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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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Elon Musk’s Twitter lawsuit: what you need to know | Elon Musk

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Elon Musk did not become the world’s wealthiest person through a lack of confidence.

But the Tesla CEO revealed on Tuesday that he had sold $6.9bn (£5.7bn) worth of shares in the carmaker, in case he loses his attempt to walk away from a $44bn takeover of Twitter.

Twitter is suing Musk in Delaware over his abandonment of the deal and wants to make him buy the company.

In a countersuit released last week, Musk put his side of the argument. According to him: Twitter misled investors; it breached the agreement by failing to provide enough information on spam accounts; another breach occurred when Twitter failed to consult with him on business moves such as firing senior employees; and its misstatement of user numbers constitutes a material adverse effect, which substantially alters Twitter’s value and therefore invalidates the deal agreement.

Here is a breakdown of Musk’s suit.

The relationship between both sides remains poor

There is $44bn at stake and the language in Musk’s countersuit is just as punchy as Twitter’s in the original lawsuit, when the company described his behaviour as “a model of bad faith”. In the preliminary statement Twitter is accused of making financial disclosures to the US financial watchdog that were “far from true”.

“Instead, they contain numerous, material misrepresentations or omissions that distort Twitter’s value and caused the Musk parties to agree to acquire the company at an inflated price. Twitter’s complaint, filled with personal attacks against Musk and gaudy rhetoric more directed at a media audience than this court, is nothing more than an attempt to distract from these misrepresentations,” said the lawsuit.

Strong words, but Musk will need strong evidence as well to convince the judge.

Musk’s core argument is about user numbers

From the moment the deal started to go sour, the focus was on the veracity of Twitter’s numbers. It is at the centre of Musk’s countersuit as well. He argues that the number of monetisable daily average users (mDAUs) – authentic, active accounts that can see adverts (hence monetisable) – is falsely inflated by Twitter miscounting the number of false and spam accounts on the platform. As well as being a threat to the ad income on which Twitter depends, Musk said his plan to introduce a subscription service for Twitter would be affected because there would be fewer customers to target than first thought.

Twitter has consistently stated that it estimates the number of false or spam accounts on the platform to be less than 5% of its mDAUs base, which stands at just under 238 million currently.

The suit says that Musk became alarmed about how Twitter accounts for its mDAUs when, three days after signing the deal agreement, it admitted it had overstated its mDAU total for three years, by between 1.4 million and 1.9 million users per quarter. Twitter denies that the user change was a “restatement” (it describes the alteration as “updated values”) but admits it did not give the information to Musk prior to the deal being signed on 25 April.

Musk is not happy with Twitter’s verification processes

After agreeing to buy the business with minimal due diligence, the suit says Musk was “astonished” to learn about how “meagre” Twitter’s processes for identifying spam accounts were. It said 100 accounts a day were sampled by human reviewers in order to come up with the less-than-5% figure. Twitter’s CEO and chief financial officer were unable to explain how these accounts were selected to be a representative sample.

“Musk realised that, at best, Twitter’s reliance on and touting of its process was reckless; at worst, it was intentionally misleading,” says the suit.

Twitter argues that it uses a much more layered process for weeding out dodgy accounts, including using automated systems. It also pointed to the detailed explanations of how it polices spam accounts, which had been given to Musk, the press, the Securities and Exchange Commission and the public via a Twitter thread by CEO Parag Agrawal. In the most notorious episode of this takeover saga, Musk replied to the latter with a poo emoji.

But according to the countersuit at least Agrawal and Musk agreed on one thing. The document states that on 8 April Musk sent the CEO an example of a spam tweet saying: “I am so sick of stuff like this.” Agrawal replied, acknowledging “[w]e should be catching this.”

Musk’s counter-estimates

Citing “preliminary expert estimates”, the countersuit claims that in early July one-third of visible accounts may have been false or spam. This means that the true proportion of spam accounts among Twitter’s user base is at least 10%.

It says users that see zero or almost no ads account for almost all the growth in monetisable daily users. The majority of ads are served to less than 16 million users, the suit claims.

Twitter says that although not every user sees ads on a given day, in the first quarter “significantly more than” 229 million accounts contributed to Twitter’s average quarterly user number.

Regarding the 10% number, Twitter says it was based on a publicly available web tool, botometer, that has designated Musk’s own account as a likely bot.

Twitter made decisions without consulting Musk

One of the clauses in the merger agreement states Musk must be told when Twitter is deviating from its obligation to conduct its business in the “ordinary course”. In the countersuit, Musk claims that Twitter has made several “significant” changes – including firing two executives, starting a hiring freeze and initiating a legal clash with the Indian government – that occurred without his consent.

Twitter’s response is that axing employees or acting to protect users’ rights in foreign jurisdictions are part of the day-to-day business of running a company.

Information was not forthcoming

Musk is also claiming that Twitter failed to provide him with all the data and information that he requested “for any reasonable business purpose related to the consummation of the transaction”. The suit says Musk was sent reams of “stale data” that didn’t answer his questions.

It says, pointedly, that Twitter was happy to send data such as “a copy of its agreement with the Golden State Warriors for courtside basketball tickets and VIP parking”.

After more back-and-forth arguments over increasingly detailed information requests, the suit claims “the only conclusion the Musk parties could draw from Twitter’s obfuscation and delay was that Twitter knew that it had something to hide”.



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Economic uncertainty can’t stop cloud growth • The Register

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The hyperscalers and public cloud providers are barreling ahead, unfazed by a rapidly deteriorating economic outlook, according to a recent Dell’Oro Group report.

In fact, these internet behemoths stand to benefit from the current market conditions in more ways than one, analyst Baron Fung told The Register.

As chipmakers like Intel, Nvidia, Micron, and others face increased pricing pressure across their lineups due to declining demand, hyperscalers are well-positioned to take advantage of this and add more capacity on the cheap, he explained.

“Looking at the recent Q2 earnings, it was really pretty impressive from a growth standpoint,” Fung said of the cloud providers.

Amazon and Azure in particular saw robust revenue gains in their most recent quarters. AWS saw revenues climb 36 percent from the prior year, while Microsoft reported its cloud biz saw year-over-year growth of 40 percent. However, things weren’t as peachy for Google, which saw a otherwise strong quarter for cloud revenue tempered by a $858 million loss in income.

Worsening macroeconomic factors may end up helping cloud providers as enterprises look for alternatives to capex-heavy server refreshes. We saw this phenomenon once before – in the early days of the pandemic.

These factors, combined with a wave of enabling technology – next-generation CPUs, GPUs, smartNICs, and CXL-enabled components to name a handful – will further accelerate hyperscaler spending, which is expected to grow 13 percent over the next five years, Fung said.

So it’s no surprise many chipmakers are optimistic about their cloud and datacenter-related revenues over the next few quarters, despite a slump in PC and gaming demand.

The analyst firm expects next-generation CPU platforms from the likes of Intel, AMD, and Ampere will be among the strongest drivers of hyperscale spending in the near term.

Intel and AMD are expected to launch their next-generation server processors later this year. Both of these chips pack a bevy of new features, including DDR5, and PCIe 5.0, in addition to having substantially higher core counts compared to the previous generation.

These chips are also among the first to support the CXL interconnect standard, “which will enable a new kind of paradigm in the datacenter,” according to Fung.

In its first iteration, the technology will allow systems builders to pack larger quantities of memory into servers than there are DIMM slots, using CXL memory-expansion modules. And in the years to come, the technology has provisions for tiered memory, memory pooling, and disaggregated compute architectures.

The operational and resource efficiencies enabled by the tech may eventually trickle down to customers in the form of lower prices, Fung added.

But it won’t just be the x86 stalwarts leading the charge in the datacenter. Fung also expects Arm chipmakers, like Ampere, to continue gaining traction in the hyperscale arena. Here, the chipmaker’s Altra and Altra Max processors have already attracted several high-profile customers including Microsoft Azure, Google, Cloudflare, and Oracle – to name just a few.

Finally, Dell’Oro predicts hyperscalers will drive edge infrastructure deployments – a market that Intel currently dominates – to 8 percent of the total datacenter infrastructure market by 2026. ®

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Limerick researchers’ findings show potential of food to treat heart disease

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The Irish-based study lead said food scientists, medical scientists and pharma companies must work together to produce functional foods to treat chronic conditions.

A team of researchers based at the Bernal Institute in University of Limerick (UL) have developed a new guide to designing functional foods to treat various chronic conditions.

Functional foods are foods that provide nutrition and act in a way that positively affects the body, similar to medicine.

According to the research, food has the potential to help in the treatment of heart diseases such as atherosclerosis.

“The capacity for our food to do more than provide us with nutrition is huge and relatively unexplored,” said study lead Daniel Granato, professor in food science and health at UL.

“Cardiovascular diseases are a main cause of death but they can be prevented. By bringing food scientists, medical scientists and pharma companies together we can employ the same methods used in producing medicinal drugs and produce foods that might mitigate health conditions,” Granato added.

The study has been published in Trends in Food Science & Technology, an academic journal. The UL researchers were joined on the project by academics from the Federal University of Alfenas and Universidade Federal de Minas Gerais in Brazil.

Granato and his team proposed an accurate computational approach to designing functional foods by predicting their bioactivity. This allowed the researchers to map how different food components benefit the body.

The study also drew attention to the potential of functional foods to treat illnesses and lessen the burden on the world’s health services. Functional foods are not too available on the market, despite their potential to help prevent conditions such as type-2 diabetes and glucose intolerance. These are both major contributors to heart disease.

Food science, cardiovascular disease therapy and computer modelling should be linked to produce functional foods that can mitigate atherosclerosis, according to Granato. He urged food and pharma companies to take note.

“This is critical to achieve United Nations Sustainable Development Goals in good health and wellbeing, as well as ensuring healthy lives and promoting wellbeing for all at all ages, by optimising discovery of bioactive compound sources, and reducing time to market for new functional foods,” he said.

Granato’s co-author and senior lecturer in the UL Department of Biological Sciences, Dr Andreas Grabrucker, said this approach could go far beyond heart disease.

“It will be the basis of a new research project at UL that aims to identify functional foods that lower the risk for neurodegenerative disorders such as Alzheimer’s disease,” he claimed.

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