The joint winner of the 11^th Annual Building Education to Advance Research (BEAR) Cage competition, Yi-an Hsieh, MSE, co-founder and CTO of Airalux Medical, gave an impressively well-rounded pitch, “Digital Incentive Spirometer to Improve Patient Adherence and Clinical Workflows,” on Monday, May 19, at the ATS 2025 International Conference. Joshua Freedman, MSE, co-founder and CEO of Airalux Medical, was the co-winner of the prize, along with Ms. Hsieh.

The BEAR Cage is a live pitch competition positioned at the intersection of scientific rigor, an unmet medical need, or challenging clinical scenario, innovation, and entrepreneurial thinking. 

The yearly competition is a singular offering from the ATS, open to early career scientists and researchers, and focused on research proposals that are not only innovative, but can be translated for clinical applications.

Three finalists, selected by the Drug, Device, Discovery, and Development (DDDD) Committee, pitched their proposals to a panel of judges from academia, industry, and government with deep experience in translational science, in front of a live audience. The contestants also answered questions from the judges, DDDD members, and the audience.

Explaining the rationale for developing a novel incentive spirometry prototype, Ms. Hsieh said that while 17 million inpatients receive post-surgery incentive spirometry for improving lung function in the United States annually, patient adherence to the device-reliant protocols is poor. More than one million (six percent) of patients who receive incentive spirometry have postoperative lung complications.

The prototype spirometer developed by Ms. Hiseh, Mr. Freedman, and colleagues sought to address key barriers to patient use and adherence. To address poor tracking of spirometry data, which can minimize clinical outcome improvements, the prototype relies on automated data tracking and a clinical interface for data access. The novel device uses a direct airflow mechanism and a readily visible display that provides real-time guidance, mitigating the risk of faulty use. Patient feedback is provided on-device on an easy-to-view screen, obviating smartphone pairing used by other spirometers that may be too complex or difficult, especially for post-surgical patients.

The Airalux incentive spirometer and the companion mobile-based app are currently being evaluated in a single-arm proof-of-concept research study to assess a two-fold improvement in adherence to digital incentive spirometers in the postoperative period for major chest surgery.

 “I think this is a wonderful opportunity for us to showcase what we are working on. We appreciate the ATS’s support of this project,” Ms. Hsieh said.

As the winners, Ms. Hsieh and Mr. Freedman will receive a funding prize of $10,000. The two runner-up finalists — Felicia Seeman, PhD, and Qiwei Xiao, PhD — will each receive $2,500 for their pitches. The prize money can be spent at the discretion of the winners, rather than as a research grant.

 “We will be working on cost reduction for the prototype and then pursuing clinical studies in specific patients who are at a high risk for complications,” and to demonstrate improved outcomes, Ms. Hsieh explained when asked about her plans for the immediate future.  

“The winnings will probably get reinvested into the company. With lots of support from the team at UPenn Medicine, we have taken the device to an early feasibility trial stage and formed a company. We are excited to see where this will go,” said Ms. Hsieh, who completed her undergraduate degree just last year.

In her pitch, “Determining the Origin of Pulmonary Edema Using MRI and a Low-Tech Low-Cost Exercise Device,” Dr. Seeman, a K99 Investigator at the National Heart, Lung and Blood Institute, National Institutes of Health, spoke about four different innovations: an affordable, easy-to-use MRI-compatible exercise device; a software package for quantitative 3D lung water imaging during exercise; an add-on digital tool for differentiating intravascular from extravascular lung fluid; and a fully automated image analysis software for real-time clinical reporting.

The pitch from Dr. Xiao, field service instructor at the Cincinnati Children’s Hospital, was “Aerospace-Driven Innovations in Phenotyping Obstructive Sleep Apnea.”  The MRI-based computational fluid dynamics (CFD) simulation developed by Dr. Xiao and colleagues can help identify the origin of upper airway collapse in obstructive sleep apnea (OSA), based on structural and functional information. The CFD simulation method can help clinicians to phenotype OSA and enable mechanism-guided treatment selection.

Contestants fielded a range of queries, not just on the scientific rationale of their innovations, but also on the relevant patient populations, clinical scenarios, production and/or distribution principles, costs, and ease of use in clinical practice.

“We always try to target early career professionals. So, it is wonderful to see a master’s student be this year’s winner, but often it is PhDs or MDs who are a little farther along on their career trajectory,” said Kathryn Hibbert, MD, assistant professor of medicine at Harvard Medical School and co-chair of the BEAR Cage competition.

The trajectory for Ms. Hsieh, who started the incentive spirometer as an undergraduate senior-year design project, “is not necessarily typical,” Dr. Hibbert said, “It is great to see someone’s passion project really come to fruition. I think the BEAR Cage is also a unique competition because it is also the only prize contestants compete for and win in real time.”