public

Health, Department of Health, London, UK

TV host George Kurdahi will be

master of ceremonies for the

event. Best known as host of the

Arabic version of Who Wants to

Be a Millionaire? (Man sa yarbah

al-malyoon), which airs on MBC

1 television, Mr. Kurdahi will

preside over the WHCC Middle

East’s opening ceremony on 11

December.

Mr. Kurdahi came to Millionaire

following a long and

distinguished broadcasting

career. After working for the

Lebanese newspaper Lisan

Elhala, Kurdahi moved to Télé

Liban, then in 1979 to Radio

Monte Carlo. After thirteen years,

he became Head of News at

Radio Orient, then General

Manager of MBC FM.


Sept/Oct 2011 | 33

Aesica Pharma

Aesica is a fast-growing UKcompany with a global footprint.When four year old R5 Pharmawas bought out by Aesica inJune 2010 Aesica FormulationDevelopment was created.Aesica FD are FormulatedProduct Specialists. Theirexpertise lies in the ability tooffer custom manufacturingservices to customers from pre-clinical stage to leading to fullcommercial supply (from AesicaFormulated Products) .

Their manufacturing facilities meet

the highest standards according to

regulatory and customer audits.

They strive to deliver efficient

manufacturing processes to

customers and are equipped to

produce high volumes of sterile and

non-sterile liquid and solid dosage

forms. With highly secure facilities

authorised to handle up to schedule

2 controlled substances, they also

have a high containment suite to

manufacture products in the Safe

Bridge Category 3 level of potency.

Their teams of experts focus on

delivering the highest quality

outputs with an unrivalled level of

customer service.

FD SpecialistsAesica are fully equipped to

develop and manufacture new

medicines and clinical trial

materials for Phase I and Phase

II clinical trials through their

Formulation Development

Business Unit.

Their team of experts ensures

seamless transfer and scale-up of

manufactured products using state-

of theart facilities and careful

processes. In-house analytics

expertise and services support the

entire manufacturing process.

Aesica are able to manage full

scale and complex formulation

manufacture with rigorous quality

assurance and regulatory

processes in place, and offer a

range of packaging technologies for

solid and liquid dosage forms

including bottle and blister

packaging. Their artwork design

service provides a full range of

coding and labelling if required.

Paul Titley, Managing Director

of Aesica FD, told MEH, “With a

keen understanding of early

stage development and clinical

trial requirements, we guide

customers through the

processes of new medicine and

material development for Phase

Iand Phase II clinical trials.

“At Aesica FD, we have a single-

minded vision to provide

market-leading formulation

development, analytics and GMP

services to the global biotech and

pharmaceutical industries. And that

vision is fast becoming reality, as

we are already acknowledged as

the leading provider of clinical

pharmaceutical dosage form

development in Europe. Our

expertise lies in the ability to offer

custom manufacturing services to

customers from pre-clinical stage to

full commercial supply.”

Aesica FD do business in Australia,

New Zealand, North America and


Sept/Oct 2011 | 34

Aesica Pharma

across Europe, and are now

looking to expand further into the

USA and India. The Middle East is

as yet an untapped market for the

company and this is something Mr

Titley wants to change, which is

why he is attending the World

Health Care Congress in Abu Dhabi

(11-13 December) to meet potential

new clients from the region.

“We have the ability and experience

to develop and manufacture almost

all dosage forms. Typical dosage

forms we work with include tablets,

capsules, liquids, suspensions,

creams, ointments, inhaled and

sterile pharmaceuticals.

Companies approach us from all

over the world to create

pharmaceuticals and so we are

delighted to be able to showcase

our services to the healthcare

community of the Middle East in

Abu Dhabi, and find out what they

need from us”, said My Titley.

Supply chain managementAesica’s extensive supply chain

management experience –

including cold chain – means that

they can securely store and supply

your products worldwide.

The experienced Regulatory Affairs

Team is ready to support customers

with all aspects of their regulatory

submissions, including preparation

of dossiers, variations, renewals

and line extensions.

hey offer a range of quality services

covering GLP/GMP audits and

validation through to supporting

your post-marketing surveillance.

Aesica’s investment in and

expansion of state-of-the-art

facilities, equipment, laboratories

and support services play a critical

part in our continuing growth and

success. They fully appreciate that

an investment in hardware alone is

no guarantee of continued prosperity.

Mitovie Specialist Medicines

Developed and manufactured by Aesica FD

Magnesium Glycerophospahte Oral Solution 1mmol/ml, 200 ml bottles

Midazolam Oral liquid 1mg/ml, 10 ml bottle including 4 oral syringes

Midazolam Oral liquid 1mg/ml in Prefilled Oral Syringe, 4

syringes/pouch. 1.0ml, 0.75ml, and 0.5ml

PovidoneIodine 5% (sterile) in 15ml dropper bottle

Market Meading Formulation Development


Sept/Oct 2011 | 35

Mitovie PharmaMitovie Pharma is a pioneering

privately held global

pharmaceutical company which

develops and commercializes

innovative medicines to meet real

clinical needs.

Headquartered in the UK, its

portfolio of available medicines

spans several therapy areas as a

result of the company’s strategy of

problem solving where there are

real medical challenges. This is

reflected in the company’s pipeline

of late stage development drugs

which offer first in class treatment

options for millions of patients

worldwide.

Mr Titley told MEH, “Our

relationship with Mitovie attaches

their expertise in solving medical

challenges with our ability to deliver

products. They know what

physicians need and have the

scientific knowledge to market our

products effectively.”

The company is led by the Mitovie

Pharma Executive Management

Team (MPEMT) which reports to

the Mitovie Group Board of

Directors (MGBD). Mitovie has

established a strong UK operation

which includes R&D, Medical,

Sales, Marketing & Support

Functions. Currently it partners for

distribution globally.

The company distributes its

medicines to full GDP including cold

chain supply, direct to patient,

hospital, retail pharmacy and

wholesaler from a purpose built

2500m² MHRA approved facility in

the UK. The company’s near term

plan is to establish its infrastructure

in the key European territories and

other selected geographies. It

intends to augment its existing

portfolio through in house development

and in-licencing/acquisition of innovative

medicines.

www.aesica-pharma.co.uk

Aesica Pharma


Sept/Oct 2011 | 36

Aesica Pharma

Royal Philips Electronics provided

clinicians from across the globe

with a glimpse of future innovations

designed to advance cardiac care,

including the current management

of cardiovascular disease (CVD)

and associated cardiac conditions,

during the 2011 Congress of the

European Society of Cardiology

(ESC), which took place in Paris.

Cardiovascular disease remains

the main cause of death in the

European Union, claiming more

than two million lives each year and

costing the economy more than

€100 billion annually.

“Philips has been a consistent

game-changer in the area of

healthcare for almost 100 years,

developing innovative and

integrated patient-focused

solutions, including some of the

earliest X-ray technologies,”

commented Joris van den Hurk,

general manager, Cardiology Care

Cycle, for Philips Healthcare. “At

this year’s ESC, we highlighted our

vision of how future innovation will

enable care-givers to transform the

way cardiovascular disease is

managed at each stage - from early

detection and diagnosis, to hospital

treatment and health care at home,

in order to reduce the burden of

cardiac disease for patients,

doctors and society at large.”

The future of cardiac careSolutions that will transform

detection, diagnosis and treatment

This vision of future innovation is

exemplified by the launch of the

world’s first sleep apnea mobile

application (“app”) designed

specifically for cardiologists, and

aiding early detection and diagnosis

amongst their patients. It’s

estimated that over 100 million

people worldwide are suspected to

have Obstructive Sleep Apnea

(OSA), of which more than 80%

remain undiagnosed.2

OSA is particularly prevalent

amongst people diagnosed with

CVD and heart failure, and if

untreated can contribute to the

development of high blood

pressure, diabetes, heart attack

and stroke. The new app, called

Sleep & Cardio aims to help expand

cardiologists’ knowledge of sleep

apnea and CVD, providing simple

steps for identifying patients who

are at risk, a summary of existing

guidelines and access to the latest

clinical information and training.

From diagnosis to treatment,

Philips’ commitment to the

advancement of CVD care was also

being showcased at the ESC in the

area of heart modeling - technology

that is in development and aims to

produce highly accurate and

detailed models of a patient’s heart

structure. Through ongoing

research and development, the

hope is that this future technology

can provide information to clinicians

quickly; to support them in planning

and refining the execution of

complex interventions based on an

individual’s specific anatomy; and

that it can calculate the likelihood of

a successful outcome while

reducing overall procedure time.

Philips Healthcare


Sept/Oct 2011 | 37

Interest in aids and topicsrevolving around rehabilitationand care is growing. This wasreflected over the course ofREHACARE 2011, InternationalTrade Fair and Congress for Self-Determined Living, that closedits doors on Saturday, 24September after the four-dayevent in Düsseldorf.

“REHACARE Düsseldorf is the right

venue for tabling the current

challenges for rehabilitation and

care and for highlighting ways for

people with disabilities, special care

needs as well as age-related

restrictions to cope with their

everyday routines as independently

as possible,” said Joachim Schäfer,

Managing Director at Messe

Düsseldorf, summing up the event.

“We have struck a nerve here,

especially with the REHACARE

Congress – dedicated this year not

only to senior-friendly living

concepts but also to the

widespread condition of dementia.

There is quite clearly a great need

for information and awareness here

amongst patients, family members

and even amongst experts.”

REHACARE 2011 attracted over

47,000 international trade visitors

and affected individuals – as

personal experts in this field – who

came here to gather information on

the innovative auxiliary means and

new findings from science and

research presented at the fair by

747 exhibitors from 29 countries. In

line with the event’s thematic

schedule this year REHACARE

once again presented a range

comparable with that of 2009. Back

then the trade fair and congress

counted 48,000 visitors.

Barbara Steffens, Minister for

Health, Emancipation, Care and the

Aged in North Rhine-Westphalia,

underlined the importance of

REHACARE 2011: Review


Sept/Oct 2011 | 38

REHACARE during her visit here

on 22 September 2011. With its

focal themes “Dementia” and

“Senior Living” the trade fair, she

said, had picked up on two topics

Germany urgently needed to

address. Such an established event

like REHACARE could make a key

contribution here, said the Minister.

Praise was also directed at

exhibitors and partners of

REHACARE 2011. Dr Martin

Danner, National Head of the

German self-help association BAG

SELBSTHILFE (Federal Self-Help

Association for People with

Disabilities and Chronic Illness and

their Families) delighted at the high

number of visitors at the stands of

self-help groups.

“The REHACARE trade fair offers a

range of products spanning

solutions suited to everyday use

through to smart assistance

systems – thereby providing insight

into the future of rehabilitation and

care,” explained Dr Danner. “And

this picks up on the key themes of

today. For affected individuals the

trade fair is far more than an

exhibition – it is the most important

forum for exchanging experience

and tabling topical issues relating to

the disabled and health policy.”

At the focus of visitor interest at

REHACARE were walking and

mobility aids, vehicles, wheelchairs,

aids for daily living aids and care.

For Heiko Keuchel, Managing

Director of the Bremervörde-based

company Thomashilfen für

Behinderte, trade fair participation

was a resounding success: “We are

very satisfied and have definitely

met our trade fair objectives. As a

company oriented to development

we seek dialogue with affected

individuals. REHACARE offers us

great opportunities in this respect.

And the trade fair is also

successfully broadening its

horizons in terms of care issues.

Congress for Self Determined Living


Sept/Oct 2011 | 39


Increases in the number of visitors

interested in geriatric products and

solutions are clearly noticeable and

we very much welcome this.”

Dick J. van der Pijl – in charge of

research and development at

Tilburg-based Dutch firm FOCAL

Meditec specialised in smart

solutions for people with limited

mobility of the arms – described

REHACARE as a key contact

exchange for meeting and taking on

international sales partners and for

exchanging ideas with specialists

from the fields of science and

technology. “This is the sixth

consecutive year we have attended

REHACARE and we are very satisfied.”

The REHACARE Congress with its

lecture series on “Senior Living”

and “Dementia” posted excellent

attendance figures. 630 specialists

and affected family members

gathered a great deal of information

on senior-friendly living concepts,

the symptoms of dementia,

preventative measures and support

options. Once again meeting with

great interest was the Wohn(t)raum

theme park with its range of barrier-

free building and living options

located in Hall 3.

The North Rhine-Westphalia

disabled sports association

(BSNW) delighted visitors with the

REHACARE Sport Centre

providing information on the

opportunities for staying fit and

healthy even with disabilities.

Recreational athletes, world

champions and Paralympic

champions celebrated their annual

festival in Hall 9 of the exhibition

centre. BSNW Managing Director

Herbert Kaul was delighted by the

event’s success:

“For us REHACARE is the most

important event for showcasing the

wide range of sports for the

disabled to the general public.”

The next REHACARE will be held

in Düsseldorf from 10 to 13 October

2012.

REHACARE 2011: Review


Sept/Oct 2011 | 40



Sept/Oct 2011 | 41

Authors: Paul G. Shiels, Liane M. McGlynn, Alan MacIntyre, Paul C. D. Johnson, G. David Batty, HarryBurns,

Jonathan Cavanagh, Kevin A. Deans, Ian Ford, Alex McConnachie, Agnes McGinty, Jennifer S. McLean, Keith

Millar, Naveed Sattar, Carol Tannahill10, Yoga N. Velupillai, Chris J. Packard

IntroductionGompertz (1825) first described

ageing as an increase in the

likelihood of mortality with

increasing chronological age [1]. In

man, this equates to a

corresponding, progressive loss of

metabolic and physiological

functions, though the trajectory for

this is not uniform, indicative of

underlying inter-individual variation

in the biology of ageing [2].

Variation in the rate of biological

ageing reflects the cumulative

burden of genetic, metabolic and

environmental stressors, resulting

in oxidative damage and elevated

inflammatory processes [3]. This is

of particular interest in Glasgow,

because of the exceptional gradient

of socio-economic status (SES) in

this city and the associated

variation in mortality and morbidity.

The latter is reflected in the large

difference in life expectancy for

men, between the most and least

deprived areas of the city, which is

28.7 years [4]; a difference which is

one of the largest in the developed

world. We investigated potential

mechanisms for such gradients as

part of the psychological, social,

and biological determinants of ill

health (pSoBid) study cohort [5], the

characteristics of which have been

described in depth elsewhere [6].

Briefly, the pSoBid study was

designed to investigate the factors

linking social circumstances,

mental wellbeing, and biological

markers of disease. Participants

were selected from the least and

most deprived areas in the NHS

Greater Glasgow Health Board

area.

We have hypothesised that such a

difference in life expectancy might

be reflected in the biological age of

individuals. In turn we considered

whether deprivation-related

measures correlated to accelerated

telomere attrition and also

determined interactions with

inflammatory status.

Suitable and validated biomarkers

for analysing biological ageing in

this context are limited in number.

Despite cell cycle inhibitor transcript

levels providing an accurate

indication of organ and T cell

biological age [7–9] the

overwhelming majority of studies

employ determination of telomere

length in peripheral blood

leukocytes (PBLs) in a clinical

context [10–12]. However, there are

many equivocal reports regarding

how useful this marker is when

applied in epidemiological studies

[13,14].

Telomeres are nucleoprotein

complexes at chromosome ends,

consisting of (TTAGGG)n direct

repeats bound to a range of

proteins involved in maintaining

cellular stability and viability

(reviewed in [3]). Typically, in larger

mammals, the telomeric DNA

component shortens with

successive cell divisions. This

arises from what has been termed

the end replication problem [15].

Telomere attrition is thought to

represent a molecular clock, at

least at the cellular level, where it

has been hypothesised to act as an

anti-neoplastic mechanism [16],

Abstract

Background: It has previously been hypothesized that lower socio-economic status can accelerate biological

ageing, and predispose to early onset of disease. This study investigated the association of socio-economic

and lifestyle factors, as well as traditional and novel risk factors, with biological-ageing, as measured by

telomere length, in a Glasgow based cohort that included individuals with extreme socio-economic differences.

Methods: A total of 382 blood samples from the pSoBid study were available for telomere analysis. For each

participant, data was available for socio-economic status factors, biochemical parameters and dietary intake.

Statistical analyses were undertaken to investigate the association between telomere lengths and these

aforementioned parameters.

Results: The rate of age-related telomere attrition was significantly associated with low relative income,

housing tenure and poor diet. Notably, telomere length was positively associated with LDL and total cholesterol

levels, but inversely correlated to circulating IL-6.

Conclusions: These data suggest lower socio-economic status and poor diet are relevant to accelerated

biological ageing. They also suggest potential associations between elevated circulating IL-6, a measure

known to predict cardiovascular disease and diabetes with biological ageing. These observations require

further study to tease out potential mechanistic links.

Research paper: Accelerated Telomere Attrition Is Associated with Relative

Household Income, Diet and Inflammation in the pSoBid Cohort


Sept/Oct 2011 | 42

proposed to function by countering

the accumulation of mutations over

successive cell divisions, which

potentially could produce neoplastic

cells. Although telomere length is

inversely related to chronological

age in humans, there is

considerable inter-individual

variation in telomere length at any

specific age [17]. Thus estimates of

the effects of chronological age as

a covariable in regression models

have relatively wide confidence

intervals, making detection of

significant effects of age-related

diseases more difficult: it may be

unclear how much of the residual

variance is explained by the

disease and how much is

attributable to error in the estimate

of an age effect. This has been

discussed in detail eleswhere

[18,19].

Recent human data have now

established telomere attrition as a

major risk factor for numerous

diseases, including cardiovascular

disease (CVD), hypertension,

diabetes and end stage renal

disease [11,20–22] as well as being

associated with elevated

psychological stresses [23].

Many such pathologies, showing an

association with increased telomere

attrition rates, are predominant in

deprived communities where there

is a higher prevalence of classical

risk factors for disease, but this

explanation does not account totally

for these variations in disease

incidence [10,24,25].

One hypothesis for the increased

disease prevalence in these

communities is underlying chronic

inflammation (elevated CRP or IL-

6), a known component and

predictor of CVD and diabetes

[26,27], that is linked to a diverse

range of pathologies. A possible

contributory factor to generating an

increased pro-inflammatory state, is

accelerated biological ageing. Both

telomere attrition and CDKN2A

expression have been reported to

show association with IL-6 levels in

disease [11] and ostensibly ‘healthy’

populations [9].

Such associations are intuitive, as

senescent cells upregulate and

secrete pro-inflammatory cytokines

as part of the senescent

secretosome [28]. A link between

accelerated biological ageing and

socioeconomic status has

previously been reported by some

[29], but not by others [30,31]. The

reasons for this equivocacy remain

Figure 1. Regressionanalysis plots that highlighthousehold income, housingtenure, and diet score wereassociated with steeper age-related decline in telomerelength. Faster rates of age-

related telomere attrition were

observed in individuals with an

average income less than

£25,000 (7.7% vs 0.6%

reduction per decade, p =

0.024, (A)), home tenants

(8.7% vs 2.2%, p = 0.038 (B))

and a diet score among the

lower 50% of scores (7.7% vs

1.8%, p = 0.05 (C)).


Sept/Oct 2011 | 43

to be proven, but may be

attributable to methodological

differences [13]. Any putative link,

however, may be weak and open to

multiple confounders, such as

parental telomere length and

epigenetic effects [32]. We have

chosen to evaluate the contribution

of socio-economic factors to

biological age, as measured by

telomere length, in thethis in turn

affects risk factors for ill health.

ResultsSocio-economic and lifestyle

factors

Telomere lengths were determined

in PBLs by Q-PCR for 382

individuals. The SES and lifestyle

factors investigated are shown in

Table S1, as are the median

telomere lengths within subgroups

of these factors, overall and by

three age groups. The relationship

between age, gender and biological

ageing was investigated by

estimating the percentage change

in telomere length associated with

a decade increase in age and

male gender.

Age was strongly negatively

associated with telomere length,

each decade predicting a 4.8%

decrease in telomere length (p

=0.002). No significant difference in

telomere length was observed

between males and females. There

was also no difference between

affluent and deprived groups either

in telomere length or age-related

telomere attrition. All subsequent

analyses were adjusted for age,

gender and deprivation.

Of the SES and lifestyle factors

investigated, only cigarette smoking

was associated with an overall

reduction in telomere length (6.6%

reduction, p= 0.050). However,

household income, housing tenure,

and diet score were associated with

steeper agerelated decline in

telomere length. Faster rates of

agerelated telomere attrition were

observed in individuals with an

average income less than £25,000

(7.7% vs 0.6% reduction per

decade, p = 0.024), a diet score

among the lower 50% of scores

(7.7% vs 1.8%, p = 0.05), and home

tenants (8.7% vs 2.2%, p = 0.038).

Figure 1 highlights differences in

telomere attrition with income,

housing tenure and diet score.

We investigated the extent to which

the associations between telomere

attrition and household income,

housing tenure, and diet score were

independent by adjusting for these

interactions. All three interactions

were attenuated to a similar degree

and were no longer significant,

suggesting that these three

interactions are correlated but no

single factor is driving these

interactions.

Biomarkers

Associations between biomarkers

investigated and telomere length

are reported in Table 2. Individuals

with longer telomereshad increased

levels of total cholesterol (2.4%

increase in total cholesterol per one

SD increase in log telomere length,

p= 0.027) and LDL cholesterol

(3.7%, p =0.027). Conversely,

shorter telomeres were associated

with increased levels of IL-6 (7.2%

decrease in IL6 levels per one SD

increase in log telomere length, p =

0.022, Tabl). Further analysis,

adjusting for deprivation, income,

diet and smoking status,

maintained the positive association

between telomere length and

cholesterol (p =0.033) and LDL

cholesterol (p= 0.026). Interestingly,

Accelerated Bio-Ageing & Socioeconomic Status


Sept/Oct 2011 | 44

the significant association between

telomere length and IL-6 was

weakened whenadjusted for these

SES factors. Analyses were

performed to establish which

individual factors had an impact on

IL-6 expression (Table 3). The

significant association between

shorter telomeres and higher levels

of IL-6 was lost when analyses

were adjusted for age and gender,

or for smoking status deprivation,

income and diet (Table 3).

DiscussionIt has been hypothesized that

socio-economic deprivation can

accelerate biological ageing,

resulting in shorter telomeres in

deprived individuals in comparison

to more affluent-aged matched

controls. Five previous studies

examining this relationship

reportpositive [29], null [30,33,34]

and negative associations [31]. The

equivocacy between these reports

is possibly due to methodological

differences, variations inherent in

individual cohorts and in the

veracity of subject answers relating

to SES data, such as income, which

may be confounded by undeclared

income. The present study has

examined the relationship between

biological ageing, SES and disease

in participants in Glasgow, a city

with an extreme socioeconomic

gradient, with documented health

issues associated with social

deprivation.

Interestingly, in the light of possible

confounders relating to the veracity

of SES data, employment status

(men who reported being out of

work) was reported to associate

significantly with shorter telomeres

[34], in a large cross sectional study

from an overlapping demographic

area (the WOSCOPS cohort).

Surprisingly, despite the prevalence

of CVD in this cohort and its proven

association with SES, there were

no other associations found with

other markers of SES (including

educational attainment, employment

status, area-based deprivation and

physical stature measured as a

proxy for early life social

circumstances).

Our data are not incongrous with

previous reports, as we observed

no associations with area based


Sept/Oct 2011 | 45


deprivation and employment.

However, we have demonstrated a

direct link between accelerated

biological ageing, low income and

poor diet. Furthermore, we have

observed a relationship with a

measure of adiposity, namely

waist/hip ratio (Table 1), a predictive

measure for CVD and diabetes as

well as all cause mortality in

prospective studies [35].

These observations are intuitive

and in keeping with the Marmot

findings [36,37] who indicated that

relative health inequalities are

associated with SES. It is

reasonable to assume that a low

relative income means a decreased

likelihood of being able to afford a

good quality diet, leading to an

acceleration in biological ageing.

Poorer quality, fat and sugar rich

diets, are known to result in the

production of more reactive oxygen

species, which directly cause DNA

breaks that lead to gene

malfunction, telomere attrition and

disease [38,39].

Notably, these observations

indicating an interaction between

biological ageing and SES are

reinforced by the finding that

telomere length, in the pSoBid

cohort, associates positively

withLDL cholesterol levels, a strong

and unambiguous causal risk factor

in CVD.

In our study, telomere attrition was

associated with increasing IL-6

levels, an emerging risk factor for

CVD, which may predict fatal

events more strongly than non-fatal

events [40]. The association of IL-6

with biological age is in keeping

with recent observations indicating

that senescent cells up-regulate

and secrete IL-6 [9,11]. It would be

expected, as a consequence of

increased telomere attrition, that

this group would have more

senescent cells present and thus

higher IL-6 levels and have an

elevated risk of a range of

conditions, if indeed IL-6 is causally

related to CVD and diabetes. The

association between accelerated

biological ageing and increased IL-

6 levels has been previously been

reported to be linked with disease

[11], general health [9] and social

deprivation [41]. These observations

are congruent with more extant

inflammatory conditions in the most

deprived, a situation exacerbated

by increasing age.

Our findings suggest the

unadjusted association between

telomere length and IL-6 is strong,

and it is still marginally significant

with adjustment for age and gender.

This association is only partially

weakened by further adjusting for

smoking but subsequent addition of

deprivation, income and diet does

not appear to weaken the IL-6-

telomere association further (Table

3). In simple terms, these

observations suggest that varying

upstream factors drive both

telomere shortening and elevated

IL-6 levels. However, we cannot

exclude the possibility that part of

the mechanism for elevated IL-6 is

via telomere shortening.

Future studies need to explore this

potential further, particularly as IL-6

is attracting increasing interest in

the diabetes and CVD arenas

[27,40]. Of the four previous studies

in this field [29–31,34] only two

have indicated an association with

SES. These comprised an analysis

of female twins, where non manual

workers had longer telomere

lengths than manual workers [29].

However, in analyses in which the

authors used a more

comprehensive range of SES

categories, no evidence of a

relationship was observed with

biological age. The other, analysed

Chinese men and indicated men

with higher self-rated

socioeconomic status have shorter

telomeres [31]. This was postulated

as possibly being mediatedthrough

psychosocial, rather than lifestyle

factors, or the presence of chronic

disease. These authors also argue

that there may be significant

cultural, ethnic and age-related

differences in social determinants

of health.

The Q-PCR methodology employed in

the present study yielded similar

telomere length data in keeping

with other reports [10,33,42] using

the same methodology. Our

observations must also be viewed

with reference to the fact that any

differences reflect that PBL

telomere length is neither an

absolute, nor precise measure of

biological ageing. The telomere

lengths measured are an average

and reflect a range of lengths in

cells. A better measure may be an

absolute marker of cellular growth

arrest, such as CDKN2A [7–9]. The

use of such a marker would avoid

the potentially confounding effects

of differences in telomere length

measurement methodology, that

currently beset the field [14].

The difference in observations

using telomere length as a marker

of biological ageing, that have been

reported by different groups have

been elegantly summarised by

Nordfjall et al [39]. Our observations

find consensus with those using a

similar methodology, when applied

to age, BMI, smoking, insulin,

triglycerides and glucose. Our

observations on the effect of

smoking, however, maybe limited

by lack of detailed information on

smoking history.

We differ in the detections of

associations with total and LDL

cholesterol, though these have

previously been reported to be

associated with telomere length in

a disease setting [11], along with

IL6 [7,9]. These observations were

also in keeping with concomitant

elevation of DNA damage (as

measured by 8-0H dG levels) in a


Sept/Oct 2011 | 46

specific disease cohort. However,

our observations are consistent

with previous biochemical analysis

of the pSoBid cohort [5], which

demonstrated that total cholesterol

and LDL were inversely associated

with deprivation. This is congruent

with more extant inflammatory

conditions in the most deprived, a

situation exacerbated by increasing

age. It is thus also in keeping with

the observed elevation of IL-6

correlating with short telomeres.Our

observations provide an intuitive

link between proven socio-

economic drivers of disease

[5,36,37] and a biological

phenomenon underlying any

predisposition, or extant disease,

namely cellular ageing.

The tendency of our data to show

faster ageing in those with lower

socio-economic status, is indicative

of this and reflects ‘more miles on

the clock’ for these individuals. This

study may be limited by its size and

cross sectional nature. Indeed, the

social gradient in Glasgow is so

extreme that a ‘survivor effect’

among the most deprived cannot

be excluded. This merits a larger,

longitudinal study to look at the

relative impacts of further markers

of SES and potential SE and

lifestyle interventions.

Such interventions are not without

precedence and appear to show

direct benefit to biological ageing. A

recent intervention study in men

with prostate cancer, reported that

changing lifestyle, primarily via

better diet and increased exercise

leads to increased telomerase

activity and deceleration of

telomere attrition rate [43]. A similar

result in the pSoBid cohort would

be expected to have significant

health benefits.

In summary, we show convincingly

that factors associated with lower

socio-economic status and poor

diet are relevant to accelerated

biological ageing in a cohort

representing extremes of social

class. Our findings also suggest

potential associations of elevated

circulating IL-6, a measure known

to predict CVD and diabetes, with

biological ageing, observations

which require further study to tease

out potential mechanistic links.

Materials and MethodsEthics Statement

The study was approved by the

Glasgow Royal Infirmary Research

Ethics Committee and all

participants gave written informed

consent.

Participants

The design of the psychological,

social, and biological determinants

of ill health (pSoBid) study has

been described elsewhere [6]. In

brief, participants were ranked on

the basis of multiple deprivation

indicators to define the least and

most deprived areas in the NHS

Greater Glasgow Health Board

area, using criteria established in

the Scottish Index for Multiple

Deprivation (SIMD). Sampling was

stratified to achieve an

approximately equal distribution of

the 666 participants across males

and females and age groups (35–

44, 45–54 and 55–64 years) within

the most (bottom 5% of SIMD

score) and least deprived areas

(top 20% of SIMD score).

Participants undertook a physical

examination (including

measurement of blood pressure,

body mass index (BMI), and waist

hip ratio (WHR)) and lifestyle

questionnaires as detailed

previously [6]. A total of 382 blood

samples were available for

telomere analysis.

Analytical parameters

Measurement of biochemical

parameters have been described in

detail elsewhere [5]. In brief,

cholesterol and triglyceride

concentrations were determined by

enzymatic colorimetric assays on a

Roche Hitachi 917 analyser (Roche

Diagnostics Ltd, Burgess Hill, UK).

Lipid fractions were measured

using ultracentrifugation and

precipitation methods. Glucose was

measured by hexokinase and

glucose-6-phosphate dehydrogenase

assay on an Abbott c8000 analyser

(Abbott Diagnostics, Maidenhead,

UK). Insulin was measured by

ELISA (Mercodia AB, Uppsala,

Sweden and ALPCO Diagnostics,

Salem, NH, USA, respectively). C-

reactive protein levels were

determined by an immunoturbidimetric

assay (Roche Diagnostics Ltd).

High sensitivty interleukin-6, von

Willebrand factor and intercellular

adhesion molecule 1 weree22521

measured by ELISA (R&D Systems

Europe Ltd, Abingdon, UK and

DAKO UK Ltd, Ely, UK). Fibrinogen

was measured on an automated

coagulometer (MDA-180; Organon

Teknika, Cambridge, UK). D-dimer

was measured by ELISA (Hyphen,

Neuville-sur-Oise, France).

Indices of dietary intake

A diet score for the consumption of

fruit and vegetables was calculated

from subjects self-reported food

frequency questionnaire responses.

Participants were asked on

average how often they consumed

a range of food categories (21 food

categories listed). Responses for

each question ranged from daily

consumption (number of portions

per day) to weekly and monthly

consumption. Participants selected

one response per food category.

For the purposes of the present

analysis, responses to four

questions from the food frequency

questionnaire relating to fruit and

vegetable intake were aggregated

to give an overall indicative diet

score (i.e. frequency of intake of

fresh fruit, cooked green vegetables

(fresh or frozen), cooked root

vegetables (fresh or frozen) and

raw vegetables or salad (including

tomatoes)). Monthly diet scores

were calculated on the basis of a 28

day month. The maximum possible


Sept/Oct 2011 | 47

total diet score was 672 (6 portions

per day x 28 days per month x 4

food category questions).

Telomere length determination

DNA was extracted from PBLs

following standard procedures and

telomere lengths in the DNA

samples were determined by

QPCR, following the method of

Cawthon [44] as described

previously [11,33]. Telomere length

determination was performedus ing

a Roche Light Cycler LC480.

Telomere length analyses were

performed in triplicate for each

sample, using a single-copy gene

amplicon primer set (acidic

ribosomal phosphoprotein, 36B4)

and a telomere-specific amplicon

primer set [7].

Quality control parameters

employed for the amplifications

comprised using a cut off 0.15 for

the standard deviation (SD) of the

threshold cycle (Ct) for sample

replicates. At a SD above 0.15 the

sample was reanalysed. The

average SD across plates was

0.05. Relative telomere length was

estimated from Ct scores using the

comparative Ct method after

confirming that the telomere and

control gene assays yielded similar

amplification efficiencies.

This method determines the ratio of

telomere repeat copy number to

single copy gene number (T/S) ratio

in experimental samples relative to

a control sample DNA. This

normalised T/S ratio was used as

the estimate of relative telomere

length (Relative T/S). The inter-

assay variation was assessed by

comparing the relativ telomere

estimates (T/S ratio) across assays

for the positive controls, which were

assayed on every assay plate. The

average inter-assay coefficient of

variance was 0.3% for telomere

and 0.1% for 36B4 plates.

Statistical analyses

Associations between telomere

length and participant characteristics

were investigated in linear

regression models. Sampling was

stratified by age, gender and

deprivation group, and all models

were adjusted for these factors.

Because telomeres are expected to

shorten gradually with age, age

was represented in models as a

continuous rather than categorical

covariate.

When investigating factors that

might influence ageing such a SES

and lifestyle, telomere length was

modelled as an outcome.

Biomarkers, on the other hand, may

be viewed as downstream of

ageing, motivating their modelling

as outcomes with telomere length

as a covariate. Telomere length and

biomarkers were log-transformed

for regression analysis to satisfy the

assumption of normally distributed

residuals.

Regression coefficient estimates

were therefore multiplicative when

transformed back to the original

scale. For example, a regression

coefficient for a binary characteristic

back-transormed to 1.1 implies the

characteristic is associated with a

10% difference in the outcome.

Thus, where log telomere length

was the outcome, regression

coefficients are presented as the

percentage change in telomere

length associated with each patient

characteristic.

Where telomere length was a

covariate, a telomere length z-score

was used so that the back-

transformed regression coefficients

could be interpreted as the

percentage change in biomarker

level associated with a one

standard deviation increase in

telomere length. The telomere

length z-score was calculated by

standardising log telomere length to

have a mean of zero and standard

deviation of one. We hypothesised

that the effects of telomere-

shortening factors accumulate over

time, therefore the largest

differences between exposed and

unexposed participants would be

expected among the oldest

participants. We investigated this

hypothesis by testing for

interactions between participant

characteristics and age.

Supporting InformationTable S1 Median (interquartile

range) telomere length within

subgroups of socioeconomic status

and lifestyle factors, overall and by

age group.

(DOC)

Table S2 Percentage change (95%

CI) in telomere length associated

with a 10-year increase in age

within subgroups of socioeconomic

status and lifestyle factors,

predicted from linear regression

models adjusted for significant main

effects and interactions. All models

were adjusted for age, gender and

deprivation group. Interactions

were investigated by testing the null

hypothesis of homogeneity of age

effects across subgroups.

(DOC)

Author ContributionsConceived and designed the

experiments: PGS LMM A.

MacIntyre PJ GDB HB JC KAD IF

A. McConnachie A. McGinty JSM

KM NS CT YNV CJP. Performed

the experiments: LMM A. MacIntyre

PGS.

Analyzed the data: LMM PGS PJ A.

McConnachie. Contributed

reagents/materials/analysis tools:

PGS LMM A. MacIntyre PJ GDB

HB JC KAD IF A. McConnachie A.

McGinty JSM KM NS CT YNV CJP.

Wrote the paper: PGS LMM A.

MacIntyre PJ GDB HB JC KAD IF

A. McConnachie A. McGinty JSM

KM NS CT YNV CJP.

www.plosone.org



Sept/Oct 2011 | 48


Citation: Shiels PG, McGlynn LM, MacIntyre A, Johnson PCD, Batty GD, et al. (2011) Accelerated Telomere Attrition

Is Associated with Relative Household Income, Diet and Inflammation in the pSoBid Cohort. PLoS ONE 6(7): e22521.

doi:10.1371/journal.pone.0022521

Editor: Daniela Cimini, Virginia Tech, United States of America

Received April 20, 2011; Accepted June 22, 2011; Published July 27, 2011

Copyright: 2011 Shiels et al. This is an open-access article distributed under the terms of the Creative Commons

Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the

original author and source are credited.

Funding: This work was funded by the Glasgow Centre for Population Health, a partnership between NHS Greater

Glasgow and Clyde, Glasgow City Council and the University of Glasgow, supported by the Scottish Government.

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the

manuscript.

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: [email protected]


Sept/Oct 2011 | 49

Philips introduces uniquebackup fetal and maternalmonitoring solution duringpregnancy, labor and delivery

Last month Royal Philips

Electronics announced the global

availability of Avalon Smart Pulse,

the first technology to provide a

new source for automatically

detecting situations where

maternal pulse may be confused

with the fetal heart rate without the

need to apply additional electrodes

or sensors. The only company to

offer this technology, Philips

developed Smart Pulse to help

clinicians make more informed

decisions about delivering a baby.

Smart Pulse is now available for

customers in the Middle East and

U.S. after being introduced to

international markets in May 2010.

Electronic fetal and maternal

monitoring is used during

pregnancy, labor and delivery to

monitor the mother’s and baby’s

heart rate, uterine activity and fetal

movement, among others.

Obstetricians use fetal monitoring

because it is one of the few

solutions that can be used before

the baby is born to help evaluate

the baby’s well-being.

Traditionally, clinicians rely on two

methods to measure maternal

pulse: ECG and SpO2. In most

pregnancies, however, these are

not routinely monitored. In

situations where ECG and SpO2

data is not collected, Smart Pulse

automatically kicks in to provide the

maternal pulse reading. Smart

Pulse technology is built into the

Toco MP transducer, the new

uterine activity transducer, which is

then routinely placed on the

mother’s abdomen to record uterine

contractions during labor and

delivery. Using a heart rate

comparison technique known as

“coincidence detection,” the

maternal pulse is continuously

compared with the fetal heart rate

and provides an important backup

to the traditional ECG electrodes or

SpO2 sensors, which may become

disconnected or are often not used

at all. Since Smart Pulse is part of

routine monitoring and is “always

on” by continuously calculating

without the need for additional wires

or sensors, it provides comfort for

mothers.

“During conventional fetal

monitoring, physicians can often

experience confusion between the

fetal heart rate and maternal pulse,

which can threaten the life of the

baby if it goes unnoticed,” said

Roger Freeman, M.D., professor of

Obstetrics and Gynecology,

University of California at Irvine

School of Medicine, Long Beach

Memorial Medical Center,

Children's Hospital. “An accurately

monitored fetal heartbeat is crucial

to improving the likelihood of a safe,

healthy outcome for mother and

baby. Smart Pulse is providing a

much-needed backup that

clinicians really need. It allows

coincidence detection of heart rates

to continue in cases when it

previously would not have been

possible.”

With Smart Pulse, two maternal

pulse sensors under the plastic

surface of the Toco MP transducer

scatter infrared light through the

bottom layer of the transducer. This

light is reflected by tissue and blood

vessels. The pulsating diameter of

small arteries causes changes in

the reflected light. The measured

light changes are evaluated and a

maternal pulse is displayed and

recorded.

“This is an important advancement

in electronic fetal monitoring that

will enhance clinician confidence

that fetal heart rate and maternal

pulse are not being confused,” said

David Russell, general manager,

Mother and Child Care, for Philips

Healthcare. “This is also about

making a difference in the lives of

mothers and babies. We are

committed to developing solutions

that help put these patients on the

healthiest path possible.”

Philips Healthcare

Sept/Oct 2011 | 50


middle east hospital magazine september 2011

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