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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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Google becomes latest tech firm to delay reopening as Delta variant spreads | Google

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Google has backtracked on plans to welcome most workers back to its sprawling campus in September, becoming the latest Silicon Valley company to delay reopening amid a surge in Covid cases.

The company announced Wednesday it is postponing a return to the office until mid-October and rolling out a policy that will eventually require everyone who returns in person to be vaccinated.

The decision sees Google join Apple and Netflix in postponing calling employees back to the office due to concerns about the highly transmissible Delta variant, which now accounts for more than 80% of new cases in the US. Twitter also halted reopening plans and closed offices last week due to the Delta variant.

In an email to Google’s more than 130,000 employees worldwide, chief executive officer Sundar Pichai said the company is now aiming to have most of its workforce back to its offices beginning 18 October instead of its previous target date of 1 September.

Google’s delay also affects tens of thousands of contractors who Google intends to continue to pay while access to its campuses remains limited.

“This extension will allow us time to ramp back into work while providing flexibility for those who need it,” Pichai wrote. This marks the third time Google has pushed back the date for fully reopening its offices.

Pichai said that once offices are fully reopened, everyone working there will have to be vaccinated. The requirement will be first imposed at Google’s headquarters in Mountain View, California, and other US offices, before being extended to the more than 40 other countries where Google operates.

Facebook announced a similar policy on Wednesday, saying it will make vaccines mandatory for US employees who work in offices. Apple is reportedly also considering requiring vaccines.

“This is the stuff that needs to be done, because otherwise we are endangering workers and their families,” said Dr Leana Wen, a public health professor at George Washington University and a former health commissioner for the city of Baltimore. “It is not fair to parents to be expected to come back to work and sit shoulder-to-shoulder with unvaccinated people who could be carrying a potentially deadly virus.”

Because children under the age of 12 aren’t currently eligible to be vaccinated, parents can bring the virus home to them from the office if they are around unvaccinated colleagues, Wen said.

The delays from these companies could influence other major employers to take similar precautions, given that the technology industry has been at the forefront of the shift to remote work triggered by the spread of Covid-19.

Even before the World Health Organization declared a pandemic in March 2020, Google, Apple and many other prominent tech firms had been telling their employees to work from home. Many others in the tech industry have decided to let employees do their jobs from remote locations permanently.

Google’s decision to require employees working in the office to be vaccinated comes on the heels of similar moves affecting hundreds of thousands government workers in California and New York as part of stepped-up measures to fight the delta variant. Joe Biden is expected to announce a mandate that all federal government workers be vaccinated.

The rapid rise in cases during the past month has prompted more public health officials to urge stricter measures to help overcome vaccine skepticism and misinformation.

While other major technology companies may follow suit now that Google and Facebook have taken stands on vaccines, employers in other industries still may be reluctant, predicted Brian Kropp, chief of research for the research firm Gartner. Less than 10% of employers have said they intend to require all employees to be vaccinated, based on periodic surveys by Gartner.

“Google is seen as being such a different kind of company that I think it’s going to take one or two more big employers to do something similar in terms of becoming a game changer,” Kropp said.

The Associated Press contributed to this report

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Privacy proves elusive in Google’s Privacy Sandbox • The Register

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Google’s effort to build a “Privacy Sandbox” – a set of technologies for delivering personalized ads online without the tracking problems presented by cookie-based advertising – continues to struggle with its promise of privacy.

The Privacy Sandbox consists of a set of web technology proposals with bird-themed names intended to aim interest-based ads at groups rather than individuals.

Much of this ad-related data processing is intended to occur within the browsers of internet users, to keep personal information from being spirited away to remote servers where it might be misused.

So, simply put, the aim is to ensure decisions made on which ads you’ll see, based on your interests, take place in your browser rather than in some backend systems processing your data.

Google launched the initiative in 2019 after competing browser makers began blocking third-party cookies – the traditional way to deliver targeted ads and track internet users – and government regulators around the globe began tightening privacy rules.

The ad biz initially hoped that it would be able to develop a replacement for cookie-based ad targeting by the end of 2021.

But after last month concluding the trial of its flawed FLoC – Federated Learning of Cohorts – to send the spec back for further refinement and pushing back its timeline for replacing third-party cookies with Privacy Sandbox specs, Google now acknowledges that its purportedly privacy-protective remarketing proposal FLEDGE – First Locally-Executed Decision over Groups Experiment – also needs a tweak to prevent the technology from being used to track people online.

On Wednesday, John Mooring, senior software engineer at Microsoft, opened an issue in the GitHub repository for Turtledove (now known as FLEDGE) to describe a conceptual attack that would allow someone to craft code on webpages to use FLEDGE to track people across different websites.

That runs contrary to its very purpose. FLEDGE is supposed to enable remarketing – for example, a web store using a visitor’s interest in a book to present an ad for that book on a third-party website – without tracking the visitor through a personal identifier.

Michael Kleber, the Google mathematician overseeing the construction of Privacy Sandbox specs, acknowledged that the sample code could be abused to create an identifier in situations where there’s no ad competition.

“This is indeed the natural fingerprinting concern associated with the one-bit leak, which FLEDGE will need to protect against in some way,” he said, suggesting technical interventions and abuse detection as possible paths to resolve the privacy leak. “We certainly need some approach to this problem before the removal of third-party cookies in Chrome.”

In an email to The Register, Dr Lukasz Olejnik, independent privacy researcher and consultant, emphasized the need to ensure that the Privacy Sandbox does not leak from the outset.

It will all be futile if the candidates for replacements are not having an adequate privacy level on their own

“Among the goals of Privacy Sandbox is to make advertising more civilized, specifically privacy-proofed,” said Olejnik. “To achieve this overarching goal, plenty of changes must be introduced. But it will all be futile if the candidates for replacements are not having an adequate privacy level on their own. This is why the APIs would need to be really well designed, and specifications crystal-clear, considering broad privacy threat models.”

The problem as Olejnik sees it is that the privacy characteristics of the technology being proposed are not yet well understood. And given the timeline for this technology and revenue that depends on it – the global digital ad spend this year is expected to reach $455bn – he argues data privacy leaks need to be identified in advance so they can be adequately dealt with.

“This particular risk – the so-called one-bit leak issue – has been known since 2020,” Olejnik said. “I expect that a solution to this problem will be found in the fusion of API design (i.e. Turtledove and Fenced Frames), implementation level, and the auditing manner – active search for potential misuses.

“But this particular issue indeed looks serious – a new and claimed privacy-friendly solution should not be introduced while being aware of such a design issue. In this sense, it’s a show-stopper, but one that is hopefully possible to duly address in time.” ®

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Government plans €10m in funding for green and digital business projects

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The Government and Enterprise Ireland are providing two funds to regional Irish businesses in a bid to help them transition to a greener, digital economy.

The Government has today (29 July ) announced it will provide €10m in funding through Enterprise Ireland to projects supporting digitalisation and the transition to a green economy.

The Regional Enterprise Transition Scheme, worth €9.5m, will provide grant funding to regional and community-based projects focused on helping enterprises to adapt to the changing economic landscape due to Covid-19 and Brexit.

Leo Clancy, CEO, Enterprise Ireland said: “The Regional Enterprise Transition Scheme is aimed at supporting regional development and the regional business eco-system, helping to create and sustain jobs in the regions impacted by Covid-19.”

Grants of up to €1.8m or 80pc of project cost are available to businesses. The projects should aim to address the impact of Covid-19 and improve the capability and competitiveness of regional enterprises.

The call for the Regional Enterprise Transition Scheme will close on 8 September 2021. The successful projects will be announced in October and all funding will be provided to the successful applicants before the end of the year.

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A separate funding scheme, the €500,000 Feasibility Study fund, will provide financial support to early-stage regional enterprise development projects.

Launching the funding schemes, Minister of State for Trade Promotion, Digital and Company Regulation, Robert Troy TD said the funds would “help stimulate transformational regional projects to support enterprises embrace the opportunities of digitalisation, the green economy as well as navigate the changed landscape arising from Covid-19.”

Minister of State for Business, Employment and Retail, Damien English TD commented at the launch that the funds would help “build Covid-19 and Brexit resilience and enable applicants to support enterprises and SMEs to respond to recent economic and market challenges which also includes the transition to a low carbon economy, digital transformation and smart specialisation.”

The Feasibility Fund is open to new projects, with grants available of up to €50,000 or 50pc of project cost and will allow promoters to test their project concept and deliver virtual or site-based solutions to their target audience.

Applications for the Feasibility Fund close on 1st October 2021.

For more information and details on how to apply for the funds, see here and here.

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