Difference between revisions of "Team:Queens Canada/Interviews"

Revision as of 05:44, 14 October 2018

Expert Interviews

Dr. Andrea Guerin
Department of Pediatrics, Queen’s University School of Medicine

Dr. Andrea Guerin is a full time Assistant Professor in Pediatrics and Medical Geneticist. She is the Year 2 Director at Queen’s University Medical School. Her work in Medical Genetics includes a consultation practice consisting of general genetics, prenatal genetics, cancer genetics and the care of patients with inborn errors of metabolism. Interviewing Dr. Guerin was a great opportunity to hear her thoughts on the pros, cons, and potential applications of using cortisol as a useful biomarker, including revelations on hypoglycemia, insulinemia, and early diagnosis of developmental disabilities. In terms of the pacifier model, she suggested potential use of a saliva collection device, which would work well as a non-invasive method of collecting DNA from infants to do genetic testing. As well, Dr. Guerin found value in the modular design of our ligand detection system and offered the potential of looking at glucose and bilirubin as other relevant metabolites in the pediatric field.

Dr. Kate Harkness
Department of Psychology, Queen’s University

Dr. Kate Harkness is Professor in the Department of Psychology and runs the Mood Research Lab at Queen’s University. She conducts research that primarily focuses on the correlation between stress and depression in adults and adolescents. Her studies focus on the effects of early childhood trauma on sensitizing the biological and psychological stress response in a manner that makes people more susceptible to psychopathology. She examines the changes in cortisol levels in response to stressors, and she pointed out several major factors that would contribute to the varying levels of cortisol in individuals raised in diverse settings. She suggested that our application should include a function to determine one’s personal cortisol baseline throughout different times of the day in order to give more meaning to the collected data. She believes our biosensor would be applicable to her line of research as it is a more time-efficient and non-disruptive method of monitoring cortisol levels in psychological studies.

Dr. Janet Menard
Department of Psychology, Queen’s University

Dr. Janet Menard is an Associate Professor in the Department of Psychology and runs the Neurobiology of Anxiety Lab at Queen’s University. Dr. Menard provided our team with lots of feedback on our project design and raised potential concerns that we must be aware of when designing our biosensor technology and the associated smartphone technology. She discussed the hyporesponsive stress period that occurs during the first year of one’s life, which provided an emphasis on the need to be able to effectively measure and determine a cortisol baseline for the app to work accurately for each user. She also discussed some of the concerns she had with the use of a genetically engineered protein being incorporated into the device. The appropriate safety testing and educational information must be readily accessible to all potential consumers to avoid any health and safety concerns. Our interview with Dr. Menard was very insightful and highlighted areas that our technology may be most useful for, with an emphasis on research and clinical settings. She believes the scientific community could benefit greatly from a cortisol-reading device that is fast, affordable and exceeds the accuracy of current devices on the market.

Dr. David Saleh
Department of Pediatrics, Queen’s University School of Medicine

Dr. David Saleh is a full time Assistant Professor in Pediatric Endocrinology and Metabolism for the Queen’s School of Medicine. His work at Hotel Dieu Hospital includes the full range of consultation in pediatric endocrinology including diabetes, growth/thyroid disorders, adrenal disorders and osteoporosis. Dr. Saleh was able to provide our team with extensive background knowledge on different metabolic disorders associated with adrenal insufficiency, as well as the current diagnostic procedures and treatments involved with these disorders. Based on personal experiences from Dr. Saleh’s line of work, he sees the need for non-invasive diagnostic systems for hormone-related disorders. As well, he suggested the use of our biosensor technology for use in monitoring the efficacy of various treatments, and to better track how the therapies or supplements are metabolized in an individual. Dr. Saleh was also able to provide our team with valuable information about the Ontario Newborn Screening process, and the endocrine-related disorders that are currently tested for -- offering insight into a potential future role for our technology as a less invasive screening method for newborns with metabolic disorders.

Dr. Kimberly Dow
Department of Pediatrics, Queen’s University School of Medicine

Dr. Kimberly Dow is a full time Professor of Pediatrics for the Queen’s School of Medicine and a neonatologist at Kingston General Hospital. She serves on both the Canadian Neonatal Network and Evidence Based Practice for Improving Quality (EPIQ) Steering Committees and is a member of the Board of Directors for the Canadian Pediatric Society. During our interview with Dr. Dow, we were able to gain valuable knowledge about daily procedures and processes that take place in Neonatal Intensive Care Units (NICU). By evaluating current practices involved in the maintenance of neonate well-being and pain-mitigation during different procedures, we were able to better understand how our project design could be implemented and beneficial in this setting. One of the specific applications that were elaborated on during our time with Dr. Dow was the use of our technology to aid in Newborn Abstinence Syndrome treatment plans and morphine dosage determination. The other application we discussed was the possibility of aiding with the use of sucrose as an analgesic for neonates, and determining the efficacy of this pain-reducing method that is currently employed. By creating a device that can quantify cortisol, stress and pain affecting non-verbal individuals can be better understood and managed to prevent detrimental developmental effects.

Parent and Daycare Employee

We interviewed a parent, and an employee of local community Daycare who has requested to remain anonymous. She is the parent of two children and would do anything to better understand what is causing stress in her children. The normal process would be to watch children very carefully and make connections to try to determine root cause of stress. Although she sees a benefit to anything that would improve the well-being and happiness of her children, she has concerns about what the cortisol information really means. Such as if there is a need to determine the cortisol change, or is it just a normal process? Could a device like this make parents less aware of their natural intuition? Overall, she expressed a general worry that the information may just make parents worry even more. However, she thought it would be better suited for diagnostic/management/screening scenarios with specific conditions or in specific situation such as in use when the parent is unable to figure out what is causing the distress in the child. We then spoke about the conversations we had have endocrinologists, and psychologists. She agreed that this device is better suited in the hands of a trained professional (doctor) opposed to parents that may misinterpret information. She stated her sentiment as follows “Parents of young children are vulnerable. They always want to do their best. We need to be careful what we offer them. We don’t want them making links that don’t exist.”

Dr. Harriet Feilotter
Department of Pathology and Molecular Medicine, Queen’s University

Dr. Harriet Feilotter is an Associate Professor in the Department of Pathology and Molecular Medicine at Queen’s University. Her research focuses on the development of biomarkers to be used in the screening, diagnosis and treatment of human diseases in clinical settings. Our meeting with Dr. Feilotter was very informative and provided a lot of insight into what research is required to validate our biosensor technology and demonstrate its effectiveness and clinical utility. She provided information pertaining to important parameters that must be evaluated when working with biomarkers, including analytic and clinical specificity and sensitivity values, negative and positive predictive values, the concentration range our technology can measure, the saturation point of our assay and cross-reactivity that might occur with molecules resembling cortisol. Dr. Feilotter was also very knowledgeable about the safety testing and potential experiments that may be useful in demonstrating the validity and safety of our device.

Austism Ontario

Autism Ontario is an organization that works to ensure that each individual with Autism Spectrum Disorder is provided with the means to achieve quality of life as a respected member of society. Members of our team were fortunate to be invited to attend one of their monthly meetings with parents to discuss the use of our product as a form of stress communication with non-verbal individuals. Ms. Penni Lochnan and Ms. Paula Ball were able to provide us with valuable feedback on the potential application of our technology that we were evaluating. They discussed the usefulness of cortisol as a biomarker in determining situations that provoke stress in the individual, as well as its use as an early indicator of illness. Some concerns that they had were related to the physical design of the pacifier surrounding sensory sensitivity and the possible refusal of use due to these issues. This has prompted us to be very thoughtful with which pacifier designs are used, and important considerations surrounding the taste, texture and durability of the product. They were also concerned about who would have access to the information, and wanted to ensure their privacy would be protected. This conversation enlightened us on the importance of considering the needs of those we would be helping, and ensuring the utility would be beneficial with no malintent. Interview Summaries: Potential Application Feedback Pacifier for the general public (parental use) ● Used by parents to monitor child’s stress levels when away ● Issues pertaining to what the end result is; what does knowing this information mean? Intervention? ● Could Δcortisol be indicative of something? ● Creating a problem that doesn’t exist ● Establishing what is a normal cortisol level and what should be a cause of concern is difficult ○ Individuals often have different baselines; would need to incorporate this into app ● May be more stress-inducing in the parents ● Parents already have intuition and ability to communicate with their children through other means (no need to replace this with technology) ● As long as proper safety testing is deployed, “engineered protein” shouldn’t be a huge concern ● May be helpful in preventing Sudden Infant Death Syndrome (SIDS) ● Expensive Pacifier for the general public (parental use) ● Used by parents to detect if child is awake/asleep ● Other technologies already exist ● May not be the fastest method to determine if infant is awake ● May be useful to know child’s breathing rate and temperature while they’re asleep Quantitative self care ● Would need to change design from pacifier to something less visible ● Similar idea to fitbits, etc. ● Growing market ● What would be the relevance of knowing changes in cortisol? ● Don’t want people to confuse healthy cortisol changes with abnormal fluctuations/indicators of disease ● Expensive Monitoring device for non-verbal individuals (i.e. developmental disabilities) ● Used to communicate stress and discomfort ● Its use may be refused due to sensory sensitivity ● Texture, taste, odour is very important ● Must be incredibly durable, not a choking hazard (single piece not multi-components) ● Better suited to be used as a diagnostic tool when something is believed to be wrong than just an everyday surveillance system ● Financial barriers → who will be able to afford this product (will it be covered by insurance?) ● Can’t use pacifier design, need a more age appropriate design Research settings ● i.e. salivary cortisol levels during psychology studies (refer to Harkness’ studies) ● Salivary cortisol levels in different settings to gauge stress in the NICU ● Could replace disruptive method of salivary collection and eliminate steps involved with sending sample off ● More efficient ● Could reveal critical information missed in current studies ● Easier to complete studies with young children and infants ● Since cortisol is such a sensitive biomarker that can fluctuate rapidly, it is important that the method used to collect the sample (i.e. needle) does not induce a change ● Must be a very accurate test (sensitivity and specificity important) Clinical applications ● Used for diagnostic purposes ○ Adrenal insufficiencies ● Communication of patient pain in non-verbal individuals (i.e. in neonates) ● Non-invasive methods would be key for NICU and other infant applications ● Could be used to complement sucrose as an analgesic (help to determine when to re-apply) ● Concerns about biomarkers in saliva being as accurate as plasma samples ● How reliable are the results in determining diagnosis (sensitivity/specificity) Clinical application #2 ● Used to monitor effects of hormonal replacement therapy ● Used to determine progress and dosages (i.e. Neonatal Abstinence Syndrome) ● Non-invasive method ● Could be used to evaluate metabolism of hormone ● Could make calls about changing dosage, etc. ● Could help to determine how effective a treatment plan is in an individual