Your Editor’s been away and then largely out of pocket over the past two weeks. Here’s our roundup/catchup beyond the bombshells:
In remote patient monitoring for chronic disease, Philips, PMV, and other investors invested €7 million ($8.6 million) in Belgium’s/Hartford CT’s LindaCare. The Series B funding will accelerate its US expansion of OnePulse for remote monitoring of chronic heart failure and cardiac arrhythmia patients with Cardiac Implanted Electronic Devices (CIED). It is in use in major European hospitals and in US trials, though there is no mention in the release or on their website on CE Marking or FDA clearance/clinical trials. Previously from its 2013 founding, it had €1.6 million in funding. Also Mobihealthnews.
TytoCare, a remote monitoring telehealth/video consult platform which integrates peripherals for a virtual physical exam, raised $25 million in a Series C round led by large Chinese insurer Ping An via their Global Voyager Fund plus Walgreens, Fosun Group, OrbiMed, LionBird, and Cambia Health Solutions. Release. Their total raise is $45.6 million since 2012 (Crunchbase). Their most current partnership is with Long Island-based Allied Physicians Group which is featuring at-home telehealth visits at its pediatric practice in Plainview.
More favorable Medicare reimbursement for telehealth is the subject of four US Congressional bills. The one furthest along is the ‘Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care Act of 2017’ (S.870), which aims to improve at-home care, increases Medicare Advantage flexibility, gives ACOs more options and expands telehealth capabilities for stroke and dialysis patients. It passed the Senate in September and now goes to the House Subcommittee on Health of the Committee on Energy and Commerce. The effect of all four is on Medicare payment parity with in-office visits, which does not currently exist and is not affected by the various state parity bills on insurance for those below 65. American Well touts a 10-fold growth in revenue, but the likelihood of any of these four bills being signed into law is small, particularly with a pending report from the Medicare Payment Advisory Commission. Becker’s Hospital Review
Norway released at end of January news on an “advanced and persistent” 8 January cyberattack on Health South East RHF. This has both a health breach and military twist.
While AI is hotly debated and the Drudge Report
features daily the eeriest pictures of humanoid robots, the hard work on determining social norms and programming them into robots continues. DARPA
-funded researchers at Brown and Tufts Universities are, in their words, working “to understand and formalize human normative systems and how they guide human behavior, so that we can set guidelines for how to design next-generation AI machines that are able to help and interact effectively with humans,” said Reza Ghanadan, DARPA program manager. ‘Normal’ people determine ‘norm violations’ quickly (they must not live in NYC), so to prevent robots from crashing into walls or behaving towards humans in an unethical manner (see Isaac Asimov’s Three Laws of Robotics
), the higher levels of robots will eventually have the capacity to learn, represent, activate, and apply a large number of norms to situational behavior. Armed with Science
This directly relates to self-driving cars, which are supposed to solve all sorts of problems from road rage to traffic jams. It turns out that they cannot live up to the breathless hype of Elon Musk, Google, and their ilk, even taking the longer term. Sequencing on roadways? We don’t have the high-accuracy GPS like the Galileo system yet. Rerouting? Eminently hackable and spoofable as WAZE has been. Does it see obstacles, traffic signals, and people clearly? Can it make split-second decisions? Can it anticipate the behavior of other drivers? Can it cope with mechanical failure? No more so, and often less, at present than humans. And self-drivers will be a bonanza for trial lawyers, as added to the list will be car companies and dealers to insurers and owners. While it will give mobility to the older, vision impaired, and disabled, it could also be used to restrict freedom of movement. Why not simply incorporate many of these assistive features into cars, as some have been already? An intelligent analysis–and read the comments (click by comments at bottom to open). Problems and Pitfalls in Self-Driving Cars (American Thinker)
A robotic arm with a neural interface that allows the user to experience touch has been developed by the University of Pittsburgh and University of Pittsburgh Medical Center, funded by the Defense Advanced Research Projects Agency (DARPA).
The Revolutionizing Prosthetics
program since 2006 has been developing advanced upper-limb prosthetics. Their first was the Gen-3 Arm System by DEKA Integrated Solutions Corporation, submitted for 510(k) in 2012. The subject for the test of the touch interface, Nathan, has been a quadriplegic from the chest down since 2004. He permitted four microelectrode arrays, each about half the size of a shirt button, to be placed in his brain: two in the motor cortex and two in the sensory cortex regions that correspond to feeling in his fingers and palm. Wires run from the arrays to the robotic arm, which has torque sensors that detect when pressure is applied to its fingers. These physical “sensations” are converted into electrical signals back to the arrays in Nathan’s brain so that he has the sensation of feeling and touch. The sensation of touch in the bionic arm is near 100 percent natural and accurate. This research has great potential both for prosthetics and for other neurological conditions. Armed With Science. Video
How can sensors better communicate with and regulate the central nervous system (CNS)? DARPA (Defense Advanced Research Projects Agency), which is part of the US Department of Defense, is on the case with research on miniaturized electronics suitable for chronic use for biosensing and neuromodulation of peripheral nerves in the Electrical Prescriptions (ElectRx) program. A DARPA-funded ElectRx research team led by the University of California, Berkeley’s Department of Electrical Engineering and Computer Sciences has developed what they term ‘neural dust’–a millimeter-scale wireless device small enough to be implanted in individual nerves, using ultrasound for power coupling and communication. In vivo test results on rodents have been published in the peer-reviewed neuroscience journal Neuron. A nice return to Armed With Science, which has been bereft of device or robotics news for months.
I sing the self-healing Body Electric!
With apologies to Ray Bradbury, in this Editor’s view, DARPA’s ElectRX
research is almost revolutionary, yet logical. Like a pacemaker, it monitors a condition (like heartbeat) and if ‘off’ stimulates the organ through an electric shock. Scale it to a nano-sized neuromodulator and you have ElectRX. In broad terms, a tiny device, perhaps delivered by a needle, analyzes an anomaly and delivers an electrical signal to nerve pathways to correct it. For diabetics, it could stimulate insulin production; to treat depression, control inflammation in the brain; for PTSD patients, stimulate the vagus nerve for neural plasticity. Controlling inflammation has other benefits, such as in spinal injury and in TBI. While the Gizmag article
spends time musing on ‘super-soldiers’ and the negative aspect, this Editor sees this research on the relationship between neural circuits and health as a significant development for both medicine and for Version 3.0 of digital health. DARPA web page on ElectRX.
At the Air Force Research Lab, Applied Neuroscience Branch
at Wright-Patterson AFB, researchers are testing transcranial direct-current stimulation (tDCS)
as a performance enhancer. We noted last August that DARPA
was one of the lead research organizations on tDCS for mental illness and neurological problems [TTA 18 Aug 14
]. AFRL is evaluating its effects on boosting cognition, memory and attention–all important factors when one is flying RPAs (remotely piloted aircraft, a/k/a drones) for multiple hours in front of a computer console. USAF RPA pilots (a/k/a Drone Drivers) now log three times as many flight hours as do pilots of real aircraft, which says volumes about priorities. Drone Drivers are also reporting combat fatigue and high levels of stress, so AFRL is also evaluating non-invasive ways of detection through pupil dilation and heart rate. Video (09:16)
USAF photo. Also Mosaic Science (Wellcome Trust)
Traumatic brain injury (TBI) has been receiving extra study in the past few years due to battlefield blast/IED injury as well as football and other sports injuries as early as junior high. The insidious nature of TBI is that long-term effects of accelerated brain aging can appear in those who have mild injuries, or who never experienced the usual symptoms indicating TBI such as dizziness, nausea and disorientation. Researchers have struggled for the reasons why “51 percent of sufferers of mild head injuries were reported as still having disability one year later at follow-up” and why a large proportion of military veterans who sustained mild brain injuries experience the heightened and uncontrollable emotionality of pseudobulbar affect (PBA). This article in the Genetic Literacy Project website works with an earthquake analogy: that there are P-waves (blast pressure) that compress tissues and disrupt neuronal communication, and in the long term accelerate brain aging and cognitive decline. Something sports injury, CTE researchers and research organizations within the military such as DARPA and DoD should be investigating. Hat tip to author and reader Dr Ben Locwin via Twitter.
An abundance of related reading in TTA can be found in searches under TBI and chronic traumatic encephalopathy. Also see our 2012 and prior archives for our writing on TBI.
They’re Still Puppets!
The final DARPA Robotics Challenge
took place last week at the Fairplex racetrack in Pomona, California. 10,000 spectators viewed 24 teams’ robots going through their disaster-response paces to win a share of $3.5 million in prize money in this final stage of the DARPA three-year program. Many of the robots were custom, but several teams fielded adaptations of the Boston Dynamics Atlas robot as a common platform. The engineering teams were sequestered in a ‘garage’ offsite and linked to their robot charges by a deliberately degraded communication system (to simulate field conditions). The robots had no cords (unlike 2013) and were given eight tasks: driving a car down a dirt road, getting out of the car, opening a door and entering a building, turning a valve, cutting a hole in a wall with a drill, completing a surprise task (flipping a switch or unplugging a tube and plugging it into another hole), navigating a pile of rubble, (more…)
This week’s priceless quote:
“A lot of the response was, ‘We live in a cornfield in the middle of Minnesota,’” he said. “’Who wants to hurt us? Who can even find us here?’”–Jim Nelms, Mayo Clinic’s first chief information security officer,
We know where you are and what you do! The precarious state of healthcare data security at facilities and with insurers, plus increased external threats from hacking has been getting noticed by Congress–when you see it in POLITICO, you know finally it’s made it into the Rotunda. It was over the horizon late last summer with the FBI alert and legislators in high dudgeon over the Community Health Systems China hack [TTA 22 Aug 14]. It’s a roof that leaks, that costs a lot to fix, doesn’t have immediate benefit (cost avoidance never does) but when it does leak it’s disastrous.
This article rounds up much of what these pages have pointed out for several years, including the Ponemon Institute/IBM study from earlier this week, the Chinese/Russian connections behind Big Hacks not only for selling data, but also IP [TTA 26 Aug 14] and how decidedly easy it is to hack devices and equipment [TTA 10 May 14]. Acknowledgement that healthcare data security is about 20 years behind finance and defense deserves a ‘hooray!’, but when you realize that on average only 3 percent of HIT spend is on security when it should be a minimum of 10 percent (HIMSS) or higher…yet the choice may be better security or uncompensated patient care particularly in rural areas, what will it be for many healthcare organizations?
The article also doesn’t go far enough in the devil’s dilemma–that the Federal Government with Medicare, HITECH, meaningful use, rural telehealth and programs like Medicare Shared Savings demand more and more data tracking, sharing and response mechanisms, stretching HIT 15 ways from sundown. At the cutely named Health Datapalooza presently going on in Washington DC, data sharing is It for Quality Care, or else. Yet the costs to smaller healthcare providers to prevent that ER readmission scenario through new care models such as PCMHs and ACOs is stunning. And the consequences may be more consolidated, less available healthcare. We are already seeing merger rumors in the insurer area and scaledowns/shutdowns/buyouts of community health organizations including smaller hospitals and clinics. Also iHealthBeat.
DARPA to the rescue? The folks who brought you the Internet may develop a solution, but it won’t be tomorrow or even the day after. The Brandeis Program is a several stage project over 4.5 years to determine how “to enable information systems that would allow individuals, enterprises and U.S. government agencies to keep personal and/or proprietary information private.” It discards the current methodology of filtering data (de-identification) or trusting third-parties to secure. Armed With Science FedBizOpps has the broad agency announcement in addition to vendor solicitation information.
Catching up on our robot friends (?), we have a potpourri of developments which concentrate on either improving health or advancing robotic capabilities:
The ASSAM (Assistants for Safe Mobility) project is not about tea, but assisting older adults with everyday mobility and facilitating autonomy centering on physical mobility assistance for declining walking capabilities, but encouraging physical exercise; cognitive assistance for declining visual and mental capabilities by obstacle recognition and avoidance, and orientation and navigational aid. ASSAM upgrades existing DME (durable medical equipment) via sensor and computing hardware/software packages. It is coordinated by the German Research Center for Artificial Intelligence (DFKI), and receives funding from the EU’s Ambient Assisted Living Joint Programme and the national ministries of Germany, Spain, and the Netherlands. ASSAM website, YouTube video Hat tip to the German Center for Research and Innovation
A robot scientist may make ‘orphan drugs’ an obsolete term. Eve, a robot scientist (more…)
The Defense Advanced Research Projects Agency (DARPA)
has awarded Harvard’s Wyss Institute for Biologically Inspired Engineering
an additional $2.9 million in development funding for its Soft Exosuit currently in prototype. The Wyss exoskeleton concept uses sensors, fabric that mimics muscles and tendons in addition to intuitive controls and a power supply. DARPA has been supporting several levels of research for some years as part of Warrior Web
and other initiatives, which your Editors have been following. Exoskeletons in use right now are designed to assist humans in heavy lifting, or (more…)
While protection against concussive and sub-concussive head blows that lead to brain trauma (TBI) and may lead long-term to chronic traumatic encephalopathy (CTE) is being developed in several areas, by DARPA, US Army research, universities and the NFL‘s helmet providers, the final test has to involve cranial bone similar to those belonging to 20-30 year olds. Testing on humans is out of the question, deceased animal and older human crania are dissimilar and surgical implants do not react like real bone. The US Army Research Laboratory (ARL) along with university partners are developing synthetic cranial bone that behaves like real 20-30 year old bone when subjected to combat-intensity blasts, for testing devices to mitigate the adverse effects and/or track the effects of those blasts. Armed With Science
Prepare to be shocked! Can brain enhancing techniques via transcranial direct-current stimulation (tDCS) be the future of performance enhancement? Will it be the future basis of recovery from some mental illnesses, stroke and other neurological diseases? It’s a hot research area, according to this Atlantic article. Researchers at DARPA, University of New Mexico, George Mason University, Stanford University, Oxford University, University of Göttingen and this Editor’s local City College of New York (CCNY) are hot on the trail. Four areas being investigated are (more…)
Focusing today on robotics in and around DARPA and the US Armed Forces, via Armed With Science. Military advances are a ‘pointer to the future’ where robotics will eventually assist older adults, the disabled and the rest of us in our daily lives. (We’ve also noted where other military protocols can work into assistive technologies–see ‘The Big Red Button’ emergency alert app.) :
- Update on the DARPA Robotics Challenge: The Phase 3-Final originally set for December will take place 4-5 June in Pomona, California due to some changes in the third round specs including an emphasis on ‘cloud robotics’ and international applicability. DARPA’s program is strictly oriented to ground operations, disaster response and human supervision. Changes in spec include full wireless, tetherless and continuous operation–the operators communicate with the robots wirelessly only including periods of latency, their power source is 100 percent onboard, and the robots must be able to complete a sequence of eight tasks and recover in a ‘challenging environment’ without outside help. Plus DARPA is throwing in a secret challenge that looks like it will be disclosed only at the final. Specs have evolved to the point where there has been a withdrawal of a finalist which is now concentrating on commercialization despite the $2 million prize. Here Come The Robots Previously in TTA: DARPA Robotics field competition (Phase 2), Robotics Challenge winners
- Robotics Secrets Revealed! In this humorous video, the Naval Research Lab’s Lucas, Octavia and PackBot set up some human furloughs (real enough) so that they get some rest. The reasoning behind their actions and the humans is explored. Robot Ruckus.
- MAST’s Mini Robots and ‘microsystems’ may be in future used to locate, identify and engage high-priority targets by increasing situational awareness. This includes drones. Emphasis more on in-field use. Unfortunately written in Pentagon-ese. The Military’s Mini Robots
- Meet a specialist in robotics. Interview with bomb disposal robot engineer Aaron O’Toole, awarded the Navy’s top engineering award in 2013. An area of his concentration is flexibility and fluidity of motion. Insights into how a developer looks at mobility and skill challenges. Meet the Scientists
DARPA’s continued research on deep brain stimulation (DBS) implants to treat PTSD and TBI, as well as other neuropsychological conditions, is given the once-over in this Defense One article. New information from the time this Editor last wrote about it in December is that the SUBNETS program (Systems-Based Neurotechnology for Emerging Therapies), funded with $12 to 26 million, will work with the University of California at San Francisco, Lawrence Livermore National Lab and Medtronic to create an implant with electrodes reaching into the brain and which does not require staying still under a machine in a lab. The prototype development is expected to take five years. The article also points out the US Air Force initiative studying the effects of low amounts of electricity on the brain to boost alertness delivered by an external cap.
This Editor, as our long-term readers know, has been following the issue and the dangers of soldier TBI and PTSD for several years. One of the problems with TBI is measuring the amount of blast a soldier has actually sustained in battle–and thus the medical danger. A cheering development is the further development of the ‘blast gauge’ developed by DARPA and the Rochester Institute of Technology (RIT), the testing of which we noted in mid-2012 [TTA 12 June 12]. It is now smaller than a wristwatch (now thumb-sized) and worn in three positions attached to a soldier’s body armor: chest, shoulder and back of helmet. As in the wristwatch model, there’s a red-yellow-green light for an instant read, in addition to the downloadable data which a medic can interpret on a laptop using a USB cable. It is now being worn by 11,000 US troops and 1000 Australian soldiers in Afghanistan. (more…)