THCB

Categories

Above the Fold

It’s Got a Good Beat and You Can Kill It

By KIM BELLARD

Most of us can identify dogs from cats just by the sounds they make. We could probably even separate a dog’s bark from a wolf’s howl. If you are a nature lover, you might be able to identify different species of birds by their calls.  If you are a cetologist, you might be able to separate the vocalizations whales make versus those dolphins make. Across the animal world, we’ve learned the different sounds that different species make, which has been useful in our survival.

But did you ever wonder if you can identify, say, e coli from other bacteria?

It turns out that you can, thanks to research at Delft University of Technology (TU Delft) in the Netherlands. Four years ago, they showed that bacteria made noise, which was, in itself, a startling finding (admit it: would you have ever guessed that?). They used a thin layer of graphene to create a graphene “drum” small enough to fit a single bacterium. Team member Cees Dekker observed: “What we saw was striking! When a single bacterium adheres to the surface of a graphene drum, it generates random oscillations with amplitudes as low as a few nanometers that we could detect. We could hear the sound of a single bacterium!”

The team used this finding to accomplish an important purpose: to find out if bacteria were resistant to specific antibiotics. If an antibiotic was applied and the sound continued; it hadn’t worked. If the sounds stopped, the bacteria had been killed.

The team wasted no time in creating a start-up – SoundCell – to commercialize the finding. It promised to identify the “right” antibiotic in one hour, rather than subjecting patients to rounds of different antibiotics in search of one the bacteria wasn’t resistant to.

The team isn’t resting on their laurels. Some of them got to wondering, huh, I wonder if different bacteria make different sounds. And, their latest research shows, not only do they but, through machine learning, those different species can be distinguished. Team lead Farbod Alijani says. “With this new study, we take a significant leap forward: we show that each bacterial species has its own nanomotion signature.”

Mind. Blown.

The researchers focused on three bacteria that are common in hospital settings: E. coli, S. aureus (which causes staph infections) and K. pneumoniae (which causes pneumonia). They tested two different machine learning models; one correctly classified the bacteria 87% of the time, and the other 88% of the time.

Continue reading…

Samira Daswani, Manta Cares

Samira Daswani is CEO of Manta Cares. Her career in consulting and digital health startups took a left turn when she was diagnosed with breast cancer and had 18 months of visits with 123 appointments, 5 ER visits and much more. And it was very hard to manage her journey. So she built a paper based map/guide and started distributing it via hospitals in the gift shops and elsewhere. Manta Cares is the digital instantiation of that cancer map with symptom tracking and an AI chatbot on top of the map. Samira demoed it extensively for me. She raised some seed funding, and is now building it out for 80% of cancers–Matthew Holt

Adrian Owen & Faraz Shafaghi, Creyos

I spoke with neuroscientist Adrian Owen, co-founder and Chief Scientific Officer & Faraz Shafaghi, Chief Product Officer, at neurological testing company Creyos (which rhymes with “chaos”). Their cognitive assessment platform gives a baseline of neurological function and is essentially getting objective data at a point of care. This can now be done as part of the annual wellness visit (in fact it’s officially required under Medicare!), and there are things you can do about it. We dove into how it works, Faraz showed a whole demo of the test itself, Adrian explained what the impact of testing will be, and they shared Creyos’ progress in moving into practice.–Matthew Holt

Dayne Williams, Quantum Health

Quantum Health is one of the biggest and original navigation companies. Dayne Williams came out of retirement to take over as CEO after Zane Burke retired for personal reasons (to care for a relative). Quantum has in recent months added two acquisitions, Embold Health that analyzes which are the best doctors to go to, and CirrusMD which is a online telehealth & primary care company. I started though asking Dayne, with health plans and primary care docs, why do we need navigators? That’s a layup for him, but this is a great explanation of how Quantum is the front door/first call for the employees of its clients–what they call first time intercept–and where it’s going with that trust–Matthew Holt

Philippe Pouletty, Carvolix

Philippe Pouletty is a physician who’s an inventor, French venture capitalist, and the founder of Carvolix. Carvolix is a medical technology company that is introducing AI into cardiology. Before Carvolix, Philippe was the founder of Abivax, which makes drugs for chronic inflammatory diseases like ulcerative colitis. He’s been working on helping French medical products develop before having to sell to bigger US companies, and Carvolix is the latest. It’s an AI system that guides cardiologists and a robot that places heart valves. It’s of particular interest to me, as I need a new heart valve. I had a long and interesting discussion with Philippe about the future of cardiology, particularly heart valve replacement, and also about their upcoming product, a robot to bust brain clots–Matthew Holt

Peter Stetson, TigerConnect

Peter Stetson is the CMIO of TigerConnect. It’s now calling itself an AI platform to connect people, especially workflows between doctors, nurses, EMTs and devices. Until recently he was CMIO at Memorial Sloan Kettering, so I asked him about what the real problems in communications were. He believes it’s all about routing the calls to the right people and figuring out which is the right person to get the message escalation based on context. That can be in the hospital, or in the home. Tiger’s evolution has been to work on that orchestration. Peter gave the example of orchestrating surgery to improve patient care & save hospitals money, but similar issues are triggered by sepsis, heart attacks, etc, all in the Tiger system, increasingly automated off devices. And I raised the issue of where does Epic stop and where does Tiger start. Always controversial these days. But Peter is confident Tiger is “safe” for now!—Matthew Holt

A Unified Sense of Self

By MIKE MAGEE

Stanford neuroscientist, David Eagleman, reminded us this week that “A coherent explanation of consciousness eludes modern science.” That was his opening line in the New York Times book review of Michael Pollan’s latest effort, “A World Appears.” In it, Pollan asks innocently, “How does the brain generate a unified sense of self?”

According to Eagleman, “Pollan is not able to furnish the answers (no one can, yet), but he presents a captivating exploration, one that is highly personal and sensitive.” In this, he is not alone. Other fields are engaged in the same pursuit.

To begin with, there are the epigeneticists. They study “how our environment influences our genes by changing the chemicals attached to them.” In the hands of these scientists, genes are not “set in stone and (fully) predetermined.” Of late, these investigators have been unraveling how various chemicals, working on the surface and inside cells are constantly altering and adjusting how our genes work. Thus the title, since “epi” is Greek for “over, outside of, around.”

Other investigators like Professor Eddy Keming Chen in the department of Philosophy at University of California San Diego come at the problem from a different direction. She bolstered her PhD in Philosophy with a Masters in Mathematical Physics, and a graduate certificate in Cognitive Science. She teaches the PHIL 130 course on Metaphysics.

In the UCSD college syllabus, she tees up the question, “Why study metaphysics?” She promises enrollees that if they sign up, they’ll find a bit of magic in exploring tough questions, like: “Do we have free will? Is it compatible with causal determinism? What is the place of the mind and of the consciousness in a physical world?”

In the Jesuit world that I came from, such courses were mandatory as part of the core curriculum. In my own alma mater, they no longer carry the same mandate, but still remain alive and well.

Consider, for example PHL 365 – a 3 credit course at LeMoyne College titled Philosophy of Mind. Once again, there is magic in the air for inquiring minds.

Continue reading…

Concierge Care for All: Yes, It Really Is That Simple

By MATTHEW HOLT & CLAUDE

You’ll recall that a few weeks back I gave Claude some prompts and my entire corpus of work on THCB and asked it to write a piece. It was about 70% my ideas and 50% my writing tone. I’m back trying it again. This time I gave it a lot of prompts from some Linkedin pieces and comments I wrote and then I spent about 20 minutes editing it. This one is about 85% my idea and maybe 70% my tone? I have rewritten something in every paragraph. But it’s a hell of a lot faster than me writing from scratch. So I am going to keep experimenting like this for a while.

This started as a LinkedIn post about Merril Goozner’s plan to cut health care costs. He pointed out that the Center for American Progress’s new 10-point health reform plan is just more incrementalism and worse too boring for anyone to pay attention. Goozner’s own proposal, capping out-of-pocket expenses, isn’t much better. We’ve spent nearly a century proving that incremental reform in American health care doesn’t work — we still have tens of millions uninsured, patients going bankrupt, and outcomes that trail most of the developed world. And of course it enables profiteers to massively extract wealth from the system. In other words, from us.

My alternative: go to the barricades and blow the whole thing up. We need revolution because modest evolution cannot work.

My proposal, which you should go and read is to give everyone a voucher for primary care, but make it Concierge care for all.

The post got some pushback, and some of the objections reveal something important. My idea isn’t too complicated, but so many of us are so imbued in our broken system that  we can’t see beyond it. And to be fair, it’s only after 35 years looking at it, that I’ve got the “burn it all down” religion.

My Basic Idea

My proposal is Concierge Care for All. Every American gets a voucher worth somewhere between $2,000 and $3,000 a year, which they have to spend with a primary care physician (or primary care organization) of their choice. Each PCP or equivalent takes on a panel of around 600 patients — roughly 1/3 to 1/4 what a typical fee-for-service PCP practice manages today, and the same as most current direct primary care practices. 

That’s $1.2 to $1.8 million in annual revenue per physician; enough to pay the doctor $500,000 to $600,000 a year and still leave $600,000 to $1.3 million for clinical staff, technology, and overhead. This is basically the MDVIP model. It works. People who use it love it. And the latest studies show that it saves a lot (31%) on hospital emergency room use and inpatient costs.  That alone saves a significant fraction of what this transition would cost.

The bulk of what a PCP does in this model is managing chronic illness — diabetes, hypertension, heart disease, COPD. These are the conditions that drive the majority of health care spending but which our current system sucks at managing. A well-resourced primary care practice, freed from the hamster wheel of volume-based billing, can do this proactively and can deploy the technology to do it at scale. Remote patient monitoring, AI-assisted care management, continuous data from wearables and home devices — the tools that many digital health companies have shown working well — all of that gets directly integrated into primary care where it belongs. The PCP organization is the purchaser of those technology services. This is basically the logic behind CMS’s new ACCESS program, except that ACCESS tries to bolt these capabilities onto the system from the outside. In this model they’re baked into primary care practice because the PCP wants to manage their patients and has the professional ethics and responsibility to do so.

I’d include a lot of mental health and dental care in the definition of primary care, as well as minor urgent care. Plenty of primary care groups in the US and elsewhere do that now, even though we’ve historically pretended that the head isn’t connected to the body and the teeth are outside it.

What isn’t there is equally important.  No co-pays, no coinsurance, no deductibles, no claims. No staff managing all that bureaucratic crap. Your PCP manages your care, knows you, and when you need a specialist or a scan or a surgery, they refer you.

What About Specialty Care?

Continue reading…

Give That 1337 a Job!

By KIM BELLARD

Chances are someone in your family is a gamer. Maybe you are a gamer yourself. After all, somewhere between two-thirds and three-fourths of Americans play video games, and if you just looked at young men, it’d be closer to 100%. Grumpy older people don’t get it, complaining that gaming is just a waste of time, but gamers believe it helps with their problem solving (although at a cost of sleep).

Well, the good news is that if you are, indeed, a gamer, the Federal Aviation Authority (F.A.A.) is looking for you.

Last Friday Transportation Secretary Sean P. Duffy announced the F.A.A.’s campaign to attract “the next generation of air traffic controllers,” It is looking for people “who possess useful skills that are transferable to a career in air traffic control, including:

  • Demonstrated high cognitive functions
  • Multitasking
  • Spatial awareness
  • Strategy and problem-solving”

By all that, they mean gamers. The announcement goes on to add: “…this effort is focused on reaching talented young people pursuing alternative career paths, many of whom are active in gaming. Feedback from controller exit interviews reinforces this, with several controllers pointing to gaming as an influence on their ability to think quickly, stay focused, and manage complexity.”

There’s a slick YouTube ad too.

“When you bring on someone who has gaming experience, particularly with air traffic control, they have an edge up,” Michael O’Donnell, an aerospace consultant who previously worked as a senior F.A.A. official focused on air traffic safety, told Karoun Demirjian of The New York Times. “They’re coming in with a skill set. But it doesn’t replace aptitude, or discipline, or decision making under pressure.”

Surprisingly, the National Air Traffic Controllers Association supports the effort, with its president Nick Daniels telling BBC:: “Our union welcomes innovative approaches to expanding the candidate pool, including outreach to individuals with high-level aptitude skills such as gamers, so long as all pathways maintain the rigorous standards required of this safety-critical profession.”

To be fair, both the F.A.A. and the NATCA probably would welcome anything that might drive people to apply. The F.A.A. only has about 75% of the target number of controllers, leaving it several thousand short. Individual airports may be staffed even lower, as might certain times of day. It’s not a new problem and it is not a problem that is going to be quickly fixed; it is not as though today you can play a video game and tomorrow you can be an air traffic controller. There is definitely a learning curve.

It also doesn’t help that air traffic controllers aren’t usually paid during government shutdowns, which Congress seems to increasingly allow. “The failure to pay air traffic controllers for 44 days created uncertainty, drove many experienced controllers out of the profession and harmed the recruitment pipeline,” a spokesperson from the Department of Transportation told CBS News in November.    

Nor does it help that air traffic controllers rely on technology that is likely to be older than they are. The F.A.A. is trying, for example, to replace its outdated radar system, but NBC reports: “The FAA has been spending most of its $3 billion equipment budget just maintaining the fragile old system that still relies on floppy discs in places. Some of the equipment is old and isn’t manufactured anymore, so the FAA sometimes has to search for spare parts on eBay.”

The National Transportation Safety Board (NTSB) Chair Jennifer Homendy complained: “This is 2026. The secretary talks about upgrading our air traffic control system. We have an old air traffic control system. This is why he talks about that. We need to upgrade.” 

I was surprised to learn that gaming might not just be an asset to become an air traffic controller, but also an asset for air traffic controllers. Josh Jennings, a supervisor at the F.A.A.’s air traffic command center in Virginia, told Ms. Demirjian that gaming is both a way for controllers to stay sharp, and as a form of “social currency” among them. “I would say it’s probably tenfold on how fast this new generation is able to pick up on our physical tech, our radar scopes,” he said. Controllers apparently often play video games on their breaks.

In similar approaches to look for unconventional backgrounds, the Marines are looking at dirt bikers to become drone pilots, while Russia is looking at university students for its drone pilots.     

Continue reading…

Cody Simmons, DermaSensor

Cody Simmons is the CEO of DermaSensor. I met him when he won the Digital Health Hub Foundation award for diagnostic tools last year. DermaSensor is a device designed to detect early skin cancer using Spectroscopy. Right now only 8% of those with potential skin cancer get the recommended screening. It’s another area where technology can potentially democratize medicine. DermaSensor is aiming for the primary care market. Cody shows how the tool works and explains how the PCP can both improve screening for their patients, and also make money from doing that–otherwise of course they wouldn’t do it! As you can imagine both the technology, the FDA approval process and the roll-out is pretty complicated. Cody explains all–Matthew Holt

assetto corsa mods