Author: Paul Curzon

Die another Day? Or How Madonna crashed the Internet

A lone mike in front of stage lights
Image by Pexels from Pixabay

When pop star Madonna took to the stage at Brixton Academy in 2001 for a rare appearance she made Internet history and caused more that a little Internet misery. Her concert performance was webcast; that is it was broadcast real time over the Internet. A record-breaking audience of 9 million tuned in, and that’s where the trouble started…

The Internet’s early career

The Internet started its career as a way of sending text messages between military bases. What was important was that the message got through, even if parts of the network were damaged say, during times of war. The vision was to build a communications system that could not fail; even if individual computers did, the Internet would never crash. The text messages were split up into tiny packets of information and each of these was sent with an address and their position in the message over the wire. Going via a series of computer links it reached its destination a bit like someone sending a car home bit by bit through the post and then rebuilding it. Because it’s split up the different bits can go by different routes.

Express yourself (but be polite please)

To send all these bits of information a set of protocols (ways of communicating between the computers making up the Internet) were devised. When passing on a packet of information the sending machine first asks the receiving machine if it is both there and ready. If it replies yes then the packet is sent. Then, being a polite protocol, the sender asks the receiver if the packets all arrived safely. This way, with the right address, the packets can find the best way to go from A to B. If on the way some of the links in the chain are damaged and don’t reply, the messages can be sent by a different route. Similarly if some of the packets gets lost in transit between links and need to be resent, or packets are delayed in being sent because they have to go by a round about route, the protocol can work round it. It’s just a matter of time before all the packets arrive at the final destination and can be put back in order. With text the time taken to get there doesn’t really matter that much.

The Internet gets into the groove

The problem with live pop videos, like a Madonna concert, is that it’s no use if the last part of the song arrives first, or you have to wait half an hour for the middle chorus to turn up, or the last word in a sentence vanishes. It needs to all arrive in real time. After all, that is how it’s being sung. So to make web casting work there needs to be something different, a new way of sending the packets. It needs to be fast and it needs to deal with lots more packets as video images carry a gigantic amount of data. The solution is to add something new to the Internet, called an overlay network. This sits on top of the normal wiring but behaves very differently.

The Internet turns rock and roll rebel

So the new real time transmission protocol gets a bit rock and roll, and stops being quite so polite. It takes the packets and throws them quickly onto the Internet. If the receiver catches them, fine. If it doesn’t, then so what? The sender is too busy to check like in the old days. It has to keep up with the music! If the packets are kept small, an odd one lost won’t be missed. This overlay network called the Mbone, lets people tune into the transmissions like a TV station. All these packages are being thrown around and if you want to you can join in and pick them up.

Crazy for you

Like dozens of cars
all racing to get through
a tunnel there were traffic jams.
It was Internet gridlock.

The Madonna webcast was one of the first real tests of this new type of approach. She had millions of eager fans, but it was early days for the technology. Most people watching had slow dial-up modems rather than broadband. Also the number of computers making up the links in the Internet were small and of limited power. As more and more people tuned in to watch, more and more packets needed to be sent and more and more of the links started to clog up. Like dozens of cars all racing to get through a tunnel there were traffic jams. Packets that couldn’t get through tried to find other routes to their destination … which also ended up blocked. If they did finally arrive they couldn’t get through onto the viewers PC as the connection was slow, and if they did, very many were too late to be of any use. It was Internet gridlock.

Who’s that girl?

Viewers suffered as the pictures and sound cut in and out. Pictures froze then jumped. Packets arrived well after their use by date, meaning earlier images had been shown missing bits and looking fuzzy. You couldn’t even recognise Madonna on stage. Some researchers found that packets had, for example, passed over seven different networks to reach a PC in a hotel just four miles away. The packets had taken the scenic route round the world, and arrived too late for the party. It wasn’t only the Madonna fans who suffered. The broadcast made use of the underlying wiring of the Internet and it had filled up with millions of frantic Madonna packets. Anyone else trying to use the Internet at the time discovered that it had virtually ground to a halt and was useless. Madonna’s fans had effectively crashed the Internet!

Webcasts in Vogue

Today’s webcasts have moved on tremendously using the lessons learned from the early days of the Madonna Internet crash. Today video is very much a part of the Internet’s day-to-day duties: the speed of the computer links of the Internet and their processing power has increased massively; more homes have broadband so the packets can get to your PC faster; satellite uplinks now allow the network to identify where the traffic jams are and route the data up and over them; extra links are put into the Internet to switch on at busy times; there are now techniques to unnoticeably compress videos down to small numbers of packets, and intelligent algorithms have been developed to reroute data effectively round blocks. We can also now combine the information flowing to the viewers with information coming back from them so allowing interactive webcasts. With the advent of digital television this service is now in our homes and not just on our PC’s.

Living in a material world

It’s because of thousands of scientists working on new and improved technology and software that we can now watch as the housemate’s antics stream live from the Big Brother house, vote from our armchair for our favourite talent show contestant or ‘press red’ and listen to the director’s commentary as we watch our favourite TV show. Like water and electricity the Internet is now an accepted part of our lives. However, as we come up with even more popular TV shows and concerts, strive to improve the quality of sound and pictures, more people upgrade to broadband and more and more video information floods the Internet … will the Internet Die another Day?

Peter W. McOwan and Paul Curzon, Queen Mary University of London, 2006

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The Emoji Crystal Ball

Reflective ball with dots of lights
Image by Alexa from Pixabay (cropped)

Fairground fortune tellers claim to be able to tell a lot about you by staring into a crystal ball. They could tell far more about you (that wasn’t made up) by staring at your public social media profile. Even your use of emojis alone gives away something of who you are.

Walid Magdy’s research team at Edinburgh University are interested in how much people unknowingly give away about themselves when they use social media. They have found that it’s possible to work out an awful lot about you from your social media activity. One of their experiments involved exploring emojis. About a fifth of posts on Twitter include emojis, so they wondered if anything could be predicted about people, ignoring what they wrote and just looking at the emojis they used in their tweets. They found that the way people use emojis in twitter posts alone gives away whether they are male or female and their ethnic background.

They started by taking a large number of tweets known to be written by either men or women and stripped out the words, leaving only the emojis they used. They then counted how often each group used different emojis. The differences in use of each emoji seemed to be revealing as there was clearly a different pattern of use overall of each emoji by men and by women. Men and women each use some emojis much more than others.

Next, they used emoji data for some of the people to train a machine learning system (creating what is known as a classifier). The classifier was given all the emojis used by a person and told which were by men and which by women. It built up a detailed pattern of what a man’s emoji profile was like and similarly what a woman’s was like. 

Given a new set of tweets from a single person the classifier could then try to predict man or woman based on whether that profile was closer to the male pattern or closer to the female pattern of emoji use. Walid’s team found their emoji classifier’s predictions were right about 80% of the time – essentially it was as accurate as doing a similar thing based on the words they wrote. When they tried a similar experiment with ethnicity (was the person black, white or of another ethnicity) the predictions were even more accurate getting it right 84% of the time.

A lot can be worked out about you from apparently innocuous information that is publicly available as a result of your social media use. Even emojis give away something of who you are 😦

Paul Curzon, Queen Mary University of London, based on a talk given by Walid Magdy at QMUL, May 2021.

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Back (page) to health

Woman wearing VR headset looking at the sky.
Image by Pexels from Pixabay

Improvements in technology and decision making are transforming the way we look after our health. Here are some more interesting ideas to keep people alive and well.

The future is in your poo

You’ve heard of telling a person’s future from reading their tea leaves. Scientists believe an effective way of seeing a town’s future may be in the poo. By looking for infection in the waste at sewerage works it’s possible to get fast and accurate local knowledge of where infection rates are high and where low to feed into decision making tools.

Health advice: Stay in the toilet, Stay safe. Help the NHS.

Virtually breaking quarantine

The game, World of Warcraft, a multi-user dungeon game, helped virologists understand how people might behave in pandemics. The game’s developers released a plague that could be passed between avatars. The game’s contaminated area was quarantined. Rather than dying out, the virus escaped – because people broke into the quarantined areas to gawk, then left taking the virus with them.

Health advice: Your avatar should obey quarantine rules too!

The missing bullet holes

To stay healthy in a war, avoid being hit by a bullet. In World War II, many aircraft returned badly damaged. Abraham Wald studied them to decide where better armour was needed. There were more bullet holes in the fuselage than the engines. Where would you add the armour? Abraham added it where there were no bullet holes. He reasoned that the lack of holes in places like engines on returning planes meant that being hit there brought the plane down. Being hit elsewhere did not kill the pilots as those planes made it home!

Health advice: Dodge bullets by making good decisions …

Cybersick of virtual reality

The AI can detect puke-inducing movement and automatically correct the image.

A problem with virtual reality is that wearing a headset can be so immersive that it makes some people actually sick. This happens if you move about when watching a 3D video that was shot from a single place. Artificial intelligence software has come to the rescue, detecting puke-inducing movement and automatically correcting the image.

Health advice: If no bucket, always keep an AI handy.

Shining light on cancers

Cancer treatments like chemotherapy and radiotherapy make patients ill. Some drugs make cancer sensitive to light, allowing tumours to be killed by painlessly shining light on them instead. Sadly, that’s not easy when cancers are inside the body. A new Japanese solution is an LED chip, based on the technology used by contactless payment cards to provide power from a distance. Surgeons place it under the skin and leave it there. They glue it in place using a sticky protein from the feet of mussels. It shines low-intensity green light on the cancer, shrinking it.

Health advice: Stick a chip to your tumour

Smart sometimes means no gadgets

Being smart about health doesn’t have to be high-tech or even involve drugs. Exercise, for example, can be as effective helping with depression as taking medicine. Being out in nature can help too, so sometimes it’s worth leaving the gadgets behind and just going for a walk to enjoy the beauty of nature.

Health advice: Walk weekly in the woods

Paul Curzon, Queen Mary University of London, Spring 2021

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Gadgets based on works of fiction

Diverse people
Image by Gerd Altmann from Pixabay

Why might a computer scientist need to write fiction? To make sure she creates an app that people actually need.

Writing fiction doesn’t sound like the sort of skill a computer scientist might need. However, it’s part of my job at the moment. Working with expert rheumatologists Amy MacBrayne and Fran Humby, I am helping a design team understand what life with rheumatoid arthritis is like, so they can design software that is actually needed and so will be used and useful.

A big problem with developing software is that programmers tend to design things for themselves. However, programmers are not like the users of their software. They have different backgrounds and needs and they have been trained to think differently. Worse, they know the system they are developing inside out, unlike its users. An important first step in a project is to do background research to understand your users. If designing an app for people with rheumatoid arthritis, you need to know a lot about the lives of such people. To design a successful product, you particularly need to understand their unfulfilled goals. What do they want to be able to do that is currently hard or impossible?

What do you do with the research? Alan Cooper’s idea of ‘Personas’ are a powerful next step – and this is where writing fiction comes in. Based on research, you write descriptions of lots of fictional characters (personas), each representing groups of people with similar goals. They have names, photos and realistic lives. You also write scenarios about their lives that help understand their goals. Next, you merge and narrow these personas down, dropping some, creating new ones, altering others. Your aim is to eventually end up with just one, called a primary persona. The idea is that if you design for the primary persona, you will create something that meets the goals of the groups represented by the other personas it replaced.

The primary persona (let’s call her Samira) is then used throughout the design process as the person being designed for. If wondering whether some new feature or way of doing things is a good idea, the designers would ask themselves, “Would Samira actually want this? Would she be able to use it?” If they can think of her as a real person, it is much easier to make decisions than if thinking of some non-existent abstract “user” who becomes whatever each team member wants them to be. It helps stop ‘feature bloat’ where designers add in every great idea for a new feature they have but end up with a product so complex no one can, or wants to, use it.

As part of the Queen Mary PAMBAYESIAN project we have been talking to rheumatoid arthritis patients and their doctors to understand their needs and goals. I’ve then created a cast of detailed personas to represent the results. These can act as an initial set of personas to help future designers designing apps to support those with the disease.

If you thought creative writing wasn’t important to a computer scientist, think again. A good persona needs to be as powerfully written and as believable as a character in a good novel. So, you should practice writing fiction as well as writing programs.

Read some of our personas about living with rheumatoid arthritis here.

Paul Curzon, Queen Mary University of London, Spring 2021

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How do you solve a problem like arthritis?

A Venn Diagram of personalisation, empowerment and participation
Composite Image by CS4FN using inset images from Pixabay
by SnapwireSnaps,  christophjkugler and  Susanne Nicolin

Some diseases can’t be cured. Doctors and nurses just try to control the disease to stop them ruining people’s lives. Perhaps smartphone apps can pull off the trick of giving patients better care while giving clinicians more time to spend with the patients who most need them? A Venn diagram is at the centre of the Queen Mary team’s prototype.

What is rheumatoid arthritis?

Normally your immune system does a good job of fighting infection and keeping you healthy. But, if you have an autoimmune disease, it can also attack your healthy cells, causing inflammation and damage. Rheumatoid arthritis is like this: a painful condition that mostly affects hands, knees and feet as the person’s immune system attacks their joints, making them swell painfully. It affects around 400,000 people in the UK and is more common in women than men.

People with the disease alternate between periods when it is under control and they have few symptoms, and with days or weeks of painful ‘flares’ where it is very, very bad. During these flares it especially affects a person’s ability to live a normal life. It can be hard to move around comfortably, do exercise – plus it interferes with their ability to work. It can also leave them totally reliant on family and friends just to do everyday things like dress or eat, never mind go out. This can lead to depression and puts a strain on friendships.

Treating the disease

Treatment, which can include tablets, injections, physiotherapy and sometimes surgery, slows the disease, keeping it under control for long periods. Sufferers are also given advice on lifestyle changes. This all reduces the risk of joint damage and helps people live their life more fully.

At appointments, doctors collect information to help them see how the disease is progressing. A Disease Activity Score (DAS) calculator lets them combine measurements for pain, how tender or swollen their patient’s joints are and how many joints are affected. Regular blood tests keep track of the amount of inflammation and how the body is reacting to drugs. This helps them decide if they need to adjust the medication.

If it is caught early, modern medicine reduces the worst effects of the disease, helped by keeping a close eye on the Disease Activity Score as treatments may need to be repeatedly adjusted to control flares. This requires regular hospital visits which uses up scarce healthcare resources and is very time-consuming for patients. It is hampered because hospital appointments may only happen twice a year due to the number of patients. Everyone wants to give more personalised care, but hospitals just can’t afford to provide it.

Supporting doctors

So, what do you do when there just aren’t enough doctors to see everyone as regularly as needed to maintain their patients’ wellbeing? One solution is to use remote monitoring with an app on a patient’s smartphone, so involving patients more directly in their own care. They can use such apps to regularly record their own disease activity measurements, sharing the information with their doctor to save visiting the hospital.

A smart app

This is an improvement, but the measurements still require expert monitoring and can take more of the doctor’s time. However, if smartphones can actually be made to be, well, smart, then they could help give advice between hospital visits and alert the hospital team, when needed, so they can step in. This might involve, for example, loading the app with background knowledge about rheumatoid arthritis, expert knowledge from lots of doctors, and creating an artificial intelligence to use this information effectively for each patient.

Hospital specialists and computer scientists at Queen Mary are developing such a prototype based on Bayesian networks as the artificial intelligence core. Bayesian networks are based on reasoning about the causes of things and how likely different things are to be the cause of something being observed. Building the prototype involves finding out if patients and clinicians find such tools useful and acceptable (some people might find clinic visits reassuring, while some may be keener to avoid taking the time off work, for example).

Smart and patient centred

This still focusses on a clinician’s view of treatment using drugs though. With a smartphone app we can perhaps do better and take the person’s life into account – but how? The first step is to understand patient goals. Patients would need to be willing to share lots of information about themselves so that the software can learn as much as possible about them. Eventually, this might be done using sensors that automatically detect information: how much pain they are in, how stiff their joints are, how much they move around, how long it takes them to get out of a chair, how much sleep they get, how often they meet others, if and when they take their medicine, and so on. Rather than just focussing on medical treatment it can then focus advice ‘holistically’ on the whole person.

The Queen Mary team’s approach is centred around three different things: helping people with physical independence so they can move around and look after themselves; empowering them to manage their condition and general well-being themselves; and participation in the sense of helping them socialise, keep friendships and maintain family bonds.

The Bayesian network processes the information about patients and computes their predicted levels of independence, empowerment and participation, working out how good or bad things are for them at the moment. This places them in one of seven positions in a Venn diagram of the three dimensions over which areas need most attention. It then gives appropriate advice, aiming to keep all three dimensions in balance, monitoring what happens, but also alerting the hospital when necessary.

So, for example, if the Bayesian network judges independence low, participation high and empowerment low, the patient is in the Venn diagram intersection of low empowerment and low independence. Advice in the following weeks, based on this area of the Venn diagram, would focus on things like coping with pain and stiffness, getting better sleep, as well as how to manage the disease in general.

By personalising advice and focusing on the whole person, it is hoped patients will get more appropriate care as soon as they need it, but doctors’ time will also be freed up to focus on the patients who most need their help.

Jo Brodie, Hamit Soyel and Paul Curzon, Queen Mary University of London, Spring 2021

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Are you there yet?

A cell phone tower looking up from inside to a blue sky
Image by Alistair McIntyre from Pixabay

Plenty of people love the Weasley family’s clock from the Harry Potter books and films. It shows where members of the family are at any given time. Instead of numbers giving the time, the clock face has locations where someone might be (home, school, shopping) and the many hands on the clock show the family members. The wizarding world uses magic to make their whereabouts clock work, but muggles (and squibs) can use mobile network data to build a simple version, and use Bayesian networks to improve it.

Your mobile phone is in contact with several cell towers in the mobile provider’s network. When you want to send a message, it goes first to the nearest cell tower before passing through the network, finally reaching your friend’s phone. As you move around, from home to school, for example, you will pass several towers. The closer you are to a tower the stronger the signal there, and the phone network uses this to estimate where you are, based on signal strength from several towers. This means that, as long as your phone is with you, it can act as a sensor for your location and track you, just like the Weasley’s whereabouts clock.

You could also have a similar system at home that monitors your location, so that it switches on the lights and heating as you get closer to home to welcome you back. On a typical day you might head home somewhere between 3 and 6pm (depending on after-school events) and as you leave school the connection to your phone from the tower nearest the school will weaken, but connections will strengthen with the other cell towers on your route home. But what if you appear to be heading home at 11 in the morning? Perhaps you are, or maybe actually the signal has just dropped from the tower nearest to the school so a tower nearer your home is now getting the strongest signal!

A system using Bayesian logic to determine ‘near home’ or ‘not near home’ can be trained to put things into context. Unless you are ill, it’s unlikely that you’d be heading home before the afternoon so you can use these predicted timings to give a likelihood score of an event (such as you heading home). A Bayesian network takes a piece of information (‘person might be nearby’) and considers this in the context of previous knowledge (‘and that’s expected at this time of day so probably true’ or ‘but is unlikely to be nearby now so more information is needed’). Unlike machine learning which just looks for any patterns in data, in a Bayesian networks approach the way one thing being considered does or does not cause other things is built in from the outset. Here it builds in the different possible causes of the signal dropping at a cell tower.

You could also set up a similar system in a home using wifi points to predict where you are and so what you are doing. Information like that could then feed data into a personalised artificial intelligence looking after you. Not all magic has to be run by magic!

Jo Brodie, Queen Mary University of London, Spring 2021

Inspired by the blog on Presence Detection Part 1: Home Assistant & Bayesian Probability and a previous cs4fn article on making a Whereabouts Clock.

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So, so tired…

A man, hands over face, very, very tired.
Image by Małgorzata Tomczak from Pixabay

Fatigue is a problem that people with a variety of long-term diseases can also suffer from.

This isn’t just normal tiredness, but something much, much worse: so bad that it is a struggle to do anything at all, destroying any chance of a normal life. Doctors can often do little to help beyond managing the underlying disease, then hope the fatigue sorts itself out. Sometimes fatigue can stay with the person long, long after. Maha Albarrak, for her PhD, is exploring how computer technology might help people cope. Her first step is to interview those suffering to find out what kind of help they really need. Then she will work closely with volunteers to come up with solutions that solve the problems that matter.

Paul Curzon, Queen Mary University of London, Spring 2021

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Is your healthcare algorithm racist?

A medical operation showing an anaesthetist and the head of the patient
Image by David Mark from Pixabay

Algorithms are taking over decision making, and this is especially so in healthcare. But could the algorithms be making biased decisions? Could their decisions be racist? Yes, and such algorithms are already being used.

There is now big money to be made from healthcare software. One of the biggest areas is in intelligent algorithms that help healthcare workers make decisions. Some even completely take over the decision making. In the US, software is used widely, for example, to predict who will most benefit from interventions. The more you help a patient the more it costs. Some people may just get better without extra help, but for others it means the difference between a disability that might have been avoided or not, or even life and death. How do you tell? It matters as money is limited, so someone has to choose. You need to be able to predict outcomes with or without potential treatments. That is the kind of thing that machine learning technology is generally good at. By looking at the history of lots and lots of past patients, their treatments and what happened, these artificial intelligence programs can spot the patterns in the data and then make predictions about new patients.

This is what current commercial software does. Ziad Obermeyer, from UC Berkeley, decided to investigate how well the systems made those decisions. Working with a team combining academics and clinicians, they looked specifically at the differences between black and white patients in one widely used system. It made decisions about whether to put patients on more expensive treatment programmes. What they found was that the system had a big racial bias in the decisions it made. For patients that were equally ill, it was much more likely to recommend white patients for treatment programmes.

One of the problems with machine learning approaches is it is hard to see why they make the decisions they do. They just look for patterns in data, and who knows what patterns they find to base their decisions on? The team had access to the data of a vast number of patients the algorithms had made recommendations about, the decisions made about them and the outcomes. This meant they could evaluate whether patients were treated fairly.

The data given to the algorithm specifically excluded race, supposedly to stop it making decisions on colour of skin. However, despite not having that information, that was ultimately what it was doing. How?

The team found that its decision-making was based on predicting healthcare costs rather than how ill people actually were. The greater the cost saving of putting a person on a treatment programme, the more likely it was to recommend them. At first sight, this seems reasonable, given the aim is to make best use of a limited budget. The system was totally fair in allocating treatment based on cost. However, when the team looked at how ill people were, black people had to be much sicker before they would be recommended for help. There are lots of reasons more money might be spent on white people, so skewing the system. For example, they may be more likely to seek treatment earlier or more often. Being poor means it can be harder to seek healthcare due to difficulties getting to hospital, difficulties taking time off work, etc. If more black people in the data used to train the system are poor then this will lead to them seeking help less, so less is being spent on them. The system had spotted patterns like this and that was how it was making decisions. Even though it wasn’t told who was black and white, it had learnt to be biased.

There is an easy way to fix the system. Instead of including data about costs and having it use that as the basis of decision making, you can use direct measures of how ill a person is: for example, using the number of different conditions the patient is suffering from and the rule of thumb that the more complications you have, the more you will benefit from treatment. The researchers showed that if the system was trained this way instead, the racial bias disappeared. Access to healthcare became much fairer.

If we are going to allow machines to take healthcare decisions for us based on their predictions, we have to make sure we know how they make those predictions, and make sure they are fair. You should not lose the chance of the help you need just because of your ethnicity, or because you are poor. We must take care not to build racist algorithms. Just because computers aren’t human doesn’t mean they can’t be humane.

Paul Curzon, Queen Mary University of London, Spring 2021

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Solving real problems with Bayesian networks

COVID virus with DNA strand in background.
Image by Pete Linforth from Pixabay

Bayesian networks give a foundation for tools that support decision making based on evidence collected and the probabilities of one thing causing another (see “What are the chances of that?“).

The first algorithms that enabled Bayesian network models to be calculated on a computer were discovered separately by two different research groups in the late 1980s. Since then, a series of easy-to-use software packages have been developed that implement these algorithms, so that people without any knowledge of computing or statistics can easily build and run their own models.

These algorithms do ‘exact’ computations and can handle Bayesian networks for many different types of problems, but they can run into a barrier: when run on Bayesian networks beyond a certain size or complexity, they take too long to compute even on the world’s fastest computers. However, newer algorithms – which provide good approximate calculations rather than exact ones – have made it possible to deal with much larger problems, and this is a really exciting ongoing research area.

Norman Fenton, Queen Mary University of London, Spring 2021

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Diagnose? Delay delivery? Decisions, decisions. Decisions about diabetes in pregnancy

Baby holding feet with feet in foreground.
Image by Daniel Nebreda from Pixabay

In the film Minority Report, a team of psychics – who can see into the future – predict who might cause harm, allowing the police to intervene before the harm happens. It is science fiction. But smart technology is able to see into the future. It may be able to warn months in advance when a mother’s body might be about to harm her unborn baby and so allow the harm to be prevented before it even happens.

Gestational diabetes (or GDM) is a type of diabetes that appears only during pregnancy. Once the baby is born it usually disappears. Although it doesn’t tend to produce many symptoms it can increase the risk of complications in pregnancy so pregnant women are tested for it to avoid problems. Women who’ve had GDM are also at greater risk of developing Type 2 diabetes later on, joining an estimated 4 million people who have the condition in the UK.

Diabetes happens either when someone’s pancreas is unable to produce enough of a chemical called insulin, or because the body stops responding to the insulin that is produced. We need insulin to help us make use of glucose: a kind of sugar in our food that gives us energy. In Type 1 diabetes (commonly diagnosed in young people) the pancreas pretty much stops producing any insulin. In Type 2 diabetes (more commonly diagnosed in older people) the problem isn’t so much the pancreas (in fact in many cases it produces even more insulin), it’s that the person has become resistant to insulin. The result from either ‘not enough insulin’ or ‘plenty of insulin but can’t use it properly’ is that glucose isn’t able to get into our cells to fuel them. It’s a bit like being unable to open the fuel cap on a car, so the driver can’t fill it with petrol. This means higher levels of glucose circulate in the bloodstream and, unfortunately, high glucose can cause lots of damage to blood vessels.

During a normal pregnancy, women often become a little more insulin-resistant than usual anyway. This is an effect of pregnancy hormones from the placenta. From the point of view of the developing foetus, which is sharing a blood supply with mum, this is mostly good news as the blood arriving in the placenta is full of glucose to help the baby grow. That sounds great but if the woman becomes too insulin-resistant and there’s too much glucose in her blood it can lead to accelerated growth (a very large baby) and increase the risk of complications during pregnancy and at birth. Not great for mum or baby. Doctors regularly monitor the blood glucose levels in a GDM pregnancy to keep both mother and baby in good health. Once taught, anyone can measure their own blood glucose levels using a finger-prick test and people with diabetes do this several times a day.It will save money but also be much more flexible for mothers.

In-depth screening of every pregnant woman, to see if she has, or is at risk of, GDM costs money and is time-consuming, and most pregnant women will not develop GDM anyway. PAMBAYESIAN researchers at Queen Mary have developed a prototype intelligent decision-making tool, both to help doctors decide who needs further investigation, but also to help the women decide when they need additional support from their healthcare team.

The team of computer scientists and maternity experts developed a Bayesian network with information based on expert knowledge about GDM, then trained it on real (anonymised) patient data. They are now evaluating its performance and refining it. There are different decision points throughout a GDM pregnancy. First, does the person have GDM or are they at increased risk (perhaps because of a family history)? If ‘yes’ then the next decision is how best to care for them and whether or not to begin medical treatment or just give diet and lifestyle support. Later on in the pregnancy the woman and her doctor must consider when it’s best for her to deliver her baby, then later she needs ongoing support to prevent her GDM from leading to Type 2 diabetes. Currently in early development work, it’s hoped that if given blood glucose readings, the GDM Bayesian network will ultimately be able to take account of the woman’s risk factors (like age, ethnicity and previous GDM) that increase her risk. It would use that information to predict how likely she is to develop the condition in this pregnancy, and suggest what should happen next.

Systems like this mean that one day your smartphone may be smart enough to help protect you and your unborn baby from future harm.

Jo Brodie, Queen Mary University of London, Spring 2021

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This post and issue 27 of the cs4fn magazine have been funded by EPSRC as part of the PAMBAYESIAN project on research agreement EP/P009964/1.

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