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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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#431424 A ‘Google Maps’ for the Mouse Brain ...
Ask any neuroscientist to draw you a neuron, and it’ll probably look something like a star with two tails: one stubby with extensive tree-like branches, the other willowy, lengthy and dotted with spindly spikes.
While a decent abstraction, this cartoonish image hides the uncomfortable truth that scientists still don’t know much about what many neurons actually look like, not to mention the extent of their connections.
But without untangling the jumbled mess of neural wires that zigzag across the brain, scientists are stumped in trying to answer one of the most fundamental mysteries of the brain: how individual neuronal threads carry and assemble information, which forms the basis of our thoughts, memories, consciousness, and self.
What if there was a way to virtually trace and explore the brain’s serpentine fibers, much like the way Google Maps allows us to navigate the concrete tangles of our cities’ highways?
Thanks to an interdisciplinary team at Janelia Research Campus, we’re on our way. Meet MouseLight, the most extensive map of the mouse brain ever attempted. The ongoing project has an ambitious goal: reconstructing thousands—if not more—of the mouse’s 70 million neurons into a 3D map. (You can play with it here!)
With map in hand, neuroscientists around the world can begin to answer how neural circuits are organized in the brain, and how information flows from one neuron to another across brain regions and hemispheres.
The first release, presented Monday at the Society for Neuroscience Annual Conference in Washington, DC, contains information about the shape and sizes of 300 neurons.
And that’s just the beginning.
“MouseLight’s new dataset is the largest of its kind,” says Dr. Wyatt Korff, director of project teams. “It’s going to change the textbook view of neurons.”
http://mouselight.janelia.org/assets/carousel/ML-Movie.mp4
Brain Atlas
MouseLight is hardly the first rodent brain atlasing project.
The Mouse Brain Connectivity Atlas at the Allen Institute for Brain Science in Seattle tracks neuron activity across small circuits in an effort to trace a mouse’s connectome—a complete atlas of how the firing of one neuron links to the next.
MICrONS (Machine Intelligence from Cortical Networks), the $100 million government-funded “moonshot” hopes to distill brain computation into algorithms for more powerful artificial intelligence. Its first step? Brain mapping.
What makes MouseLight stand out is its scope and level of detail.
MICrONS, for example, is focused on dissecting a cubic millimeter of the mouse visual processing center. In contrast, MouseLight involves tracing individual neurons across the entire brain.
And while connectomics outlines the major connections between brain regions, the birds-eye view entirely misses the intricacies of each individual neuron. This is where MouseLight steps in.
Slice and Dice
With a width only a fraction of a human hair, neuron projections are hard to capture in their native state. Tug or squeeze the brain too hard, and the long, delicate branches distort or even shred into bits.
In fact, previous attempts at trying to reconstruct neurons at this level of detail topped out at just a dozen, stymied by technological hiccups and sky-high costs.
A few years ago, the MouseLight team set out to automate the entire process, with a few time-saving tweaks. Here’s how it works.
After injecting a mouse with a virus that causes a handful of neurons to produce a green-glowing protein, the team treated the brain with a sugar alcohol solution. This step “clears” the brain, transforming the beige-colored organ to translucent, making it easier for light to penetrate and boosting the signal-to-background noise ratio. The brain is then glued onto a small pedestal and ready for imaging.
Building upon an established method called “two-photon microscopy,” the team then tweaked several parameters to reduce imaging time from days (or weeks) down to a fraction of that. Endearingly known as “2P” by the experts, this type of laser microscope zaps the tissue with just enough photos to light up a single plane without damaging the tissue—sharper plane, better focus, crisper image.
After taking an image, the setup activates its vibrating razor and shaves off the imaged section of the brain—a waspy slice about 200 micrometers thick. The process is repeated until the whole brain is imaged.
This setup increased imaging speed by 16 to 48 times faster than conventional microscopy, writes team leader Dr. Jayaram Chandrashekar, who published a version of the method early last year in eLife.
The resulting images strikingly highlight every crook and cranny of a neuronal branch, popping out against a pitch-black background. But pretty pictures come at a hefty data cost: each image takes up a whopping 20 terabytes of data—roughly the storage space of 4,000 DVDs, or 10,000 hours of movies.
Stitching individual images back into 3D is an image-processing nightmare. The MouseLight team used a combination of computational power and human prowess to complete this final step.
The reconstructed images are handed off to a mighty team of seven trained neuron trackers. With the help of tracing algorithms developed in-house and a keen eye, each member can track roughly a neuron a day—significantly less time than the week or so previously needed.
A Numbers Game
Even with just 300 fully reconstructed neurons, MouseLight has already revealed new secrets of the brain.
While it’s widely accepted that axons, the neurons’ outgoing projection, can span the entire length of the brain, these extra-long connections were considered relatively rare. (In fact, one previously discovered “giant neuron” was thought to link to consciousness because of its expansive connections).
Images captured from two-photon microscopy show an axon and dendrites protruding from a neuron’s cell body (sphere in center). Image Credit: Janelia Research Center, MouseLight project team
MouseLight blows that theory out of the water.
The data clearly shows that “giant neurons” are far more common than previously thought. For example, four neurons normally associated with taste had wiry branches that stretched all the way into brain areas that control movement and process touch.
“We knew that different regions of the brain talked to each other, but seeing it in 3D is different,” says Dr. Eve Marder at Brandeis University.
“The results are so stunning because they give you a really clear view of how the whole brain is connected.”
With a tested and true system in place, the team is now aiming to add 700 neurons to their collection within a year.
But appearance is only part of the story.
We can’t tell everything about a person simply by how they look. Neurons are the same: scientists can only infer so much about a neuron’s function by looking at their shape and positions. The team also hopes to profile the gene expression patterns of each neuron, which could provide more hints to their roles in the brain.
MouseLight essentially dissects the neural infrastructure that allows information traffic to flow through the brain. These anatomical highways are just the foundation. Just like Google Maps, roads form only the critical first layer of the map. Street view, traffic information and other add-ons come later for a complete look at cities in flux.
The same will happen for understanding our ever-changing brain.
Image Credit: Janelia Research Campus, MouseLight project team Continue reading
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#431392 What AI Can Now Do Is Remarkable—But ...
Major websites all over the world use a system called CAPTCHA to verify that someone is indeed a human and not a bot when entering data or signing into an account. CAPTCHA stands for the “Completely Automated Public Turing test to tell Computers and Humans Apart.” The squiggly letters and numbers, often posted against photographs or textured backgrounds, have been a good way to foil hackers. They are annoying but effective.
The days of CAPTCHA as a viable line of defense may, however, be numbered.
Researchers at Vicarious, a Californian artificial intelligence firm funded by Amazon founder Jeff Bezos and Facebook’s Mark Zuckerberg, have just published a paper documenting how they were able to defeat CAPTCHA using new artificial intelligence techniques. Whereas today’s most advanced artificial intelligence (AI) technologies use neural networks that require massive amounts of data to learn from, sometimes millions of examples, the researchers said their system needed just five training steps to crack Google’s reCAPTCHA technology. With this, they achieved a 67 percent success rate per character—reasonably close to the human accuracy rate of 87 percent. In answering PayPal and Yahoo CAPTCHAs, the system achieved an accuracy rate of greater than 50 percent.
The CAPTCHA breakthrough came hard on the heels of another major milestone from Google’s DeepMind team, the people who built the world’s best Go-playing system. DeepMind built a new artificial-intelligence system called AlphaGo Zero that taught itself to play the game at a world-beating level with minimal training data, mainly using trial and error—in a fashion similar to how humans learn.
Both playing Go and deciphering CAPTCHAs are clear examples of what we call narrow AI, which is different from artificial general intelligence (AGI)—the stuff of science fiction. Remember R2-D2 of Star Wars, Ava from Ex Machina, and Samantha from Her? They could do many things and learned everything they needed on their own.
Narrow AI technologies are systems that can only perform one specific type of task. For example, if you asked AlphaGo Zero to learn to play Monopoly, it could not, even though that is a far less sophisticated game than Go. If you asked the CAPTCHA cracker to learn to understand a spoken phrase, it would not even know where to start.
To date, though, even narrow AI has been difficult to build and perfect. To perform very elementary tasks such as determining whether an image is of a cat or a dog, the system requires the development of a model that details exactly what is being analyzed and massive amounts of data with labeled examples of both. The examples are used to train the AI systems, which are modeled on the neural networks in the brain, in which the connections between layers of neurons are adjusted based on what is observed. To put it simply, you tell an AI system exactly what to learn, and the more data you give it, the more accurate it becomes.
The methods that Vicarious and Google used were different; they allowed the systems to learn on their own, albeit in a narrow field. By making their own assumptions about what the training model should be and trying different permutations until they got the right results, they were able to teach themselves how to read the letters in a CAPTCHA or to play a game.
This blurs the line between narrow AI and AGI and has broader implications in robotics and virtually any other field in which machine learning in complex environments may be relevant.
Beyond visual recognition, the Vicarious breakthrough and AlphaGo Zero success are encouraging scientists to think about how AIs can learn to do things from scratch. And this brings us one step closer to coexisting with classes of AIs and robots that can learn to perform new tasks that are slight variants on their previous tasks—and ultimately the AGI of science fiction.
So R2-D2 may be here sooner than we expected.
This article was originally published by The Washington Post. Read the original article here.
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#431362 Does Regulating Artificial Intelligence ...
Some people are afraid that heavily armed artificially intelligent robots might take over the world, enslaving humanity—or perhaps exterminating us. These people, including tech-industry billionaire Elon Musk and eminent physicist Stephen Hawking, say artificial intelligence technology needs to be regulated to manage the risks. But Microsoft founder Bill Gates and Facebook’s Mark Zuckerberg disagree, saying the technology is not nearly advanced enough for those worries to be realistic.
As someone who researches how AI works in robotic decision-making, drones and self-driving vehicles, I’ve seen how beneficial it can be. I’ve developed AI software that lets robots working in teams make individual decisions as part of collective efforts to explore and solve problems. Researchers are already subject to existing rules, regulations and laws designed to protect public safety. Imposing further limitations risks reducing the potential for innovation with AI systems.
How is AI regulated now?
While the term “artificial intelligence” may conjure fantastical images of human-like robots, most people have encountered AI before. It helps us find similar products while shopping, offers movie and TV recommendations, and helps us search for websites. It grades student writing, provides personalized tutoring, and even recognizes objects carried through airport scanners.
In each case, the AI makes things easier for humans. For example, the AI software I developed could be used to plan and execute a search of a field for a plant or animal as part of a science experiment. But even as the AI frees people from doing this work, it is still basing its actions on human decisions and goals about where to search and what to look for.
In areas like these and many others, AI has the potential to do far more good than harm—if used properly. But I don’t believe additional regulations are currently needed. There are already laws on the books of nations, states, and towns governing civil and criminal liabilities for harmful actions. Our drones, for example, must obey FAA regulations, while the self-driving car AI must obey regular traffic laws to operate on public roadways.
Existing laws also cover what happens if a robot injures or kills a person, even if the injury is accidental and the robot’s programmer or operator isn’t criminally responsible. While lawmakers and regulators may need to refine responsibility for AI systems’ actions as technology advances, creating regulations beyond those that already exist could prohibit or slow the development of capabilities that would be overwhelmingly beneficial.
Potential risks from artificial intelligence
It may seem reasonable to worry about researchers developing very advanced artificial intelligence systems that can operate entirely outside human control. A common thought experiment deals with a self-driving car forced to make a decision about whether to run over a child who just stepped into the road or veer off into a guardrail, injuring the car’s occupants and perhaps even those in another vehicle.
Musk and Hawking, among others, worry that a hyper-capable AI system, no longer limited to a single set of tasks like controlling a self-driving car, might decide it doesn’t need humans anymore. It might even look at human stewardship of the planet, the interpersonal conflicts, theft, fraud, and frequent wars, and decide that the world would be better without people.
Science fiction author Isaac Asimov tried to address this potential by proposing three laws limiting robot decision-making: Robots cannot injure humans or allow them “to come to harm.” They must also obey humans—unless this would harm humans—and protect themselves, as long as this doesn’t harm humans or ignore an order.
But Asimov himself knew the three laws were not enough. And they don’t reflect the complexity of human values. What constitutes “harm” is an example: Should a robot protect humanity from suffering related to overpopulation, or should it protect individuals’ freedoms to make personal reproductive decisions?
We humans have already wrestled with these questions in our own, non-artificial intelligences. Researchers have proposed restrictions on human freedoms, including reducing reproduction, to control people’s behavior, population growth, and environmental damage. In general, society has decided against using those methods, even if their goals seem reasonable. Similarly, rather than regulating what AI systems can and can’t do, in my view it would be better to teach them human ethics and values—like parents do with human children.
Artificial intelligence benefits
People already benefit from AI every day—but this is just the beginning. AI-controlled robots could assist law enforcement in responding to human gunmen. Current police efforts must focus on preventing officers from being injured, but robots could step into harm’s way, potentially changing the outcomes of cases like the recent shooting of an armed college student at Georgia Tech and an unarmed high school student in Austin.
Intelligent robots can help humans in other ways, too. They can perform repetitive tasks, like processing sensor data, where human boredom may cause mistakes. They can limit human exposure to dangerous materials and dangerous situations, such as when decontaminating a nuclear reactor, working in areas humans can’t go. In general, AI robots can provide humans with more time to pursue whatever they define as happiness by freeing them from having to do other work.
Achieving most of these benefits will require a lot more research and development. Regulations that make it more expensive to develop AIs or prevent certain uses may delay or forestall those efforts. This is particularly true for small businesses and individuals—key drivers of new technologies—who are not as well equipped to deal with regulation compliance as larger companies. In fact, the biggest beneficiary of AI regulation may be large companies that are used to dealing with it, because startups will have a harder time competing in a regulated environment.
The need for innovation
Humanity faced a similar set of issues in the early days of the internet. But the United States actively avoided regulating the internet to avoid stunting its early growth. Musk’s PayPal and numerous other businesses helped build the modern online world while subject only to regular human-scale rules, like those preventing theft and fraud.
Artificial intelligence systems have the potential to change how humans do just about everything. Scientists, engineers, programmers, and entrepreneurs need time to develop the technologies—and deliver their benefits. Their work should be free from concern that some AIs might be banned, and from the delays and costs associated with new AI-specific regulations.
This article was originally published on The Conversation. Read the original article.
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