Archives for October 20, 2018

THE COUNTDOWN is underway for the launch of a pioneering spacecraft which scientists hope will help unlock the mysteries of Mercury – and British innovation is at the very heart of the exciting project.

Bepicolombo, a collaboration between the European Space Agency (ESA) and the Japan Aerospace Exploration Agency (JAX), is due to lift off from European Space Agency’s (ESA) base in Kourou, French Guiana, in the early hours of tomorrow morning.

Taking seven years to reach the planet closest to the Sun, the challenges are formidable – but Joe Zender, deputy project scientist with ESA, said the potential rewards were likewise enormous.

He said: “Mercury is the least understood rocky planet.

“If we look at the origins of the other planets in our solar system, we have an idea of how they formed.

“There is one exception – Mercury, which does not fit with our model.

“It’s a mystery – it does not fit with our current understanding.”

Bepicolombo – named after Italian mathematician Giuseppe “Bepi” Colombo, who died in 1984, will be taken into space by an Ariane 5 rocket which will be launched from the ESA’s base in Kourou, French Guiana – with Mr Zender and his colleagues facing an anxious wait until then.

It will take the BepiColombo spacecraft into orbit around Earth, the first stage of a five billion mile journey to Mercury which will take seven years.

Mr Zender said the probe will study the structure and evolution of Mercury, which previous NASA missions have suggested the planet has a molten core far larger than Earth’s.

He said: “If we look at the densities of planets, Mercury is much too dense for where it is, according to what we know.

“It also has an atmosphere and a magnetosphere.

“It reveals a huge gap in our understanding.”

Mr Zender said the journey to Mercury was difficult because of the enormous gravitational pull of the Sun.

In order to compensate for this, ESA scientists will attempt to reduce its speed by performing “slingshots” around the Earth, Venus and Mercury itself.

And crucially, the spacecraft is fitted with four T6 ion thrusters, fuelled by the inert gas xenon, which were designed and built right here in the UK by QinetiQ at its base in Farnborough.

Mr Zender said: “They are masterpieces of engineering.

“What is really new is the way that they use ion propulsion.”

The thrusters carried an extremely high voltage of 1200 watts, Mr Zender explained, significantly more than previous similar devices, which reached a maximum of 900 watts.

Nor is this the only British involvement. Aerospace company Airbus is responsible for the systems design and building of the mission’s Mercury Planetary Orbiter (MPO), which will study the planet’s surface and internal composition; the Mercury Transfer Module (MTM), providing solar-electric propulsion on the trajectory to Mercury; and MOSIF, the sunshield which will protect it from the colossal temperatures it will face at it approaches the Sun.

Assuming all goes well with the launch, Bepicolombo should start getting data by April 2026, so Mr Zender is facing a long and anxious wait for news.

He said: “Tomorrow’s a big moment but it is exciting.

“This is a chance to do some tremendous science.”

Cityblock Health’s Iyah Romm talks about how to combine technolgoy and hyper local resources to remedy patient distrust in the system.

Distrust in the healthcare system is a major obstacle in providing needed care to some of the most vulnerable populations in the US.

“[M]illions of Americans all across the country … are failed by the healthcare system everyday. Specifically we don’t understand the services that they need,” Iyah Romm, founder and CEO of Cityblock Health, an Alphabet spinout focused on urban-focused public health, said at the Connected Health Conference in Boston. “We haven’t built a system that is [tuned] in on how to engage, facilitate interaction and fundamentally to solve, what I believe is a foundation problem in healthcare today, trust.”

Only about half of Americans say they can trust their doctor—and the number of distrust goes up considerably for people living in poverty and people of color, he went on to say. But he argues that relationships are at the heart of solving this problem.

“We have to invest time in meaningful relationships. We are focused on building technology that does just that,” Romm said. “Trust and technology together will build care that works. Building a foundational system that builds relationships that matter, that are available, and always on, and do the most fundamental thing in healthcare, which is keep our promises.”

While health tech tools have been increasingly available for consumers—those tools often focus on white upper middle class or upper class individuals, he said. That doesn’t mean that people living in poverty don’t have smartphones—he notes that 97 percent of people in that demographic do have smartphones.

One of the ways that Romm and his team at Cityblock have proposed solving this issue is through a platform called The Common. The tool allows a care team to wrap around a patient and connect.

“Part of the notion here is that technology has to stitch this ecosystem together,” he said. “The notion that health is local and pervades everything we all talk about across why these models don’t scale. So as opposed to running away from that and saying ‘it’s impossible’ we’ve embraced it. We said ‘How do we build a tech platform that adapts to locality?’”

But it isn’t just about the technology platform. Cityblock employs a new model of care, where a Community Health Partner (CHP), who ise hired from the community and trained in empathy and relationships, acts as the point person for the patient. Then the technology puts the CHP at the center of the care and communication team.

“Importantly [the CHPs] are the culture center for the team. If a patient doesn’t like how a doctor is interacting with them—the community health partner is never going to say don’t prescribe that medication—that’s not their job—but they are going to say check your bias. That is a statement that this member now no longer trusts you and we can push [the doctor] off the care team to bring in another member.”

The system is also designed to help teams look at the patient holistically and take different cultural norms into consideration.

“We have to be responsive in how we conductive assessments like this so it isn’t checking boxes,” Romm said. “It is a dynamic learning system that allows us over time to adapt to race sex, gender, trauma geography, religion, whatever those factors may be, so that over time we are adapting.”

Since Romm and his team prioritize trust, he said providing transparency to patients is key. With permission, Cityblock lets its patients get their health records through their Gmail account.

“In a trusting relationship. [providers] do not have something different than our members have,” Romm said. “So we give them free access to everything we say and do — side notes and all.”

While this platform maybe be targeted at people living with poverty, Romm said that these tools could help the entire health ecosystem in the future.

“Solutions for the one percent simply do not trickle down. We have had this solution in healthcare over and over again,” Romm said. “We believe the inverse is true however, that if you build for those with the most complexity there is tremendous value. So we don’t build with the notion that we are only building for poor people, we build with the notion that you have to take into consideration those who have the most complexity first. This drives all new ways of thinking and it drives us to check our biases in design.”

The sky’s the limit as the city of Calgary opens what it believes is the first testing area in Canada for drones, autonomous vehicles and other technologies.

The city has set aside a 50-hectare site in its industrial southeast to offer airspace for an increasing demand from companies and educational institutions wanting to do mass tryouts of commercial drones.

A downturn in the energy industry when oil prices took a free fall in 2014-15 spurred the development of geospatial sciences, said Patti Dunlop of Calgary Economic Development.

“There’s many companies that came out of the downturn that actually took their engineers, mathematicians and … transitioned into … another burgeoning technology,” she said. “Energy will always be our backbone but we are more than that.”

Geographic information systems are designed to capture, store, analyze and manage spatial or geographic data.

Mayor Naheed Nenshi said the Calgary testing site will be a boon to many sectors, including oil and gas, film and financial services.

“We have a part of the city that is part of the endless prairie where there are no buildings, so the concept of the living lab, here, for the first time in Canada … really allows us to help these companies grow,” he said Friday at the official opening of the testing area.

Nenshi gave an example of how new technology can be used in everyday life.

“I had my roof damaged in a hailstorm. The insurance company was able to send a drone over my roof to look at the damage without having to send someone over to climb a ladder and have a look there.”

Dunlop said a pilot project last year offering a test area within the city was so successful it led to the permanent site that opened Friday.

“From what I know, nobody else has started doing this. There’s places in the United States that have testing, but in Calgary we’re the first municipality that’s allowing this type of testing to happen.”

There are requirements companies have to meet to use the test centre. They include licensing fees, proof of $2 million in corporate liability insurance and a special flight operations certificate for drone technology.

The interim update of the ACOG Practice Bulletin on Tubal Ectopic Pregnancy1provides a review of information on the current understanding of tubal ectopic pregnancy and offers comprehensive guidelines for timely diagnosis and management options. Compared to the previous publication, the current bulletin provides comprehensive management options for ectopic pregnancy by incorporating new guidance on pregnancy of unknown location and on surgical management of ectopic pregnancy, as well as revised guidance on use of hCG levels for diagnosis.

ACOG recommends not using serum hCG values alone to diagnose an ectopic pregnancy and that they be correlated with the patient’s history, symptoms, and ultrasound findings. If the concept of the hCG discriminatory level is to be used as a diagnostic aid in women at risk of ectopic pregnancy, the value should be conservatively high (eg, as high as 3500 mIU/mL) to avoid the potential for misdiagnosis and possible interruption of an intrauterine pregnancy that a woman hopes to continue.

Overall, in this Practice Bulletin, ACOG is advocating use of a comprehensive approach and more conservative guidelines to avoid the potential for misdiagnosis, possible interruption of an intrauterine pregnancy or unnecessary medical treatment that could lead to teratogenicity in surviving pregnancies.

While this Practice Bulletin specifically and clearly emphasizes the importance of discussion of risks versus benefits with patients in determining treatment method, there are also other logistical issues that may arise and affect decisions about treatment. Most ectopic pregnancies are managed in the outpatient setting and with minimal variation in the team involved. However, depending on individual hospital and office setup, if different laboratories and/or hCG assays are used for trending hCG levels, it is possible that these inter-assay/laboratory variabilities in hCG values could significantly affect the clinical decision-making process. In addition, the issue concerning insured and uninsured patients deserves special consideration. It has been shown that there exists substantial insurance-related variation in treatment. Uninsured women and Medicaid recipients were less likely to receive treatment with methotrexate and were less likely to undergo salpingostomy. In the same article, the authors also discuss the disparity in that black and Hispanic women were less likely to receive tube-conserving surgery.

Some of the recent changes that have facilitated a more conservative approach in treatment of tubal ectopic pregnancy include wider availability of methotrexate, use of early sonography and management of pregnancy of unknown location with uterine aspiration to distinguish between early intrauterine pregnancy loss and ectopic pregnancy. These factors are leading to earlier diagnosis of the disease and subsequent growth in medical management in the outpatient setting. When indicated, surgical management with minimally invasive surgical techniques is preferable to laparotomy. It is important to note that ACOG recommends that the decision to perform a salpingostomy or salpingectomy for treatment of ectopic pregnancy be guided by the patient’s clinical status, her desire for future fertility, and the extent of damage to the fallopian tube.

There has been a decline in rates of salpingostomy compared to salpingectomy. Although cumulative rates of intrauterine pregnancy and recurrence of ectopic pregnancy in patients who had salpingostomy versus salpingectomy are not statistically significantly different in randomized controlled trials, the move towards salpingectomy is increasing.This is likely due to a combination of many factors, including patient history, intraoperative findings, physician preference and comfort with the procedure as well as increased availability of in vitro fertilization. As the number of salpingostomies being performed nationwide continues to decrease,it is possible that over time, younger physicians will become unskilled in performing the procedure and the frequency could drop even more drastically. Furthermore, recent publications favoring opportunistic salpingectomy for risk reduction of ovarian cancer may be leading physicians towards complete tubal removal whenever feasible.