5G and Healthcare...
Author: Prof K Ganapathy
Director Apollo Telemedicine Networking Foundation, Apollo Tele Health Services | Distinguished Visiting Professor IIT Kanpur | Distinguished Professor The Tamilnadu Dr MGR Medical University | Emeritus Professor National Academy of Medical Sciences
5G is the fifth generation of wireless communication technology, promising faster data transfer speeds, lower latency (round trip latency >10 milliseconds), increased network capacity (1 million devices per sq km), 99.999% network reliability and battery life of up to 10 years for IoT devices. There is considerable hype in the media that deployment of 5G will revolutionize healthcare by enabling new medical applications and improving existing ones. Using Edge computing, 5G Data can be processed closer to where it is generated. IoMT (Internet of Medical Things) devices generate huge amounts of data. Cloud computing can provide the necessary infrastructure to process and analyze this data. Faster transmission of data will enable more efficient storage in the cloud. Accessing more bandwidth and computing resources, and providing infrastructure to enable scalability will now be less problematic.
No doubt clarity of images transmitted will be better and the immersive experience in video conferencing will be an all-time high. Mammograms, CT, MRI, and ultrasound images generate large amounts of data. High-speed transfer and processing will save a few minutes. Onboard cameras, camera-based Headgear, and ‘Body Cams’ for paramedics can transmit patient data to hospitals in real-time using ultra-fast and low-latency 5G connected ambulances, with medical equipment, patient monitoring applications and telemetry devices that ensure excellent pre-hospital management. 5G can facilitate real-time control of medical robots, enabling precise and safe interventions in performing complex procedures. 5G enables faster and more efficient data transfer, facilitating clinical trials and drug development, as these require the collection of large amounts of data from multiple sources.
The media loves dramatising “telesurgery” – the use of 5G in enabling remote surgical procedures. The world’s first remote brain surgery using 5G was conducted in March 2019. Deep Brain Stimulation was performed for a Parkinsonian patient, with the surgeon 3000 km away. In India there have been sporadic anecdotal reports of the use of 5G in remote interventional procedures, The sceptic would wonder why the patient could not go to where the surgeon is located!!! In May 2021, the Thoracic Surgery Education Group enabled 200 thoracic surgeons to access a virtual environment (VE) wearing a head-mounted display (HMD). Discussions in real-time occurred while observing surgery in a VE. Moving the mouse, every corner of the Operation Theatre (OT) was visible to surgeons from different continents. 3D glasses enabled viewing of High Resolution 3D images. Pathologists could display microscopic images on the large screen of the OT and the surgeon could listen to pathologic findings in real-time & share opinions. I believe that 5G assisted telementoring and telemonitoring is more important, doable and necessary than the media hyped “telesurgery”.
The healthcare “industry” is generally more conservative in jumping on to the bandwagon, in deploying future-ready technology. Interoperability, portability, stakeholder customization, human factors (skills, resistance, distrust, cyber-attacks), legislation and regulations need to be factored in. The adoption of any new technology to a large extent depends on the return on investment. Making a product cost effective in turn depends on scalability and mass deployment.
Now that the sales pitch is over, as an old fashioned clinician belonging to the BC era, let me ask my favourite question, dreaded by multinational corporations worldwide - SO WHAT? In Utopia, a clinician, whose primary reason for existence is to promote good health, postpone illness, reverse, reduce symptoms and signs, and significantly improve health outcome – needs the results of a good, well designed, prospective study where the primary question is “Did 5G really make a difference?”
Such a study can be done in India – with global ramifications. The real world is different. If we do not use 5G we are in the Jurassic Park!! Time alone will tell if 5G needs to be an integral part of a hospital’s armamentarium.
Article first published in Telemedicine Society of India, Tamil Nadu Chapter Newsletter April 2023
1st InnovaSpace Journal Club...
Author: Lucas Rehnberg
NHS Doctor - Anaesthetics & Intensive Care | MSc Space Physiology & Health
Extremely pleased to report on the 1st InnovaSpace Journal Club meeting that had the participation of a very international audience, with attendees from Belgium, Brazil, India, Israel, Italy, Romania, and UK! Thank you to all those who attended and look forward to future talks and discussions.
For those who couldn’t attend, or are interested in the Space Journal Club, I have created a ‘one page’ summary of the paper we discussed. I have also added in the discussion points raised after the critical appraisal of the paper, together with links to additional reading material for anyone wishing to learn more.
PAPER PRESENTED & DISCUSSED:
After 50+ years of spaceflight, the first documented venous thrombus in an astronaut identified - highlighting a new pathology, not previously diagnosed in astronauts.
Who are the authors?
Experts in this field from several space agencies => NASA, IBMP (Russia), ESA
Funding => NASA, under the Human research program. Part of the multi-institution international fluid shifts study.
What is interesting about this paper/ Why would the medical space community be interested in this?
New pathology, not diagnosed before. Potentially massive implications for future long duration missions. LBNP could potentially be a countermeasure to enhance venous blood flow or improve cerebral venous outflow.
The research question.
Loss of hydrostatic gradient and variation on Earth, sustained fluid redistribution. Effect on cerebral venous drainage/blood flow. Possible mechanism linked to SANS? Increased risk of clot formation due to static/retrograde flow?
Why is this research question important?
Static/stagnant flow can predispose individuals to thrombus formation. Long lasting effects of thrombi for astronauts, potentially affecting crew performance (i.e. risk of anticoagulation, emboli, then leading to reduced performance affecting the crew and mission).
The study design.
Primary research => prospective cohort study (follow a similar patient group over time, comparing a particular outcome). Subjects were 11 astronauts, on the ISS.
Ultrasonographic assessment of left IJV (IJV are main conduits of cerebral drainage)
- pre flight (3 positions, seated, supine & head down tilt)
- at approximately D50 and D150 of spaceflight
- with and without LBNP (approx the same days, Russian Chibis-M LBNP)
9 crew members participated in LBNP sessions. 17 LBNP sessions, 10 of these (59%) showed improved IJV blood flow patterns. Other 7 sessions were equal or worse flow. No syncopal episodes recorded.
Potential countermeasure to blood flow stasis and thrombosis (but DIDN’T reach seated baseline in +1Gz).
Flaws? Biases? Limitations?
All papers that involve human subjects in space have a common flaw => lack of numbers (compared to terrestrial studies)
Non-invasive pressure measuring of IJV likely overestimated values. Only the left IJV was assessed (right IJV has been examined previously). No lower limb assessment either (i.e. for DVTs). Measurements over 150 days, LOTS of variables (exercise, EVAs, other activities, diet, etc).
Can these results be applied to your patient population? (i.e. other astronauts)
In my opinion => YES!
Tough with small sample size to draw definitive conclusions. However, it would almost be irresponsible to ignore and say it is a ‘one off’.
Tested in similar population in similar conditions (i.e. not in a lab or analogue in simulated conditions like 6o head down). Space medicine is often ‘best evidence we have’ based, augmented with experts and experience.
Is this clinically relevant and how could this affect future management and treatment?
There needs to be a lot more research to determine the actual level of risk of thrombus formation in microgravity, affects of countermeasures on venous blood flow, and benefits of screening pre and during flight.
Then future management -crews performing point of care ultrasound with minimal support (with time delays going to Mars), limited resources and pharmacy, prophylaxis, risk/benefit of anticoagulation, and so many more questions!
Discussion of the paper after the critical appraisal was very interesting with a variety of topics and issues raised, such as:
Surveillance for jugular venous thrombosis in astronauts. Pavela et al 2022
The Vascular Frontier: Exploring the diagnosis and management of vascular conditions in spaceflight. Drudi et al 2022
Venous Thrombosis during Spaceflight. Auñón-Chancello et al 2020
The effect of microgravity on the human venous system and blood coagulation: a systematic review. Kim et al 2021
Missed the discussion? Catch up below with InnovaSpace YouTube videos!
Sign up to our social media (@InnovaSpaceNews) for future Journal Club dates.
InnovaSpace Journal Club
Author: Lucas Rehnberg
NHS Doctor - Anaesthetics & Intensive Care | MSc Space Physiology & Health
My name is Lucas, I am a doctor in the UK working in anaesthetics (or Anaesthesiology for any American readers) and intensive care medicine. I have had an interest in space medicine for over 10 years now, inspired by none other than Prof Thais Russomano who has mentored me over the years and still does. My Master’s dissertation (back in 2009) focused on CPR (cardiopulmonary resuscitation) methods in microgravity, with my continued research interest surrounding critical care in space. I am careful to say that I am a doctor with an interest in space medicine and physiology, as opposed to a ‘Space Doctor’ – as there are many individuals out there who have committed many more years than I have to this field and are vastly more experienced than I am! A club I aspire to join one day.
The idea of this blog, or series of blogs, is to look at some of the latest research in space physiology and space medicine, then consider how this will play out clinically. With a particular focus on critical care and potentially worst-case scenarios when in space (or microgravity environment). Something all doctors will have done in their careers; we are equipped with the skills to critically appraise papers and then ask if they are clinically relevant, or how will it change current practice.
Over the last 60 (ish) years of human space flight, there is lots of evidence to show that there are many risks when the human body has prolonged exposure to microgravity, which can affect most body systems – eyes, brain, neuro-vestibular, psychological, heart, muscle, bone, kidneys, immune system, vasculature, clotting and even some that we haven’t fully figured out yet. But then what needs to be done is to tease out how clinically relevant are these from the research, how could that potentially play out if you were the doctor in space, then how to mitigate that risk and potentially treat it.
Author: Tobias Leach
3rd Year Medical Student | University of Bristol | Passionate about space!
Space provides boundless opportunities for human existence and innumerable threats to human health.
The question is, are we yet prepared to deal with a catastrophic event, such as a cardiac arrest in space?
To gain an understanding of the current state of CPR in microgravity with a focus on chest compressions in the event of a sudden cardiac arrest onboard.
An Ovid Medline search was conducted: 17 articles were found; 12 were excluded; six additional articles were found in the references of the remaining five articles, bringing the total number of articles included to 11. These were then critically analysed.
No CPR method currently reaches the European Resuscitation Council (ERC) guidelines. The Handstand (HS) method appears to be the strongest. Evetts-Russomano (ER) is the second strongest method. Automatic chest compression device (ACCD) performed consistently well.
CPR appears to be far more difficult in microgravity. Inconsistencies in research methodology do not help. The ER method should be used as a first contact method and the HS method should be used once the casualty is restrained. An ACCD should be considered as part of the medical equipment. Further research is needed, directly comparing all positions under the same conditions.
Girls from Kazakhstan, Kyrgyzstan and Uzbekistan have launched nanosatellites to analyse air pollution, as reported by the UNICEF Office in Kyrgyzstan. According to the organisation, three nanosatellites were created by participants of the UniSat educational program, within a joint project between UNICEF and the Al-Farabi Kazakh National University.
The organisation further reported that - "nanosatellites, which belong to the class of small spacecraft, weigh up to 10 kilograms and are equipped with several cameras, one of which is capable of capturing elliptical images of the Earth with 4K resolution. During launch, UniSats allow you to capture stunning high-resolution images of the Earth and space. Sensors collect data on radiation, pressure, gravity, light and gas composition, and large amounts of data, video and images are sent back to Earth for analysis."
"The launch of the nanosatellites is symbolic. It demonstrates the limitless potential of girls and women in Central Asia. Their ability to push the boundaries of science and technology. We are extremely pleased that this year we were able to include 2,000 female participants from the three countries in the program and inspire them to continue their education and careers in science, technology, engineering and mathematics. We believe that the results of the UniSAT program will bring a cosmic change in society."
The nanosatellites were created by the girls as part of a 10-day marathon. The project participants mastered the design, engineering, programming, and assembly of the spacecraft. They were able to visit the centre for space technology and remote sensing, and the theoretical knowledge they gained was immediately put in practice during the classes. Under the mentors’ guidance, they designed nanosatellite bodies using 3D modelling and printed them on a 3D printer. The girls also programmed UniSat subsystems and tested them in the lab before launch.
"In Kyrgyzstan, only one in three girls aged 15-19 is computer literate, and more than 80 percent of girls choose social and human sciences. But how much do these choices reflect girls’ professional interests and aspirations? That’s why UNICEF launched Girls in Science in 2020 to help them expand their horizons, overcome gender stereotypes, and make their career choices. Every year, more than 10,000 girls join the initiative and more girls gain confidence in developing a career in science. In this context, the nanosatellite launch event is not only the result of two years of work for us, but also an inspiration for the potential of girls and our youth."
The UniSat program is supported by the Dubai Cares International Education Foundation, Clé de Peau Beauté brand, and philanthropist Nazanin Alakija
Article originally published (28/03/2022) in Russian on the website 24.Kg - LINK
Our thanks to Myrza Karimov (University of Central Asia) for supplying InnovaSpace with the version translated into English
Space Law & Policy Analyst
On the 2nd of October 2020, the Astro Zimba space education curriculum for young children began its programme, launching a pilot study with the Whitestone School, in Bulawayo, Zimbabwe. This space education curriculum recognises that building Zimbabwe’s space autonomy is hinged on the nation’s capacity to make a critical mass of skilled individuals. This capacity-building must necessarily begin from the early developmental stages.
The Astro Zimba curriculum, created by myself and Marco Romero, in collaboration with InnovaSpace and Students for Exploration & Development of Space (Zimbabwe), is a series of lectures on space and space-related themes, using interactive sessions, games, videos, comic books and other learning activities to spark space science and technology curiosity amongst the youth. This is done in the hopes that more children, especially young girls, will be inspired to take up STEM subjects and careers. The founders of this programme identified a gap in existing curricula, one which they wish had been filled during their initial years, and one which they believe has a profound impact on the development of the space industry.
Space sciences and technology, while a rapidly developing and exciting field, can often be quite a technical subject area for young children to understand. That said, having a dedicated programme which delivers science content in an engaging, tailored and fun way helps to boost interest in young children. It has the dual effect of inspiring both genders to become involved, which is the goal of the Valentina project for girls, facilitated by InnovaSpace, acknowledging that young girls are underrepresented in the STEM sciences. Giving access to quality education boosts social and economic circumstances, alleviates poverty and empowers young girls, positively impacting on the SDG 1 (poverty reduction), SDG4 (quality education) and SDG5 (gender equality).
The following lesson plans were presented during the pilot study. The introductory video sought to spark the learner’s curiosity and inspire more children to pursue careers in the space industry. Having careers in the space industry, the Founders thought it important to add a touch of personal experience and insights, including initiatives that have made a difference in their personal career journeys. The learners are introduced to each week’s theme through an interactive video message, before proceeding with practical in-person class sessions.
Welcome to project HABDM!
National Point of Contact, Space Generation Advisory Council - Zimbabwe
High Altitude Balloon Discover Mission (HABDM) is the first space student-led project that has been done in Zimbabwe. The project was a collaborative engagement project between students from the Students for the Exploration and Development of Space Zimbabwe (SEDS Zimbabwe) and the Meteorological Service Department (MSD) of Zimbabwe. The purpose of this mission was to spearhead space education in Zimbabwe and ensure that students are aware of the opportunities that space has. Our primary goal was to record the flight to the stratosphere and use that footage for educational purpose as well as celebrating the World Space Week. Prior to the launch date we decided that we would send our payload together a radiosonde from the MSD so that we could compare the atmospheric information obtained.
To add to the mission, we covered the capsule pink acknowledging that the month of October is the month for breast cancer awareness. It only took us three days to have all the equipment for the payload. Despite the risks involved and the probability of failing to recover our instruments was high because we did not have enough time to prepare. We had seen videos of well-prepared teams who had done high altitude projects facing some challenges in recovering their payloads when they were using state of the art equipment. So in our case to avoid too much disappointment we had to lower our expectation and accept any outcome.
On the 10th of October the whole team met at the MSD offices and without wasting time the balloon was launched. We were graced by the presence of the Deputy Director of MSD Zimbabwe, Mr Mazhara. Unfortunately on the launch the weight of the payload posed a huge challenge. We ended up removing the radiosonde to ensure that the balloon ascended to the stratosphere. Our payload consisted of two cameras, mobile device, usb adapter, power bank and a data logging system. The team consisted of students from University of Zimbabwe and National University of Science and Technology Zimbabwe, with the assistance from Claire a geography teacher at St John’s College in Harare and William, a self-employed space enthusiast. It was through the collaborative effort of the team that we were able to have all the resources that were needed for the launch. The MSD came through for us by providing us with the balloon and hydrogen gas.
This week InnovaSpace is highlighting the great work taking place in Angola by the Academy of Kandengue Scientists, with a blog written by Mentor of the project Pedro Paris and Aeronautical Engineer Marco Romero. We thank the Academy for the contribution of their students to our Kids2Mars project - and for their amazing work in creating opportunity for the local people and community! You are all stars!
The Academy of Kandendgue Scientists is a technology-based start-up that empowers children and adults from 5 to 25 years of age, instilling the seed of inventive and technological skills from an early age. Enabling children to discover their own potential helps them to avoid bad practices, such as drugs, prostitution and delinquency, and envisages a society that is technologically well prepared for future challenges, and perhaps even a renewed Africa.
Formed in 2017 by Professor and Inventor Pedro Paris (telecommunications technician) and Aeronautical Engineer Marco Romero, the project aims to provide more opportunities for children and young people without access to education.
In 2012, an ordinary residence in Viana in the province of Luanda was transformed into a laboratory, an explanatory and preparatory centre, and 5 years later the idea was born to include children who lacked the opportunity to access education, but who, like others, had the enormous potential to become “Kandengue Scientists”. The Academy already has the involvement of around 80 Kandengues aged from 6 to 30 years, of which 30 are now tutors with more than 5 years of experience, having been trained by Professor Pedro Paris.
KANDENGUE VISION: To transform children and adults from Angola, Africa and the World into budding scientists and professional IT technicians, so they can provide solutions to the problems of their community and country.
KANDENGUE MISSION: To bring sustainable technologies to the neediest communities, occupying the spare time of children and adults with art, education and sustainable technology.
KANDENGUE VALUES: Discipline, Love, Patriotism
In recent years, more than 976 children and adults from private and public schools, and foster homes throughout the nation have learned the basics of electronics, robotics, programming, game development, applications, aeronautics and space technology, thanks to the “Kandengue Scientists”. Changes in the lives of many families can already be felt, having received the tools and knowledge needed to put bread on their tables, having access to schools and universities, and solving community problems.
The financial and logistical difficulties for ensuring better conditions for the children in the development of educational activities are initially resolved by the tutors, who create teaching methods and materials tailored to existing conditions, for example, reusing electronic waste for e-learning and the creation of decorative and visual arts. Partnerships with public entities have already taken place in 2019 and 2020, such as with the network of Angolan media libraries, Ministry of Telecommunications and Information Technologies (MTTI), National Technology Centre, Ministry of Higher Education, Science, Technology and Innovation (MESCTI), BusCenter, Unitel, Methodist University of Angola, and the Seaka Center (Angolan Spiritualist Society Allan Kardec), in which the academy made available 10 professors to help the institution with a lack of teaching staff.
Some of our KEY SUSTAINABILITY INITIATIVES are:
And below are just some of the ideas and projects the Kandengue Scientists have been developing:
“innovations arise from simple ideas that fully resolve the observed problem”
If you would like to know more about the Kandengue Scientists and the wonderful work they do in Angola,
do get in touch with Marco Romero at - Pariscientista@gmail.com
The First Lego League (FLL) is an annual international tournament involving teams of young people aged 9-16 years. It introduces a scientific and real-world challenge for teams to focus on, research, and create solutions to identified problems, and includes a robotics challenge to perform a set task with a programmable robot constructed from LEGO electronic and mechanical components. This year, over 40,400 teams competed in regional, national and international tournaments with their ideas, including team AC/DC/EG from Brazil, who had a very successful competition and were kind enough to give us an insight into their FLL Into Orbit experience in this year's competition, in their words below:
"The AC/DC/EG team was created on 07/12/2007 to represent the Eduardo Gomes College in São Caetano do Sul, Brazil in the FIRST LEGO League tournament. The team name is formed from the name of the rock band AC/DC together with EG for Eduardo Gomes, and so far, we have participated in competitions at 11 State, 11 National and 7 International stages.
The 2018/2019 FLL - INTO ORBIT tournament has been sensational for us. Our team began taking shape in May 2018, and underwent some changes, beginning with 8 team members and finishing up with 5 members - Eduardo, Felipe and Sophia (from the beginning), and later joined by Gabriella and Fernanda. And it was with this team of 5 that our coach Reginaldo and mentors Giovanni and Giovanna reached the end of the competition.
The official launch of the FLL tournament took place on August 1st 2018, so we used the time from May to August to research several problems related to this year's theme by visiting universities, watching films and videos, reading books, magazines and theses, and talking to experts in the field.
At the beginning of September, we talked with Aerospace Medicine & Space Physiology specialist Dr Thais Russomano, presenting to her everything we had studied so far, and it was during one of our initial conversations that we realised there was a problem faced by astronauts, which is: WASHING IN SPACE
We already had the FLL competition documentation in this initial period of our discussions so we began to compare the problems raised to make sure they fitted in with the competition guidelines. In all, we analysed 14 problems:
A phrase we heard that marked our work was by NASA space scientist Robert Frost, who said: "When several people are trapped in an enclosed space, HYGIENE IS OF GREAT IMPORTANCE." So, having done our analysis, we chose the subject of how to wash the body in space and defined our problem:
THE INEFFICIENCY OF WASHING IN MICROGRAVITY
And we asked:
HOW CAN WASHING BE MADE MORE EFFICIENT IN MICROGRAVITY?
We continued studying, raising new points and discussing them with Dr Russomano. We looked at the ways of washing that have previously been used and the current method of washing in space.
⇨ A sponge with soap and water, used during the Gemini and Apollo missions.
⇨ A shower on the MIR Space Station that wasted a lot of time, water and energy.
⇨ The Russian kit, which consists of a pre-moistened wipe and can be used for up to 3 days, using less water.
⇨ The NASA Kit, which is a cloth moistened with soap and water.
We noted that, to be ideal, washing should be able to deal with dead skin cells, sweat, oiliness, odour, and bacteria and fungi!
We had a lot of ideas, including a kind of human jet wash that used little water – but this and other ideas were discarded as our objective was for something low-cost, water-free and lightweight, that would occupy very little space on a spacecraft.
It was in thinking about this goal that we discovered a gel called DryBath, created by Ludwick Marishane, mostly for use on the African continent and in places with a scarcity/lack of water. Ludwick’s idea is that water should only be used for drinking and cooking, and for washing it can be replaced by the gel. With just 15ml of the gel, it is possible for an adult to wash without using water, and without the need to remove the gel from skin, as it is moisturising. All of our team tried using the gel, including our coach.
The benefits of the gel in comparison with the existing solutions are enormous, as besides dispensing with the need for water for washing, there is a gain in transport weight and the gel occupies a minimum of space on a spacecraft. However, we needed to know its viability for use in space, so we talked to Chemical Engineer Matheus Messias, who confirmed the gel is non-flammable, and with Dermatologist Oswaldo Cipullo, who said the gel fulfils all the requirements for body washing and can be used daily.
Nonetheless, the current gel packaging makes it unfeasible for use in space, as it generates a lot of waste. Therefore, after some brainstorming and tests, we developed a new storage and application system utilising a 2-litre urine collection bag filled with gel, calculating that each explorer would need 3 such bags to cover a 1-year period. Each bag is fitted with a valve connector to guarantee the pressure required to transport the gel into a syringe-type applicator, which allows its controlled delivery to the body.
This system for gel storage and use saves important resources, enables fast application, requires no cleaning of the equipment, has no loss, and needs no repairs. Currently, 4 litres of water is used in space per wash, whereas, with this quantity of gel it would be possible to have 266 washes, meaning water will no longer be needed for washing the body and can be used for something else within the spacecraft. The cost of the gel and the system is 1610 Brazilian real (approx. £310) per person for a year.
Therefore, it is possible to take something that was designed for use on Earth and adapt it to make its use possible in space, rather like the tortillas of astronaut Rodolfo Vela, as quoted in the FLL Into Orbit competition guidelines."
The InnovaSpace team would like to congratulate the AC/DC/EG team and everyone who supported them for their success and the enthusiasm and joy they brought to the tournament stages! Congratulations also go to the thousands of teams from around the world for their hard work, curiosity, research and enthusiasm - YOU ARE ALL STARS!
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