click to enlargeUS Army research labs have been leading the way for some years in researching how impacts, such as those experienced from explosive devices or other sources of concussion, can affect the brain and body. One tactic Army researchers in the Research, Development and Engineering Command (RDECOM) are taking is to engineer increased protection in ground vehicles (ground vehicle systems in Army-speak). However, testing designs can’t be done with humans. One method used is a sensor-laden crash dummy (Warrior Injury Assessment Manikin or WIAMan, seen above left). Fred Hughes, director of the WIAMan Engineering Office, commented that “The manikin’s sophisticated bio-fidelity and robust sensor design provides an unmatched level of accuracy determining the potential effects of blast on soldiers in new vehicle systems.” Another tool is the Microsoft-designed Hololens which allows researchers to virtually explore explosion simulations. Both are being used to assess survivability and mobility design in vehicles. Armed With Science
At another part of RDECOM located atthe Aberdeen (Maryland) Proving Ground, US Army Research Laboratory researchers have simulated brain texture and mass through a specially designed gel. These nanomaterials are designed to fluoresce at graduated intensities under pressure. The goal is that researchers can track blast effects on the brain at the cellular level. ARL research in this area is jointly conducted with counterparts in the Japanese Defense Ministry, where researchers are contributing their knowledge of physiological effects such as cortical depressant, blood circulation and oxygen levels in tissue. ARL News, YouTube video. Both tracks of research are designed to protect soldiers in the field from TBI, and better understand the effects of blast-created trauma to the brain.
Telehealth has been confirmed as the way forward for sustainably treating the leading chronic diseases in Australia says a report published following a scientific study. The study, which analysed the effects of monitoring a mixed group of patients with chronic conditions using home-based telehealth equipment, concludes that use of home-based telehealth will not only reduce the hospital admissions but will also reduce the length of stay when admitted. The analysis of the data from the trial has shown that for chronically ill patients, an annual expenditure of AU$2,760 could generate a saving of between AU$16,383 and AU$19,263 representing a rate of return on investment of between 4.9 and 6. This is equivalent to a saving of AU$3 billion a year, says the report.
The Australian study, carried out by the Commonwealth Scientific and Industrial Research Organisation (CSIRO) is reminiscent of UK’s Whole System Demonstrator (WSD), the world’s largest randomised control trial of telehealth. Although the Australian study is much smaller with a total of 287 participants over 5 sites (covering the 5 States) compared with over 6,000 in the WSD, the principles are similar. Due to the smaller sample sizes and the need to have patients connected to the National Broadband Network (NBN) the selection of patients was not random but other techniques were used to obtain statistically significant results. Patients selected had unplanned acute hospital admissions indicationg one or more of Chronic Obstructive Pulmonary Disease (COPD), Coronary Artery Disease, Hypertensive Diseases, Congestive Heart Failure, Diabetes and Asthma.
The TeleMedCare Systems Clinical Monitoring Unit (CMU) was used as the home-based unit although not all features offered by the device were utilised in this study. The CMU system deployed in this study was developed in Australia, registered with TGA (Therapeutic Goods Administration) and has been extensively used and tested in previous trials.
Typically patients would have some or all vital signs measurements scheduled at a convenient time, typically in the morning. These measurements were blood pressure, pulse oximetry to measure arterial blood oxygen saturation, ECG (single channel), lung capacity, body temperature, body weight and blood glucose concentration. In addition to scheduled times, patients could take their vital signs at any time. A full suite of clinical questionnaires was also available.
The full report Home Monitoring of Chronic Diseases for Aged Care is available to download here.
Future technologies are expected to play an important role in supporting independence in later life says one of the main findings click to enlargefrom research published this week in the UK. People aged 65 and over who have not grown up with technology around them, perhaps unsurprisingly, find it more difficult to master the latest technologies initially than younger groups do and there are concerns that society could become more inactive and too reliant on technology. This are some of the other main findings given in the report ‘How Tech Savvy are We?’ from the Institution of Engineering and Technology (IET) in the UK.
Although the research was not focused on just the older age group there are some aspects which are particularly looking at this group of people.
There is no clear consensus on which of the six proposed technologies in the research would be most useful in later life – smart healthcare devices are rated most useful by 27%, whilst driver-less cars and robot help are deemed the most useful by only 10%. This suggests a possible disconnect between what industry is developing and what the public actually wants says the IET.
Commenting on the report’s findings, Chris Cartwright, Chair of the IET Information and Communications Sector, is quoted as saying: “It’s great to see strong public support and understanding for the potential benefits new technologies offer an ageing population. But it’s less encouraging that this support is still hindered by concerns around cost, lack of physical activity and loss of human contact. There is also a lack of clarity about which technologies people will find most useful, probably because they are unclear of the benefits.
An agency of the US Department of Health and Human Services, the Agency for Health Research and Quality (AHRQ), has published, for peer review, a draft of a new report (a “technology assessment”) entitled “Telehealth: an Evidence Map for Decision making”. AHRQ, the report explains, “through its Evidence-based Practice Centers (EPCs), sponsors the development of evidence reports and technology assessments to assist public and private sector organizations in their efforts to improve the quality of health care in the United States.”
The purpose of this new technology assessment is given as creating a review of the evidence available (essentially a literature review) so as to inform decision makers. The authors had identified 1,305 citations about telehealth of which 44 had been selected for this review. Unsurprisingly, the report says ” comparatively large volume of research reported that telehealth interventions produce positive results when used for communication/counseling and monitoring and management for several chronic conditions and for psychotherapy as part of behavioral health.”
It recommends additional primary research be carried out on topics such as telehealth for triage in urgent/primary care, management of serious paediatric conditions and the integration of behavioral and physical health. Finally, it recommends that telehealth research should be integrated into evaluation of new models of care and payment so that the potential of telehealth can be assessed in organizations that are implementing these reforms. (more…)
Researchers at MIT are working on a project to measure the heart rate and breathing using a smartphone’s accelerometer in the user’s pocket or bag without the need for wearable sensors. When the user is at rest the slight movements due to breathing and heart beat are measured using the smartphone and used to derive the heart and breathing rates.
According to a paper published recently, in a test with a dozen participants (a very small sample for this type of test) the heart rates measured using the new method were within one beat when compared to FDA approved sensors they were using simultaneously. The measurements of breathing rate were about a quarter of a breath of the approved sensors.
The aim is to sense when someone is stressed by using the heart rate and breathing and then help cope with the situtation by suggesting, say, breathing exercises or calling for help.
Anyone interested in pursuing an education in health informatics or data science at UCL is invited to an open evening on 25th June from 4:30pm at 222 Euston Road, London. This is billed as an informal event with an opportunity to meet staff and students and to learn more about the work of the Centre for Health Informatics and Multiprofessional Education, the UCL Institute for Health Informatics and the Farr Institute.
The occasion will be the launch event for UCL’s new MSc in Data Science for Research in Health and Biomedicine. This programme is set to equip graduates for new careers in academia, healthcare organisations, pharmaceutical companies and consultancies dealing with Big Data. UCL will be working closely with NHS, research and commercial partners to deliver an innovative and practical programme that will give students real exposure to practical research in one of the top centres for data science in health and biomedicine.
Findings of a new literature analysis of the impact of telemedicine on diabetes management has been published in Telemedicine and e-Health.
The authors, from the University of Michigan and the University of Kentucky, analysed 73 research publications (selected from a potential 17,000 list) published between 2005 and 2013. They conclude that although the individual research studies varied significantly in, for example, the outcomes measured, there was sufficient evidence to point to the positive effect of telemedicine.
The full paper describes the analysis methodology and gives detailed results and would be of interest to those working in diabetes management as well as those applying telemedicine to other long term conditions.
Telehealth and telecare applications can often depend on the willingness of the users to use the click to enlargeinternet and that is not to be taken for granted with older users. On the other hand it is indeed the older people who can most benefit from these technologies. Recent research in the UK shows encouraging results in this respect.
Ofcom, the UK telecoms regulator, has a duty to promote media literacy and to carry out research to measure the usage of all forms media. The results of the most recent surveys commissioned by Ofcom were published on Tuesday. Adults’ Media Use and Attitudes Report 2014 is an encouraging report showing that the use of the internet by over-65s has increased by over a quarter over the past 12 months.
“The proportion of people aged over 65 that are accessing the web reached 42% in 2013, up nine percentage points from 33% in 2012. One reason found for this is an increase in the use of tablet computers by older people aged 65-74 to go online, up from 5% in 2012 to 17% in 2013. This has helped to drive overall internet use up from 79% of all adults in 2012 to 83% in 2013” say Ofcom.
“However, older people spend significantly less time surfing the web than younger people (16-24 year olds), who on average spend more than a whole day (24 hours 12 minutes) each week online. This compares to an average 9 hours 12 minutes online per week among adults over 65.”
Although these results are for the UK, they probably broadly represent the trends in most developed countries.
Some pretty exciting work is happening at Newcastle University’s Digital Interaction Group with researchers evaluating the potential of Google Glass to support people with Parkinson’s. Much of the work is relevant to other conditions that affect movement, including Stroke and Multiple Sclerosis.
The great thing about Google Glass for people with motor control problems such as tremors, is that it gets around the difficulties in trying to negotiate the touch screen of a phone, or when trying to press a panic button. This is because the technology can be voice-operated and links to the internet. So in an emergency you can just tell it to call someone and it will. (more…)
Health apps are often in the news these days. Ofcom, the UK telecommunications regulator, commissioned Kantar Media to carry out qualitative research on attitudes and behaviours of apps users when using devices such as smart phones and tablets. The resulting report, Apps Environment, published today by Ofcom makes interesting reading.
Although the report was commissioned by the UK regulator, I think the findings are applicable to any country. What’s more, the generic nature of the conclusions make them relevant to health apps as much as to any others.
The report says that “among app users, several perceptions were found to be influencing behaviours, attitudes and the low level of concern in the app environment. These perceptions were:
• official app stores monitor and vet the apps they make available;
• well-known brands provide a safe, secure and reliable user experience, and;
• apps are safer than browsers due to their more limited and contained nature compared to browser-based internet use.”
Another finding was that many app users said they paid very little attention to permissions requested by apps – nothing new there then. How many times have you ticked that “I Agree” box to the terms and conditions without reading them?
Very few participants in the research are reported to have raised spontaneous concerns about apps. The researchers say that when prompted, in-app purchasing and advertising were of greatest concern to parents, and at most, a frustration or annoyance to others.
This shows that when it comes to more critical apps such as health apps or those that are designed to provide a safety net in a care environment a stronger regulation may be needed as well as a pro-active educational effort to emphasise the need to be aware of issues such as data privacy.
Responsive holograms that change colour in the presence of certain compounds are being developed into portable medical tests and devices, which could be used to monitor conditions such as diabetes, cardiac function, infections, electrolyte or hormone imbalance easily and inexpensively, according to the University of Cambridge. It is claimed that the technique can be used to test blood, breath, urine, saliva or tears for glucose, alcohol, drugs, bacteria or hormones. Clinical trials are said to be underway to test glucose and urinary tract infections (UTI) in diabetics at Addenbrooke’s Hospital.
It is estimated that the reusable sensors could cost as little as UK £ 0.1 (about US 15 cents) to produce, making them affordable for use in developing countries. A prototype smartphone-based test suitable for both clinical and home testing of diabetes and clinically relevant conditions is under development.
If this is a commercial success this could form the basis of a multi-purpose portable tester suitable for telehealth use.
F for Fake was the film master Orson Welles’ last released film; it was a small documentary on the art forger Elmer de Hory, with a side serving of Clifford Irving (the author of the fake Howard Hughes autobiography), and explored the nature of authorship and authenticity. We now have a burgeoning ‘F for Fake’ scandal in peer-reviewed open-access scientific journals which can’t–or won’t –detect bogus research. A Science Magazine(American Association for the Advancement of Science–AAAS) journalist, John Bohannon, drafted a ‘spoof’ paper which was submitted to 304 peer-reviewed, open-access journals. It detailed the anticancer qualities of a chemical derived from lichen. Despite the complete fabrication of the discovery, the researcher and his university (more…)
A pair of “smart glasses” being developed by researchers at Oxford University could help blind people in unfamiliar surroundings. The majority of people registered as blind have some residual ability to perceive light and motion. With this in mind, the team are developing glasses with mini cameras on either side which detect objects. Enhanced images are then displayed on the lenses. In addition, the cameras can detect how far an object is from the wearer by comparing the distance between the cameras. (more…)
Written for the Technology Strategy Board and published by the Housing Learning & Improvement Network, the purpose of the main study is to “outline the case for a revolution in long term care all to be set in a time scale of 2012, 2020 and 2050. This includes evidence about the views of older people and their carers in the UK, lessons from abroad and the implications for industry/providers.” It is written as a ‘study of studies’ on a broadly-scoped problem; it focuses considerably on issues such as care provision, housing (including co-housing and communities) and putting the older person in more control of decisions, housing and tech design. Telehealth and telecare, while not the focus, have a hefty section (pages 32-41) but their conclusions will not be a huge surprise to our readers such as expanding inexpensive, simple assistive technologies, the need for more research and better design. The fact it is comparative is extremely helpful for those who want to see beyond borders, and there is a large section on ethical issues which is certainly unusual in studies of this type. We thank the lead author, Professor Anthea Tinker, Institute of Gerontology, Department of Social Science, Health and Medicine, King’s College London, for providing information on and the PDFs of the studies.Assisted Living Platform – The Long Term Care Revolution and A study of innovatory models to support older people with disabilities in the Netherlands
Do we detect a slight air of surprise in the comment of Pia Rafller, one of the authors of a report by Yale University’s department of Political Science that “The findings do show that the reality is more complicated than at times we like to think, that information can have a different impact on different types of people”? The report was on an mHealth project designed by Google and the Grameen Foundation’s AppLab which allowed users in 60 central Ugandan villages to text questions on sexual and reproductive health to a server and receive pre-prepared responses from a database. The expectation was that the information would lead to a reduction of risky behaviour but it had some unintended consequences… Ugandan mHealth initiative increases ‘promiscuity’ IRIN Africa.
The seventh of 15 expected academic papers arising from the study of the Whole System Demonstrator (WSD) programme has just been published in the Journal of Health Services Research & Policy. The big takeaway is that local ‘ownership’ of new services DID lead to more collaborative practices across the care system BUT that the concept of whole system redesign around remote care is currently unrealistic. With headings such as ‘Misalignment between vision and enactment’, ‘Wider barriers’ and ‘Whole system working: Ambiguity and diversity’ one can see that the underlying analysis is more nuanced than the main conclusion might suggest. Stimulating whole system redesign: Lessons from an organizational analysis of the Whole System Demonstrator programme by Theopisti Chrysanthaki1, Jane Hendy and James Barlow, all of Imperial College, London is also available as a free 10-page PDF download.
A complete list of the WSD papers, updated as they are published, is being maintained here by Mike Clark, to whom thanks for the heads-up on this publication.
Telehealth and Telecare Aware posts pointers to a broad range of news items. Authors of those items often use terms 'telecare' and telehealth' in inventive and idiosyncratic ways. Telecare Aware's editors can generally live with that variation. However, when we use these terms we usually mean:
• Telecare: from simple personal alarms (AKA pendant/panic/medical/social alarms, PERS, and so on) through to smart homes that focus on alerts for risk including, for example: falls; smoke; changes in daily activity patterns and 'wandering'. Telecare may also be used to confirm that someone is safe and to prompt them to take medication. The alert generates an appropriate response to the situation allowing someone to live more independently and confidently in their own home for longer.
• Telehealth: as in remote vital signs monitoring. Vital signs of patients with long term conditions are measured daily by devices at home and the data sent to a monitoring centre for response by a nurse or doctor if they fall outside predetermined norms. Telehealth has been shown to replace routine trips for check-ups; to speed interventions when health deteriorates, and to reduce stress by educating patients about their condition.
Telecare Aware's editors concentrate on what we perceive to be significant events and technological and other developments in telecare and telehealth. We make no apology for being independent and opinionated or for trying to be interesting rather than comprehensive.