Prof chris lowe manchester university

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Prof chris lowe manchester university

  1. 1. mHEALTHCARE OPPORTUNITIES,CHALLENGES AND PROSPECTS PROFESSOR C R LOWEUNIVERSITY OF 4th FUTURE OF WIRELESS INTERNATIONAL CONFERENCECAMBRIDGE THE MØLLER CENTRE, CHURCHILL COLLEGE, CAMBRIDGE
  2. 2. WHY DO WE NEED mHEALTHCARE? THE WORLD IS CHANGING LIFESTYLE / WELLBEING TRADITIONAL RISKS OBESITY CANCER PSYCHIATRIC DISORDERS/ NEURODEGENERATIVE CEREBROVASCULAR DISEASE DIABETESRISK FOOD/WATER QUALITYSIZE URBAN AIR QUALITY OCCUPATIONAL RISKS SECURITY / TERRORISM UNDERNUTRITION INFECTIOUS DISEASES WATER MODERN RISKS SANITATION HYGIENE TIME HUMAN ENVIRONMENT CHEMICAL INTELLIGENCE LIFESTYLE HEALTH & WELFARE CLINICAL DISORDERSUNIVERSITY OF WHY DO WE NEED mHEALTHCARE? THE WORLD ISCAMBRIDGE CHANGING
  3. 3. MOTIVATION FOR mHEALTH CONSTRAINTS FELT BY HEALTHCARE SYSTEMS POPULATION GROWTH AND DEMOGRAPHICS HIGH BURDEN OF DISEASE PREVALENCE LOW HEALTHCARE WORKFORCE LARGE NUMBERS OF RURAL INHABITANTS LIMITED FINANCIAL RESOURCES TO SUPPORT HEALTHCARE INFRASTRUCTURE AND HEALTH INFORMATION SYSTEMS RAPID RISE IN MOBILE PHONE PENETRATION IN DEVELOPING NATIONSUNIVERSITY OFCAMBRIDGE MOTIVATION FOR mHEALTH
  4. 4. mHEALTH MARKET SEGMENTATION INSURANCE COVERAGE HOSPITAL CHRONIC DISCHARGE DM HOME CARE CORPORATE FITNESS HOME mVISIT DIAGNOSTICS MEDICAL HOME SENIOR PRACTICE FITNESS MEDICATION EMR MONITORING PROFESSIONALSELF-CARE mPERSONAL CARE MEDICATION HEALTH RECORDS RETAIL REMINDER CLINIC FITNESS FALL MONITORING ONLINE TRACKING DM WANDER-OFF MONITORING AT-HOME WELLNESS/ TeleHEALTH DIET mEXPERT ACTIVITY FITNESS CONTROL OPINION CONSUMER MONITORING WIKI mHEALTH mCARE SELF-PAY UNIVERSITY OF CAMBRIDGE mHEALTH MARKET SEGMENTATION
  5. 5. FACTORS SHAPING THE FUTURE OF mHEALTHCARE LIFETIME DIAGNOSTIC MANAGEMENT EARLY CONCERN SYMPTOMS DISEASE HEALTHY WORRIED ACUTELY CHRONICALLY WELL SICK ILLFOOD/WATER/AIR QUALITY BLOOD ANALYTES DIABETESLIFESTYLE LIVER/KIDNEY DYSFUNCTION CANCERALCOHOL/DRUGS OF ABUSE FAECAL OCCULT BLOOD ISCHAEMIC HEART DISEASESTRESS GLUCOSE COPDSLEEP DISORDERS HAEMOGLOBIN A1C NEURODEGENERATIVE/MIGRAINE ASTHMA NEUROPSYCHIATRIC DISORDERSPREGNANCY MENOPAUSE CEREBROVASCULAR DISEASEFERTILITY COAGULATION/PLATELET FUNCTION HIV/AIDS INFECTIOUS DISEASES STI HOME HOME A&E CENTRAL WORKPLACE PHYSICIAN’S OFFICE BEDSIDE LABORATORY CLINICAL CENTRE ITU UNIVERSITY OF FACTORS SHAPING THE FUTURE OF mHEALTHCARE CAMBRIDGE LIFETIME DIAGNOSTIC MANAGEMENT
  6. 6. FACTORS SHAPING THE FUTURE OF mHEALTHCARE EMERGING THERANOSTIC INTERVENTIONS COMPLIANCE TESTINGSUSCEPTIBILITY MONITOR PATIENT RESPONSE RISK PREDICTION TREATMENT REGIME (THERAPEUTIC DIAGNOSIS STRATIFICATION) ADR DISEASE EVOLUTION PROGNOSIS PATIENT STRATIFICATION UNIVERSITY OF EMERGING THERANOSTIC CAMBRIDGE INTERVENTIONS
  7. 7. FACTORS SHAPING THE FUTURE OF mHEALTHCARE DIAGNOSTIC TIME FRAMES AND CONCENTRATION RANGE RAPID BLOOD GASES (pO2, pCO2) REAL-TIME GLUCOSE IONS (Na+, K+, Cl- HORMONES (CORTISOL) NEUROTRANSMITTERS MEDIUM METABOLITES/BIOMARKERS UREA CREATININE BILIRUBIN TRIGLYCERIDES LONG IRON ALBUMIN HAEMOGLOBIN A1c IMMUNOGLOBULINS CHOLESTEROL CONCENTRATION RANGE [C] = 10-1-10-18MUNIVERSITY OF FACTORS SHAPING THE FUTURE OF mHEALTHCARECAMBRIDGE DIAGNOSTIC TIME FRAMES AND CONCENTRATION RANGE
  8. 8. NON-INVASIVE PATIENT SENSOR RECORDING FORMATS NON-INVASIVE MINIMALLY (SPECTROSCOPIC) INVASIVE INTELLIGENT CLOTHES/ CONTACT LENS ACCESSORIES/ BREATH JEWELLRY ANALYSIS BLOOD ISF SKIN E-PATCH CSF WATCH DIGITAL PLASTER INVASIVE FINGERSTICK BREATH COSMETICS TEARSINDWELLING SALIVA SMART TATTOOCATHETERS SWEAT BLOODSUBCUTANEOUS URINEIMPLANTS FAECES SEMEN UNIVERSITY OF CAMBRIDGE PATIENT SENSOR RECORDING FORMATS
  9. 9. BIOSENSOR PRINCIPLES AND TRANSDUCERS ANALYTE ELECTRICAL (BIO)RECOGNITION SYSTEM OPTICAL ACOUSTIC THERMALTRANSDUCER MAGNETIC INSTRUMENTATION MICROENGINEERED UNIVERSITY OF BIOSENSOR PRINCIPLES AND CAMBRIDGE TRANSDUCERS
  10. 10. KEY ATTRIBUTES OF MOBILE/WEARABLE SENSORSQUICK TIME-TO-ANSWERSIMPLE READOUTLOW COSTEASILY/INEXPENSIVELY MANUFACTUREDMINIATURE AND LOW (OR NO) POWER BURDENGOOD SENSITIVITY AND SPECIFICITYUSED BY MINIMALLY TRAINED PERSONNELFUNCTION >30 °C AND AT HIGH HUMIDITYLONG STORAGE TIMES WITHOUT REFRIGERATIONNO LOCAL REAGENTS/WATER AND/OR SPECIALIZEDEQUIPMENTDETECT MULTIPLE PATHOGENSUNIVERSITY OFCAMBRIDGE KEY ATTRIBUTES OF MOBILE/WEARABLE SENSORS
  11. 11. MICROAMPEROMETRIC BIOSENSORS 40 LACTATE 30 20 GLUCOSE 10 0 0 0.5 1 1.5 2 2.5 [SUBSTRATE] (mM)UNIVERSITY OFCAMBRIDGE MICROAMPEROMETRIC BIOSENSORS
  12. 12. MAGNETIC ACOUSTIC RESONATOR SENSOR (MARS)LIQUID SAMPLEACOUSTIC WAVE PIEZOELECTRIC ALUMINISED QUARTZ DISC GLASS DISC (AT-cut, 0.25mm thick, 12mm dia) RF COIL N NdFeB MAGNET RF COIL AIR GAP S UNIVERSITY OF MAGNETIC ACOUSTIC RESONATOR SENSOR CAMBRIDGE (MARS)
  13. 13. MAGNETIC ACOUSTIC RESONATOR SENSOR (MARS) Signal Generator AM Detector Copper Coil AM DETECTOR Lock-in Amplifier OUTPUT Output LOCK-IN AMPLIFIER 400 300 SIGNAL GENERATOR COIL/DEVICE 200 100 16th HARMONICA (mV) 0 0 50 100 150 200 250 300 350-100-200-300 f (MHz)-400 UNIVERSITY OF CAMBRIDGE MAGNETIC ACOUSTIC RESONATOR SENSOR (MARS)
  14. 14. REMOTE ACOUSTIC MEASUREMENTS WITH A TOROIDAL ELECTRIC FLUX SUBCUTANEOUSLY IMPLANTED e-PATCH 30 CONTACT LENS 20 MRAS QUARTZ DISC 10 0 -10 -20 -30 20.1 20.12 20.14 20.16 20.18 20.2 f (MHz) 100 100 pH 50 pH 50 pH Amplitude (mV) 0 pH Amplitude mV 0 pH -50 pH -50 pH -100 pH -100 pH -150 -150 pH TOROIDAL ANTENNA -200 pH -200 (TRANSCEIVER) -250 -250 6.57 6.59 6.61 6.63 6.65 6.67 6.69 6.71 6.73 6.57 6.59 6.61 6.63 6.65 6.67 6.69 6.71 6.73 Frequency MHz Frequency (MHz) UNIVERSITY OF REMOTE ACOUSTIC MEASUREMENTS WITH CAMBRIDGE A TOROIDAL ELECTRIC FLUX
  15. 15. ACOUSTIC GLUCOSE SENSOR BASED ON 3-APB MARS O 1.0 O O 6MHz -B Normalised Amplitude 20MHz HOH 2 C 0.8 HO 33MHz HO 47MHz HO 0.6 60MHz 73MHz 0.4 0.2 0 0 5 10 15 20 [Glucose](mM) Poly (acrylamide-co-3-APB)(78.5mol% acrylamide; 1.5mol% MBA; 20mol% 3-APB) PBS Buffer pH 7.4UNIVERSITY OFCAMBRIDGE ACOUSTIC GLUCOSE SENSOR BASED ON 3-APB MARS
  16. 16. DYNAMIC GLUCOSE AM Detector MEASUREMENT SYSTEM PC Lock-in Amplifier Signal Generator MARS Jig 250 Gilson minipuls 2Amplitude of the experimental y = 1.0434x - 19.187 Pump 200 R² = 0.9969 fludic system (mV) 150 100 50 0 50 100 150 200 250 Amplitude of the static system (mV) UNIVERSITY OF DYNAMIC GLUCOSE CAMBRIDGE MEASUREMENT SYSTEM
  17. 17. SPATIAL LASER FILTER MIRROR ACHROMAT GLASS TANK EMULSION 4° MIRRORUNIVERSITY OFCAMBRIDGE FABRICATION OF HOLOGRAPHIC SENSORS
  18. 18. n “Smart” Polymer θ COLOUR BRIGHTNESS IMAGE/ALPHANUMERIC MESSAGE POSITION OPTICAL ELEMENTS ΣRi MICRO-HOLOGRAMS 35 30reflectance (%) 25 d 20 lpk 15 Rpk λmax = 2ndcosθ 10 5 0 600 610 620 630 640 650 660 wavelength (nm) UNIVERSITY OF CAMBRIDGE PRINCIPLE OF HOLOGRAPHIC SENSORS
  19. 19. DIABETIC MONITORING WITH GLUCOSE HOLOGRAMS WHOLE BLOOD O O O INDWELLING CATHETER -B HOH 2 C SUBCUTANEOUS NEAR-IR HO HO CONTACT LENS HO SKIN PATCH/TATTOO 180 mol% 3-APB 160 25 140 120 15 max(nm) 100 80 12 60 40 10 20 8 5 0 -20 2 4 6 8 10 [GLUCOSE] (mM)UNIVERSITY OF DIABETIC MONITORING WITH GLUCOSECAMBRIDGE HOLOGRAMS
  20. 20. CONTACT LENS HOLOGRAPHIC GLUCOSE SENSOR TOXICITY TEAR [GLUCOSE]<BLOOD [GLUCOSE] pH VARIABILITY (5.8-7.8) TIME LAG (~MIN) SELECTIVITY (LACTATE/FRUCTOSE) OPTICAL PHYSICS COMFORT/COSMETIC APPEARANCE INSTRUMENTATIONUNIVERSITY OFCAMBRIDGE CONTACT LENS HOLOGRAPHIC GLUCOSE SENSOR
  21. 21. TRACKING OF BLOOD GLUCOSE IN TEAR FLUID IN VIVO 160 740 Blood-Glucose [mg%] 140 Wavelength [nm] 720 120 700 100 80 680 0 12 16 19 23 26 Time [minutes]UNIVERSITY OF TRACKING OF BLOOD GLUCOSE IN TEAR FLUIDCAMBRIDGE IN VIVO
  22. 22. HUMAN BREATH ANALYSIS DIABETIC KETOACIDOSIS RENAL FAILUREH2ETHANE LIVER DYSFUNCTIONn-PENTANE ALCOHOL INTOXICATIONBUTANENO CANCERCO CYSTIC FIBROSISNH3ETHANOL ASTHMAACETONE GIT DISORDERS (H pylori)THIOLS HALITOSIS STRESSUNIVERSITY OFCAMBRIDGE HUMAN BREATH ANALYSIS
  23. 23. RESPONSE OF PDMS HOLOGRAM TO ALKANE GASES 90 A B 1-Butyne 80 Butane 70 1-Butene Iso-butane 60 Propane 50 Propyne/propadione (nm) Propene 40 Ethane Ethyne 30 20 10 0 0 2 4 6 8 10 100 200 300 Time (s) Time (s) 80 590 100 1-Butyne 580 Butane 60  (nm)10 Butane 570 1 1-Butene 560  (nm) 10 20 30 40 40 isoButane  (nm) Temperature (°C) 550 540 20 Propane 530 Propene 520 0 Ethane Ethyne 510 0 100 200 300 400 500 600 700 0 20 40 60 80 100 Time (s) Concentration (%v/v)UNIVERSITY OFCAMBRIDGE RESPONSE OF PDMS HOLOGRAM TO ALKANE GASES
  24. 24. PHYSICIAN’S WANTING PATIENTS TO TRACK/MONITOR HEALTH AT HOME No (12%) Digestive health Acid reflux/indigestion Bladder control Yes (88%) Cardiac rhythm Sleep patterns Pain level Calories/fat content taken in Exercise/physical activity Vital signs (Blood pressure/heart rate/respiratory rate) Blood sugar Weight 0 20 40 60 % 80Source: PriceWaterhouseCoopers HRI Physician Survey (2010) UNIVERSITY OF PHYSICIAN’S WANTING PATIENTS TO CAMBRIDGE TRACK/MONITOR HEALTH AT HOME
  25. 25. IMPACT OF mHEALTH ACCORDING TO PHYSICIANS HAVE NOT AFFECTED ALLOW MORE MY DAY-TO-DAY WORK TIME WITH (24%)PATIENTS (26%) EXPEDITE DECISION MAKING (56%)INCREASE COLLABORATION DECREASE TIME ITAMONG PHYSICIANS TAKES FOR (36%) ADMINISTRATIVE TASKS (39%)UNIVERSITY OFCAMBRIDGE IMPACT OF mHEALTH ACCORDING TO PHYSICIANS
  26. 26. mHEALTH AND HEALTHCARE OUTCOMES IMPROVED HEALTH OUTCOMES AND COST SAVINGS INCREASED ACCESS TO HEALTHCARE AND HEALTH- RELATED INFORMATION ACCESS TO HARD-TO-REACH POPULATIONS REGIONS OF POOR LITERACY RATES AND LIMITED LOCAL LANGUAGE-ENABLED PHONES IMPROVED ABILITY TO DIAGNOSE AND TRACK DISEASES TIMELIER, MORE ACTIONABLE, PUBLIC HEALTH INFORMATION EXPANDED ACCESS TO ONGOING MEDICAL EDUCATION AND TRAINING FOR HEALTH WORKERS IMPROVED HEALTHY LIFESTYLESUNIVERSITY OFCAMBRIDGE mHEALTH AND HEALTHCARE OUTCOMES
  27. 27. EMERGING TRENDS IN mHEALTHCARE EMERGENCY RESPONSE SYSTEMS (ROAD TRAFFIC ACCIDENTS, OBSTETRIC CARE) MOBILE VOICE AND SMS SUPPORT TO REMOTE CLINICIANS REMOTE PATIENT MONITORING MONITORING OUTBREAKS AND EPIDEMICS HEALTH-RELATED mLEARNING FOR PUBLIC TRAINING AND CONTINUED PROFESSIONAL DEVELOPMENT FOR HEALTHCARE WORKERS HEALTH PROMOTION AND COMMUNITY MOBILIZATION SUPPORT OF LONG-TERM CHRONIC CONDITIONS (DIABETES,NEUROPSYCHIATRIC DISORDERS)UNIVERSITY OFCAMBRIDGE EMERGING TRENDS IN mHEALTHCARE
  28. 28. CLOUDMOBILE HEALTH TOOLREAL-TIME MONITORINGPHYSICIAN TRACKINGFEEDBACKCARER ALERTSDRUG AUTOMATPATIENT SENSOR/ TRANSMITTER SERVER Intelligent WATCH algorithms PHYSICIAN Messaging WIRELESS MONITOR DRUG HEALTHCARE AUTOMAT PROVIDER UNIVERSITY OF CAMBRIDGE mHEALTH

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