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#431427 Why the Best Healthcare Hacks Are the ...

Technology has the potential to solve some of our most intractable healthcare problems. In fact, it’s already doing so, with inventions getting us closer to a medical Tricorder, and progress toward 3D printed organs, and AIs that can do point-of-care diagnosis.
No doubt these applications of cutting-edge tech will continue to push the needle on progress in medicine, diagnosis, and treatment. But what if some of the healthcare hacks we need most aren’t high-tech at all?
According to Dr. Darshak Sanghavi, this is exactly the case. In a talk at Singularity University’s Exponential Medicine last week, Sanghavi told the audience, “We often think in extremely complex ways, but I think a lot of the improvements in health at scale can be done in an analog way.”
Sanghavi is the chief medical officer and senior vice president of translation at OptumLabs, and was previously director of preventive and population health at the Center for Medicare and Medicaid Innovation, where he oversaw the development of large pilot programs aimed at improving healthcare costs and quality.
“How can we improve health at scale, not for only a small number of people, but for entire populations?” Sanghavi asked. With programs that benefit a small group of people, he explained, what tends to happen is that the average health of a population improves, but the disparities across the group worsen.
“My mantra became, ‘The denominator is everybody,’” he said. He shared details of some low-tech but crucial fixes he believes could vastly benefit the US healthcare system.
1. Regulatory Hacking
Healthcare regulations are ultimately what drive many aspects of patient care, for better or worse. Worse because the mind-boggling complexity of regulations (exhibit A: the Affordable Care Act is reportedly about 20,000 pages long) can make it hard for people to get the care they need at a cost they can afford, but better because, as Sanghavi explained, tweaking these regulations in the right way can result in across-the-board improvements in a given population’s health.
An adjustment to Medicare hospitalization rules makes for a relevant example. The code was updated to state that if people who left the hospital were re-admitted within 30 days, that hospital had to pay a penalty. The result was hospitals taking more care to ensure patients were released not only in good health, but also with a solid understanding of what they had to do to take care of themselves going forward. “Here, arguably the writing of a few lines of regulatory code resulted in a remarkable decrease in 30-day re-admissions, and the savings of several billion dollars,” Sanghavi said.
2. Long-Term Focus
It’s easy to focus on healthcare hacks that have immediate, visible results—but what about fixes whose benefits take years to manifest? How can we motivate hospitals, regulators, and doctors to take action when they know they won’t see changes anytime soon?
“I call this the reality TV problem,” Sanghavi said. “Reality shows don’t really care about who’s the most talented recording artist—they care about getting the most viewers. That is exactly how we think about health care.”
Sanghavi’s team wanted to address this problem for heart attacks. They found they could reliably determine someone’s 10-year risk of having a heart attack based on a simple risk profile. Rather than monitoring patients’ cholesterol, blood pressure, weight, and other individual factors, the team took the average 10-year risk across entire provider panels, then made providers responsible for controlling those populations.
“Every percentage point you lower that risk, by hook or by crook, you get some people to stop smoking, you get some people on cholesterol medication. It’s patient-centered decision-making, and the provider then makes money. This is the world’s first predictive analytic model, at scale, that’s actually being paid for at scale,” he said.
3. Aligned Incentives
If hospitals are held accountable for the health of the communities they’re based in, those hospitals need to have the right incentives to follow through. “Hospitals have to spend money on community benefit, but linking that benefit to a meaningful population health metric can catalyze significant improvements,” Sanghavi said.
Darshak Sanghavi speaking at Singularity University’s 2017 Exponential Medicine Summit in San Diego, CA.
He used smoking cessation as an example. His team designed a program where hospitals were given a score (determined by the Centers for Disease Control and Prevention) based on the smoking rate in the counties where they’re located, then given monetary incentives to improve their score. Improving their score, in turn, resulted in better health for their communities, which meant fewer patients to treat for smoking-related health problems.
4. Social Determinants of Health
Social determinants of health include factors like housing, income, family, and food security. The answer to getting people to pay attention to these factors at scale, and creating aligned incentives, Sanghavi said, is “Very simple. We just have to measure it to start with, and measure it universally.”
His team was behind a $157 million pilot program called Accountable Health Communities that went live this year. The program requires all Medicare and Medicaid beneficiaries get screened for various social determinants of health. With all that data being collected, analysts can pinpoint local trends, then target funds to address the underlying problem, whether it’s job training, drug use, or nutritional education. “You’re then free to invest the dollars where they’re needed…this is how we can improve health at scale, with very simple changes in the incentive structures that are created,” he said.
5. ‘Securitizing’ Public Health
Sanghavi’s final point tied back to his discussion of aligning incentives. As misguided as it may seem, the reality is that financial incentives can make a huge difference in healthcare outcomes, from both a patient and a provider perspective.
Sanghavi’s team did an experiment in which they created outcome benchmarks for three major health problems that exist across geographically diverse areas: smoking, adolescent pregnancy, and binge drinking. The team proposed measuring the baseline of these issues then creating what they called a social impact bond. If communities were able to lower their frequency of these conditions by a given percent within a stated period of time, they’d get paid for it.
“What that did was essentially say, ‘you have a buyer for this outcome if you can achieve it,’” Sanghavi said. “And you can try to get there in any way you like.” The program is currently in CMS clearance.
AI and Robots Not Required
Using robots to perform surgery and artificial intelligence to diagnose disease will undoubtedly benefit doctors and patients around the US and the world. But Sanghavi’s talk made it clear that our healthcare system needs much more than this, and that improving population health on a large scale is really a low-tech project—one involving more regulatory and financial innovation than technological innovation.
“The things that get measured are the things that get changed,” he said. “If we choose the right outcomes to predict long-term benefit, and we pay for those outcomes, that’s the way to make progress.”
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#431412 3 Dangerous Ideas From Ray Kurzweil

Recently, I interviewed my friend Ray Kurzweil at the Googleplex for a 90-minute webinar on disruptive and dangerous ideas, a prelude to my fireside chat with Ray at Abundance 360 this January.

Ray is my friend and cofounder and chancellor of Singularity University. He is also an XPRIZE trustee, a director of engineering at Google, and one of the best predictors of our exponential future.
It’s my pleasure to share with you three compelling ideas that came from our conversation.
1. The nation-state will soon be irrelevant.
Historically, we humans don’t like change. We like waking up in the morning and knowing that the world is the same as the night before.
That’s one reason why government institutions exist: to stabilize society.
But how will this change in 20 or 30 years? What role will stabilizing institutions play in a world of continuous, accelerating change?
“Institutions stick around, but they change their role in our lives,” Ray explained. “They already have. The nation-state is not as profound as it was. Religion used to direct every aspect of your life, minute to minute. It’s still important in some ways, but it’s much less important, much less pervasive. [It] plays a much smaller role in most people’s lives than it did, and the same is true for governments.”
Ray continues: “We are fantastically interconnected already. Nation-states are not islands anymore. So we’re already much more of a global community. The generation growing up today really feels like world citizens much more than ever before, because they’re talking to people all over the world, and it’s not a novelty.”
I’ve previously shared my belief that national borders have become extremely porous, with ideas, people, capital, and technology rapidly flowing between nations. In decades past, your cultural identity was tied to your birthplace. In the decades ahead, your identify is more a function of many other external factors. If you love space, you’ll be connected with fellow space-cadets around the globe more than you’ll be tied to someone born next door.
2. We’ll hit longevity escape velocity before we realize we’ve hit it.
Ray and I share a passion for extending the healthy human lifespan.
I frequently discuss Ray’s concept of “longevity escape velocity”—the point at which, for every year that you’re alive, science is able to extend your life for more than a year.
Scientists are continually extending the human lifespan, helping us cure heart disease, cancer, and eventually, neurodegenerative disease. This will keep accelerating as technology improves.
During my discussion with Ray, I asked him when he expects we’ll reach “escape velocity…”
His answer? “I predict it’s likely just another 10 to 12 years before the general public will hit longevity escape velocity.”
“At that point, biotechnology is going to have taken over medicine,” Ray added. “The next decade is going to be a profound revolution.”
From there, Ray predicts that nanorobots will “basically finish the job of the immune system,” with the ability to seek and destroy cancerous cells and repair damaged organs.
As we head into this sci-fi-like future, your most important job for the next 15 years is to stay alive. “Wear your seatbelt until we get the self-driving cars going,” Ray jokes.
The implications to society will be profound. While the scarcity-minded in government will react saying, “Social Security will be destroyed,” the more abundance-minded will realize that extending a person’s productive earning life space from 65 to 75 or 85 years old would be a massive boon to GDP.
3. Technology will help us define and actualize human freedoms.
The third dangerous idea from my conversation with Ray is about how technology will enhance our humanity, not detract from it.
You may have heard critics complain that technology is making us less human and increasingly disconnected.
Ray and I share a slightly different viewpoint: that technology enables us to tap into the very essence of what it means to be human.
“I don’t think humans even have to be biological,” explained Ray. “I think humans are the species that changes who we are.”
Ray argues that this began when humans developed the earliest technologies—fire and stone tools. These tools gave people new capabilities and became extensions of our physical bodies.
At its base level, technology is the means by which we change our environment and change ourselves. This will continue, even as the technologies themselves evolve.
“People say, ‘Well, do I really want to become part machine?’ You’re not even going to notice it,” Ray says, “because it’s going to be a sensible thing to do at each point.”
Today, we take medicine to fight disease and maintain good health and would likely consider it irresponsible if someone refused to take a proven, life-saving medicine.
In the future, this will still happen—except the medicine might have nanobots that can target disease or will also improve your memory so you can recall things more easily.
And because this new medicine works so well for so many, public perception will change. Eventually, it will become the norm… as ubiquitous as penicillin and ibuprofen are today.
In this way, ingesting nanorobots, uploading your brain to the cloud, and using devices like smart contact lenses can help humans become, well, better at being human.
Ray sums it up: “We are the species that changes who we are to become smarter and more profound, more beautiful, more creative, more musical, funnier, sexier.”
Speaking of sexuality and beauty, Ray also sees technology expanding these concepts. “In virtual reality, you can be someone else. Right now, actually changing your gender in real reality is a pretty significant, profound process, but you could do it in virtual reality much more easily and you can be someone else. A couple could become each other and discover their relationship from the other’s perspective.”
In the 2030s, when Ray predicts sensor-laden nanorobots will be able to go inside the nervous system, virtual or augmented reality will become exceptionally realistic, enabling us to “be someone else and have other kinds of experiences.”
Why Dangerous Ideas Matter
Why is it so important to discuss dangerous ideas?
I often say that the day before something is a breakthrough, it’s a crazy idea.
By consuming and considering a steady diet of “crazy ideas,” you train yourself to think bigger and bolder, a critical requirement for making impact.
As humans, we are linear and scarcity-minded.
As entrepreneurs, we must think exponentially and abundantly.
At the end of the day, the formula for a true breakthrough is equal to “having a crazy idea” you believe in, plus the passion to pursue that idea against all naysayers and obstacles.
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#431315 Better Than Smart Speakers? Japan Is ...

While American internet giants are developing speakers, Japanese companies are working on robots and holograms. They all share a common goal: to create the future platform for the Internet of Things (IoT) and smart homes.
Names like Bocco, EMIEW3, Xperia Assistant, and Gatebox may not ring a bell to most outside of Japan, but Sony, Hitachi, Sharp, and Softbank most certainly do. The companies, along with Japanese start-ups, have developed robots, robot concepts, and even holograms like the ones hiding behind the short list of names.
While there are distinct differences between the various systems, they share the potential to act as a remote control for IoT devices and smart homes. It is a very different direction than that taken by companies like Google, Amazon, and Apple, who have so far focused on building IoT speaker systems.
Bocco robot. Image Credit: Yukai Engineering
“Technology companies are pursuing the platform—or smartphone if you will—for IoT. My impression is that Japanese companies—and Japanese consumers—prefer that such a platform should not just be an object, but a companion,” says Kosuke Tatsumi, designer at Yukai Engineering, a startup that has developed the Bocco robot system.
At Hitachi, a spokesperson said that the company’s human symbiotic service robot, EMIEW3, robot is currently in the field, doing proof-of-value tests at customer sites to investigate needs and potential solutions. This could include working as an interactive control system for the Internet of Things:
“EMIEW3 is able to communicate with humans, thus receive instructions, and as it is connected to a robotics IT platform, it is very much capable of interacting with IoT-based systems,” the spokesperson said.
The power of speech is getting feet
Gartner analysis predicts that there will be 8.4 billion internet-connected devices—collectively making up the Internet of Things—by the end of 2017. 5.2 billion of those devices are in the consumer category. By the end of 2020, the number of IoT devices will rise to 12.8 billion—and that is just in the consumer category.
As a child of the 80s, I can vividly remember how fun it was to have separate remote controls for TV, video, and stereo. I can imagine a situation where my internet-connected refrigerator and ditto thermostat, television, and toaster try to work out who I’m talking to and what I want them to do.
Consensus seems to be that speech will be the way to interact with many/most IoT devices. The same goes for a form of virtual assistant functioning as the IoT platform—or remote control. Almost everything else is still an open ballgame, despite an early surge for speaker-based systems, like those from Amazon, Google, and Apple.
Why robots could rule
Famous android creator and robot scientist Dr. Hiroshi Ishiguro sees the interaction between humans and the AI embedded in speakers or robots as central to both approaches. From there, the approaches differ greatly.
Image Credit: Hiroshi Ishiguro Laboratories
“It is about more than the difference of form. Speaking to an Amazon Echo is not a natural kind of interaction for humans. That is part of what we in Japan are creating in many human-like robot systems,” he says. “The human brain is constructed to recognize and interact with humans. This is part of why it makes sense to focus on developing the body for the AI mind as well as the AI mind itself. In a way, you can describe it as the difference between developing an assistant, which could be said to be what many American companies are currently doing, and a companion, which is more the focus here in Japan.”
Another advantage is that robots are more kawaii—a multifaceted Japanese word that can be translated as “cute”—than speakers are. This makes it easy for people to relate to them and forgive them.
“People are more willing to forgive children when they make mistakes, and the same is true with a robot like Bocco, which is designed to look kawaii and childlike,” Kosuke Tatsumi explains.
Japanese robots and holograms with IoT-control capabilities
So, what exactly do these robot and hologram companions look like, what can they do, and who’s making them? Here are seven examples of Japanese companies working to go a step beyond smart speakers with personable robots and holograms.
1. In 2016 Sony’s mobile division demonstrated the Xperia Agent concept robot that recognizes individual users, is voice controlled, and can do things like control your television and receive calls from services like Skype.

2. Sharp launched their Home Assistant at CES 2016. A robot-like, voice-controlled assistant that can to control, among other things, air conditioning units, and televisions. Sharp has also launched a robotic phone called RoBoHon.
3. Gatebox has created a holographic virtual assistant. Evil tongues will say that it is primarily the expression of an otaku (Japanese for nerd) dream of living with a manga heroine. Gatebox is, however, able to control things like lights, TVs, and other systems through API integration. It also provides its owner with weather-related advice like “remember your umbrella, it looks like it will rain later.” Gatebox can be controlled by voice, gesture, or via an app.
4. Hitachi’s EMIEW3 robot is designed to assist people in businesses and public spaces. It is connected to a robot IT-platform via the cloud that acts as a “remote brain.” Hitachi is currently investigating the business use cases for EMIEW3. This could include the role of controlling platform for IoT devices.

5. Softbank’s Pepper robot has been used as a platform to control use of medical IoT devices such as smart thermometers by Avatarion. The company has also developed various in-house systems that enable Pepper to control IoT-devices like a coffee machine. A user simply asks Pepper to brew a cup of coffee, and it starts the coffee machine for you.
6. Yukai Engineering’s Bocco registers when a person (e.g., young child) comes home and acts as a communication center between that person and other members of the household (e.g., parent still at work). The company is working on integrating voice recognition, voice control, and having Bocco control things like the lights and other connected IoT devices.
7. Last year Toyota launched the Kirobo Mini, a companion robot which aims to, among other things, help its owner by suggesting “places to visit, routes for travel, and music to listen to” during the drive.

Today, Japan. Tomorrow…?
One of the key questions is whether this emerging phenomenon is a purely Japanese thing. If the country’s love of robots makes it fundamentally different. Japan is, after all, a country where new units of Softbank’s Pepper robot routinely sell out in minutes and the RoBoHon robot-phone has its own cafe nights in Tokyo.
It is a country where TV introduces you to friendly, helpful robots like Doraemon and Astro Boy. I, on the other hand, first met robots in the shape of Arnold Schwarzenegger’s Terminator and struggled to work out why robots seemed intent on permanently borrowing things like clothes and motorcycles, not to mention why they hated people called Sarah.
However, research suggests that a big part of the reason why Japanese seem to like robots is a combination of exposure and positive experiences that leads to greater acceptance of them. As robots spread to more and more industries—and into our homes—our acceptance of them will grow.
The argument is also backed by a project by Avatarion, which used Softbank’s Nao-robot as a classroom representative for children who were in the hospital.
“What we found was that the other children quickly adapted to interacting with the robot and treating it as the physical representation of the child who was in hospital. They accepted it very quickly,” Thierry Perronnet, General Manager of Avatarion, explains.
His company has also developed solutions where Softbank’s Pepper robot is used as an in-home nurse and controls various medical IoT devices.
If robots end up becoming our preferred method for controlling IoT devices, it is by no means certain that said robots will be coming from Japan.
“I think that the goal for both Japanese and American companies—including the likes of Google, Amazon, Microsoft, and Apple—is to create human-like interaction. For this to happen, technology needs to evolve and adapt to us and how we are used to interacting with others, in other words, have a more human form. Humans’ speed of evolution cannot keep up with technology’s, so it must be the technology that changes,” Dr. Ishiguro says.
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#431081 How the Intelligent Home of the Future ...

As Dorothy famously said in The Wizard of Oz, there’s no place like home. Home is where we go to rest and recharge. It’s familiar, comfortable, and our own. We take care of our homes by cleaning and maintaining them, and fixing things that break or go wrong.
What if our homes, on top of giving us shelter, could also take care of us in return?
According to Chris Arkenberg, this could be the case in the not-so-distant future. As part of Singularity University’s Experts On Air series, Arkenberg gave a talk called “How the Intelligent Home of The Future Will Care For You.”
Arkenberg is a research and strategy lead at Orange Silicon Valley, and was previously a research fellow at the Deloitte Center for the Edge and a visiting researcher at the Institute for the Future.
Arkenberg told the audience that there’s an evolution going on: homes are going from being smart to being connected, and will ultimately become intelligent.
Market Trends
Intelligent home technologies are just now budding, but broader trends point to huge potential for their growth. We as consumers already expect continuous connectivity wherever we go—what do you mean my phone won’t get reception in the middle of Yosemite? What do you mean the smart TV is down and I can’t stream Game of Thrones?
As connectivity has evolved from a privilege to a basic expectation, Arkenberg said, we’re also starting to have a better sense of what it means to give up our data in exchange for services and conveniences. It’s so easy to click a few buttons on Amazon and have stuff show up at your front door a few days later—never mind that data about your purchases gets recorded and aggregated.
“Right now we have single devices that are connected,” Arkenberg said. “Companies are still trying to show what the true value is and how durable it is beyond the hype.”

Connectivity is the basis of an intelligent home. To take a dumb object and make it smart, you get it online. Belkin’s Wemo, for example, lets users control lights and appliances wirelessly and remotely, and can be paired with Amazon Echo or Google Home for voice-activated control.
Speaking of voice-activated control, Arkenberg pointed out that physical interfaces are evolving, too, to the point that we’re actually getting rid of interfaces entirely, or transitioning to ‘soft’ interfaces like voice or gesture.
Drivers of change
Consumers are open to smart home tech and companies are working to provide it. But what are the drivers making this tech practical and affordable? Arkenberg said there are three big ones:
Computation: Computers have gotten exponentially more powerful over the past few decades. If it wasn’t for processors that could handle massive quantities of information, nothing resembling an Echo or Alexa would even be possible. Artificial intelligence and machine learning are powering these devices, and they hinge on computing power too.
Sensors: “There are more things connected now than there are people on the planet,” Arkenberg said. Market research firm Gartner estimates there are 8.4 billion connected things currently in use. Wherever digital can replace hardware, it’s doing so. Cheaper sensors mean we can connect more things, which can then connect to each other.
Data: “Data is the new oil,” Arkenberg said. “The top companies on the planet are all data-driven giants. If data is your business, though, then you need to keep finding new ways to get more and more data.” Home assistants are essentially data collection systems that sit in your living room and collect data about your life. That data in turn sets up the potential of machine learning.
Colonizing the Living Room
Alexa and Echo can turn lights on and off, and Nest can help you be energy-efficient. But beyond these, what does an intelligent home really look like?
Arkenberg’s vision of an intelligent home uses sensing, data, connectivity, and modeling to manage resource efficiency, security, productivity, and wellness.
Autonomous vehicles provide an interesting comparison: they’re surrounded by sensors that are constantly mapping the world to build dynamic models to understand the change around itself, and thereby predict things. Might we want this to become a model for our homes, too? By making them smart and connecting them, Arkenberg said, they’d become “more biological.”
There are already several products on the market that fit this description. RainMachine uses weather forecasts to adjust home landscape watering schedules. Neurio monitors energy usage, identifies areas where waste is happening, and makes recommendations for improvement.
These are small steps in connecting our homes with knowledge systems and giving them the ability to understand and act on that knowledge.
He sees the homes of the future being equipped with digital ears (in the form of home assistants, sensors, and monitoring devices) and digital eyes (in the form of facial recognition technology and machine vision to recognize who’s in the home). “These systems are increasingly able to interrogate emotions and understand how people are feeling,” he said. “When you push more of this active intelligence into things, the need for us to directly interface with them becomes less relevant.”
Could our homes use these same tools to benefit our health and wellness? FREDsense uses bacteria to create electrochemical sensors that can be applied to home water systems to detect contaminants. If that’s not personal enough for you, get a load of this: ClinicAI can be installed in your toilet bowl to monitor and evaluate your biowaste. What’s the point, you ask? Early detection of colon cancer and other diseases.
What if one day, your toilet’s biowaste analysis system could link up with your fridge, so that when you opened it it would tell you what to eat, and how much, and at what time of day?
Roadblocks to intelligence
“The connected and intelligent home is still a young category trying to establish value, but the technological requirements are now in place,” Arkenberg said. We’re already used to living in a world of ubiquitous computation and connectivity, and we have entrained expectations about things being connected. For the intelligent home to become a widespread reality, its value needs to be established and its challenges overcome.
One of the biggest challenges will be getting used to the idea of continuous surveillance. We’ll get convenience and functionality if we give up our data, but how far are we willing to go? Establishing security and trust is going to be a big challenge moving forward,” Arkenberg said.
There’s also cost and reliability, interoperability and fragmentation of devices, or conversely, what Arkenberg called ‘platform lock-on,’ where you’d end up relying on only one provider’s system and be unable to integrate devices from other brands.
Ultimately, Arkenberg sees homes being able to learn about us, manage our scheduling and transit, watch our moods and our preferences, and optimize our resource footprint while predicting and anticipating change.
“This is the really fascinating provocation of the intelligent home,” Arkenberg said. “And I think we’re going to start to see this play out over the next few years.”
Sounds like a home Dorothy wouldn’t recognize, in Kansas or anywhere else.
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