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Unlocking the full potential of healthcare with software research at Lero

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Researchers at Lero are discovering how software engineering can help healthcare catch up to the digital age.

Our world is one where healthcare revolutions come in many forms. Penicillin, insulin, vaccination, the discovery of DNA – the list goes on. All of them have shaped the way we conceptualise and treat our bodies, and the way clinicians treat their patients. The field of medicine is rapidly advancing, and yesterday’s science fictions are now in early trials.

What, then, is the role of Lero, the Science Foundation Ireland research centre for software? Hosted by the University of Limerick, Lero’s research covers everything from driverless cars and artificial intelligence to cybersecurity, fintech, gov-tech, smart communities, agtech and health-tech.

But what can software engineering and computer programming offer healthcare? Connection, digitisation and integration are just some of the benefits.

‘I talk about technology supporting, not replacing’
– PROF ITA RICHARDSON

Lero researchers have a plethora of health problems they would like to solve with software. A recent example involved a public health nurse arriving to check on an elderly patient. Of the 15 minutes assigned to the visit, thirteen minutes were spent recording the details required for a new mattress. After taking down this information, later to be transcribed to an online system, the nurse did what she could for the patient in the short time left.

The following day, the nurse was shopping and noticed a shipment of bread being delivered. The barcodes had all of the information needed for the process and were quickly scanned with a handheld device. Why did this similar process take less than 10 seconds, while the health system had no such ability? Why not scan the mattress, and send this information to the system?

For all of our amazing advances, there is a disconnect that hampers our healthcare. Technology is of no help if the user doesn’t have sufficient access. A profile of health problems is futile if it is stored on an inaccessible paper file. A treatment plan for a brain disorder lacks efficacy when it is misplaced or, worse still, never recorded for a patient. A doctor can’t analyse information they never received. And this is all too often the world we live in.

Our healthcare system is handicapped not by a lack of understanding or ability, but by inadequate communication systems that can’t cope with the volume or sophistication that must be accommodated. For Lero, software is the answer.

An ear for surgery

Our world is one where sound is abundant with information. Auditory analysis can map the seabed. The depth of a turkey’s ‘gobble’ might infer how many kilograms it weighs. And, most importantly to mechanical and medical engineer Dr Daniel Riordan, sound can tell a surgeon when to stop scooping bone marrow from a femur.

When a hip is being replaced, the ball of the ball and socket joint is sawn off. Its replacement is put in, and a stem is inserted into the femur to attach it. If the stem is inserted directly into the soft marrow, there will be some wobble and an instability in the hip. As a result, it is necessary to scrape out the marrow until the stem can be secured. If too little marrow is taken out, the hip won’t be secure. Too much, and the bone will crack.

Currently, surgeons performing a hip surgery replacement know when to stop by the sound and feel of the instrument inside the bone. There’s no precise measurement or feedback system. No exact way to know when the surgery is finished. There is just a sense from the tactile and auditory feedback, honed from years of experience.

New medical students practise with fake limbs before levelling up to pig bones (the closest animal analogue) and then onto human cadavers before finally taking the reins in the operating theatre.

Dr John Rice is an orthopaedic surgeon with years of experience in the process, and Lero’s team hope to replicate his ear in software. By recording auditory information as well as the level of success of the surgery, Riordan hopes to replicate this feedback system and empower other surgeons with Rice’s finely tuned experience.

‘The real research is the AI to make this work, to understand every bone and every person’
– DR DANIEL RIORDAN

Capturing Rice’s inherent knowledge of hip surgeries has the potential to save years of surgery training. But giving software this auditory intuition isn’t easy. Hips vary. People vary. Some are taller, some are wider, some are older. All of these factors affect the acoustics of the bone as if it was a musical instrument. Capturing the variation requires as many surgeries as possible. Riordan reckons it would take 100 participants for the software to be effective but the more, the better.

“The real research is the artificial intelligence to make this work, to understand every bone and every person. This project has a duration of four years, and if we find positive results, we would be looking at contacting teams that make surgical robots,” said Riordan.

Paging Dr Google

Our world is one where the knowledge gap between doctor and patient hinders both sides. Patients will try to help a doctor understand their situation in as much detail as they know to provide, but doctors are often left playing medical detective, picking up what they can in an effort to provide cure, care or both.

The more driven patients will take to Google to self-diagnose and speed the process along, as well as advocate for themselves. Practitioners, in response, will fall into one of two camps: those who dismiss the search results as unreliable, and those who parse through the information and evaluate through a medically trained lens.

From a doctor’s perspective, the problem with Google is multi-layered. Its search algorithm is not optimised for accuracy or balance. What’s more, many of the articles will be inaccessible due to medical jargon.

Lero is working to close this patient-doctor information gap. Dr Marco Alfano’s objective is to design an intelligent platform that will empower patients to act as their own advocate. This involves translating existing medical texts so they can be understood, and filtering existing web search results with an algorithm that reflects a patient’s needs, rather than a commercial driving force. It also involves fostering a medical understanding, as well as patient-to-patient relationships, and connecting communities.

As Alfano points out, very few of these needs even require innovation. What’s needed is a coherent design that can be given to patients. The technology is already there, if only it can be integrated.

He and his research team have been working on a prototype website. He types ‘diabetes’ into the custom search engine and the results are ranked on various degrees of accuracy and quality, with the logic of their ranking explained. He then takes this information and feeds it into the team’s text translator. Difficult words are highlighted and a brief explanation of tricky medical terminology is included. Medical files, textbook definitions and doctor’s comments suddenly make sense. He brings up a diagram of the human body, where he can point and click and assign an ailment in an effort to diagnose.

The technology is there. The knowledge is there. And integration could mean diagnosis and treatment is within reach.

Patient-led design

Sometimes the practice of healthcare is older than the technologies and techniques that comprise the system. Digital imaging files and results from advanced analytical techniques are often kept on paper. Physical space constraints can mean that the file is all too often out of reach when needed. Patients’ voices, if heard at all, are lost to mountains of paperwork and a system not yet digitised.

Lero’s work, however, is distinctly patient-driven. This philosophy is no more prominent than in the research conducted by Prof Ita Richardson and Dr Jim Buckley.

Richardson works on software processes for groups in need. These have included diabetics, people with mild intellectual disabilities, and the ageing population. By talking to these cohorts alongside their medical professionals, Richardson hopes to build apps that reflect what people need, rather than what software producers think they need. She acknowledges that many patient-generated apps have been amazing, but often fail to comply with EU regulations surrounding data safety and accessibility. And as these accessibility guidelines are more than 100 pages long, it is easy to understand why.

A man in a blue check shirt smiles as he leans with his back against a large tree.

Dr Jim Buckley. Image: Alan Place/Fusionshooters

Once data-compliant, patient-led apps have been designed and implemented, Richardson said the benefits are almost immediate. In the case of an app designed to measure a diabetic person’s weight, blood pressure and glucose levels, patient outcomes improved purely through the process of recording data and visualising it in graphs. By seeing how their blood sugars improved after a walk or with a healthier meal, patients implemented their own interventions.

Even the simple act of recording the data is valuable. And Richardson said the goal would be to feed this data back to the doctors to reduce the visits necessary and relieve stress on both patient and doctor contact hours.

“I talk about technology supporting, not replacing,” said Richardson. “Diabetes patients need to meet with their doctor for medical assessment. That’s different than needing to have their blood pressure checked every six weeks. They need to work out medically how often they need to meet.”

Reaching out to the relevant groups, fostering relationships and getting real-life patient feedback is key to what researchers call PPI: public and patient involvement. Through this process, needs can be understood, accounted for and integrated. It can also take researchers down unconventional routes.

Richardson told me of one colleague working with mastectomy patients who joined the Shannon Dragons, a group of Dragon Boat rowers. Rowing is particularly beneficial to those who have undergone mastectomies as the upper body and arm workout is essential to rehabilitation.

‘One of the big battles is adoption’
– DR JIM BUCKLEY

Buckley, on the other hand, is involved in the Covigilant project to evaluate the Irish public’s attitude to the Ireland’s Covid-19 tracking app. He and his team have been seeking out the public’s opinion on different aspects of the app. What works well and what doesn’t? What are their worries? What would they like to see implemented? They have no hypothesis or point to prove – their work simply aims to find out how people genuinely feel about the app on their phone.

The Covid Tracker Ireland app is likely the healthcare app people have become most familiar with. Developed by Waterford company Nearform for the Irish Government’s Health Service Executive (HSE), there is no weightier example of an app coming from the top down.

“One of the big battles is adoption. You want to get people adopting it, and people using it,” said Buckley. “My job isn’t to coerce people to use it, but to evaluate how it is perceived and see best international practice. And to feed that information back to the HSE so that they can consider the insights for future evolutions of the app.”

The first results of the Covigilant study found that 82pc were supportive of the app and intended to download it. The study also revealed fears, largely around data protection and privacy. However, after deployment, user reviews on the Apple and Google Play stores indicated that the public’s perception of the app, in terms of data protection, was favourable.

Lero researchers continued to seek people’s opinions in order to configure the app moving forward, often with interesting insights.

The Covid-19 tracker app isn’t without its flaws. An earlier iteration saw it draining the battery of thousands of Android phones, which was a big blow to adoption. A fix was applied within days, however, and the real strength of integrated health came to the fore.

While old systems can exist for decades with delays and issues, Lero hopes to put patient needs first and fully utilise every opportunity on offer. They hope to revolutionise healthcare using what is already there – the software that can unlock its full potential.

By Sam Cox

Sam Cox was named the science and technology winner in the 2020 National Student Media Awards (Smedias). This award category is sponsored by Science Foundation Ireland and includes a €1,000 bursary to support and encourage up-and-coming science and technology journalism.

The 2021 Smedias are now open for entries. The deadline for applications is 15 April 2021.

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Bitcoin price back above $40,000 after Elon Musk comments | Bitcoin

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The price of bitcoin hit a three-week high on Monday, climbing back above $40,000 after Elon Musk said that Tesla would resume allowing transactions made in the digital currency once crypto mining becomes greener.

The electric car company’s latest change of direction on its acceptance of bitcoin once again highlighted the continuing ability of Tesla’s billionaire chief executive to influence the price of bitcoin and other cryptocurrencies.

“When there’s confirmation of reasonable (~50%) clean energy usage by miners with positive future trend, Tesla will resume allowing bitcoin transactions,” Musk said in a tweet on Sunday.

The price of one bitcoin climbed to a high of $41,033 (£29,063) on Monday before slipping back to $40,580, still up more than 12% from its price before Musk’s tweet.

Musk, one of the most high-profile proponents of cryptocurrencies, also said that Tesla sold about 10% of its holdings to confirm bitcoin could be liquidated easily without moving the market.

He announced in May that Tesla would no longer accept bitcoin for car purchases, citing long-brewing environmental concerns for a swift reversal in the company’s position on the cryptocurrency. In February, Tesla revealed it had bought $1.5bn of bitcoin and would accept it as a form of payment for cars. But the cryptocurrency’s production is at odds with the company’s mission toward a “zero-emission future”.

Bitcoin fell more than 10% after Musk’s tweet in May. He said that he believed cryptocurrency had a promising future but it could not be at great cost to the environment.

The energy used to produce bitcoin alone is equivalent to the annual carbon footprint of Argentina, according to the Cambridge Bitcoin Electricity Consumption Index, a tool from researchers at Cambridge University that measures the currency’s energy use.

Bitcoin mining – the process in which a bitcoin is awarded to a computer that solves a complex series of algorithms – is deeply energy-intensive. Because there is a finite number of bitcoins that can be mined – 21m – computers have to solve harder and harder algorithms in order to get bitcoin. The special equipment and intense processing power use a lot of electricity – as much as some entire countries.

The concerns over energy use aside, cryptocurrencies have split opinion among investors and financial regulators for other reasons, including the rollercoaster ride sparked by their frequent swings in price.

Despite bitcoin’s recent rise, it is still trading about a third lower than the record high of $63,000, which it reached in April. A year ago, bitcoin’s value was under $9,500.

Earlier in June, the Central American country of El Salvador became the first in the world to adopt bitcoin as legal tender, as part of its technology-loving president’s proposals to use the cryptocurrency to promote “financial inclusion”, investment and economic development.

However, others remain unconvinced, and cryptocurrencies remain controversial. Global regulators are sceptical, on account of their volatility and vulnerability to theft or hacking.

The Bank of England has previously warned that the rise of digital currencies could set off a flood of withdrawals from high-street banks, risking financial stability and the wider economy, and cautioned that investors risk losing their money.

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According to various measures, bitcoin is undervalued at current prices, said Alexandra Clark, a sales trader at the digital asset broker GlobalBlock, although she added: “Many analysts are still on the fence when it comes to determining whether the digital asset is ready to continue its uptrend.”

Tesla’s decision to sell 10% of its bitcoin holding “has brought about fresh accusations of pumping and dumping by Musk and reiterated the need for an investigation by the SEC [US Securities and Exchange Commission],” Clark said.

The US securities watchdog warned Tesla last year that Musk had twice violated a settlement requiring his tweets and material public communications to be preapproved by company lawyers, the Wall Street Journal reported at the start of June.

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Price-capped broadband on hold for New York State after judge rules telcos would ‘suffer unrecoverable losses’ • The Register

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A new law due to come into force tomorrow that would force broadband providers in New York State to provide net access to low-income households for $15 a month has been put on hold.

A preliminary injunction [PDF] was granted by United States District Judge Denis R Hurley on Friday after a string of trade bodies – including the New York State Telecommunications Association and The Broadband Association – launched the action on behalf of their members.

The ruling notes that telcos and ISPs forced to impose the price caps would “suffer unrecoverable losses increasing with time” and that the “bulk of these losses will stem from lost income.”

“While a telecommunications giant like Verizon may be able to absorb such a loss, others may not: the Champlain Telephone Company, for example, estimates that nearly half [approximately 48 per cent] of [its] existing broadband customers will qualify for discounted rates,’ with each such customer ‘caus[ing] a monetary loss’,” it states.

The legal action also highlighted that not only would telcos lose revenue by offering cut-price access, they would also incur additional costs associated with increased spending on advertising.

In April, New York Governor Andrew Cuomo put his name to legislation that would force operators in the state to offer $15 a month high-speed internet to low-income families across the state.

The legislation also made it a legal requirement for operators to inform the authorities about their broadband products and prices, and how many had taken up the offers.

In all, it was estimated this change would impact seven million New Yorkers and some 2.7 million households.

At the time, Governor Cuomo said the need for remote access to work, education, and healthcare – which had been brought into sharp focus by the pandemic – had underlined the “need to make sure every household has access to affordable internet.”

“This program – the first of its kind in the nation – will ensure that no New Yorker will have to forego having reliable home internet service and no child’s education will have to suffer due to their economic situation,” he said.

US telcos in the crosshairs of the enforced price cap were quick to challenge the legislation, pointing out, among other things, a temporary $50-a-month discount being offered to households as part of a federal benefit.

In a 19-page lawsuit filed on 30 April, the industry lined up to say that they’re already doing their bit to help close the digital divide including offering cut-price tariffs to people on low incomes.

They also claim that New York is acting beyond its jurisdiction.

“In short, New York has overstepped its regulatory authority,” lawyers acting on behalf of the telcos said in their lawsuit.

Governor Cuomo hit back almost immediately and in a statement on the same day as the 30 April lawsuit said: “I knew giant telecom companies would be upset by our efforts to level the playing field, and right on cue, they’re pushing back. This is nothing more than a transparent attempt by billion-dollar corporations putting profit ahead of creating a more fair and just society.”

Fast-forward to this week and the decision to grant a temporary injunction halting the introduction of the $15-a-month broadband cap has left many wondering what happens next.

In a statement, US Telecom said: “The broadband industry is committed to working with state and federal policymakers on sustainable solutions that will serve the needs of all low-income Americans. While well-intended, the state’s law ignored the $50 monthly broadband discount Congress enacted, as well as the many commitments, programs and offerings that broadband providers have made for low-income consumers.” ®

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Sweden’s Vässla raises $11m for its e-bike rental service

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The company is building a subscription service for its micromobility vehicle, which is a cross between a moped and a traditional e-bike.

Vässla, a Swedish micromobility start-up, has raised $11m in fresh funds to expand during the increasing demand for e-bikes.

The Stockholm-based company initially launched with e-mopeds and is now launching an e-bike with a club-like subscription model.

Vässla Club will target individuals, delivery drivers and businesses like hotels and holiday resorts with a subscription model to access its e-bikes with fleet management features built in for businesses.

The round of funding was led by Swedish investment firm Skabholmen Invest with eEquity contributing to the round.

The company is running trials in the Scandinavian market with further trials pencilled in for Berlin, Vienna, Hamburg and Madrid. It is also planning a UK launch once legislation around e-scooter and other electric micromobility vehicles has been introduced beyond the current trial stages across the country.

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Vässla designed its bikes in-house and describes it as a midway point between a moped and an electric scooter. It has a maximum speed of 25km/hr and battery range of 40km.

The company was founded by chief executive Rickard Bröms over his frustration with commuting and a mission to reduce dependency on privately owned cars.

“The problem with electric pedal bikes is that your morning commute becomes a workout session – you arrive at work or at your important meeting sweaty and tired. It’s really no better than using packed trains or buses,” Bröms said.

The new iteration of its bike is lighter but capable of multiple trips a day, he added.

“The investment, which will help us launch Vässla Club, and expand into other territories, comes at a very exciting time and we are very much looking forward to seeing how the attitudes of the general public towards micromobility will change over the next few years.”

Wilhelm Pettersson, CEO of lead investor Skabholmen Invest, said that it invested in the company as it believes the “future of urban planning will exclude personal cars”.

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