Public Health Crisis: Suicides

This is a public health related piece. I produced a video about suicides. The data that I analyzed was from the Centers for Disease Control.

Suicide has been on the public radar recently because of the scrutiny it has received in the press. And the concerns expressed in the press about the rising numbers and rate of suicide.

When I was in college, I was taught that suicide was a largely based on the victim's emotional state. That the answers of how to address it were to be found in psychology and psychiatry. That may have been true then, but the data that I analyzed, that you will see in this movie, says that suicide may now be more of a socio-economic problem.

Here is the link to the video:

Let us know what you think.

Public Health Alert: Centers for Disease Control records 72,300 Drug Related Deaths in 2017

Here is the article from the New York Times reporting the number of drug related deaths from the Centers for Disease Control (CDC) for 2017.

https://www.nytimes.com/2018/08/15/upshot/opioids-overdose-deaths-rising-fentanyl.html?em_pos=small&emc=edit_up_20180815&nl=upshot&nl_art=0&nlid=67594383emc%3Dedit_up_20180815&ref=headline&te=1

In my own analysis https://professionalpredictivemodels.blogspot.com/2018/07/drugs-deaths-1999-to-2016-and.html my worst case prediction was for approximately 69,000 in 2017. To have a worst case exceeded by over 3000 deaths is a stunning development. My worst case prediction for 2018 is for the number of deaths to be between 76,000 and 77,000. And by 2025 my worst case prediction is for the number of drug related deaths to be between 150,000 and 160,000. I have had a difficult time believing the trends that the numbers appear to show. They seem unbelievable, but given that my own worst case, my own worst fears have been outstripped by the actual numbers ... well it now it appears that my own worst case fears may exceeded by reality.

Measuring cortisol — the stress hormone, remotely

Having the ability to remotely and continuously measure the level of a stress-related hormone would seem to be something of real value.

A new wearable biosensor, developed by the Salleo lab at Stanford, measures the amount of cortisol in a person’s sweat. 

Here is the link to the announcement/article: https://www.medicaldesignbriefs.com/component/content/article/mdb/insider/32762?utm_source=TBnewsletter&utm_medium=Email&utm_campaign=20180808_Medical_Newsletter&eid=376600177&bid=2199287

FCC approves telemedicine pilot for veterans, low-income, rural Americans

I'm actually surprised that this trial had not been approved earlier. Here is the announcement from the FCC.

 This is a link to an article that provide more detail on this program.

https://www.mobihealthnews.com/content/fcc-approves-telemedicine-pilot-veterans-low-income-
rural-americans?mkt_tok=eyJpIjoiT1dJNVl6UmxaVFExT1RkaCIsInQiOiJrb1B5Y0drbTRBMzRoMHFcLzBpUlpCTVljT1lBUGhhcUNCazA2RndKOW8zXC94dTFVSU5ua1VYY1NzeHBQazRsYW5hMkdsaTRETndXb01CTDZjN1Zva2VRYmRIUElic0FCc21BYVowSWdFTGVtTSt1Y2kxTXFGSHRuYlNCcitSRU5TIn0%3D

Since this is a pilot program, data should be collected about it's effectiveness. This is something that those who are interested in medical remote monitoring and remote patient management should be interested in following. I know I will.

New York Times Magazine Article: Losing Earth - CO2 concentration in the atmosphere and it's relationship to global average temperature

This is related to public health not just for now but in the future as well. Here's the link to the article: https://www.nytimes.com/interactive/2018/08/01/magazine/climate-change-losing-earth.html This article is definitely worth your time.

I use this as a lead in to something that I posted on my other blog, Professional Predictive Models. I did this analysis on the connection between CO2 concentration in the atmosphere and it's relationship to the global average temperature. The strength of the relationship of these two measurement actually startled me. Here's the link to the blog post: https://professionalpredictivemodels.blogspot.com/2018/08/relationship-between-carbon-dioxide.html

Article: Wearable Technology Is the Future of Healthcare

A bit of light reading about wearable fitness and medical devices.

Here's the link to the article: https://www.hcanews.com/news/wearable-technology-is-the-future-of-healthcare

An interesting quote from the article ...

There is no doubt that the adoption and retention of medical wearable devices will, at least for now and the foreseeable future, outrun that of general fitness wearable devices. This is understandable, as they fulfill a direct and current need for the consumer. However, my belief is, and I assume yours too, if you believe in prevention over treatment, that the more general one of these two has the feared but powerful potential to truly change the status quo. Where now, overall health goes down just before the age of 50, general fitness wearable devices could move up that number.  ...

Drugs Deaths: 1999 to 2016 and Predicting Outcomes in Future Years

I write another (new) blog that dedicated to statistical analysis of a variety of sources of data and to predictive models. I recently wrote an article that is public health related. Although it has nothing to do with medical devices, it nevertheless is related to public health, treatment and sorry to say, death rates.

Here's the link to the article.

https://professionalpredictivemodels.blogspot.com/2018/07/drugs-deaths-1999-to-2016-and.html

Here is a preview:

The Centers for Disease Control (CDC) has a comprehensive online database known as Wonder (https://wonder.cdc.gov) that is accessible to all. So if you have public health related questions, the data to answer them can be found in Wonder.

Unless you've been living under a rock, you know that deaths from drug overdoses particularly opioid related deaths have been steady increasing. I am interested in not only in the number of deaths, but the rate of increase and what that suggests for the future. I believe you will find the results of my analysis both interesting and troubling, particularly for the future.

Here's a chart showing the number deaths from 1999 to 2016:

...

Using the equation derived from the 2008 to 2016 data, the picture that arises is much more concerning. In fact the crude rate in 2025 is twice the rate predicted by the trend line equation derived from the 1999 to 2016 data. This suggests that the number of drug related deaths would be near 500,000 by the mid 2020s and that the number of drug related deaths during the 2020s would be closer to 1 million to 1,500,000 where the number of deaths per year would be no less than 100,000 and possibly up to 150,000 each year. Most of these deaths would come about as a result of opioid overdoses.

Apple Watch 4: Will it be suitable as a remote medical monitoring device? Part 1

When I first commented about the Apple Watch as being a possible platform for a remote medical monitoring system in 2015, I was initially excited about the possibilities. Sadly, the technology in 2015 was not quite ready as a platform for remote medical monitoring systems. However, Apple may be turning a corner with the Apple Watch 4 due to be released in Fall 2018. 

To be an effective remote medical monitoring and remote patient management device, the Apple Watch will need to reach acceptable levels of performance in the following seven areas of concern:

1. Bio-sensors
• Built in: are there enough bio sensors with enough resolution?
• Extended: the capability to have additional bio sensors that communicate wirelessly with the watch?
2. Communications over the Internet: Is there a reliable and secure means of communication back to the patient's monitoring system? And the means to communicate with the patient over that same communications channel(s)? 
3. Processing capability, hardware and software: Does the watch have the processing capability to host medical applications?
4. User interface: Visual, touch screen - will patients be able to interact with medical application using the touch screen? Will the watch have an effective audio user interface in order to hear instructions and make requests of the application running on the watch?
5. Reliability: Will the hardware and software reliable enough for a remote medical monitoring and patient management application to run on it?
6. Battery life: When running a remote medical monitoring and patient management application(s) on the watch, will the battery life before needing to recharge be acceptable?
7. Rugged: Is the Apple Watch 4 rugged enough to be a remote medical monitoring and patient management device?

I'm going to touch on each of the areas of concern regarding the performance of the Apple Watch 4.

1. Bio-sensors: I'm not going to address this issue until the Apple Watch 4 has been released. Once it has been released, I'll write an article specifically discussing this topic.
2. Communications over the Internet: A model of the Apple Watch 3 does have the capability of communicating over 4G so reliable communication over the commercial wireless provider networks is possible. We can assume that this capability will continue to the next release. So communications capabilities are likely to be adequate. 
3. Processing capability, hardware and software: Improvements in both are promised over the Apple Watch 3. We can probably assume that hardware and software capabilities will be adequate.
4. User interface:
• Visual, touch screen: The Apple Watch screen has been targeted to those with good visual acuity (with or without glasses) and fine finger control to be able to use the touch screen effectively. Current reports say that the screen will be larger than the Apple Watch 3. Nevertheless it's still a small screen. 
• Auditory: The Apple Watch 3 has Siri, meaning it does have an auditory user interface. More on this after the release of Watch 4.
5. Reliability: Apple has made positive strides in reliability with each release of the Apple Watch. We can assume that this will continue and that the Apple Watch 4 will be reliable enough to serve as a platform for remote medical monitoring and remote patient management applications.
6. Battery life: The Apple Watch 3 has a reported battery life of up to 18 hours. Again Apple has continued its improvements in this area. Patient medical monitoring should be continuous and without long breaks. Even with one or more days of battery life, the watch will still need to be changed and that could take hours. However, having said that, the price of an Apple Watch (because of the ruggedness requirement) that would serve as a remote medical monitoring and patient management device would be around $600. As medical devices go, that's inexpensive and inexpensive enough so that the patient could or should have at least two Apple Watches that would enable the patient to switch watches when necessary. That would place a burden on application software developers to manage when patients change watches, however, this should be manageable.
7. Rugged: The Apple Watch 3 has a version in a stainless steel case. This should be adequate for most situations. Also the issue of reasonably low price and the ability to have redundant watches should effectively address this issue.

Adhesives: Part of the Future for the Remote Monitoring Sensors?

I just ran across this article a few minutes ago. It's a serious article published in Machine Design. Here's the link: http://www.machinedesign.com/mechanical/adhesives-enabling-future-wearable-medical-devices?NL=MD-005&Issue=MD-005_20180724_MD-005_524&sfvc4enews=42&cl=article_1_b&utm_rid=CPG05000003255032&utm_campaign=18775&utm_medium=email&elq2=5b76b40ea8f44d76b2b883c5c09f23fe

It's an extremely readable article and what's being described has in my opinion real applicability in the future of medical sensors. Adhesive, "band-aid" or strip sensors development applies to both the fitness set as well as to remotely monitored patients.

Transmitting data to monitoring systems and people will likely require an intermediate device such as a smart phone. I suspect that the real issues and hurdles will likely revolve around digital communications issues and standardization. Having worked most of my life in the communications domain, communications issues can be successfully overcome.

Here are a few quotes from the article:

Device manufacturers are taking steps to create medical devices that are smaller, lighter, and less invasive. Whether they’re adhering device components together or sticking a device to skin, adhesives are uniquely bonded to a device’s success.

Both consumers and patients want wearable devices to be smaller, lighter and less cumbersome to use for seamless integration into their everyday lives. The design process can get challenging when devices must maintain accurate sensing capabilities, but also reduce friction to ensure precise data collection. Adhesives can help to keep friction to a minimum by being breathable and maintaining a low profile. In addition, options with flex electronics, as well as addressing battery implications and electromagnetic interference, provide opportunities for advancement.

Adhesive wear time is a crucial consideration when designing a wearable device, impacting overall resilience and durability, as well as how often the user will need to change their device. 

______________

I should mention that by the looks of things, it appears to me that 3M maybe behind the article. Nevertheless, I think that considering adhesives in the research, design and development process of a bio-sensor is worth your time. 

15 Game-Changing Wireless Devices to Improve Patient Care

I happened across this slide show today and decided to share it.

https://www.medscape.com/features/slideshow/wireless-devices#17

Remote monitoring has by implication another side to it: remote patient management. The remote monitoring side of these devices seem to be on a strong, positive path of development, but I'm not seeing the same level of development on the remote patient management side. That piece of seems to be lagging and probably for good reason: it's the more difficult. And I can say that from experience working in the area. In addition, it will likely require further development of supporting automation, that is, artificial intelligence or expert systems.