Futures Slide, Euro Rises Ahead Of ECBTyler DurdenThu, 09/10/2020 - 07:43
Wednesday's tech-led rally in stock markets stalled in Europe on Thursday as traders pulled back to hear what the European Central Bank would say about the euro’s run-up in recent months and this morning. Meanwhile, S&P futures dropped 17 points suggesting the rally in underlying stocks will stall once again amid concerns over record valuations.
The drop came after the gains in technology shares drove the largest Nasdaq advance since April on Wednesday as the S&P 500 rose the most since June following the fastest Nasdaq correction from an all-time high in history. The increased volatility in recent days suggests that U.S. stocks may be due for a pullback, with investors weighing catalysts to decide on the trajectory.
Mizuho Bank’s head of economics and strategy in Singapore, Vishnu Varathan, said investors were grappling with whether this month’s steep U.S. tech selloff was really done, and beyond that an increasingly uncertain U.S. political outlook and persistent Sino-U.S. tensions.
Meanwhile, the ECB’s upcoming meeting, along with emergency Brexit talks in London after negotiations turned chaotic again, and wilting commodity markets kept the bulls firmly on the leash. An early push from the pan-European STOXX 600 faltered as tech struggled, the euro and government bonds gained pre-ECB, and drooping oil and metals prices hit the region’s drillers and miners.
Analysts also waited to see whether reports that the ECB will fractionally revise up its COVID-battered economic and inflation forecasts later would ultimately effect the chances of a further ramping up of stimulus, which would rein in the euro (see our full ECB preview here).
“What happens at the ECB today is quite important for global markets,” said TD Securities’ European head of currency strategy Ned Rumpeltin. "There is still one trade, which is reflate or die,” he said referring to stimulus aid lifting asset prices. “So the degree to which the ECB either takes that one step forward or one step back today will be important."
While the ECB is widely expected to keep policy steady, investors will be closely watching comments from President Christine Lagarde for any hints on whether the stronger euro is becoming a problem for the region. Analysts have speculated that Lagarde and her colleagues could start laying the groundwork for an intervention that would prevent the euro’s strength from slowing an economic recovery.
"The persistent dollar weakness since March has started making some governments and central banks uncomfortable," said Athanasios Vamvakidis, head of Bank of America’s Group-of-10 currency strategy. “We expect the ECB to push against euro strength today. It is still early to talk about risks of a currency war, but I would expect more push against further dollar weakness."
Earlier in the session, MSCI's broadest index of Asia-Pacific shares outside Japan snapped its longest losing streak since February with a 0.7% gain. Japan's Nikkei rose 0.9% and Chinese blue chips rose 0.8%. Markets in Sydney and Hong Kong were just better than flat though and, in a reminder of the risks, Jakarta nosedived 5% on plans to re-introduce COVID-19 social restrictions in the Indonesian capital. Like Europe though, Wall Street futures traded down between 0.5%-0.7% ahead of trading there.
In FX, the euro advanced a second day against the dollar as traders awaited Thursday’s European Central Bank’s policy decision. The pound rose as investors awaited the outcome of emergency Brexit talks between the U.K. and the European Union. Risk- sensitive Scandinavian and antipodean currencies edged lower as European stock markets and U.S. equity futures failed build on Wednesday’s gains; the Swiss franc led G-10 peers.
In rates, bond buyers also returned after a tepid response to a $35 billion U.S. 10-year auction overnight, pushing the yield on U.S. 10-year debt down by a whisker to 0.7001% near high end of a less-than-2bp daily range; bunds lag by 2bp ahead of ECB, gilts by 1bp. Treasuries were slightly richer vs Wednesday’s close after paring small gains, with U.S. session focused on August PPI and 30-year bond reopening. Treasury auction cycle concludes with $23b 30-year reopening at 1pm ET (+$4b vs previous 30-year reopening), on the heels of soft demand at both the 3- and 10-year offerings this week.
In commodities, concerns about demand for fuel also had oil prices back under pressure, in an indication of wavering confidence in global growth. Brent crude futures fell back to $40.45 a barrel after bouncing back from a three-month low overnight. U.S. crude futures slipped 0.8% to $37.68 a barrel.
Expected data include jobless claims and wholesale inventories. Chewy, Oracle and Peloton are reporting earnings.
Market Snapshot
S&P 500 futures down 0.3% to 3,378.75
STOXX Europe 600 down 0.4% to 368.13
MXAP up 0.6% to 170.42
MXAPJ up 0.2% to 559.27
Nikkei up 0.9% to 23,235.47
Topix up 1.2% to 1,624.86
Hang Seng Index down 0.6% to 24,313.54
Shanghai Composite down 0.6% to 3,234.82
Sensex up 1.2% to 38,650.61
Australia S&P/ASX 200 up 0.5% to 5,908.52
Kospi up 0.9% to 2,396.48
Brent futures down 0.8% to $40.45/bbl
Gold spot little changed at $1,946.17
U.S. Dollar Index down 0.2% to 93.08
German 10Y yield fell 1.1 bps to -0.473%
Euro up 0.3% to $1.1834
Italian 10Y yield fell 0.7 bps to 0.895%
Spanish 10Y yield fell 2.4 bps to 0.315%
Top Overnight news from Bloomberg
ECB President Christine Lagarde will have to walk a fine line as she portrays a euro-area economy that’s recovering as hoped from the coronavirus pandemic yet still in need of massive support; see decision day guide
China’s next five-year plan beginning in 2021 will call for increases to its mammoth state reserves of crude, strategic metals and farm goods
Trump administration appointees suppressed intelligence on Russian election interference and the threat from white supremacists, according to a whistle-blower complaint filed by the Department of Homeland Security’s former intelligence chief
One in five U.K. companies is a “zombie,” with profits only just covering debt interest payments, according to a report by an influential Conservative think tank
A quick look around global markets courtesy of NewsSquawk
Asia-Pac bourses were initially mostly positive, but ultimately finished mixed, after taking advantage of the constructive handover from the US where tech rebounded from the recent sell-off to lift the Nasdaq out of a correction, while vaccine concerns also abated amid reports AstraZeneca may resume trials next week. ASX 200 (+0.5%) and Nikkei 225 (+0.9%) gained from the open with tech and mining names leading the advances in Australia but with upside later reversed amid weakness in financials and ongoing tensions with its largest trading partner China after reports that 6 Chinese citizens either left or were denied entry into Australia for alleged espionage or foreign interference. The Japanese benchmark was kept afloat by recent favourable currency moves and better than expected Machinery Orders data, while Tokyo also lowered its virus alert level by one notch. Hang Seng (-0.6%) and Shanghai Comp. (-0.6%) were somewhat cautious after mixed US-China related headlines with the US said to have revoked more than 1000 visas of Chinese nationals as of September 8th due to ties with the Chinese military, although there were also reports that TikTok’s parent, ByteDance, was in discussions with the US government on possible arrangements that would allow the app to avoid a full sale of its US operations. Focus was also on Yum China shares which declined 4% on an underwhelming Hong Kong debut, although Beigene shares were boosted on its inclusion in the HK-mainland stock connect program, while hefty losses were seen in the IDX Composite (-5.0%) which triggered a circuit breaker intraday after the Jakarta Governor announced to reimpose large-scale social restrictions. Finally, 10yr JGBs were lacklustre following the recent mild weakness in T-notes and rebound in equity markets, with price action in 10yr JGBs also hampered by resistance at the 152.00 level and as all metrics suggested a weaker than previous 20yr JGB auction.
Top Asian News
Dollar’s Dominance Gives U.S. Upper Hand in China Fight
Yum China Has Hong Kong’s Weakest Debut in More Than a Year
Tokyo Lowers Virus Alert Level, Eases Restrictions on Bars
Turkey Is Said to Be Discussing Oil and Gas Exploration in Libya
European stocks trade mixed (Euro Stoxx 50 -0.1%) having experienced directionless trade throughout much of the morning, following on from a mixed/choppy APAC session. Fresh fundamental news flow has been relatively light as participants gear up for the ECB policy decision (full preview available in the research suite). Sectors are mostly lower with no clear risk profile to be derived – Basic Resources, Banks and Oil & Gas stand are the laggards, with the latter on account of softer oil prices, whilst Autos, Travel & Leisure reside on the other side of the spectrum. In terms of individual movers, Akzo Nobel (+3.5%) remains buoyed as the group continues to see improving trends in Q3, with total revenue expected to be close to prior year’s levels – thus providing support to the European Chemical sector. Nexi (+5.2%) remains a top gainer in the region after sources stated that the Co. and SIA are close to clearing a hurdle to a potential merger. Finally, Morrison (-5.1%) trades at the bottom of the Stoxx 600 following their trading update which noted that COVID-19 continues to have a significant and widespread impact on business.
Top European News
Euronext Is Said to Ready Over $4 Billion Bid for Borsa Italiana
Nexi, SIA Close to Clearing Hurdle to Blockbuster Merger
Deadly Hog Fever Arrives in Germany, Europe’s Top Pork Producer
Navalny Security Tightened as Putin Foe Revives, Spiegel Says
In FX, there was not much movement in G10 currencies compared to the frantic price action that panned out on Wednesday, but the ECB policy meeting and press conference from President Lagarde hold potential to spark another bout of volatility along with the extraordinary joint committee convene between the EU and UK arranged after yesterday’s controversial IMB. In the interim, Usd/major pairs are mixed and relatively rangebound as inferred by the DXY holding within a tight range just above 93.000 (93.281-036) ahead of US claims, ppi and wholesale inventories. Meanwhile, the Euro is meandering between 1.1839-01 and well flanked by decent option expiry interest (down to 1.1775 and up to 1.1900 – full details on the headline feed at 6.56BT), with Cable pivoting 1.3000 and Eur/Gbp hovering nearer the upper end of 0.9105-0.9075 parameters.
NOK/SEK - Little independent impetus or direction via Scandinavian inflation data (headline as forecast and core firmer in Norway vs mostly softer than expected Swedish CPI and CPIF), but wavering risk sentiment following the midweek session recovery and a downturn in crude prices have pushed the Crowns back down within 10.6720-10.6210 and 10.3516-10.3206 respective parameters.
CHF/JPY/CAD/NZD/AUD - The Franc is outperforming above 0.9100 vs the Greenback and just shy of 1.0750 against the Euro for no apparent or obvious reason other than consolidation off recent lows, while the Yen is retracing towards 106.00 where heavy expiries reside (2 bn) ahead of almost as much from 105.85 to 105.80 (1.9 bn), and with latest BoJ source reports about a looming economic assessment upgrade largely shrugged aside. Elsewhere, the Loonie retains some post-BoC momentum in advance of Governor Macklem’s speech, with Usd/Cad straddling 1.3150 and the Antipodean Dollars are essentially idling vs their US counterpart as Nzd/Usd and Aud/Usd rotate around 0.6680 and 0.7275. Next up for the Kiwi, NZ manufacturing PMI and food price index reads for August, while the Aussie will continue to monitor Chinese diplomatic developments and daily PBoC fixes for the Cny. Talking Yuan, market observers report that Usd 3 bn options for Cnh to hit 8 in one year went through during Asian trade and for reference the pair is now circa 6.8400, so devaluation and/or a major Buck rally envisaged by the aggressor.
EM - The Rand is lagging in wake of a much wider than anticipated SA Q2 current account deficit, but for once the Lira is showing a degree of resilience in the face of Greek calls for tough EU sanctions against Turkey and data revealing a rise in unemployment. Indeed, Usd/Try has defended attempts on 7.5000, thus far at least.
In commodities, WTI and Brent front month futures have been drifting lower in early European trade after relatively sideways overnight price action, with the benchmarks straddling figures just below USD 38/bbl and USD 40.50/bbl respectively. A few updates for the complex – the EIA STEO revised its US oil supply forecasts lower by 210k BPD for 2020. However, after September, “EIA expects U.S. crude oil production to decline slightly, averaging just under 11.0mln BPD during the first half of 2021 because EIA expects that new drilling activity will not generate enough production to offset declines from existing wells.” Meanwhile, the delayed Private Energy Inventory report adds further to the bearish narrative after printing a surprise build of 3mln bls vs. Exp. -1.3mln bbls during the last week – traders will be eyeing confirmation via today’s EIA DoE’s released at 1600BST/1100ET. Elsewhere, participants are keeping an eye on the storage situation given the touted demand decline amid a resurgence in COVID-19 cases, with sources via EnergyIntel noting that traders and international oil companies are actively booking VLCC supertankers for the next 6-12 months – suggesting participants are looking for storage of oil as opposed to sales – reflected in the curve contango. Also note, ahead of the JMMC meeting on the 17th, sources stated that the recent price decline was causing concern in Riyadh, but not yet panic - adding that there was not a need for a "bigger cut" at this point. Elsewhere, spot gold and silver remain relatively contained within tight ranges just sub-USD 1950/oz and around USD 27/oz respectively ahead of the ECB policy decision later today. In terms of base metals LME copper prices have been declining alongside stocks, with participants keeping an eye on the easing COVID-19 measures in Chile.
US Event Calendar
8:30am: PPI Final Demand MoM, est. 0.2%, prior 0.6%; PPI Ex Food and Energy MoM, est. 0.2%, prior 0.5%
8:30am: PPI Final Demand YoY, est. -0.3%, prior -0.4%; PPI Ex Food and Energy YoY, est. 0.3%, prior 0.3%
8:30am: Initial Jobless Claims, est. 850,000, prior 881,000; Continuing Claims, est. 12.9m, prior 13.3m
Disorder certainly continues to rule at home. Last week I beamed at how easy the first couple of days at nursery were for the twins. Well this week has been a different story. I think they believed that after two days followed by a weekend of no school that was their education was over with and were thus quite relaxed. This week as soon as my wife has pulled out their uniform to dress them, they have screamed and kicked the house down. My wife rung me in my cozy isolated home office at 915am yesterday to let me know that the only way she could get them to school was in their pyjamas and then to get the teacher to help change them at school once she’d dropped my daughter off. She was still shaking and needed to pause before she drove home. I felt a bit guilty being on an earlier work conference call during the turmoil downstairs. Having said that please please book me for a call any day between 8-9am so I can avoid a nervous breakdown.
Markets went from breaking down to recovery yesterday and recouped much of their losses from the previous day’s selloff. US tech outperformed, with the NASDAQ advancing +2.71%. That included strong performances from Tesla (+10.92%), Microsoft (+4.26%) and Apple (+3.86%), though the broader S&P 500 was also up +2.01% as 23 of 24 industries rose on the day (Autos at -0.37% the sole exception). The rebound was the best day for the S&P in over three months, while the NASDAQ’s daily advance was the most since 29 April. Similarly equities bounced back in Europe, where the STOXX 600 rose +1.62%, while the DAX climbed +2.07% to leave the index down just -0.09% on a YTD basis.
Speaking of Europe, the ECB will be taking centre stage for markets today as they announce their latest monetary policy decision and also release their updated macroeconomic forecasts. This meeting has come increasingly into focus in recent weeks, with the euro having risen above $1.20 at one point for the first time in over 2 years, and this appreciation has triggered a verbal reaction from ECB speakers. Meanwhile there’s the risk that the rising exchange rate reinforces low inflation, with the latest flash CPI estimate for August showing a negative reading (at -0.2%) for the first time in over 4 years. That said, we did get a Bloomberg headline yesterday saying that the forecasts were said to show more confidence in the outlook, with the euro moving higher after the news broke.
In terms of what we’re expecting today, our European economists think that the policy stance will be left unchanged, but that the ECB will reinforce their communications with a resolutely dovish message, before easing further in December with an expansion of their asset purchase programme. That December easing would coincide with the release of the ECB’s staff 2023 inflation forecasts, which could form the basis for a policy shift.
Ahead of this, markets in Asia are following Wall Street’s lead with the Nikkei (+0.64%), Hang Seng (+0.04%), Shanghai Comp (+0.29%) and Kospi (+0.82%) all up. Meanwhile Yields on 10y USTs are down -1.7bps this morning reversing much of yesterday’s rise and futures on the S&P 500 and Nasdaq are down -0.30% and -0.27% respectively.
On the coronavirus, here in the UK yesterday the government officially announced the overnight news that gatherings in England would now be limited to a maximum of 6, either indoors or outdoors. That came as a further 2,682 cases were reported yesterday, which pushed the 7-day average (2,363) to its highest since May 27. Prime Minister Johnson said that mass testing could be the route back to normal life, and that the first pilot of this would go ahead in the English city of Salford next month. In other news, following the pause in the AstraZeneca trial after a person developed neurological disorder that causes inflammation of the spinal cord, the FT reported that the trials could resume next week. Having been more than -3% lower following the open, the company’s share price pared back its losses by the end of the session to close up +0.15%. Bloomberg has reported that “an unrelated neurological illness” led to a pause in trials in July as well which was confirmed by an AstraZeneca spokeswoman who said that “There was a brief trial pause in July while a safety review took place after one volunteer was confirmed to have an undiagnosed case of multiple sclerosis,” and added that the independent panel monitoring the trial concluded the diagnosis was unrelated to the vaccine after which the trials resumed. Elsewhere, Asahi has reported that the Tokyo Metropolitan Government has decided to lower its coronavirus alert by one notch from the highest of four levels. The same report also added that Tokyo is planning to end its request of shorter hours at bars and restaurants next week.
The virus news in the US steadily gets better, while the service industry in New York City got a huge boost yesterday when Governor Cuomo announced that indoor dining may resume on September 30. Elsewhere in the US, California had its lowest cases since May and Miami has eased its city-wide curfew and has reopened outdoor public spaces such as the zoo and theme parks.
Concerns over Brexit remained yesterday as the UK government published their Internal Market Bill, which would allow the government to override elements of the Withdrawal Agreement reached between the UK and the EU last year. A number of senior EU figures weighed in negatively in response to the bill’s release, with Commission President von der Leyen tweeting that she was “Very concerned about announcements from the British government on its intentions to breach the Withdrawal Agreement. This would break international law and undermines trust.” Others to respond negatively included the Irish PM, the European Council President, as well as the former UK Conservative Prime Minister John Major, though EU sources told Reuters that they would not seek to suspend the talks between the two sides on their future relationship. Speaking of those discussions, the 8th negotiating round wraps up today, so we should hopefully get some headlines on whether there’s been any progress or not from the key players. Meanwhile, Bloomberg has reported overnight that the EU believes it may have a case to seek legal remedies even before the UK internal-market bill is passed by the UK Parliament and that it would have a clear justification once the bill becomes law, according to the EU’s preliminary analysis of the UK legislation. Criticism on the internal-market bill has also come from across the Atlantic with the US House Speaker Nancy Pelosi saying that the UK must ensure the free flow of goods across the border, as agreed in Britain’s deal with the EU last year. She added that “If the UK violates that international treaty and Brexit undermines the Good Friday accord, there will be absolutely no chance of a US-UK trade agreement passing the Congress.”
Over in fixed income, sovereign bonds sold off yesterday, with yields on 10yr Treasuries (2.1bps), bunds (+3.3bps) and gilts (+4.9bps) all moving higher. Other safe have assets also struggled, with the Japanese Yen being the worst-performing G10 currency, while the dollar index (-0.25%) fell back as well. Oil rebounded however, with WTI (+3.51%) and Brent (+2.54%) recovering at least some of the previous day’s losses. It was the largest one-day move higher for WTI since mid-June as the risk-on sentiment mixed with expectation that American stockpiles have dropped for a seventh week running. With the greenback falling, gold rose the most in 2 weeks (+0.77%) even with higher yields on the day.
Finally there wasn’t much data of note yesterday, though the number of job openings in the US in July rose to a higher-than-expected 6.618m (vs. 6m expected), which is their highest level since February before the impact of the pandemic was felt. That said, unlike in February when unemployment was below 6m, the total number of unemployed workers in July stood at 16.3m, so the number of unemployed far exceeded the number of openings.
Looking to the day ahead, the aforementioned ECB decision and President Lagarde’s subsequent press conference will be a key highlight. Lagarde will also be speaking at a Bundesbank event later in the day, and separately the ECB’s Villeroy and Bank of Canada Governor Macklem will be speaking. Data releases include French and Italian industrial production for July, while from the US there’s the weekly initial jobless claims and August’s PPI reading. Finally, the 8th negotiating round between the UK and the EU on their future relationship concludes today.
EUR/AUD bearish breakdown supported by additional China fiscal stimulus and AU inflation
Weak PMI readings from the Eurozone, an increase in China’s budget deficit ratio, and renewed inflationary pressures in Australia may trigger a persistent…
Weak PMI readings from the Eurozone, an increase in China’s budget deficit ratio, and renewed inflationary pressures in Australia may trigger a persistent bearish sentiment loop in EUR/AUD.
Watch the key short-term resistance at 1.6700 for EUR/AUD.
A break below 1.6250 key medium-term support on the EUR/AUD may trigger a multi-week bearish impulsive down move.
The Euro (EUR) tumbled overnight throughout the US session as it erased its prior gains against the US dollar recorded on Monday, 23 October; the EUR/USD shed -104 pips from yesterday’s intraday high of 1.0695 to close the US session at 1.0591, its weakest performance in the past seven sessions.
Yesterday’s resurgence of the USD dollar strength has been attributed to a robust set of October flash manufacturing and services PMI data from the US in contrast with weak readings seen in the UK and Eurozone that represented stagflation risks.
Interestingly, the Aussie dollar (AUD) has outperformed the US dollar where the AUD/USD managed to squeeze out a minor daily gain of 21 pips by the close of yesterday’s US session. The resilient movement of the AUD/USD has been impacted by positive news flow out from China, Australia’s key trading partner.
China’s national legislature has just approved a budgetary plan to raise the fiscal deficit ratio for 2023 to around 3.8% of its GDP which was above the initial 3% set in March and set to issue additional sovereign debt worth 1 trillion yuan in Q4. This latest round of additional fiscal stimulus suggests that China’s top policymakers are expanding their initial targeted measures to address the ongoing severe liquidity crunch in the domestic property market as well as to reverse the persistent weak sentiment inherent in the stock market.
In addition, the latest set of Australia’s inflation data surpassed expectations has also reinforced another layer of positive feedback loop in the Aussie dollar which in turn may put Australia’s central bank, RBA on a “hawkish guard” against cutting its policy cash rate too soon.
The less lagging monthly CPI Indicator has risen to an annualized rate of 5.6% in September, above consensus estimates of 5.4%, and surpassed August’s reading of 5.2% which has translated into a second consecutive month of uptick in inflationary growth.
In the lens of technical analysis, a potential bearish configuration setup has emerged in the EUR/AUD cross pair from a short to medium-term perspective.
Fig 1: EUR/AUD medium-term trend as of 25 Oct 2023 (Source: TradingView, click to enlarge chart)
Even though the price actions of the EUR/AUD have been oscillating within a major ascending channel since its 25 August 2023 low of 1.4285 and traded above the key 200-day moving average so far, the momentum of this up movement is showing signs of bullish exhaustion.
Yesterday (24 October) price action ended with a daily bearish reversal “Marubozu” candlestick coupled with the daily RSI momentum indicator that retreated right at a significant parallel resistance in place since March 2023 at the 65 level which suggests a revival of medium-term bearish momentum.
EUR/AUD bears are now attacking the minor ascending support
Fig 2: EUR/AUD minor short-term trend as of 25 Oct 2023 (Source: TradingView, click to enlarge chart)
The EUR/AUD has now staged a bearish price action follow-through via the breakdown of its minor ascending support from its 29 September 2023 low after a momentum bearish breakdown that was flashed earlier yesterday (24 October) during the European session as seen from the 4-hour RSI momentum indicator.
Watch the 1.6700 key short-term pivotal resistance (also the 50-day moving average) for a further potential slide toward the intermediate supports of 1.6460 and 1.6320 in the first step.
On the other hand, a clearance above 1.6700 invalidates the bearish tone to see the next intermediate resistance coming in at 1.6890.
GigXR partners with NUS Medicine to deliver holographic clinical scenarios for gastroenterology training
GigXR, Inc., a global provider of holographic healthcare training, announced today its partnership with the Yong Loo Lin School of Medicine, National University…
GigXR, Inc., a global provider of holographic healthcare training, announced today its partnership with the Yong Loo Lin School of Medicine, National University of Singapore (NUS Medicine), one of the world’s leading medical schools, to introduce a new gastrointestinal module for the award-winning HoloScenarios application. Created to better prepare medical and nursing students in diagnosing and treating acute gastrointestinal diseases, HoloScenarios: Gastrointestinal delivers evidence-based, robust clinical simulations that present hyperrealistic holographic simulated patients and medical equipment to be used in any physical learning environment, accessed anywhere in the world.
Credit: Yong Loo Lin School of Medicine, National University of Singapore (NUS Medicine), and GigXR
GigXR, Inc., a global provider of holographic healthcare training, announced today its partnership with the Yong Loo Lin School of Medicine, National University of Singapore (NUS Medicine), one of the world’s leading medical schools, to introduce a new gastrointestinal module for the award-winning HoloScenarios application. Created to better prepare medical and nursing students in diagnosing and treating acute gastrointestinal diseases, HoloScenarios: Gastrointestinal delivers evidence-based, robust clinical simulations that present hyperrealistic holographic simulated patients and medical equipment to be used in any physical learning environment, accessed anywhere in the world.
Going beyond linear step-based training traditionally seen with virtual reality (VR), HoloScenarios: Gastrointestinal uses mixed reality (MR) to simulate the entire patient journey, while including branching logic to catalyze variance in learning experiences. From taking basic medical history to performing invasive testing and emergency procedures, the new module empowers learners to master vital medical decision-making and manual skills as they would see them in real-life clinical scenarios and patient care.
HoloScenarios: Gastrointestinal is created in collaboration with renowned medical professionals and educators from NUS Medicine who specialize in the fields of Gastrointestinal (GI) Surgery and holographic medical training. The module is delivered by the Gig Immersive Learning Platform, the enterprise-scale platform enabling the creation, curation, and sharing of immersive training applications and modules made by the world’s preeminent healthcare institutions and MR developers.
“Gastrointestinal pathologies can be complex and challenging to diagnose. This module will allow learners to form a deeper understanding and appreciation of the gastrointestinal tract, especially the three-dimensional understanding of anatomy and body functions,” said Associate Professor Alfred Kow Wei Chieh from the school’s Department of Surgery and Assistant Dean (Education) at NUS Medicine. “We believe mixed reality is the next evolution in healthcare training, and collaborating with immersive platform innovators like GigXR helps us to bring this vital content to more learners globally and, ultimately, improve patient care.”
With international medical and surgical credentials that include MBBS (S’pore), M Med (Surg), FRCSEd (Gen Surg), FAMS, and FACS, Associate Professor Kow has trained thousands of healthcare professionals and advanced surgical fellows. He received the 2023 REAL Advancing in Liver Transplantation Award for his contributions to global liver transplantation education and is a founding member of The Holomedicine® Association.
“GigXR has one of the most advanced and comprehensive platforms in mixed reality, especially in medical training, and enables the exchange of developments, innovation, and expertise with a wider community across Asia and beyond,” added Associate Professor Kow. He is also the Head and Senior Consultant of the Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, at Singapore’s National University Hospital (NUH), the teaching hospital of NUS Medicine.
The new module also delivers enhanced realism in training learners to more accurately diagnose and treat acute gastrointestinal diseases. Whereas VR has been widely used in gastroenterology training for linear step-based skills, such as in endoscopic procedures, it is limited in its ability to simulate fully realized clinical scenarios. Holographic patient simulation in MR merges hyper-realistic holograms in physical learning spaces that accurately reflect the clinical environment and tools with which learners will care for real patients.
With HoloScenarios: Gastrointestinal, learners can interact with the holographic simulated patients, holographic medical equipment, instructors, and each other. This allows them to master both technical and soft skills, such as patient empathy and team communication, in hyper-realistic, safe-to-fail environments that reduce cognitive load. If the holographic patient displays the need for further care, such as a definitive surgery, learners can discuss a definitive treatment plan.
To gain a deeper evaluation of outward symptoms, co-located learners can safely walk around the patient hologram that is displayed on top of their real-world surroundings. Whereas VR locks learners into a virtual “box,” MR enables clear visibility and awareness of physical surroundings. This allows learners to move freely without fear of physical collisions and safety so they can fully focus on learning key gastrointestinal treatment, diagnostic, and communication skills with peers and instructors.
“In healthcare, educators are not only trying to help learners master and retain vital knowledge, but recall and apply it when a patient’s life may be at risk,” said Dr. Gao Yujia, MBBS (S’Pore), MRCS, FRCSEd, Consultant and Assistant Group Chief Technology Officer at Singapore’s National University Health System, and Vice Chairman of The Holomedicine® Association. “With HoloScenarios: Gastrointestinal, learners will have the ability to not only visualize the presentation of a given disease in 3D but better understand how to apply key learnings in the clinical context and within team environments.” Dr Gao is also the Director of Undergraduate Medical Education for Surgery at NUS Medicine.
With scenarios across gastrointestinal pathologies that include gastrointestinal bleeding, intestinal obstruction, and chronic liver failure, learners can master complex and potentially critical situations. They can learn, for example, how to stabilize patients who are dehydrated, bleeding, or septic, as well as the types of diagnostic procedures that may then be required to get a definitive diagnosis. Using mixed reality headsets or any Android, iOS smartphone or tablet, learners can access HoloScenearios: Gastrointestinal from anywhere for remotely distributed, yet highly immersive simulation.
“Immersive technology has accelerated the sharing of expertise for teaching, training, and simulation. Mixed reality, with its natural propensity to facilitate hyperrealistic, safe, and collaborative learning, continues to accelerate both the quality and scale of training outcomes,” said Jared Mermey, CEO of GigXR. “We are immensely proud to partner with NUS Medicine which has been at the forefront of adopting mixed reality in both clinical and educational use cases. By bringing their esteemed expertise onto our platform with the co-creation of HoloScenarios’ newest module, we believe clinical breakthroughs in diagnosing and treating gastrointestinal diseases will take a giant leap forward.”
Designed specifically for pedagogy, the Gig Immersive Learning Platform is trusted by over 70 enterprise-scale healthcare institutions across four continents to build full immersive curricula utilizing a robust content catalog – all of which is managed from a single dashboard. Third-party content developed by leading 3D medical partners, including DICOM Director, 3D4Medical by Elsevier, and ANIMA RES, seamlessly integrates with the platform to provide complementary, in-depth anatomy applications that empower learners with a broader physical context for the pathologies that they study.
“The Gig Immersive Learning Platform has quickly become the premier educational, social network for sharing healthcare training expertise in the immersive format, spanning global healthcare institutions and the Department of Defense to content developers and enterprises large and small,” said David King Lassman, Founder of GigXR. “HoloScenarios: Gastrointestinal marks the latest milestone in our rapidly expanding catalog, which now boasts a dozen different licensable training modules that span holographic simulated patients, clinical scenarios, anatomy, pathophysiology, and 3D medical imaging.”
NUS joins the University of Cambridge and Cambridge University Hospitals (CUH) NHS Foundation Trust, University of Michigan, and Morlen Health, a subsidiary of Northwest Permanente, P.C., as the world-class institutions partnering with GigXR to co-create holographic healthcare training. These simulations include modules centered around Respiratory diseases, Basic Life Support, Advanced Cardiac Life Support, Neurology scenarios, and now, with NUS, Gastrointestinal diseases.
GigXR and NUS Medicine plan to launch HoloScenarios: Gastro in Spring 2024. For more information on GigXR, visit GigXR.com or email sales@gigxr.com. For more information on NUS, visit nus.edu.sg.
Public support for extending the 14-day rule on human embryo research indicated by foundational dialogue project
The findings of a foundational UK public dialogue on human embryo research are published today, Wednesday 25th October 2023, as part of the Wellcome-funded…
The findings of a foundational UK public dialogue on human embryo research are published today, Wednesday 25th October 2023, as part of the Wellcome-funded Human Developmental Biology Initiative (HDBI). The HDBI is an ambitious scientific endeavour to advance our understanding of human development. The dialogue project, which was co-funded by UKRI Sciencewise programme, engaged a diverse group of the public to consider how early human embryo research can be used to its fullest, the 14-day rule and the fast-paced field of stem cell-based embryo models.
Credit: Dr Matteo Molè (Babraham Institute)
The findings of a foundational UK public dialogue on human embryo research are published today, Wednesday 25th October 2023, as part of the Wellcome-funded Human Developmental Biology Initiative (HDBI). The HDBI is an ambitious scientific endeavour to advance our understanding of human development. The dialogue project, which was co-funded by UKRI Sciencewise programme, engaged a diverse group of the public to consider how early human embryo research can be used to its fullest, the 14-day rule and the fast-paced field of stem cell-based embryo models.
Headline findings include:
Appetite for review of the 14-day rule: Participants recognised that extending the 14-day rule could open up ways to achieve benefits in fertility and health, with participant support for reviewing this, including national discussion.
Confidence in regulation: There was a high level of confidence in how human embryo research is regulated, despite a low level of awareness of the regulators and statutes themselves. This included strong desire to see robust regulation governing any changes to the 14-day rule and further regulation for the use of stem cell-based embryo models.
Support for improved fertility and health outcomes: The strongest hopes for future human embryo research were where new knowledge would deliver improvements in understanding miscarriage, preventing health conditions such as spina bifida and raising the success rates of IVF procedures.
Concerns about genetically engineering humans: The public expressed concerns on the application of developments in this field to genetically alter or engineer humans.
The dialogue engaged a group of 70 people broadly reflective of the UK population in over 15 hours of activities including a series of online and face-to-face workshops with scientists, ethicists, philosophers, policy makers and people with relevant lived experience (such as embryo donors from IVF procedures).
Dr Peter Rugg-Gunn, scientific lead for the HDBI and senior group leader at the Babraham Institute, said: “Recent scientific advances bring incredible new opportunities to study and understand the earliest stages of human development. To ensure this research remains aligned with society’s values and expectations, we must listen and respond to public desires and concerns. This public dialogue is an important first step and as a scientist I am reassured by the findings but there is still a long way to go to fully understand this complex issue.”
The report is exceedingly timely, following notable scientific advances in human developmental biology presented at conferences and in leading scientific journals in recent months. As well as generating excitement in scientific fields and with the public, announcement of these breakthroughs also prompted some concerns and criticisms, with the view that these findings raised significant ethical issues. The dialogue provides insight into public considerations following deliberation on early human embryo research. The hope is that it will act as a foundational reference point that others in the sectors can build upon, such as in any future review of the law on embryo research.
Professor Robin Lovell-Badge, co-chair of the HDBI Oversight group, senior group leader and head of the Laboratory of Stem Cell Biology and Developmental Genetics at the Francis Crick Institute, said: “We have learnt a lot about human development before 14 days, but there are areas of investigation that could change how we understand development, and associated diseases, that lie beyond our current window of knowledge. Despite low awareness of current laws, members of the public quickly recognised many of the critical issues researchers are keenly aware of when it comes to growing embryos beyond the current limit. This dialogue also reinforced the fact that the public are in support of research that will yield better health outcomes, and in this case, increase the success of IVF procedures.
Other countries will be looking to the UK to see how we deal with the 14-day rule; we are not there yet with any mandate to make a change, but this does give a strong pointer. The next step will be to delve deeper into some of the topics raised through this dialogue as they apply to specific areas of research, as well as feeding into policy changes.”
The 14-day rule and the regulation of stem cell-based models
When considering the regulation of research involving human embryos, the dialogue explored participant’s views on the 14-day rule. Introduced in 1990, the 14-day rule is a limit enforced by statute in the UK. It applies to early human embryos that are donated by consent to research and embryos that are created for research from donated sperm and eggs. It limits the amount of time early human embryos can be developed in a laboratory for scientific study to 14 days after fertilisation. Due to technical advances, it is now possible to grow embryos in the lab past 14 days, but researchers are not allowed to by the law. If the law changed, it would open up this ‘black box’ of development with researchers able to investigate this crucial time in development from 14-28 days after fertilisation.
Professor Bobbie Farsides, co-chair of the HDBI Oversight group and Professor of Clinical and Biomedical Ethics at the Brighton and Sussex Medical School, said: “It has been a fascinating experience to support HDBI in the undertaking of this exercise. I commend the participants for the care and mutual respect they have shown throughout. Their engagement and commitment to a subject few of them had previously considered allowed for a wide range of views to be expressed and considered. I hope the scientists involved will be encouraged by the high level of interest in their work, and will want to keep the public conversation going around these important subjects.”
The dialogue included participant discussion on what a change to the 14-day rule might look like, and identified points that should be considered, such as defining what the benefits of extending the rule would be and potential mis-alignment with human embryo research regulations in other countries.
Participants acknowledged the astonishing possibilities of stem cell-based embryo models. The majority of participants would like to see these models further regulated. Work in establishing potential governance mechanisms is already underway. In recognition of the need for additional guidance and regulation in this area, the Cambridge Reproduction initiative launched a project in March 2023 to develop a governance framework for research using stem cell-based embryo models and to promote responsible, transparent and accountable research.
Future steps
A key outcome from the public dialogue is the identification of areas for further exploration, with participants proposing how future national conversations might be shaped. It is hoped that the project acts as a reference base for both widening engagement with the subject and also prompting deeper exploration of areas of concern.
Dr Michael Norman, HDBI Public Dialogue coordinator and Public Engagement Manager at the Babraham Institute, said: “This dialogue shows that people want the public to work closely with scientists and the government to shape both future embryo research legislation and scientific research direction. It is crucial that others in the sector build on these high quality, two-way engagement methodologies that allow for a genuine exchange of views and information to ensure that the public’s desires and concerns are listened to and respected. Transparency and openness around science is vital for public trust and through this we, as a society, can shape UK research in way that enriches the outcomes for all.”
Public Participant (Broad public group, south) said: “I do think that an extension of this public dialogue, and educating a wider society has a benefit in itself. This is really complex and sensitive and the wider you talk about it before decisions are made, the better.”
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