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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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Chinese developers rebel against 996 working hours culture • The Register

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Chinese software developers have crowdsourced a spreadsheet that dishes the dirt on working conditions at hundreds of employers.

Dubbed WorkingTime, the protest aims to offer transparency regarding how many work hours are expected. Many organisations expect 72-hour working weeks – an arrangement dubbed “996” after the 9am to 9pm, six days a week culture in place at many Chinese companies.

The practice has sometimes been promoted by the rich and famous: Alibaba’s Jack Ma publicly stated that employees should actually want to work long hours and a job you love enough to spend that much time doing is a “blessing”.

Chinese courts take a different view. A recent decision found 996-style hours aren’t permissible, as Chinese law caps overtime at 36 hours per month and requires compensation for the extra hours. But China is not a workers’ paradise, and the practice persists because oversight is limited and independent labour unions are illegal in the Middle Kingdom.

The WorkingTime project aims to assist developers looking for work to understand what they’re signing up for.

“The opacity of working hours in some companies, working time is a very important factor in choosing an offer,” wrote a movement founder on Chinese Q&A site Zhihu.

The spreadsheet in which workers record how many hours they work a week, job descriptions, breaks and other remarks strongly suggest that grueling hours remain at some workplaces. Others stick to a 40-ish hour working week and add perks like happy hours and subsidized housing.

The anecdotes, visible on an openly accessible spreadsheet associated with the project, provide a similar service for Chinese tech workers to web pages like Glassdoor – giving tips on company culture and requirements.

Some remarks include:

  • “I often go on business trips. I have been on business for half of a month. I leave work after 10 o’clock every night at the customer’s site. I have to work overtime on weekends. The entire department has worked for two years except for the leaders.”
  • “Feel free to ask for leave and lunch time, because it’s the field work, whether you are in the company or not, and you can play games casually, regardless of the leader. If you drink too much, it’s fine if you don’t come.”
  • “Mandatory to keep people on duty every night, compulsory all staff to work overtime every Saturday, no overtime pay, working hours over 10 hours.”
  • “When the daily work cannot be completed, it is necessary to work overtime at home.”
  • “The work pace is fast and the work content is highly saturated. Flexible commute, just do everything.”

The WorkingTime project has gone viral, with the founders reporting over ten million views and thousands of entries as of last Tuesday. While the founders remain anonymous, contributors hail from a diverse subset of companies that includes some of China’s big tech giants like Alibaba, Tencent, Huawei and Bytedance, as well as multinational companies such as SAP, Dyson, Intel and IBM.

According to the project’s GitHub page, lawyers are currently pitching in to sort out legal issues prior to making the project freely downloadable. However, a summary table of data collated daily is already available in Chinese.

Unsurprisingly, the project has stirred some ire. The founders have asked that participants do not apply for editing permission, explaining that “due to malicious editing” such privileges will not be granted. ®

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Johnson & Johnson Ireland moves to 100pc renewable electricity

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The move comes following a power purchase agreement between Johnson & Johnson and Ørsted, which has windfarm sites in Clare and Kerry.

Johnson & Johnson has revealed plans to move to 100pc renewable electricity across its Irish operations.

The company has entered into an eight-year corporate power purchase agreement in Ireland with Danish company Ørsted. The agreement will help to ensure that the company’s entire Irish operations will be powered by electricity from 100pc renewable sources from now on.

Ørsted will supply the company with more than 1TWh of renewable energy during this period from two windfarms located in Kerry and Clare. The agreement will also help Ørsted as it invests in its strategy to construct more renewable generation in the future.

Taoiseach Micheál Martin, TD, praised the move in the context of Ireland’s climate action plans.

“Johnson & Johnson has embraced its environmental responsibilities globally, but also here in Ireland, and this agreement will help the company to achieve its wider climate goals. We are at a crucial point in the global fight against climate change and initiatives like this should become the benchmark for all companies to aspire to,” he said.

Towards net zero

Last year, Johnson & Johnson’s worldwide VP of environmental health, safety and sustainability, Paulette Frank, spoke at Silicon Republic’s Future Human event about the company’s “bold” climate goals. From her base in the US, Frank told attendees of the virtual event that her colleagues viewed the pandemic as “inspiration to propel” its climate action “further faster.”

Sourcing electricity from 100pc renewable sources is a goal the company set to achieve by 2025. By 2030, it wants to achieve carbon neutrality in its global operations.

John Lynch, plant leader at Johnson & Johnson Vision Care Ireland, said the company was proud to have met its targets in its Irish operations.

“Across our 10 sites and workforce of more than 5,000 here in Ireland, we are committed to supporting Johnson & Johnson’s climate action goals. In the last decade we have invested more than €60m in over 80 carbon footprint reduction projects.

“Today is a major landmark on our journey in Ireland to achieve net zero carbon emissions by 2030 and underlines our commitment to ensuring a better, healthier world.”

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‘At once intolerable and addictive’: five wellbeing courses and apps, road-tested | Health & wellbeing

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Australians are the world’s biggest consumers of health and wellness apps, punching well above our per capita weight in our quest for peak physical and mental condition, according to research from telecommunications company Uswitch. In recent years we have also been making them – with everyone from fitness influencers to mental health advocacy groups launching digital products.

I’m partial to a bit of mobile-based movement and mindfulness myself, but I have a complex relationship with wellness. While I love green juices, pilates and my “ness” being “well”, I can’t abide many contemporary uses of the word. In the diet, fitness, fashion and other industries, “wellness” can feel like a barely repackaged “weight loss”, while “healthy” has replaced “slim” as companies respond superficially to the body positivity movement without really changing their ways.

Despite wholesome beginnings in the 1950s, wellness is often framed as a goal for the financially and genetically privileged – and don’t get me started on the pseudoscience.

So I choose cautious cynicism when engaging with wellness and wellbeing products – but I’ve also been alone in my house for the greater part of two years, so I’ll try pretty much anything.

Sweat

Cost: $19.99 a month

Screen shot of the Sweat app from Kayla Itsines.

Sweat is a women’s health app co-founded by Australian fitness influencer Kayla Itsines, who boasts a worldwide social media following of more than 40 million. It offers over 30 programs for training at home or the gym, including high-intensity interval training (Hiit), low-intensity training, yoga and barre.

I did sessions from the PWR Zero Equipment program and it was all easy to follow and very doable. Audio and written instructions and onscreen demonstrations are clear, and self-accountability is super easy. It’s perfect for lockdown and for busy people cramming in exercise wherever and whenever they can. Plus, I can report that burpees are still the merciless work of Satan herself.

Itsines has created an app that exists in the wellness space with little of the self-congratulatory, quasi-spiritual hoopla other influencers lean so heavily into. Sweat isn’t pretending to be something it’s not. It’s a workout app, you do workouts on it. Yes, there are recipes and lifestyle tips but they aren’t offered as miracle pathways to a higher plane of being.

Is it my preferred mode of exercise? No. But it’s convenient and flexible and I can see myself using it when I travel. If that’s a thing that ever happens again.

Worry Time

Cost: Free

ReachOut’s WorryTime app
ReachOut’s WorryTime app. Photograph: Reach Out

ReachOut’s WorryTime is an anxiety management app from the online youth mental health service that uses cognitive behavioural therapy (CBT) techniques to disrupt and manage repetitive thinking.

I am by no definition a youth, but I have mild anxiety and WorryTime’s methodology appealed to me. You nominate a daily time to do all your worrying and when you feel anxious, you note why in the app; every day at the designated time, you worry about what’s still plaguing you and delete what’s not. Easy!

I used WorryTime diligently for a while, noting my fears, my troubles and doubts and reassessing them every 24 hours. All was going well until I got busy with work, stressed about work and scared I’d stop getting work. Where the app had been a welcome task, it became a bugbear.

I was trying not to think about things that made me anxious and knowing the app contained a list of them created a classic avoidance paradigm. I skipped a day. And the next day. And the day after that. Soon the WorryTime alarm was causing me the very anxiety it was engaged to minimise. After a few weeks of this mental chicken-egg dance, I deleted the app. I may have been in the foetal position at the time.

I’m not advocating against WorryTime. It could be a great tool for others. There are no one-size-fits-all mental health salves. It would be nice if there were though.

Bibliotherapy with State Library Victoria

Cost: Free

Dr Susan McLaine, host of State Library Victoria’s Bibliotherapy podcast
Dr Susan McLaine, host of State Library Victoria’s Bibliotherapy podcast. Photograph: Supplied

My favourite discovery from this whole exercise is bibliotherapy or book therapy, an age-old practice that uses literature to support better mental health and wellbeing. Basically, you read or are read aloud a prescribed text, specifically chosen to raise questions, uncover truths and encourage healing. It’s also fun to say.

In response to the pandemic, a new podcast called Bibliotherapy with State Library Victoria was launched. Hosted by bibliotherapy practitioner Dr Susan McLaine, it offers to help people “stay calmer in this fragile time”. In each episode, McLaine reads a short story and a poem and poses questions for listeners. Texts range from emerging and obscure writers to Tolstoy, Donne and Kipling.

I love this podcast. There’s something so intimate and soothing about being read to, no doubt embedded in childhood nostalgia. McLaine’s voice takes some getting used to, though to be fair I find this with most podcast hosts, but her choice of texts is excellent and she reads everything slowly and deliberately, “savouring every word and offering space between words”. It’s the closest thing to a hug I’ve had in months.

The only bad thing about it is that there are only two short seasons. After a brief search for similarly soporific, story-based podcasts and apps, I found the excellent Dreamy podcast, a collection of beautiful sleep stories by First Nations storytellers like Jazz Money and Aurora Liddle-Christie. Bringing tens of thousands of years of oral tradition into the digital world, Dreamy is “helping people of all walks of life to quiet their minds, drift into dreams, and disconnect from their devices”.

I also found Sleep Stories on the Calm app ($14.99 a month). It’s full of grown-up tales and mindful nonsense to soothe or bore you into slumber. There are even equally terrible and amazing celebrity cameos: Matthew McConaughey, Cillian Murphy and the hot duke from Bridgerton will read to you like you’re a child. Last night Harry Styles read me the worst poem I’ve ever heard – for 40 minutes. Five stars. Would listen again.

The Resilience Project

Price: $4.49 one time fee

The Resilience Project Wellbeing App.
Photograph: Supplied

The Resilience Project app is a “daily wellbeing journal” for all ages from a Melbourne-based organisation of the same name, providing evidence-based mental health strategies and “sharing the benefits of gratitude, empathy and mindfulness” to schools, sports clubs and businesses.

Users are encouraged to log on every day, note how they feel, record who or what they’re grateful for, perform acts of kindness and do a short guided meditation. This nice daily ritual only takes a few minutes but proves a small antidote to the current news cycle.

I don’t see myself using it long-term, because of repetitiveness and the world’s shortest attention span, but during this lockdown I’ve appreciated the nightly reminder to acknowledge my blessings and privilege and to reach out to friends.

Though it can’t do the heavy lifting where mental health is concerned, I’ll put it in my arsenal of chronic depression coping mechanisms, and try to use it in bad times. It won’t soothe what only drugs and Great British Bake Off can, but it might provide a few minutes respite.

The Class

Cost: $40 a month

The Class Digital Studio is a mat-based exercise program, with elements of yoga, pilates, cardio, free-style dance, expansion, and release.
The Class Digital Studio is a mat-based exercise program, with elements of yoga, pilates, cardio, free-style dance, expansion, and release. Photograph: The Class Digital Studio

The Class is an American exercise methodology-slash-mindfulness practice with semi-cult vibes, taught by a host of ridiculously hot and relentlessly cool twentysomethings who can pull off white Lycra and blend in on a Girls set.

In fortuitous timing, founder Taryn Toomey launched online classes in late 2019, taking the Class into locked down homes around the world from 2020. Australians can access a wide selection of on-demand and live online classes, and there’s even an Australian teacher. Timezone differences narrow live options quite a bit, but most live classes become on-demand classes, so it doesn’t really matter.

Frequented by celebrities including Alicia Keys, Naomi Watts and Emma Stone, the Class is a mat-based, music-driven “cathartic workout experience” designed to “strengthen the body and balance the mind”. It’s yoga meets Les Mills meets clubbing. Movements are simple, repetition is key and loud exhales are encouraged. You may do squats for a whole song, free dance for another and star jumps for the next. In between, there’s stillness.

Teachers speak a kind of motivational psychobabble that is at once intolerable and addictive. It verges on the spiritual and flirts with cultural appropriation but remains just secular enough that I don’t turn it off. “Be in your power”; “You are enough”; “Softness is your birthright” and so on. Many teachers end their sessions with “I love you” which I somehow don’t hate.

At first, I struggled to put aside my prejudices against self-indulgent, pseudo-mystical wellness fads and find peace with beautiful women telling me to accept myself while making me do burpees. But the more I did it, the more I was able to just let go and roll with the theatre. Plus, it’s actually a very good workout.

I am now willingly paying for the Class. Let’s never speak of this again. I love you.

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