"Big brother is watching you"

How the development of technology is changing our lives

Anna Petrenko, "Biomolecule"

New technologies are changing our lives day by day. Last but not least, this applies to medical technologies. Who knows, perhaps in a dozen years it will be wearable devices that will become the first and last things that a person sees in his life. Compact devices are already being used for diagnostics, monitoring and rehabilitation of patients. In addition, such technologies open up many opportunities for the training of doctors themselves. It is precisely such innovations that have become the topic of this article. The next articles in the series about wearable technologies will tell about fitness trackers and mobile applications that track every breath of the owner, and cyborgs among us.

Have you counted how many times a day you encounter various devices and mechanisms? A running alarm clock, an electric toothbrush and kettle, a smartwatch... Technology has flooded our lives. It would be surprising if these innovations did not penetrate into more intimate spheres, namely, they would not help us to monitor our health.

To be a happy user of new medical technologies, it is not necessary to become a cyborg with implanted mechanical devices (like in vivo biosensors [1]). One of the most fashionable trends is non–invasive wearable technologies, or wearables. By opening an online store or a corresponding scientific journal, you can find a wide range of devices: pedometer, sleep tracker, calorie counter or pulse... Every respectable follower of healthy lifestyle has a fitness tracker that helps to track all these parameters of vital activity (but whether such tricks help to become healthier, "Biomolecule" will tell a little later). In addition, companies produce smaller versions of bulky devices, the use of which has traditionally been limited to hospital walls. And yet the field of application of new devices is much wider: perhaps soon they will be used by everyone – from babies to centenarians.

Doctors are also learning not to disdain new technologies, because it is very convenient to monitor the condition of patients at a distance. The spread of this is largely facilitated by technical developments that make the device smaller, more convenient and cheaper [2, 3]. What devices pave the way for the future of healthcare today and how is the usual system of medical care changing?

Distinguish and track: diagnostic devices

The focus of companies developing medical devices has shifted from the hospital to the patient himself [4]. Previously, the doctor often met with the patient at his workplace in an emergency. Now, more and more attention is being paid to chronic diseases and calculating the risk of developing diseases [5]. It is the new technologies that allow you to monitor the condition of a potential or "active" patient in real time. In addition, with the development of computer technology and the improvement of programs that can quickly calculate large amounts of data, wearable devices could change the entire healthcare system and help scientific research. After all, theoretically, this allows you to get a huge amount of information about the whole population – without the presence of a doctor or researcher! In addition, it would significantly reduce healthcare costs.

Schizophrenia vs. bipolar disorder

It is not surprising that devices for medical diagnostics and patient monitoring occupy a special place in the development of wearable technologies. Such devices can do seemingly incredible things: for example, distinguish patients with schizophrenia and bipolar disorder by the nature of movements. These conditions are often misdiagnosed: many biological characteristics and symptoms of diseases overlap, and there are no reliable methods of distinguishing them. Some even believe that schizophrenia and bipolar disorder are opposite ends of the same continuum [6]. However, the therapy of diseases is by no means the same, and therefore it is important for the doctor to make the correct diagnosis.

As scientists from the University of California at San Diego (USA) found out, in a new environment, patients with schizophrenia and bipolar disorder behave differently. A computerized LifeShirt vest that tracks hyperactive and repetitive movements and some physiological indicators helps to determine this.

Lenses on the guard of glaucoma

Wearable technologies can fit into an extremely small volume and at the same time give the highest efficiency output. For example, the Sensimed Triggerfish "smart" silicone lens helps predict the rate of glaucoma development in patients with the initial stages of the disease. Now, to assess the progression of the disease, you need to visit a doctor often. The built-in sensor of the new device monitors intraocular pressure for 24 hours, responding to changes in the curvature of the lens. When such changes are detected, the signal is transmitted to a wireless antenna around the eye, and the antenna in turn transmits the information to a portable recording device located in the patient. After the end of the recording period, Bluetooth data is transmitted to the doctor's computer (Fig. 1).

Figure 1. The "smart" lens helps to monitor intraocular pressure and the development of glaucoma. The figure shows the complete equipment: 1 – the lens itself; 2 – the antenna glued around the eye receives information wirelessly from the contact lens; 3 – data is transmitted from the antenna to the portable recording device via cable; 4 – the portable recording device stores the received data and transmits it to the doctor, to a computer with a special program installed. Drawing from the website sensimed.ch .

To evaluate the effectiveness of Sensimed Triggerfish, researchers monitored the intraocular pressure of 40 patients for two years. As it turned out, the severity of changes in the curvature of the lens at night and their frequency (a special program presents everything in the form of graphs with characteristic peaks) correlate with the progression of the disease. Thus, by obtaining reliable information with the help of a lens, rather than visits to a doctor, it is possible to assess how the disease behaves. The smart lens has already been approved for use in the UK, Switzerland, Italy, Austria and other European countries.

Such different electrodes

If we talk about the devices – the "favorites" of developers, then these are, perhaps, wearable devices with electrophysiological sensors. With their help, you can get an electrocardiogram, an electromyogram and an electroencephalogram.

Devices with such detectors are used for a variety of purposes, even entertainment: for example, MobilECG developers have created a funny business card visualizing the ECG of the person holding it in his hands (see video).

But an ECG can also be used for the most serious diagnostics: for example, predicting falls – the main cause of injuries in the elderly [7]. As it has been shown, short-term episodes of imbalance, dizziness, weakness, etc., leading to a fall, often indicate cardiovascular diseases, in particular orthostatic hypotension and autonomic dysfunction. These disorders are associated with the state of the autonomic nervous system, the work of which can be assessed by the heart rate variability calculated from the ECG.

To improve the recorded signal when removing electrophysiological parameters, polyclinics usually use a special electrolytic gel. It is applied to the area of skin contact with the detector of electrical activity, and because of this, standard electrodes are dubbed "wet". However, the gel dries out gradually, so the signal registration deteriorates.

Modernization of this process is necessary, for example, to improve the operation of the brain-computer interface (BCI) [8]. Such systems transmit commands from a person to a computer or other electronic device and back. The main practical application of these developments is computer programs and prostheses that can be controlled by the "power of thought" (see video). Thanks to the new comb-like electrodes, which do not require gel, it will become much more convenient and easier to use such technology [9].

The Telegraph correspondent tested the brain-computer interface and tried to draw Van Gogh's "Sunflowers", repeating the experience of a paralyzed patient diagnosed with amyotrophic lateral sclerosis, who used this technology to create a picture of flowers (see the article Creative minds: painting with brain power).

Researchers from North Carolina State University solved the same problem in another way: by developing "dry" electrodes with silver nanowires. "Our new electrodes provide better signal quality than most– if not all – existing dry electrodes," says Dr. Yong Zhu, senior author of the paper [10]. The device is compatible with standard ECG and EMG readers and is suitable for long-term monitoring of patients.

Ennobled old age

Figure 2. The new GyroGlove glove reduces limb tremor in patients with Parkinson's disease. Drawing from the website jewishbusinessnews.com .

Developments on new wearable technologies are very different, and one of the target audiences of developers is the elderly. This cannot be called a surprise, because the population of our planet is steadily aging [11].

The field of attention of developers includes rehabilitation after a stroke [12], and monitoring of the mental state [13], and assistance to people with impaired vision [14]. But some diseases are more equal among equals – for example, Parkinson's disease. This neurodegenerative scourge of the planet's aging population affects up to ten million people worldwide, and there is still no cure. However, early detection and timely administration of supportive medications can slow the progression of the disease.

For the diagnosis of Parkinson's disease, a pull test is often used to assess the patient's postural instability [15]. In this test, the patient is pulled back by the shoulders and then assessed how he maintains balance. To make this test more objective and better, scientists have come up with a new device: sensors are attached to shoes and allow you to accurately track violations of the patient's movements. Sensors in the device on each shoe are a three-axis linear accelerometer and a gyroscope. During testing, patients perform a series of motor tests, and then, based on information from sensors, they are diagnosed.

To deliver drugs to patients with Parkinson's disease, you can also use not standard methods, but "smart skin". Usually, you need to take medicine for this disease every few hours, otherwise the trembling of the limbs appears again. The new skin patch recognizes when the tremor begins to return, and releases a small dose of medicine stored in the nanoparticles of the lower layer of the patch. Thus, the main difference between the new patch and others (for example, nicotine) is that the drug enters the body only when it is needed. Unfortunately, the built-in batteries for the device have not yet been invented, so we have to be content with an external power source. A special temperature sensor protects the "smart skin" from overheating and, consequently, the human skin from burns.

For those whose disease is already at a late stage and the tremor of the hands significantly worsens the quality of life, a special GyroGlove glove was invented (Fig. 2). As Faii Ong, the 26-year-old founder of GyroGear, says, it reduces involuntary movements by 90%, using physical laws to stabilize. Although there are already cutlery and tableware for people with such problems, they help to solve only the issue of nutrition. GyroGlove, by mechanically reducing tremor, provides a universal solution. It is only necessary to put on such a glove – and you can again independently perform basic movements without fear of dropping or spilling something. In addition to the company itself, Imperial College London and the National Health Service of Great Britain financially support the project to develop gloves for parkinsonists.

What will your tattoos tell you about

Have you ever thought about getting a tattoo, or maybe you already have a couple? If not, then you probably pasted transferable tattoos as a child, or at least saw a new fashion – pasting short-lived golden patterns "flash tatoo" on the skin. Wearable technologies are also keeping up with new trends. Now there is a whole class of the thinnest, stylish and useful devices that are glued to the skin and look like a patch or tattoo. They can monitor, for example, the state of the cardiovascular system by heart rate or by blood flow in the area of the skin on which they are glued [16].

Especially for moms, scientists have developed a digital analogue of Mary Poppins – a colorful adhesive thermometer Fever Scout, which not only measures the baby's body temperature around the clock, but also transmits this information in real time to a smartphone via Bluetooth (Fig. 3). The device can even send notifications if the baby's temperature has increased too much. All data on temperature fluctuations are stored in the mobile application, which allows mom to monitor the effect of medications – well, or to identify situations when a child does not want to go to school and stuffs his temperature by sticking a thermometer in hot tea.

Figure 3. A magic patch in the form of a colorful zigzag is glued to the child's skin and measures his temperature in real time. The temperature information is transmitted to the mobile application. Drawing from the website xabes.com .

Moreover, there are new devices created specifically for diabetics. Just the other day, WHO practically declared war on this disease, because already every 12th inhabitant of our planet is diabetic. Patients with this disease have a lot of inconveniences with tracking glucose levels, since traditionally it is necessary to analyze blood from a finger for this. Now progress has reached the point that the adhesive skin patch determines and even regulates blood sugar levels (Fig. 4). The creation of the device became possible because scientists have found an exact correlation between blood glucose and sweat levels. The new patch includes sensors that register the concentration of glucose in sweat, and a system of microneedles that inject the drug metformin if the sugar concentration is high. If the recording of glucose levels using a patch has already been tested on two healthy people, then metformin delivery has so far been tested only on a mouse model. After a number of improvements and more extensive human studies, the developers are going to make their technology widely available.

Figure 4. The new "smart skin" detects the concentration of glucose in sweat, correlating with the concentration of glucose in the blood, and even introduces metformin when required. Drawing from the website newscientist.com .

Google's development can compete with the skin patch – a contact lens with a sensor that measures the concentration of glucose in the tear fluid (Fig. 5). Its tiny wireless chip and a miniature sensor are embedded between two layers of soft material of ordinary contact lenses. The readings are taken at a frequency of once per second.

Figure 5. Google and Novartis are going to bring to the consumer market a "smart" lens that detects the level of glucose in the tear fluid. Drawing from the website hotshowlife.com .

According to the developers, these sensors are so tiny that they look like sequins, and the built-in antenna is thinner than a human hair. Moreover, it is supposed to insert miniature LED bulbs into the design, which will light up when the glucose concentration reaches a certain value. Google Lab, together with its partner, Novartis pharmaceutical company, announced the start of the technology licensing process in 2014.

Revolution today

The gaze of the developers of new technologies is directed not only at patients or people who are likely to become them soon. Potential users also live on the other side of the "barricades" – and these are the doctors themselves. In their professional environment, wearable devices are already winning back their space.

Google Glass can revolutionize the training of young doctors (Fig. 6). Instead of regular glasses, users of this device get a whole set of functions: voice control, built-in microphone and camera, viewing messages, texts and pictures, recording audio and video, data synchronization with a smartphone and much more. This wearable device was released in 2013, but now there is no open access to it.

Figure 6. The new Google Glass technology, temporarily unavailable to the general consumer, can help in training young doctors. Drawing from the website nezavisne.com .

There are many uses for Google Glass in medical practice [17]. The student will be able to visit the skin of a practicing doctor and see the communication with the patient step by step live. In addition, young doctors will feel independent in performing simple actions, while they will be supervised by experienced mentors.

Finally, you can observe the operation in real time – and not from the side, but as if "from the first person". In 2014, Shafi Ahmed, a surgeon from The Royal London Hospital, removed tumors from the liver and intestines of a patient live in front of 13,000 medical students, broadcasting videos to the Internet using Google Glass. During the operation, students also asked questions that were reflected on the doctor's device. 90% of students later noted that they would like to include this type of training in the curriculum [18]. Just the other day, the success of the live broadcast of the operation was repeated – now using virtual reality technology with a 360-degree viewing angle (see video).

Of course, the first Google Glass model has many drawbacks – from battery life to questions about the protection of personal information. Perhaps a new development – a "smart" lens from Samsung – will cope with the training task even better (although there are even more questions about data privacy with it). It is equipped with a camera, an antenna, several sensors and a display that projects an image directly into the eye. To use the lens, you need a smartphone.

To be continued...

As can be seen from this cursory review, the world's largest manufacturers are betting on wearable technologies. The range of diseases in the diagnosis and monitoring of which such devices are beginning to be used is expanding – from cardiovascular diseases to complex neurological disorders. With regard to the shape of the devices, general trends can be identified: for example, devices in the form of "smart skin" or "smart" lenses are popular. Both the type and the purpose of future devices can give us surprises more than once. In addition, such developments help not only patients, but also doctors. Perhaps even healthcare at the global level will benefit from innovations in this area in terms of resource allocation and budget savings.

Two more categories of technical innovations cannot be ignored. The first is devices that are implanted into the human body and are not always visible to the eye. The second is daily trackers that perform seemingly elementary functions: counting the number of steps, speed of movement, sleep duration, etc. – however, due to the competition of manufacturers and dizzying technical development, such devices know a lot and know a lot about their owner.

In addition, similar developments help athletes improve their form without doping and global scandals, and in addition, reduce the traumatism of their professional activities. These types of wearable technologies will be discussed in the next article.

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Portal "Eternal youth" http://vechnayamolodost.ru  10.05.2016