JohnPatrick.com

Thanks for stopping by. My name is John Patrick and Attitude LLC is the name of my company. My activities include writing, speaking, investing, and board service. My areas of focus include healthcare, Internet and mobile voting, and technology. As you will see in the books I have written, I believe most big problems and big solutions involve Attitude. My latest book is Robot Attitude: How Robots and Artificial Intelligence Will Make Our Lives Better (2019). Robot Attitude and all the prior books are part of a Series called “It’s All About Attitude“. You can find all the details about each book here.


My blog below has more than 2,000 stories about technology, music, motorcycles, travel, business, Internet voting, robots, AI, healthcare, and more. Every Saturday morning, I publish an e-brief which contains an easy to read post or two about new developments in my areas of interest. Please sign up and give it a try. If you don’t like it, you can make one click and you will not receive it again. You can find me on social media on Facebook, LinkedIn, Twitter, and YouTube. You can also find my background in Wikipedia.

John R. Patrick
News from johnpatrick.com

There is an overwhelming amount of information out there about Covid-19, more than anyone can read. Bill Gates wrote in his Gates Notes a post he calls “The first modern pandemic“. If you found Bill’s comprehensive post interesting, you may want to listen to the podcast with him on the Ezra Klein show.

You can follow the curves and projections by country or state at healthdata.org. Monitor the number of new cases and deaths by country or state at the Coronavirus Dashboard.

The How We Feel app is gaining momentum. The number of people using it has more than doubled in ten days. Just 4.4% of people are not feeling well. It seems simple, but to researchers the data is powerful and it will help in contact tracing efforts. Donate your data to help scientists track the virus. It is completely private. No login required.

If you don’t have the app yet, get it here for Apple or here for Android.

News from johnpatrick.com

As of mid-afternoon Friday, Tesla market capitalization is up $20 billion to $142 billion. The five giant tech company market caps climbed another couple of hundred billion for the week. Quite a bit higher than at the end of February. All five companies are global, but to put their massive valuation into perspective, it now represents 20% of the market cap of the U.S. S&P 500. Shareholders are happy but government regulators and politicians are gearing up for new regulations. I believe pressure on big tech will continue to mount.

MAGFA Market Cap (05/08/20 3:45 PM)
Microsoft$1.396Trillion
Apple$1.340Trillion
Google$0.946Trillion
Facebook$0.603Trillion
Amazon$1.185Trillion
   
Total$5.470Trillion
   
S&P 500 1/31/20$26.720Trillion
   
MAGFA20% 
Will Clinical Trials Give Us The Best Cure For Covid-19?

In last week’s e-brief, I listed a number of terms from our coronavirus related vocabulary. A very important addition to the list is the term clinical trials. With the high mortality we are experiencing from Covid-19, there is a tremendous interest in finding therapies and vaccines, and finding them fast. A particular drug which cures one disease doesn’t mean it will cure another, and proclaiming about a drug for the most seriously ill, “Try it. What is there to lose?” does not validate whether a treatment is safe and effective.

Only clinical trials can provide a scientific basis for approval of a new cure. I believe the processes for developing, approving, and manufacturing can be made more streamlined and efficient and get drugs and treatments to needy patients more quickly. However, only scientific methods can ensure a new cure is safe and effective. Clinical trials are central to the scientific methods.

The experts have been using the term clinical trials in their testimonies and interviews, but many people may not know exactly what a clinical trial is. It is the purpose of this article to shed some light on the subject.

First, a few words on what a clinical trial is not. Clinical means the observation and treatment of actual patients, not a theory or something in the laboratory. Trial means a test of the performance, qualities, or suitability of something. A clinical trial is not giving a patient a new drug and see if it works and, if not, then try a different new drug.

Clinical trials are research investigations in which people volunteer to test new treatments. Researchers look at how people respond to a new intervention and what side effects might occur. The trials extend over four phases and, as I describe what goes on in each phase, it may help explain why the approvals take so long. As I mentioned earlier, I believe the time can be shortened.

At the latest count on angel.co, there are 255 startup companies focused on improving all aspects of clinical trials. There are 13,866 investors who have bet more than $1 billion on the startups. They are promising cloud based technologies for collaboration and artificial intelligence to accelerate data analysis. I am 100% certain new technologies will have a big impact on the time and cost of getting new drugs and treatments available to patients.  

Following are the steps involved in bringing a new drug to market.

Preclinical studies

Before pharmaceutical companies start clinical trials on a drug, they conduct extensive preclinical studies. These studies take place in test tubes or petri dishes. They also do animal experiments using wide-ranging doses of the study drug to obtain preliminary data on efficacy, toxicity and pharmacokinetics. The latter measures what living cells will do to the drug which in turn helps establish drug dosage. The bottom line is the preclinical studies help companies determine if it is worth moving forward.

Phase 0

Phase 0 trials are relatively new and are known as human micro-dosing studies.  The purpose is to speed up development of promising drugs by establishing very early if the drug behaves in human subjects as was expected from the preclinical studies. Phase 0 trials include the administration of very small doses of the drug to 10 to 15 patients to gather preliminary data. Drug companies use Phase 0 studies to rank drug candidates in order to decide which has the best odds of justifying human studies.

Phase I

Phase I trials are sometimes called “first-in-humans” trials. They are designed to test the safety, side effects, best dose, and formulation for the drug in a small group of 20 – 100 healthy volunteers who are recruited. These trials are often conducted in a clinic where the subject can be observed by full-time staff. The subject who receives the drug is usually observed until the amount of the drug remaining in the body is very low. The focus of Phase I is the safety and tolerability and to find the best dosage. About 70% of Phase I trials are successful and move to phase II.

Phase II

Phase II trials are performed on larger groups, 100 – 300 patients who have the disease the drug is supposed to help or cure. The goal is to assess efficacy and side effects. Design of the trial is key. There are many types of study designs but the workhorse praised by most experts is the randomized controlled trial (RCT).

An RCT is a scientific experiment which aims to reduce bias when testing the effectiveness of something new. RCT is used in many areas but currently the most interesting use is for medical treatments and drugs. The concept of an RCT is to randomly allocate patients into two groups, treat each group differently, and then compare the outcomes to see if there is a statistically significant difference. The experimental group receives the treatment or drug being evaluated. The other group, usually called the control group, receives standard care without the experimental treatment or drug. The success rate for Phase II trials is about 33%.

Phase III

If an experimental drug or treatment makes it to Phase III, it is presumed to be at least somewhat effective. This is why, when a new drug gets to Phase III, the stock of the pharmaceutical company goes up. Phase III trials typically have 300 – 3,000 patients with the specific disease being addressed. Even though the success rate for a Phase III trial is about 50%, the manufacturer begins building up the marketing and manufacturing programs to be ready if the trial is successful and the drug gets approved. 

Once a drug has had a successful Phase III trial, an enormous amount of “paperwork” is unleashed containing a comprehensive description of the methods and results of human and animal studies, manufacturing procedures, formulation details, dosage information, and shelf life. The massive collection of information makes up the “regulatory submission” for review by the regulatory authorities.

Phase IV

A Phase IV trial is basically a form of post marketing surveillance. Phase IV monitors safety but also provides a way for manufacturers to test interaction with other drugs, find new applications of the drug, and test in other populations. If any safety issues are discovered, a drug can be pulled off the market such as happened with Merck’s Vioxx in 2004 after a clinical trial showed the drug carried an increased risk for heart attacks and strokes. Unfortunately, I was a Merck stockholder at the time.

Overall cost

Phase II and III trials can cost tens of millions of dollars. The entire process of developing a drug from preclinical research to marketing can take 10 to 15 years or more and cost hundreds of millions of dollars, some well over $1 billion. This is why there are so many startup companies focused on clinical trials and other related processes. 

Final Comments

If you were not already familiar with the phases of clinical trials, I hope the summary level description I have cobbled together is helpful. I have been a subject in a clinical trial some years ago (and still recall the huge amount of paperwork involved). Then in 2014, I conducted a randomized controlled trial for my doctoral dissertation. I will conclude by sharing a bit of what I learned.

First is the design of the trial. It can be complex, but getting the right design is critical to a successful study. I saw a study about a product where the experimental group consisted of participants who were paid a fee. Such a design would not be a random selection of participants and would introduce bias into the study. Likewise, if the experimental group is 80% female and the control group is 80% male, that is not a random selection. An RCT has to have participants in both groups which are similarly situated; age, gender, sickness, degree of sickness, etc. If one group is in a metro hospital, and the other group is in a nursing home, that would not be a randomized selection.

Another factor is the size of the groups. This is called the N. You may have noticed Dr. Fauci comment on one of the Remdesivir trials saying it was very well “powered”. That means the N was large, in that case about 1,000. I have seen studies with an N equal 25 or even less. A small N proves nothing because the results might have been random or not statistically significant. 

Suppose a new drug trial shows the control group patients were discharged from the hospital after an average of 15 days and the experimental group after 14 days. Even with a big N, the difference achieved is probably not statistically significant. The results could actually have an equal probability of being 15/14 or 14/15. In other words, the study design was ok and proved the drug or treatment was not effective.

In the case of one of the Remdesivir trials, the control group patients were discharge from the hospital in 15 days on average and for the experimental group after 11 days. This is statistically significant, but at what cost. The four day improvement is good, but how about if the drug cost $250,000? In cancer treatment, a $1 million drug sometimes adds a few weeks to a person’s life. Is that justified? In Europe, they don’t think so. In the U.S. the usual opinion is adding a day to Daddy’s life is worth whatever it costs (as long as the government or health insurer is paying for it).

Finally, I would like to say a few words about clinicaltrials.gov. The site currently shows details on 337,990 research studies in all 50 states and in 210 countries. There are 1,133 studies related to Covid-19. For Covid-19 and Remdesivir, there are 19 studies.

Some studies take place only in hospitals. Others at home. Some are with seriously ill patients. Others with patients who are only mildly ill. Some compare one drug to another. You can see many variations of study designs. Some studies are underway, others are actively recruiting subjects. You can search for a drug or a disease or ailment, and learn everything about the study. If they are recruiting, you or your doctor can contact the researchers directly. Unfortunately, there are many conditions which don’t have reliable cures. Clinicaltrials.gov is a great resource to either join a study or follow one to its conclusion. In summary, yes, clinical trials will give us the best cure for Covid-19.

News from johnpatrick.com

There is an overwhelming amount of information out there about Covid-19, more than anyone can read. Bill Gates wrote in his Gates Notes a post he calls “The first modern pandemic“. If you found Bill’s comprehensive post interesting. You may want to listen to the podcast with him on the Ezra Klein show.

You can follow the curves and projections by country or state at healthdata.org. You can monitor the number of new cases and deaths by country or state at the Coronavirus Dashboard.

The How We Feel app is gaining momentum. It seems simple but to researchers the data is powerful and it will help in contact tracing efforts. Donate your data to help scientists track the virus.

If you don’t have the app yet, get it here for Apple or here for Android.

News from johnpatrick.com

As of mid-morning Friday, Tesla market capitalization is up to $134 billion. The five giant tech company market caps are climbing back and now all higher than they were at the end of February. All five companies are global, but to put their massive valuation into perspective, it now represents 20% of the market cap of the U.S. S&P 500. Shareholders are happy but government regulators and politicians are gearing up for new regulations. The pressure on big tech will continue to mount.

MAGFA Market Cap (05/01/20 11:30 AM)
Microsoft$1.341Trillion
Apple$1.287Trillion
Google$0.907Trillion
Facebook$0.580Trillion
Amazon$1.143Trillion
   
Total$5.258Trillion
   
S&P 500 1/31/20$26.720Trillion
   
MAGFA20% 
Do We Really Need 100,000 Contact Tracers?

According to lexicographer and dictionary expert Susie Dent, the average active vocabulary of an adult English speaker is around 20,000 words. We also have a passive vocabulary of around 40,000 words, words we have stored but don’t use. The current environment is adding to our active vocabularies. It seems every day we hear the words antibody testing, bioinformatics, community spread, computational biology, contact tracing, coronavirus, Covid-19, epidemiology, flattening the curve, N95 masks, pandemic, pathogens, personal protection equipment (PPE), serology testing, social distancing, swabs, therapeutics, and ventilators, just as a sample.

Between now and year end, the most important term in our vocabulary may turn out to be contact tracing. In combination with extensive testing, contract tracing is an important tool to counteract a potential second wave and prevent cases from spiraling upward again.

The concept behind contact tracing is simple: identify those who test positive for Covid-19, isolate them and monitor their health, and reach out to people who may have been in contact with the infected person and urge them to quarantine themselves. “In contact with” means the people who may have been within 6 feet of the infected person for more than 10 minutes, more like 5 minutes in a healthcare setting. Communication with those contacts needs to advise them to quarantine themselves and monitor their health. The goal is simple — stop the spread. The implementation is difficult.

One estimate of the scope of contact tracing in the U.S. calls for 100,000 contact tracers at a cost of nearly $4 billion. Even if they can be brought on board and trained, their task is daunting. For example, suppose, sometime in phase 3, a person tests positive and the county department of health assigns a tracer to call her. The tracer asks where the infected person has been in the last 14 days. Who had she been close to? Where had she been? If the answer is visiting a friend or relative, the tracer records the contact information and reaches out to them. That would be the easy examples. Suppose the infected person responded she had been at the shopping mall. What stores? Apple store. Who did you talk to? What time were you there? What did you touch? She called the tracer back and said she had forgotten to mention a couple of things. She had also stopped at Chick-fil-A at the Food Court and had some lunch. Also, took a walk through Macy’s and looked at various things on three floors of the store. Oh, and stopped in Bed Bath & Beyond and looked at some things. Talked to one of the sales people but don’t know their name. Oh, one more thing, on the way out of the mall, she walked through the Concourse where a number of merchants had small booths selling smartphone covers, jewelry, and other items. Don’t recall exactly, but I might have stopped at a few of them. It is easy to imagine the tracing task could overwhelm the departments of health.

Is it possible technology could help with contact tracing? I think so. I will first describe an imaginary solution to show an extreme of what might be possible, but may not be practical. Then I will describe an approach which I believe is practical.

Imagine you had an app which could perform an accurate Covid-19 test by simply touching the fingerprint reader on your smartphone or perhaps with a small attachment of some kind which could test a drop of blood you extract from a finger. The test could be done as often as you would like. If you become tested positive, the app would ask your permission to notify the public health department. They would confirm your positive test and advise you on steps to take and they would monitor your health status.

Now here comes the interesting part. Your app would detect a notification from others who have a smartphone whenever you are within ten feet of them. Your smartphone would receive an encrypted code from the other person’s smartphone via BlueTooth. Bluetooth is a wireless technology built into all smartphones. It is typically used to connect AirPods or other wireless headphones. The code you receive contains no personal information about the other person. Codes are only stored for 14 days. If you become tested positive and your smartphone has notified the public health department, the department would then notify the people who have opted in to participate in the program and let them know they have been in close contact with a person who is infected. They are advised to quarantine themselves for 14 days and to monitor their temperature and be on the lookout for symptoms.

In effect, the smartphone app, in conjunction with a public health database, have become the contact tracers. Would it work? Perhaps. To make it work would require a large number of people, perhaps 60-70%, to opt in. The whole process would have to be designed to insure privacy, and people would have to trust that the privacy protection is real and enduring. The other major assumption in this imaginary scenario is the availability of fast, easy, regular testing, which is not yet the case.

I believe there is another alternative or at least a supplement to full blown manual contact tracing. It is called “How We Feel” (HWF). HWF is a smartphone app which lets you self-report your age, sex, ZIP code, and any health symptoms you may have. It only takes 30 seconds or less to use it. Aggregate data is shared securely with select scientists, doctors and public health professionals who are actively working to stop the spread of Covid-19. The app doesn’t ask you to sign in or share your name, phone number or email address. The first time you download the app and donate your data with a check-in, HWF donates a meal to people in need through Feeding America, a nationwide network of more than 200 food banks which feed more than 46 million people through food pantries, soup kitchens, shelters, and other community-based agencies.

The HWF app was built by an independent, nonprofit organization called The How We Feel Project. The organization was founded by a volunteer team of scientists, doctors and technologists. Their mission is to make the world healthier by connecting citizens with the global health community. The organization was created in March 2020 to help fight the COVID-19 pandemic.

HWF works with scientists, doctors and public health professionals from leading institutions including The Harvard T.H. Chan School of Public Health, the McGovern Institute for Brain Research at MIT, Broad Institute of MIT and Harvard, Howard Hughes Medical Institute, University of Pennsylvania, Stanford University, University of Maryland School of Medicine, and the Weizmann Institute of Science.

I like everything I have learned about HWF, and I use it every day. HWF is collaborating with Dr. Gary King from Harvard University’s Institute for Quantitative Social Science’s Privacy Insights Project. Dr. King specializes in developing technologies to make data available to researchers while protecting participants’ individual identities. Here is where you can get the app:

Download on the App StoreDownload on the Play Store

 

Scientists and doctors will use the data the public provides to identify new outbreaks, understand how the virus is spreading, discover new populations that may be at risk, and evaluate how interventions are working to slow the spread of the disease. This data is crucial right now because there’s a widespread shortage of COVID-19 testing. Self-reported data can be a powerful new tool in the fight against the pandemic. We need to find a way to stop the spread of the virus.

I urge everyone to use the HWF app and use it daily. If you are feeling great, that is important data too. The goal of the app is to get an aggregate sense of how people are feeling across America. I trust this app. You do not need to provide any personal information, no name, phone number, or email address. You won’t be asked to create an account or log in through other accounts.

There are other innovative technologies and aggregate county-by-county surveys which I believe will help automate contact tracing. Mark Zuckerberg wrote an op-ed for the Washington Post this week which summarized the situation quite well. Following are some excerpts from what he had to say.

“I think providing aggregate data to governments and health officials is one of the most important tools tech companies can provide to help respond to COVID”. “We have a new superpower: the ability to gather and share data for good.” “If we use it responsibly, I’m optimistic that data can help the world respond to this health crisis and get us started on the road to recovery.”

Notes: As of April 24, 2020 in Danbury, CT, the How We Feel app showed 1,132 people were feeling well and 79 not well.

I would like to thank my friend Myles Trachtenberg for telling me about #HowWeFeel. The app is not perfect, but it strikes a good balance between surveillance and privacy.

News from johnpatrick.com

There is an overwhelming amount of information out there about Covid-19, more than anyone can read. Bill Gates wrote in his Gates Notes a post he calls “The first modern pandemic“.  It is quite long and parts of it are technical. However, it is the best article I have seen. Gates breaks the needed innovation into five categories: treatments, vaccines, testing, contact tracing, and policies for opening up. He concludes without advances in each of these areas, we cannot return to the business as usual or stop the virus. I highly recommend taking the time to read Bill’s comprehensive post.

You can follow the curves and projections by country or state at healthdata.org. You can monitor the number of new cases and deaths by country or state at the Coronavirus Dashboard.

My post about telehealth last week got picked up by CircleID. They have published several other of my articles. CircleID claims it “is the world’s leading platform for Internet developments with more than 5200 professional participants worldwide.”

Although the basic protocols of the Internet have not changed in 50 years, the Internet has been able to handle the surge in traffic brought on by the novel coronavirus. Vint Cerf, co-father of the Internet and recovering from COVID-19, said, “This basic architecture is 50 years old, and everyone is online,” he said. “And the thing is not collapsing.”

Last week, Doug Maine and I presented “The Origins of the Internet” in a Zoom webinar hosted in the Virtual Playhouse of Bedford, NY. During the Q&A after our presentations, a Zoom attendee asked me if I believe autonomous cars will be possible within five years. I said yes definitely. If you have any doubts watch the YouTube video lecture by Andrej Karpathy. Andrej is the director of artificial intelligence and Autopilot Vision at Tesla. The 33-year-old Stanford PhD blew my mind. I can see why Tesla is so far ahead of others and why Elon Musk pays him a $2 million salary. Watch the video here or at the end of this post.

In early April I had a routine consultation with my electrophysiologist at Nuvance Health via telehealth. Nuvance uses telehealth technology from American Well. In preparation for the consult, I took my blood pressure with a Qardio cuff and my iPhone, weighed myself on the Fitbit scale, and took a 30-second ECG with the Apple Watch. A nurse called 15 minutes before my appointment and took the information for input to the Electronic Health Record. The consult went very smoothly between the iMac and FaceTime camera at my home, and the doctor with a Windows computer with a camera. No drive to the Medical Arts building where the doctor is located. No crowded waiting room with other senior citizens during flu season during a pandemic.

A week later, my wife had a routine consultation with her primary care physician using Apple FaceTime. Other providers use Zoom, WebEx, or Skype. Hospitals and larger groups use more clinically oriented video platforms such as AmWell and Teladoc.

Why did it take a pandemic to be able to use telehealth? One thing I learned in the early years of my study of healthcare was a very simple concept: follow the money. It answers most questions about why and how things in healthcare are done. Providers did not like telehealth prior to now for a number of reasons. The main reason was they were not compensated. I agree with them. Telehealth reimbursements have been in place for years, but only for patients in very remote areas. Part of the executive orders related to Covid-19 eliminated the remote areas provision. Telehealth is now booming, although there are some consumers who may not have access to good Internet connectivity.

Telehealth is going to get better and better. In my first example, I described how the nurse called me for information which she then entered into a system. In time, the patient will be able to enter the data directly themselves. Another big change to make telehealth more comprehensive will be the integration of mHealth devices. (See peer-reviewed paper about mHealth I wrote in 2015). For example, one mHealth device allows a mother to insert an iPhone camera attachment into a child’s ear and enable a telehealth doctor to see whether there is an infection.

A hospital in Israel shows how mHealth can be applied to diagnosis of a Covid-19 patient who is at home but being followed. The hospital sends a small package to the patient. The patient schedules a telehealth consult with the doctor. First he or she logs in with a computer or mobile device. The telehealth app guides the patient to use two devices which were delivered in the package. The first device is a small handheld wireless scanner which can take the patient’s temperature from the forehead. The device also has a camera which can look at the patient’s throat. The other device is a small handheld wireless stethoscope. The app guides the patient to the places on the body where they should place the device. After the doctor has received the inputs, he or she can tell the patient how their progress is with their Covid-19 infection. Watch the 2-minute video above and you will see how all this works.

When we return to “normal”, I expect we will see telehealth continue to expand. There still will remain a number of scans and other diagnostics which cannot be done at home. However, I believe we will see a large percentage of cases which will be handled by mHealth devices and telehealth. The docs will be reimbursed. The patients will be happy they don’t have to drive to a crowded waiting room.

The Covid-19 curves are bending at different rates depending on country, state, and county. You can follow the curves by country or state at healthdata.org. Unfortunately, the deaths curves are continuing to rise. The healthdata site shows the projections. You can monitor the number of new cases by country or state at the Coronavirus Dashboard.


In last week’s e-brief, I wrote about how Zoom works nicely for family gatherings. I got an email from Khris Hall, Selectman from the town of New Fairfield, CT. She pointed out Zoom has allowed towns such as New Fairfield to continue to move forward with required processes, such as producing, publicizing, taking comment, finalizing the annual budget, and reviewing plans for new school buildings. She said, “We would be frozen without this tool.”


On Wednesday evening, Doug Maine and I presented “The Origins of the Internet” in a Zoom event hosted in the Virtual Playhouse of Bedford, NY. Doug and I were both involved in the early days of the Internet, circa 1993-1995. Doug was CFO at MCI and I was VP of Internet Technology at IBM. Twenty-six attendees connected and we had a robust Q&A session for a half-hour after our presentations. Zoom is not the same as being there, but we will all get used to video chats as a way to remain connected to learn and share.


The Founders Hall event for May 15 will be rescheduled to the Fall. Other author events are under discussion.

Date

Event

Time

Location

June 11, 2020

Meet the Author

7:00 PM

Ridgefield Library
472 Main Street, Ridgefield, CT 06877

May 15, 2020 (to be rescheduled)

Meet the Author

1:00 PM

Founders Hall
193 Danbury Rd, Ridgefield, CT 06877

Arpil 15, 2020

Origins of the Internet   with Doug Maine and John Patrick

7:30 PM with Zoom

Virtual Playhouse
by Bedford Playhouse 
Bedford, NY

March 19, 2020 (to be rescheduled)

Community Forum

11:30 AM

AdventHealth Palm Coast 
60 Memorial Medical Pkwy
Palm Coast, FL 32164

February 14, 2020

Health Attitude with John Patrick

8:30 AM

Senior Provider Information Network
2 Corporate Dr.
Palm Coast, FL

February 6, 2020

Tech Talk 9 with John Patrick

1:00 PM

Hammock Dunes Club
Palm Coast, FL
Private event: Request invite
Mail to [email protected]

November 14, 2019

Meet the Author

1:00 PM

New Fairfield Senior Center
33 CT-37
New Fairfield, CT

October 9, 2019

Housatonic Habitat for Humanity Robotics Night

5:30 PM

Crowne Plaza Hotel
18 Old Ridgebury Rd
Danbury, CT

August 29, 2019

Meet the Author

5:30 PM

The Boiler Room
Hawley Silk Mill
8 Silk Mill Drive
Hawley, PA

Gallery View of a Video Chat. This is not my family.

Social distancing has pushed us apart. At the same time, it has pushed many of us online. Children are learning online. Old and young are streaming video entertainment. Millions are at their job virtually. They are communicating and collaborating with colleagues and customers. Doctors are seeing their patients via Telehealth portals. 

When we get to the other side of the curve, we will have learned a lot about how to get proficient with all these things online. A lot of our newly formed online engagements will continue. It will seem very odd to sit in a doctor’s waiting room reading old magazines and enduring the coughs and sneezes of other patients. Some parents will get interested in lifelong learning after watching the experience their children have had. Some companies will find part of the work employees have been doing online can continue to be done online. They will save office space and business related travel expense.

One of the beneficiaries of the e-stay_at_home phenomenon has been San Jose, CA based Zoom Video Communications, Inc. Even before the Covid-19 outbreak, Zoom had become the de facto video chat service for the roughly 90% of Americans who are under orders to stay at home. Zoom users have gone from 10 million per day to 200 million. The company’s technology has gone from an interesting enterprise communications tool to global critical infrastructure.

The company’s share price (ZM) has risen substantially since its initial public offering last year. On March 23, Zoom shares surged 135%, closing at an all-time high of $159.56. As of the close on Thursday, Zoom was valued at about $35 billion, and the CEO has joined the Forbes list of billionaires. Various security weaknesses have emerged but the CEO claims to have a solid plan in place to regain customer loyalty. More on the security issues coming up.

Early in the week, I setup a group video chat with my wife and I plus our four children, two spouses, and six grandchildren. Our family group spanned Colorado, Connecticut, Massachusetts, and Pennsylvania. Ages varied from 5 to 75. Each person, or in some cases a few persons, appeared in a separate video window. The video quality was excellent and everybody had a good time sharing what they are doing, cooking, eating, watching, reading, learning, etc. 

You may have read about security concerns with Zoom. Zoombombing, where uninvited participants have joined Zoom meetings, has gotten headlines. The primary solution to prevent Zoomboming is simple: use strong passwords. Zoom should make it mandatory to use a password. Another security exposure is the meeting ID. The host/owner/administrator of a Zoom video conference has a meeting ID; e.g. 189-654-652. If an invited participant shares the ID on social media or email, it is possible someone may get access to it and guess the password if it is abc123 or other trivial password, and then join the meeting and act inappropriately. A simple precaution is the Zoom option to have a random meeting ID assigned for each meeting.

Zoom is one of many video conferencing services. I have used a number of them, but I find Zoom to be the easiest and most reliable. The cost is free for video chats of 40 minutes or less. For $150 per year, the PRO option allows for unlimited chats with up to 100 people. The Zoom service works on desktops, laptops, or mobile devices. Whether it is FaceTime, Google Hangout, WebEx, Uber Conferences, or Zoom, video chats are a good way to communicate with friends, family, or professional engagements.

Zoom is also being used for community engagement. The Bedford Playhouse, Home of Clive Davis Arts Center is in downtown Bedford, New York. The Playhouse website has a Virtual Playhouse where Zoom is used to bring content to the community. The Playhouse website says,

If there’s a silver lining on lockdown, it’s that we have an unprecedented amount of time with our families + the opportunity to explore an exciting amount of art, film and culture online.  Virtual Playhouse aims to bring you a selection of interactive experiences, connectivity and conversations to enjoy with our amazing community — just like you normally would at the Playhouse. 

Virtual Playhouse

Bedford is in Westchester County, NY where, as of Friday morning, there were more than 17,000 Covid-19 cases and growing. You can see below the information about one of the Playhouse’s programs for next week. Doug Maine and I have known each other for decades. Doug was a senior exec at MCI and I was at IBM. We both had involvement with the early days of the Internet and that will be the topic we discuss next week. Anyone is free to listen in with or without video.

The Origins of the Internet ~ Presentation + Discussion with Doug Maine and John Patrick – April 15, 7:30pm

Deep inside the offices of IBM and MCI in the 1980s, Doug Maine and John Patrick were two men at the heart of conversations, inventions, partnerships and developments that would transform our lives, business and culture on a global scale. Join us on April 15 via Zoom for a TED-talks style conversation with Doug and John about their fascinating rolls in “inventing the internet”.

The coronavirus numbers are growing as expected, and will be growing much more. There are many websites with coronavirus information. I am sharing below the sites I have found most useful to see how the data are trending. The newest site I have discovered was created by Avi Schiffmann, a high schooler in Washington State. He calls the site Coronavirus Dashboard. It is very colorful and creative. Unfortunately, like the other sites, it is a dire story the data are telling us.

Coronavirus Dashboard
Global
States 
Connecticut
Florida 
New York
Pennsylvania


Data Fact. The Human Genome Project estimated humans have between 20,000 and 25,000 genes. In our mouths are ten times that many and there is a like amount in our guts. Researchers are sequencing the microbiome, and a lot will be learned.


The next author event will be about the Origins of the Internet. I will be doing this with Doug Maine. The Zoom event is scheduled in the Virtual Playhouse on April 15th at 7:30 PM. See table below and the last part of this week’s e-brief above. The Founders Hall event on May 15 will be rescheduled in the Fall.

Date

Event

Time

Location

June 11, 2020

Meet the Author

7:00 PM

Ridgefield Library
472 Main Street, Ridgefield, CT 06877

May 15, 2020 (to be rescheduled)

Meet the Author

1:00 PM

Founders Hall
193 Danbury Rd, Ridgefield, CT 06877

Arpil 15, 2020

Origins of the Internet   with Doug Maine and John Patrick

7:30 PM with Zoom

Virtual Playhouse
by Bedford Playhouse 
Bedford, NY

March 19, 2020 (to be rescheduled)

Community Forum

11:30 AM

AdventHealth Palm Coast 
60 Memorial Medical Pkwy
Palm Coast, FL 32164

February 14, 2020

Health Attitude with John Patrick

8:30 AM

Senior Provider Information Network
2 Corporate Dr.
Palm Coast, FL

February 6, 2020

Tech Talk 9 with John Patrick

1:00 PM

Hammock Dunes Club
Palm Coast, FL
Private event: Request invite
Mail to [email protected]

November 14, 2019

Meet the Author

1:00 PM

New Fairfield Senior Center
33 CT-37
New Fairfield, CT

October 9, 2019

Housatonic Habitat for Humanity Robotics Night

5:30 PM

Crowne Plaza Hotel
18 Old Ridgebury Rd
Danbury, CT

August 29, 2019

Meet the Author

5:30 PM

The Boiler Room
Hawley Silk Mill
8 Silk Mill Drive
Hawley, PA

On March 13, I posted a story about the silver lining in the coronavirus cloud (See re-post below). Despite the enormous pain and suffering millions of people will endure, I continue to believe there will be many good things, in addition to the things I mentioned in the earlier post, which will emerge on the other side. In today’s post, I will highlight some DIY (Do It Yourself) activities happening which will have long term benefits.

Gui Cavalcanti is Founder & Co-Executive Director of Open Source Medical Supplies in the San Francisco Bay Area. Mr. Cavalcanti has a background in robotics and has been working on  creating robust, low-cost fluidic robots which can operate in environments as extreme as deep water, outer space, and everything in between. Over the past couple of months he stopped building robots due to a Covid-19-based global supply chain failure which stopped the supply of parts needed to build them.

Mr. Cavalcanti realized the world would soon face the same supply chain situation for medical equipment and supplies. He founded a Facebook group to collect open source medical supply designs and document them so local communities could fabricate their own medical supplies. Within less than three weeks, the Facebook group had grown to 64,000 people from all over the world. In addition, 460 dedicated volunteers jumped on board helping write an 80+ page Open Source Medical Supply Guide and a Local Response Guide to help communities self-organize. The DIY group produced more than 280,000 medical supply items and delivered them to healthcare institutions all over the globe.

You can visit the Open Source COVID19 Medical Supplies group on Facebook and see the amazing things the group is doing. One person uploaded a detailed instruction guide on how to make vented masks starting with cutting cardboard pieces from a used cereal box. Rod, a local yet internationally experienced fabric and apparel designer, engineered and spearheaded the first production cutting run for an additional 230 hoods and gowns. Another group is making powered, air-purifying respirators (PAPR) used to safeguard healthcare workers. The DIY group is doing remarkable things.

One of the most pressing shortages facing hospitals is a lack of ventilators. These machines keep patients breathing when they can no longer breath on their own. The media has widely reported ventilators cost around $30,000 or more. A rapidly assembled team of volunteer engineers, physicians, computer scientists, and others, centered at MIT, has developed a safe, inexpensive alternative for emergency use. MIT is going to post the free detailed plans for an emergency ventilator which can be built quickly around the world at a cost of $100.

Part of the silver lining is the revelation of the dependence on a non-U.S. supply chain and the cost of critical healthcare supplies and equipment. Why does a ventilator cost $30,000? Because medical equipment companies can charge that much. These companies are very profitable. They should be profitable, but how profitable? Is there enough competition? Why is the supply chain broken? Because companies outsourced to China to shave pennies off the cost of production. The silver lining is these issues will get significant focus on the other side of the pandemic. The results will be positive and help prepare for the next pandemic and also lower the cost of medical equipment.

The coronavirus numbers are growing as expected, and will be growing much more. There are many websites with coronavirus information. I am sharing below the sites I have found most useful to see how the data are trending. The newest site I have discovered was created by Avi Schiffmann, a high schooler in Washington State. He calls the site Coronavirus Dashboard. It is very colorful and creative. Unfortunately, like the other sites, it is a dire story the data are telling us.

Coronavirus Dashboard
Global
States 
Connecticut
Florida 
New York
Pennsylvania


Data Fact. The Human Genome Project estimated humans have between 20,000 and 25,000 genes. In our mouths are ten times that many and there is a like amount in our guts. Researchers are sequencing the microbiome, and a lot will be learned.


The next author event is scheduled for May 15th at Founders Hall in Ridgefield, CT. I expect it will need to be rescheduled.

Date

Event

Time

Location

June 11, 2020

Meet the Author

7:00 PM

Ridgefield Library
472 Main Street, Ridgefield, CT 06877

May 15, 2020 (to be rescheduled)

Meet the Author

1:00 PM

Founders Hall
193 Danbury Rd, Ridgefield, CT 06877

Arpil 15, 2020

Origins of the Internet   with Doug Maine and John Patrick

7:30 PM with Zoom

Virtual Playhouse
by Bedford Playhouse 
Bedford, NY

March 19, 2020 (to be rescheduled)

Community Forum

11:30 AM

AdventHealth Palm Coast 
60 Memorial Medical Pkwy
Palm Coast, FL 32164

February 14, 2020

Health Attitude with John Patrick

8:30 AM

Senior Provider Information Network
2 Corporate Dr.
Palm Coast, FL

February 6, 2020

Tech Talk 9 with John Patrick

1:00 PM

Hammock Dunes Club
Palm Coast, FL
Private event: Request invite
Mail to [email protected]

November 14, 2019

Meet the Author

1:00 PM

New Fairfield Senior Center
33 CT-37
New Fairfield, CT

October 9, 2019

Housatonic Habitat for Humanity Robotics Night

5:30 PM

Crowne Plaza Hotel
18 Old Ridgebury Rd
Danbury, CT

August 29, 2019

Meet the Author

5:30 PM

The Boiler Room
Hawley Silk Mill
8 Silk Mill Drive
Hawley, PA

In January, virologists in China isolated a new virus. In March the Coronaviridae Study Group of the International Committee on Taxonomy of Viruses named the virus SARS-CoV-2. Most people call it the coronavirus. The virus causes a disease called Covid-19. The vocabulary can be very confusing. The goal of this article is to shed some light on the various terms.

Let’s start with taxonomy, a scheme of classification of things, especially living things. A Swedish naturalist named Carolus Linnaeus is considered the “Father of Taxonomy”. In the 1700s, Linnaeus developed a method we still use today to name and organize species. The table below shows one version of the Linnaean Classification of Humans.

Kingdom

Animalia

Phylum

Chordata

Subphylum

Vertebrata

Class

Mammalia

Subclass

Theria

Infraclass

Eutheria

Order

Primates

Suborder

Anthropoidea

Superfamily

Hominoidea

Family

Hominidae

Genus

Homo

Species

Sapiens

The level of detail can make your head hurt. We humans are often referred to simply as Homo Sapiens. There is much more detail beyond the table if you want to drill down. When it comes to viruses, the taxonomy makes the human taxonomy look really simple. See the following table from Nature.com to get a glimpse of it. The complete 8,000-word article is here.

To put the complexity in perspective, consider SARS-CoV-2, the cause of the pandemic, is one of 6,828 virus species which have been named. Researchers say they know of hundreds of thousands more species. Some believe there may be trillions waiting to be found. This is the virosphere.

The good news is there are a number of profound research projects underway to deal with the world of viruses. This is incredibly important because viruses are not going away. Some experts are saying a new and different virus will appear next year or even later this year. Hopefully, we will be ready. The wake up call this time was so loud and clear, I believe we will be prepared.

One new approach under development is the use of synbio, as described in last week’s e-brief. A vaccine made from synthetic ingredients can potentially offer some significant advantages. The big one is scalability. Synbio vaccines could be produced efficiently for millions or even billions of doses. Synbio vaccines are developed using computer models, not flasks and test tubes. With billions of calculations, a nanoparticle can be designed which has the exact properties desired. The really big breakthrough with synbio is the attachment of multiple different viral molecules to the nanoparticle and thereby create a universal coronavirus vaccine. One vaccine for all corona viruses. That will be the breakthrough.

Another positive development in the silver lining of the coronavirus cloud is tech companies large and small are jumping in the boat to help. For example, IBM is collaborating with the White House Office of Science and Technology Policy and the Department of Energy to launch the COVID-19 High Performance Computing Consortium. The Consortium will provide supercomputing power to researchers developing predictive models to analyze the coronavirus progression and identify potential treatments. Researchers from around the world can submit proposals, and the Consortium will select the projects which could have the most immediate impact. Other partners in the consortium include NASA, MIT, and the Argonne National Laboratory.

Another significant Covid-19 effort is taking place at Oak Ridge National Laboratory in Oak Ridge, Tennessee. As of November 2019, Oak Ridge had the fastest supercomputer in the world. It is capable of performing one thousand million million (1015) operations per second.

Scientists at Oak Ridge have deployed the massive supercomputer to look for compounds which can bind to the “spike protein” of the virus. It is the spike protein which the virus uses to infect host cells. The right compound could render the spike protein ineffective, and the virus would be stopped from spreading. Using digital models, the supercomputer can simulate how particles in the viral protein would react to different drug compounds. The researchers started with a list of 77 compounds and narrowed it down to the top seven most promising candidates which could become effective treatments for covid-19. The research is at the early stage but I believe we can be hopeful.

The coronavirus numbers are growing as expected, and will be growing much more. There are many websites with coronavirus information. I did some digging around to find the ones which presented the data I wanted to see. I am sharing below the sites I have found most useful to see how the data is trending. Fyi.

Global
States 
Connecticut
Florida 
New York
Pennsylvania

The numbers are going to rise significantly from what already looks high. We should not be surprised or alarmed. More tests are going to happen and more cases will be found. If you are interested in the impact of the numbers, I suggest reading “The Sober Math Everyone Must Understand about the Pandemic” by Jason Warner. The essence of his article is if we take action on social distancing now, we can bend the curve and save a lot of lives and avoid a crisis for our healthcare system. If we do not do a good job of social distancing, like what millennials were doing on Florida beaches, then we face catastrophe. Jason’s article steps through the numbers, and it is not pretty.


I posted an op-ed piece in a technical newsletter called TNW. The title of the op-ed is “Mobile voting is far from perfect, but it’s better than what we have now”. The current situation of voting challenges is proof perfect. You can read the op-ed it here. The Congress could do remote voting very easily and safely. One Senator said the Senate should get with it in the 21st century. The vote on the rescue package was 96-0. The four missing Senators were at home. Senators are so technically unaware they could agree on a way to allow the four Senators to vote remotely. The speaker of the house said, “We can not vote from home”. As I have said so many times, we can put a robot on Mars, but we can’t figure out how to vote remotely.


The next author event is scheduled for May 15th at Founders Hall in Ridgefield, CT. Time will tell if it will need to be rescheduled.

Date

Event

Time

Location

June 11, 2020

Meet the Author

7:00 PM

Ridgefield Library
472 Main Street, Ridgefield, CT 06877

May 15, 2020 (to be rescheduled)

Meet the Author

1:00 PM

Founders Hall
193 Danbury Rd, Ridgefield, CT 06877

Arpil 15, 2020

Origins of the Internet   with Doug Maine and John Patrick

7:30 PM with Zoom

Virtual Playhouse
by Bedford Playhouse 
Bedford, NY

March 19, 2020 (to be rescheduled)

Community Forum

11:30 AM

AdventHealth Palm Coast 
60 Memorial Medical Pkwy
Palm Coast, FL 32164

February 14, 2020

Health Attitude with John Patrick

8:30 AM

Senior Provider Information Network
2 Corporate Dr.
Palm Coast, FL

February 6, 2020

Tech Talk 9 with John Patrick

1:00 PM

Hammock Dunes Club
Palm Coast, FL
Private event: Request invite
Mail to [email protected]

November 14, 2019

Meet the Author

1:00 PM

New Fairfield Senior Center
33 CT-37
New Fairfield, CT

October 9, 2019

Housatonic Habitat for Humanity Robotics Night

5:30 PM

Crowne Plaza Hotel
18 Old Ridgebury Rd
Danbury, CT

August 29, 2019

Meet the Author

5:30 PM

The Boiler Room
Hawley Silk Mill
8 Silk Mill Drive
Hawley, PA

Microscopic virus close up with 3D rendering

The numbers continue to grow and, as Dr. Fauci says, it is going to get worse before it gets better. If we all do a good job in social distancing, the curve will bend sooner rather than later. The government is pulling out all stops for therapeutic solutions, as Dr. Kuhn described on Thursday. As I wrote last week, there is a silver lining to the dark cloud hovering over all of us. One of the numerous positive things going on is the development of a vaccine for Covid-19.

Significant progress is being made by Moderna Therapeutics, CureVac, and Inovio Pharmaceuticals, who are going as fast as possible to begin human testing. Nevertheless, the approach they are taking uses biological DNA and RNA as the core ingredient. As advanced as the current development process is, vaccines as we know them have a number of shortcomings. The most visible shortcoming is they take years to develop and manufacture. Potentially more significant is they become obsolete if and when the virus evolves, which it will. There are already multiple strains, and there will be more. Finally, the immune response the vaccines produce may not be strong enough to be effective.

A totally new approach is under development using synbio. The Bill and Melinda Gates Foundation has put $60 million into coronavirus research including for the synbio effort. If you read Daniel Suarez science fiction novels (among my favorite authors) you have already heard of synbio. It takes a major role in his book, Change Agent, which takes place in 2045, and is about Interpol’s Genetic Crime Division which grapples with a new type of crime: illicit genetic editing. It is quite a thriller.

Synbio stands for synthetic biology. Synbio is mostly about the design and construction of new biological parts, devices, and systems, and the re-design of existing, natural biological systems. More specific to the issue of the day, synbio may replace the DNA and RNA ingredients mother nature has provided for the development of vaccines with synthetic ingredients.

A vaccine made from synthetic ingredients can potentially offer some significant advantages. The big one is scalability. Synbio vaccines could be produced efficiently for millions or even billions of doses. Another advantage is synthetic ingredients do not need to be refrigerated. This would be a huge benefit for places like sub-Saharan Africa.

Synbio vaccines are developed using computer models, not flasks and test tubes. With billions of calculations, a nanoparticle can be designed which has the exact properties desired. The really big breakthrough with synbio is the attachment of viral molecules to the nanoparticle. Neil King at the University of Washington and his synbio colleagues knew there would be another coronavirus epidemic, like the SARS and MERS outbreaks before the current Covid-19 outbreak. King said, “…there will be another one after this,” perhaps from yet another member of this virus family. We need a universal coronavirus vaccine.” One vaccine for all corona viruses. That will be the breakthrough.

Sharon Begley wrote a beautiful article in STAT which explains the synbio efforts underway in much more detail. See To develop a coronavirus vaccine, synthetic biologists try to outdo nature. STAT has great articles about life sciences and the fast-moving business of making medicines.

The coronavirus numbers are growing, and will be growing much more. There are gazillions of websites with coronavirus information. I did some digging around to find the ones which presented the data I wanted to see. I am sharing below the sites I have found most useful to see how the data is trending. Fyi.

Global
States 
Connecticut
Florida 
New York
Pennsylvania

The numbers are going to rise significantly from what already looks high. We should not be surprised or alarmed. More tests are going to happen and more cases will be found. If you are interested in the impact of the numbers, I suggest reading “The Sober Math Everyone Must Understand about the Pandemic” by Jason Warner. The essence of his article is if we take action on social distancing now, we can bend the curve and save a lot of lives and crisis for our healthcare system. If we do not do a good job of social distancing, like what millennials have been doing on Florida beaches, then we face catastrophe. Jason’s article steps through the numbers, and it is not pretty.


I posted an op-ed piece in a technical newsletter called TNW. The title of the op-ed is “Mobile voting is far from perfect, but it’s better than what we have now”. The current situation of voting challenges is proof perfect. You can read the op-ed it here. The Congress could do remote voting very easily and safely. One Senator said the Senate should get with it in the 21st century. The speaker of the house said, “We can not vote from home”.


The next author event is scheduled for May 15th at Founders Hall in Ridgefield, CT. Time will tell if it will need to be rescheduled.

Date

Event

Time

Location

June 11, 2020

Meet the Author

7:00 PM

Ridgefield Library
472 Main Street, Ridgefield, CT 06877

May 15, 2020 (to be rescheduled)

Meet the Author

1:00 PM

Founders Hall
193 Danbury Rd, Ridgefield, CT 06877

Arpil 15, 2020

Origins of the Internet   with Doug Maine and John Patrick

7:30 PM with Zoom

Virtual Playhouse
by Bedford Playhouse 
Bedford, NY

March 19, 2020 (to be rescheduled)

Community Forum

11:30 AM

AdventHealth Palm Coast 
60 Memorial Medical Pkwy
Palm Coast, FL 32164

February 14, 2020

Health Attitude with John Patrick

8:30 AM

Senior Provider Information Network
2 Corporate Dr.
Palm Coast, FL

February 6, 2020

Tech Talk 9 with John Patrick

1:00 PM

Hammock Dunes Club
Palm Coast, FL
Private event: Request invite
Mail to [email protected]

November 14, 2019

Meet the Author

1:00 PM

New Fairfield Senior Center
33 CT-37
New Fairfield, CT

October 9, 2019

Housatonic Habitat for Humanity Robotics Night

5:30 PM

Crowne Plaza Hotel
18 Old Ridgebury Rd
Danbury, CT

August 29, 2019

Meet the Author

5:30 PM

The Boiler Room
Hawley Silk Mill
8 Silk Mill Drive
Hawley, PA

Novel Coronavirus. Microscope virus close up. 3d rendering.

One thing all the Coronavirus experts agree on is the virus will continue to spread for some time. One important question related to this is how contagious is the virus? The key measure is transmissibility, how rapidly the disease spreads. Transmissibility is indicated by its reproductive number, abbreviated as Ro and pronounced R-nought or r-zero. Ro represents the average number of people to which a single infected person transmits the virus. On January 23, the World Health Organization estimated Ro for covid-19 to be between 1.4 and 2.5. Other studies have estimated Ro between 2.4 and 4.0. An outbreak with a Ro less than 1 will gradually disappear. A Ro of 4.0 would produce an extremely bad situation. For comparison, the Ro for the common flu is 1.3 and for SARS it was 2.0.

If we do nothing, then Ro will be high and the number of cases and deaths will be very high. As predicted by some, if we do nothing, the spread could go exponential and lead to millions of cases. If we take aggressive actions, however, the Ro will be lower and the growth rates of the disease will be flattened.

The spread of the disease to date should be a wake up call for every person and organization. Supplies are being hoarded which should already have been on hand. Action plans are rolling out, but they should have been ready from Day 1. The government is prepared for hurricanes but not totally prepared for a pandemic. The good news is the Federal, State, and Local governments are learning a lot from the situation and the emergency plans to reduce bureaucracy should have a very positive impact. Public private partnerships in retail and lab testing are set to solve the critical problem of testing. The wake up call may lead to a silver lining in the coronavirus cloud. Following are some components of the silver lining.

  1. The development time for vaccines must continue to get shorter. The good news on this is they can sequence the genome of the virus in hours. Sequencing the first human genome cost about $1 billion and took 13 years to complete. In the case of the coronavirus, the detection of the virus was confirmed in France on Friday, January 24. Later that day, the Institut Pasteur received samples of three suspected cases they detected with the novel coronavirus and began preparation for the sequencing. The process started on Monday and was completed early Tuesday evening. Remarkable. The next step is the process for creating, testing, and manufacturing a vaccine. The process to get from recipe to tested and available vaccine needs a major upgrade and modernization.
  2. A major information technology (IT) upgrade is needed between state and federal public health organizations. Now that millions of test kits are being distributed, the public will be asking what were the results. As it stands, the answer from the government will have to be, “We don’t know”. This is a problem I wrote about in Health Attitude in 2015. State governments have been reluctant to share data with the Federal government. It is partly cultural and partly because there is no efficient way to do the sharing. The bureaucracy involved is immense. The Feds have spent hundreds of millions on incentives to get states to share their data but it is not happening as it could. The benefits of sharing will be huge. Once millions of consumers, labs, and providers add data to an anonymized national database, a multitude of data will become available for the greater good. Researchers can study the anonymized data and gain insights about the health of the population at a community level, nationally, or globally. This will be extremely helpful for establishing travel bans and imposing quarantines on a more pinpointed basis rather than a cancel everything everywhere approach. Hopefully, better data sharing will be in place before the next pandemic.
  3. A big question which needs an answer is what is the best therapeutic for treating covid-19? Various drugs are being tried. This is new. Historically, if you have a certain disease, you are prescribed a certain drug. For example, if you have breast cancer, then take XYZ drug. Oncologists have learned a combination of drugs may work better than the normally prescribed drug. Either approach in a sense implies one size fits all. In fact, every cancer is different and very personal. This is where AI and machine learning (ML) come in. Globally, more than 350,000 chemical compounds (including mixtures of chemicals) have been registered for production and use. Might one of them work to cure covid-19? I would say it is likely. How do they find the chemicals which can work? ML can be applied to all hundreds of thousands of possible cures based on the genomic sequence of the patient and of the novel coronavirus. You might think of it as a digital clinical trial done in hours, not months. I am confident this type of approach will evolve. 
  4. Like you, I have been receiving emails from a lot of organizations ranging from global travel companies to our local dry cleaner. They are all very similar. One I received caught my eye. They said, “Currently, our entire staff is equipped to work remotely and to support our clients and one another via phone and email. We will send updates to you as appropriate, and information regarding our status and availability will be posted on our website”. This is an organization which was prepared. Many were not. Many companies and schools and conferences are saying they are going remote: e-learning, e-meetings, e-conferences. Saying you are e-whatever doesn’t make it happen. Do all the employees and customers have access to reliable high-speed bandwidth? Probably not. Are they all trained on how the e-engagement works? Probably not. Effective e-whatever takes a lot of planning, testing, and training. The good news is bandwidth is generally much better than it was a decade ago. The wakeup call will result in organizations asking key questions. How well do we function as an e-organization? Before we go back to “normal” do we really need everybody to go back to the way it was? Can we streamline our organization and our services by fine tuning our e-capabilities?
  5. The pandemic is exposing the weaknesses of our paper-based government, including how we vote. Social separation is being urged but to vote, thousands had to stand in line for hours. Those that voted remotely did so by licking an envelope and stamp. Online and mobile voting can work with security, privacy, accuracy, and verifiability if we put our mind to it. Digital discourse can strengthen our democracy. The discourse doesn’t have to be in crowded rooms. Hopefully, the wake up call will get policymakers thinking about the many things we do by touching paper touched by others. Real estate closings, bank loans, paying for things with cash, and the list goes on.

The pandemic has provided a wake up call. If we do nothing, hide like a hermit, and hope it goes away, things will get worse. If we take aggressive actions as described at coronavirus.gov, we can flatten the curves and start thinking about covid-21 and how we can prepare now.


Data Facts of the Week

The coronavirus numbers are growing, but see my article, “Is There a Silver Lining in the Coronavirus Cloud?” If you like to follow what is going on in the coronavirus world statistically, take a look at worldometers.info/conronavirus. After the table of country by country statistics, the page shows the specific things which changed from the prior day. For other interesting real-time statistics about population growth, visit the homepage at worldometers.info. Each day the dedicated doctors and scientists learn more and more about the DNA of the virus and how to cure it and ultimately prevent it.


On Friday morning I was a guest on WNZF “Free For All Fridays”. The Flagler County, Florida news station program was hosted by General Manager David Ayers. Local government officials, a hospital executive, and a congressional representative participated. You can find the podcast here.


The next author event was scheduled for March 19th at AdventHealth in Palm Coast, FL. The event was cancelled by AdventHealth. It will be rescheduled.

Date

Event

Time

Location

June 11, 2020

Meet the Author

7:00 PM

Ridgefield Library
472 Main Street, Ridgefield, CT 06877

May 15, 2020 (to be rescheduled)

Meet the Author

1:00 PM

Founders Hall
193 Danbury Rd, Ridgefield, CT 06877

Arpil 15, 2020

Origins of the Internet   with Doug Maine and John Patrick

7:30 PM with Zoom

Virtual Playhouse
by Bedford Playhouse 
Bedford, NY

March 19, 2020 (to be rescheduled)

Community Forum

11:30 AM

AdventHealth Palm Coast 
60 Memorial Medical Pkwy
Palm Coast, FL 32164

February 14, 2020

Health Attitude with John Patrick

8:30 AM

Senior Provider Information Network
2 Corporate Dr.
Palm Coast, FL

February 6, 2020

Tech Talk 9 with John Patrick

1:00 PM

Hammock Dunes Club
Palm Coast, FL
Private event: Request invite
Mail to [email protected]

November 14, 2019

Meet the Author

1:00 PM

New Fairfield Senior Center
33 CT-37
New Fairfield, CT

October 9, 2019

Housatonic Habitat for Humanity Robotics Night

5:30 PM

Crowne Plaza Hotel
18 Old Ridgebury Rd
Danbury, CT

August 29, 2019

Meet the Author

5:30 PM

The Boiler Room
Hawley Silk Mill
8 Silk Mill Drive
Hawley, PA

Press articles about Internet voting abound. The articles quote technology experts who are worried about the theoretical risks of Internet voting, mobile or otherwise. They correctly say the Internet is not perfect. But, neither is the paper-base system we have. The anti-Internet voting activists continue to compare Internet voting to a perfect world which we will never have. They fail to compare it to the old fashioned paper based system which is now the preferred method to vote. How good is the paper based approach?

This past week’s Democratic primaries in Texas and California showed some of the imperfections of current voting methods. For many voters, the primaries were a nightmare. Some lines were up to six hours long. CNN reported voters walked away because they could not wait any longer. Axios reported, “Long wait times put a special hardship on low-income voters who are less likely to have flexible work hours, around-the-clock transportation and child care.” Another problem is southern states have closed 1,200 polling sites, presumably because of the cost to maintain them. It is no coincidence the closed polling sites had mostly been for Latino and black citizens, many of whom could not get to the alternate polling sites.

The paper based voting systems have numerous problems. The Los Angeles Times reported, “In California, machine jams slowed the rolls, delaying lines up to two hours.” Errors in voter registration forced voters to cast paper provisional ballots which would not be counted until the voter registration was confirmed manually. Voters were also confused about how to use the new voting machines. In some races, the voter had to click “more” to see additional candidates on the voting machine screen. At some voting locations, voting machines just flat out did not work.

We should not trust Internet voting, but we should trust the paper based approach? But wait, there is more. Western states have been pushing early voting my mail for years. It has grown rapidly. The number of early votes cast for Super Tuesday Democratic primaries was 4 million. In California, the early votes were 40%. Many of the votes were wasted because Pete Buttigieg, Amy Klobuchar, and Tom Steyer dropped out after the early voters had cast their ballot. Many voters were quite disappointed they could not change their vote. With Internet voting, they could have. In fact, with Internet voting a citizen can vote as many times as they want up until the polls close. The last vote is the only one which counts.

We put a robot on Mars, 34 million miles away, and it is still roaming the Red Planet. We can also make Internet voting safe, secure, private, accurate, accessible, reliable, and verifiable. All we need to do state by state and county by county is to develop detailed plans, select vendors which have the best technology, and test, test, test. The only other thing we need is the political and technological will to make it easier for the many millions of people who couldn’t get to the polls or wasted votes by casting paper ballots early.


Data Facts of the Week

This past week, the AP reported there currently are 17 times as many new infections outside China as inside China. If you like to follow what is going on in the coronavirus world statistically, take a look at worldometers.info/conronavirus. After the table of country by country statistics, the page shows the specific things which changed from the prior day. For other interesting real-time statistics about population growth, visit the homepage at worldometers.info. Although each day the dedicated doctors and scientists learn more and more about the DNA of the virus and how to cure it and ultimately prevent it, fear and market reaction continues.


On Friday morning March 13 at 9 AM, I will be a guest on WNZF “Free For All Fridays”. As in past visits to this great local Flagler County, Florida news station, I anticipate a range of challenging questions from host and General Manager David Ayers. Tune in to 92.7 FM or visit flaglerbroadcasting.com/wnzf.


The next author event will be on March 19th at AdventHealth in Palm Coast, FL. The event is open to the public. Seating is limited, so RSVP by calling 386-586-4440 or email [email protected]The first 65 to register will get an autographed copy of Robot Attitude: How Robots and Artificial Intelligence Will Make Our Lives Better which I will be discussing.

Date

Event

Time

Location

June 11, 2020

Meet the Author

7:00 PM

Ridgefield Library
472 Main Street, Ridgefield, CT 06877

May 15, 2020 (to be rescheduled)

Meet the Author

1:00 PM

Founders Hall
193 Danbury Rd, Ridgefield, CT 06877

Arpil 15, 2020

Origins of the Internet   with Doug Maine and John Patrick

7:30 PM with Zoom

Virtual Playhouse
by Bedford Playhouse 
Bedford, NY

March 19, 2020 (to be rescheduled)

Community Forum

11:30 AM

AdventHealth Palm Coast 
60 Memorial Medical Pkwy
Palm Coast, FL 32164

February 14, 2020

Health Attitude with John Patrick

8:30 AM

Senior Provider Information Network
2 Corporate Dr.
Palm Coast, FL

February 6, 2020

Tech Talk 9 with John Patrick

1:00 PM

Hammock Dunes Club
Palm Coast, FL
Private event: Request invite
Mail to [email protected]

November 14, 2019

Meet the Author

1:00 PM

New Fairfield Senior Center
33 CT-37
New Fairfield, CT

October 9, 2019

Housatonic Habitat for Humanity Robotics Night

5:30 PM

Crowne Plaza Hotel
18 Old Ridgebury Rd
Danbury, CT

August 29, 2019

Meet the Author

5:30 PM

The Boiler Room
Hawley Silk Mill
8 Silk Mill Drive
Hawley, PA

Novel Coronavirus. Microscope virus close up. 3d rendering.

What is becoming clear about the coronavirus situation is it will not be contained. The question is what to do about it. The answer requires knowing where the virus will spread and when. The good news is artificial intelligence (AI) can provide answers now, and even more accurately in the future.

Dr. Kamran Khan, a 49-year-old Canadian epidemiologist and infectious disease specialist in Toronto, was working at a hospital during the SARS epidemic of 2003. The SARS virus started in provincial China and spread to Hong Kong and then to Toronto, where it killed 44 people. Khan concluded there must be a better way to track diseases. With that goal in mind, Khan founded a company in 2014 called BlueDot.

BlueDot has developed an algorithm that can sift through hundreds of thousands of news stories and airline traffic information everyday. The goal is to detect and monitor the spread of infectious diseases. BlueDot applies AI technologies to create alarms about impending virus attacks. Its first success was accurately predicting the spread of Zika from Brazil to south Florida in 2016. Early on, it predicted the spread of coronavirus on December 31, 2019.

BlueDot has 40 employees including data scientists, epidemiologists, physicians, veterinarians, and software developers. Using natural language processing and machine learning, the BlueDot team has developed a real-time warning system based on the vast amount of data it analyzes. The data is retrieved every 15 minutes around the clock from scans of official reports, online news sources, professional forums and information retrieved from key word and phrase searches.

The Economic Times reported BlueDot, “Can read text in 65 languages and can track 150 different types of diseases.” Mr. Khan told The Times, “We call it the needles in the haystack”. After the AI software has analyzed the data, it presents the findings to human experts who tag information they believe is related to a threat.

“There’s a massive amount of data and the machine is finding the needles and presenting it to the human experts,” who then review it and train the AI to understand if the information corresponds to an actual threat. The Times reported, “If the threat looks real, the AI software then looks further for nearby airports and commercial air travel itineraries from around the world. Climate data, national health system databases, and even the presence of mosquitoes or animals that transmit diseases to humans are all taken into account.”

Once BlueDot is confident it has valid data, it sends an alert to its clients including airlines, hospitals, and government agencies informing them where the majority of the airline passengers might disembark. The recipients of the alerts can then prepare for a major disease outbreak.

The Times reported, “So on December 31, in the early morning, the BlueDot system picked up an article in Mandarin that mentioned 27 people suffering from pneumonia, all linked to a wet market in Wuhan.” The virus was not yet identified but the data contained some similarities to the SARS outbreak. BlueDot AI technology predicted the virus would likely spread from Wuhan to Bangkok, Hong Kong, Singapore, Taipei, and Tokyo, all of which have since reported cases of the novel coronavirus.

Other startup companies, government laboratories, Harvard Medical School, and numerous other centers of excellence are using AI to study massive amounts of data. They are using tools which were not available ten years ago. AI is being used to examine large numbers of chemical molecules to determine if they might be therapeutic toward coronavirus. Long term, it is likely there will be new diseases appearing. The good news is AI is getting smarter and smarter every day, and will eventually be able to predict outbreaks earlier and develop cures and vaccines much more quickly than is currently possible.

This Canadian start-up used AI to track coronavirus and raised alarm days before the outbreak

Press articles continue to beat up on Internet voting. They say the only way we can have accurate elections is with paper ballots. Paper elections are so accurate in Iowa they flip a coin to break ties. In Nevada they use cards. Meanwhile millions of people don’t vote because they can’t get to the polls.


Data Facts of the Week

If you like to follow what is going on in the world statistically, take a look at worldometers.info. As of Thursday morning, the site showed year-to-date deaths from Coronavirus at 2,814 and from seasonal flu at 76,441. The reason for so much fear and market reaction to coronavirus is because there is so much we don’t know about it, namely exactly how it spreads and how quickly.

Axios reported not only are pundits and policymakers concerned about tech headed toward out of control, but also the general population has concerns. A new survey shows 61% think tech is changing too fast, 66% worry technology is making it impossible to know what information is real or fake, and 61% think government think does not understand tech well enough to regulate it. 


 

As of mid-morning Friday, Tesla market capitalization has dropped by more than $40 billion. The five giant tech company market caps plunged by more than a half-trillion dollars. All five companies are global, but to put their massive valuation into perspective, it still represents 18% of the market cap of the U.S. S&P 500. Shareholders are not happy and government regulators and politicians are gearing up for new regulations. The pressure on big tech will continue to mount.

MAGFA Market Cap (02/28/20)
Microsoft      $1.210 Trillion
Apple      $1.180 Trillion
Google      $0.890 Trillion
Facebook       $0.540 Trillion
Amazon      $0.924 Trillion
     
Total      $4.744 Trillion
     
S&P 500 1/31/20      $26.720 Trillion
     
MAGFA        18%  

 


 

The next author event will be on March 19th at AdventHealth in Palm Coast, FL. The event is open to the public. Seating is limited, so RSVP by calling 386-586-4440 or email [email protected]The first 65 to register will get an autographed copy of
Robot Attitude: How Robots and Artificial Intelligence Will Make Our Lives Better

Date

Event

Time

Location

June 11, 2020

Meet the Author

7:00 PM

Ridgefield Library
472 Main Street, Ridgefield, CT 06877

May 15, 2020 (to be rescheduled)

Meet the Author

1:00 PM

Founders Hall
193 Danbury Rd, Ridgefield, CT 06877

Arpil 15, 2020

Origins of the Internet   with Doug Maine and John Patrick

7:30 PM with Zoom

Virtual Playhouse
by Bedford Playhouse 
Bedford, NY

March 19, 2020 (to be rescheduled)

Community Forum

11:30 AM

AdventHealth Palm Coast 
60 Memorial Medical Pkwy
Palm Coast, FL 32164

February 14, 2020

Health Attitude with John Patrick

8:30 AM

Senior Provider Information Network
2 Corporate Dr.
Palm Coast, FL

February 6, 2020

Tech Talk 9 with John Patrick

1:00 PM

Hammock Dunes Club
Palm Coast, FL
Private event: Request invite
Mail to [email protected]

November 14, 2019

Meet the Author

1:00 PM

New Fairfield Senior Center
33 CT-37
New Fairfield, CT

October 9, 2019

Housatonic Habitat for Humanity Robotics Night

5:30 PM

Crowne Plaza Hotel
18 Old Ridgebury Rd
Danbury, CT

August 29, 2019

Meet the Author

5:30 PM

The Boiler Room
Hawley Silk Mill
8 Silk Mill Drive
Hawley, PA

A Walmart robot – Source: Walmart Inc.

If you have not seen a robot motoring around a local retailer, you will. Historically, robots have been deployed mostly in manufacturing. However, robots are now fulfilling more and more tasks in retail. They are flipping burgers in restaurants and patrolling shopping malls for security. In big box retailers, robots are patrolling the aisles and scanning the shelves.

Walmart is expanding its shelf-scanning robots by 650 bringing its fleet to 1,000. The six-foot-tall robots are made by San Francisco-based Bossa Nova Robotics Inc. Each robot is equipped with 15 cameras. The robots roam the aisles looking for items which are out of stock, and send alerts to store employees’ smartphones who can take appropriate action. The robots can also report if the price on an item is different than the price indicated on the shelf. Industry analysts claim out of stock items cost retailers nearly a trillion dollars in lost sales per year.

Some employees are chatting about the robots as “job stealers”. The employees have a right to be concerned. Other robots can scrub floors and unload trucks. Walmart claims the robots make it possible to redeploy employees to less mundane jobs. That can be true in the short term, but eventually the jobs being eliminated by robots will far outpace the redeployment opportunities. Only one presidential candidate talked about the impending problem, but he dropped out of the race after the New Hampshire primary.

To learn more about the coming robots, read Robot Attitude: How Robots and Artificial Intelligence Will Make Our Lives Better.


I added the following Disclosure to my post about the Iowa caucus, Internet voting, MIT researchers, and Voatz:

Disclosure: I am not an investor in Voatz or any other Internet voting company. I do not receive any fees of any kind for what I say or write about Internet voting.

As predicted, the press has jumped on the idea of Internet voting and pointed out how insecure it is. I could not resist writing another post to get a more balanced point of view entered into the mix. I have also given some interviews and participated on panels about the subject. Following are some links to videos of what I had to say. There is some redundancy in the New York interviews. The links are:

https://www.youtube.com/watch?v=tLsHkes9-qQ&t=95s Pepperdine
https://www.youtube.com/watch?v=XxUm30YdYbw NYC 11/2016
https://www.youtube.com/watch?v=FVajKvM4sco&t=32s NYC full interview
https://www.youtube.com/watch?v=QdsZI-2ipes NYC August 2016
https://www.youtube.com/watch?v=1NWqWSY8z9k&t=303s Internet voting
https://www.youtube.com/watch?v=_Um4wnMZ1-s NYC August 2016
https://www.youtube.com/watch?v=2cJGsvfWyaw NYC August 2016
https://www.youtube.com/watch?v=7SfT6ENx-jg&t=3s NYC August 2016


Data Fact of the Week

Each of our body’s 10 trillion or so cells contains about six feet of DNA, the enormously long molecule that contains all the genetic information which makes us a person. If laid end to end, the DNA would reach to the sun and back dozens of times. An equally amazing comparison is with the size of each of our cell’s nucleus, the container which holds our DNA. The diameter of a typical nucleus is about 1 ten-millionth of an inch, making it 400,000 times smaller than the DNA which has to fit inside it. The compression factor is equivalent to folding 20 miles of string perfectly into a tennis ball.


Tesla has now reached a market capitalization of more than $160 billion. This is remarkable but just a fraction of the MAGFA group. See the table below. The five giants market cap has pulled back a bit but is nearly five and a half trillion dollars. All five companies are global, but to put their massive valuation into perspective, it represents 20% of the market cap of the U.S. S&P 500. Shareholders are happy, but government regulators and politicians are licking their chops. The pressure on big tech will continue to mount.

MAGFA Market Cap (02/21/20)
Microsoft $1.370 Trillion
Apple $1.390 Trillion
Google $1.030 Trillion
Facebook $0.602 Trillion
Amazon $1.050 Trillion
     
Total $5.442 Trillion
     
S&P 500 1/31/20 $26.720 Trillion
     
MAGFA 20%  

The next author event will be on March 19th at AdventHealth in Palm Coast, FL. The event is open to the public. The first 65 to register will get an autographed copy of
Robot Attitude: How Robots and Artificial Intelligence Will Make Our Lives Better

Date

Event

Time

Location

June 11, 2020

Meet the Author

7:00 PM

Ridgefield Library
472 Main Street, Ridgefield, CT 06877

May 15, 2020 (to be rescheduled)

Meet the Author

1:00 PM

Founders Hall
193 Danbury Rd, Ridgefield, CT 06877

Arpil 15, 2020

Origins of the Internet   with Doug Maine and John Patrick

7:30 PM with Zoom

Virtual Playhouse
by Bedford Playhouse 
Bedford, NY

March 19, 2020 (to be rescheduled)

Community Forum

11:30 AM

AdventHealth Palm Coast 
60 Memorial Medical Pkwy
Palm Coast, FL 32164

February 14, 2020

Health Attitude with John Patrick

8:30 AM

Senior Provider Information Network
2 Corporate Dr.
Palm Coast, FL

February 6, 2020

Tech Talk 9 with John Patrick

1:00 PM

Hammock Dunes Club
Palm Coast, FL
Private event: Request invite
Mail to [email protected]

November 14, 2019

Meet the Author

1:00 PM

New Fairfield Senior Center
33 CT-37
New Fairfield, CT

October 9, 2019

Housatonic Habitat for Humanity Robotics Night

5:30 PM

Crowne Plaza Hotel
18 Old Ridgebury Rd
Danbury, CT

August 29, 2019

Meet the Author

5:30 PM

The Boiler Room
Hawley Silk Mill
8 Silk Mill Drive
Hawley, PA

On Thursday morning, The New York Times ran a story about how MIT researchers found alleged flaws in the Voatz software used to support overseas military voters from West Virginia. Voatz has great success with mobile voting in multiple precincts around the country with no security problems. The terrible way in which the Iowa caucus vote reporting app was implemented with woefully inadequate testing and training was a rallying cry to researchers to find something wrong with Voatz. Researchers can be very helpful, but only if their approach to the research is itself beyond critique. It is not always the case.

Like many negative stories about Internet voting, the Times cited an experience with TrustTheVote software used by Washington, D.C. in 2010. The city technology team which implemented the voting system found a problem with the router which connected the voting server to the Internet. Perhaps because of time constraints, the router was replaced with a new one without setting a strong password. Protection of the voting server was limited to a default, out of the box, password which a high school kid could easily guess. When the voting server was turned on to the public for testing, with no security testing, researchers from the University of Michigan were able to break in to the server within minutes. Rather than quickly and discreetly work with the Washington technology team to fix the problems, the researchers caused the voting system to play the University of Michigan fight song each time the voting system’s integrity failed.

Is that research? Was the goal to help advance Internet voting for the benefit of the millions of voters who are disenfranchised by our 150 year old system, or was it to gain notoriety and bragging rights by taking down a poorly implemented voting server?

In the case of the MIT researchers and Voatz, there is much to question about their “research” approach. Suppose Apple found some bugs in release 10.0 of its software which they fixed in release 10.1. Suppose researchers decided to evaluate Apple’s software and, to do so, they elected to test the release 10.0, and then reported the bugs Apple had already fixed. Is that helpful research? In the case of Voatz mobile Internet voting software, the MIT researchers analyzed an Android version of the Voatz app that was at least 27 versions old. The software they reported on was never used in an election. The researchers did not have access to the Voatz server, so they created one which they believed would work like the Voatz server.

Research? Had the researchers taken the time, like nearly 100 other researchers who evaluated Voatz software, to test and verify their claims using the latest version of the Voatz platform, the outcome of the research would have been quite different. The MIT researchers did not inform Voatz of their testing nor offer to collaborate for the benefit of disenfranchised voters. Instead, they chose to remain anonymous and seek media attention around their findings. 

The leadership of the Democratic caucus did a terrible disservice to American democracy. With people already skeptical of Internet voting, the experts are now piling on saying “See, we told you so. Don’t even consider Internet voting”. The anti-Internet voting activists do not seem to be interested in the 100 million people in 2016 who could have voted but did not. 

West Virginia has not received much press coverage on the great leadership it has provided in this area. The state wants to make it easy for military and disabled citizens to vote wherever they may be. Rather than roll it out at the last minute with no testing, West Virginia worked with Voatz to thoroughly test the mobile voting system. Voter satisfaction with Voatz Internet voting was high, and the vote was accurate and secure.

Voatz has been very progressive and open in their testing approach. They established a public bug bounty program two years ago. Nearly 100 researchers helped the company find bugs. They were paid a bounty for bugs they found. The MIT researchers could have joined the public bug bounty program. Instead they chose a sneaky approach and tested out of date software and gave the results to The New York Times.

America has the best researchers in the world. They can help make Internet voting a great success which would strengthen our democracy. The goal should be enabling people to vote conveniently, securely, privately, accurately, and with verifiability. This can be done as Voatz has demonstrated. Come on researchers, let’s collaborate to make it even better.

Disclosure: I am not an investor in Voatz or any other Internet voting company. I do not receive any fees of any kind for what I say or write about Internet voting.

A Meet the Author event was held on Friday at a monthly meeting of the Senior Provider Information Network. The meeting was at the beautiful Market Street Memory Care Residence in Palm Coast, Florida. Additional author events will be held in Florida during the 1st quarter of 2020 and then more back in Connecticut in the Spring. The table below shows events scheduled so far. Details on upcoming events will follow. Questions to [email protected]


As predicted, the press has jumped on the idea of Internet voting and pointed out how insecure it is. I could not resist writing another post to get a more balanced point of view entered into the mix. I have also given some interviews and participated on panels about the subject. Following are some links to videos of them. There is some redundancy in the New York interviews. The links are:

https://www.youtube.com/watch?v=tLsHkes9-qQ&t=95s Pepperdine
https://www.youtube.com/watch?v=XxUm30YdYbw NYC 11/2016
https://www.youtube.com/watch?v=FVajKvM4sco&t=32s NYC full interview
https://www.youtube.com/watch?v=QdsZI-2ipes NYC August 2016
https://www.youtube.com/watch?v=1NWqWSY8z9k&t=303s Internet voting
https://www.youtube.com/watch?v=_Um4wnMZ1-s NYC August 2016
https://www.youtube.com/watch?v=2cJGsvfWyaw NYC
https://www.youtube.com/watch?v=7SfT6ENx-jg&t=3s NYC


Data Fact of the Week

Each of our body’s 10 trillion or so cells contains about six feet of DNA, the enormously long molecule that contains all the genetic information which makes us a person. If laid end to end, the DNA would reach to the sun and back dozens of times. An equally amazing comparison is with the size of each of our cell’s nucleus, the container which holds our DNA. The diameter of a typical nucleus is about 1 ten-millionth of an inch, making it 400,000 times smaller than the DNA which has to fit inside it. The compression factor is equivalent to folding 20 miles of string perfectly into a tennis ball.


Tesla has now reached a market capitalization of $145 billion. This is remarkable but just a fraction of the MAGFA group. See the table below. The five giants have now reached a market cap of five and a half trillion dollars. All five companies are global, but to put their massive valuation into perspective, it represents 21% of the market cap of the U.S. S&P 500. Shareholders are rejoicing, but government regulators and politicians are licking their chops. 

MAGFA Market Cap
Microsoft $1.400 Trillion
Apple $1.420 Trillion
Google $1.040 Trillion
Facebook $0.610 Trillion
Amazon $1.060 Trillion
     
Total $5.530 Trillion
     
S&P 500 1/31/20 $26.720 Trillion
     
MAGFA 21%  

 

Date

Event

Time

Location

June 11, 2020

Meet the Author

7:00 PM

Ridgefield Library
472 Main Street, Ridgefield, CT 06877

May 15, 2020 (to be rescheduled)

Meet the Author

1:00 PM

Founders Hall
193 Danbury Rd, Ridgefield, CT 06877

Arpil 15, 2020

Origins of the Internet   with Doug Maine and John Patrick

7:30 PM with Zoom

Virtual Playhouse
by Bedford Playhouse 
Bedford, NY

March 19, 2020 (to be rescheduled)

Community Forum

11:30 AM

AdventHealth Palm Coast 
60 Memorial Medical Pkwy
Palm Coast, FL 32164

February 14, 2020

Health Attitude with John Patrick

8:30 AM

Senior Provider Information Network
2 Corporate Dr.
Palm Coast, FL

February 6, 2020

Tech Talk 9 with John Patrick

1:00 PM

Hammock Dunes Club
Palm Coast, FL
Private event: Request invite
Mail to [email protected]

November 14, 2019

Meet the Author

1:00 PM

New Fairfield Senior Center
33 CT-37
New Fairfield, CT

October 9, 2019

Housatonic Habitat for Humanity Robotics Night

5:30 PM

Crowne Plaza Hotel
18 Old Ridgebury Rd
Danbury, CT

August 29, 2019

Meet the Author

5:30 PM

The Boiler Room
Hawley Silk Mill
8 Silk Mill Drive
Hawley, PA

A lot of knowledgeable experts will be weighing in with their points of view about what went wrong with the Iowa caucus vote counting. There were many problems but it is clear as can be the core problem was the lack of testing. I learned decades ago about the importance of testing anything involving software. The other thing I learned is software always does exactly what you tell it to do, not what you want it to do. The only way to get software to do what you want it to do is testing, and you can never test too much.

My team at IBM built a website for the Atlanta Olympic Games of 1996. In 1995, there were not many people who knew a lot about how to build really large websites or, for that matter, any kind of website. The Olympic site was the largest in the world back then, and we learned a lot in building it. We were humble with our expectations. We didn’t know how many people would come to the site, when they would come, or what they might do when they got there. We learned many lessons, but I can summarize it in a simple mantra: Think big, act bold, start simple, iterate fast (with testing). Another way to say it is to take a lot of baby steps.

The Olympic Games website was successful. For the first time, people around the world had real-time access to the individual and country results from the Olympic Games. We had a lot to share about how the site was developed but, unfortunately the story was overshadowed by a glitch in an unrelated application (the word app had not yet been invented) developed in Atlanta. The application was designed to distribute news and results to the press. A software developer made a change to the application but failed to test it. The result was a disaster. If an application was to have a failure for a customer, the last place you would want it to happen is with the press. 

In software development parlance, testing happens in phases. First is the alpha test to see if the concept works. Then comes beta testing where you bring in a small number of users and get their feedback. Sometimes software can be in the beta phase of testing for months or even years. When it is finally ready to go live for all users, the software is released. As an extreme example, Google introduced gmail in 2004 and kept it in beta for five years, signaling the company was still making feature changes and testing them. As of 2019, there are 1.5 billion users.

Development of a test plan is at least as important as the plan for the product or service itself. In the innovation group at IBM, my team would develop a new application and conduct the alpha test among just our own team. When everybody was happy, we would roll it out to a small subset, by invitation. When the team was satisfied with the testing progress, more beta users would be added. When it was clear the application was working properly and the users were happy, the application would be released for all users. 

Almost 20 years later I heard about the impending launch on October 1, 2013 of healthcare.gov. I knew it would be a failure from the get go. A project as massive as healthcare.gov which intends to serve all types of insured citizens in all 50 states can have many possible points of failure. It reminded me of the mantra I learned in 1996. It appeared the mantra for healthcare.gov was “think big, act big, start big, fail big”. The healthcare.gov site could have been introduced in one state for one type of insured. After successful testing, another state could be added. Then another type of insured. The proper testing would have spanned at least a year, in my opinion.

Clay Shirky, an American writer, consultant and teacher on the social and economic effects of Internet technologies, analyzed the failure in “Healthcare.gov and the Gulf Between Planning and Reality“. He concluded the developer’s idea that “failure is not an option” but, with no testing, was a fantasy. The developers feared if they openly tested the system before releasing it to the public, politicians would attack the purpose and efficacy of the site. The lack of testing caused catastrophic results.

And now, in 2020, after a vast accumulation over decades of experience with the Internet, the leaders of the Democratic caucus released an app which had virtually no testing. People in 1,700 precincts were told to download the app for the first time on the night of the caucus. The app was not available in the app store because it had not had proper testing. The users in the precincts had to follow a special download process which was daunting for many. In interviews before the caucus, leaders said they had a backup plan if things did not go well. The backup plan was a call center which also served as the technical support center for users having trouble with the app. Some users were on hold for hours and finally gave up. 

How difficult would it have been to have an alpha/beta test plan? It would have been relatively easy. It could have started with 17 of the 1,700 precincts. If successful, another 17, then 170, and after all were happy, released to all. A solid test plan would have taken months. It is clear from the various news reports the Democratic leadership had little or no technical competency and the vendor who developed the app had little experience with apps. 

The leadership of the Democratic caucus did a terrible disservice to American democracy. With people already skeptical of Internet voting, the experts are now piling on saying “See, we told you so. Don’t even consider Internet voting”. The Internet had nothing to do with this massive failure. It all came down to one simple concept: Testing. 

Another root cause of the Iowa disaster is the lack of technical skills. Voting was delegated by the Constitution to the Secretaries of State most of whom are lawyers. The administration of voting takes place at the county level, 3,000 of them. The staff and volunteers are hard working and dedicated to enabling people to vote. Unfortunately, the system they have to work with is a 150-year-old paper based system, the staffers are not technical, and budgets to upgrade are limited. 

In 2016, 100 million people who could have voted did not. Why? There is a long list of reasons. Absentee and vote early paper-based voting is not the answer. In Election Attitude – How Internet Voting Leads to a Stronger Democracy, I described how our smartphones with biometric authentication and blockchain technology can automate the voting process with security, privacy, accuracy, and verifiability. If we can land a robot on Mars, we certainly can automate voting. We just need the right attitude politically and technologically and a lot of testing.

West Virginia has shown great leadership in this area. They have been working with a Boston based technology company called Voatz. Voatz has a team of technology and voting experts. They designed a mobile blockchain app which has proven to be secure and easy to use. Rather than roll it out at the last minute with no testing, West Virginia worked with 144 overseas military voters residing in 31 countries. Ballots were submitted via the app for the November 2018 election. Before that, there was a smaller pilot of the system in two West Virginia counties in May 2018. Voter satisfaction with Voatz Internet voting was high, and the vote was accurate and secure.

We should not let the mismanaged Iowa experience diminish the vision to enfranchise the 100 million people who didn’t vote in 2016. We need Internet voting to have a strong democracy. As Vint Cerf, one of the fathers of the Internet said, “We can do this.” 

On Thursday afternoon I made a presentation to about 50 members at the Hammock Dunes Club, where I am a member. The topics I discussed included 5G, augmented reality (AR), Bitcoin, Blockchain, CRISPR-Cas9 gene editing for cancer treatment, facial recognition, home automation, Internet voting, mHealth, robots, and AI. All of these have been and will continue to be topics of my weekly blog posts.


Tesla has now reached a market capitalization of $138 billion. This is remarkable but just a fraction of what I call the MAGFA group. See the table below. The five giants have now reached a market cap of five and a half trillion dollars. All five companies are global, but to put their massive valuation into perspective, it represents 21% of the market cap of the U.S. S&P 500. Shareholders are rejoicing, but government regulators and politicians are licking their chops. 

MAGFA Market Cap
Microsoft $1.400 Trillion
Apple $1.420 Trillion
Google $1.040 Trillion
Facebook $0.607 Trillion
Amazon $1.040 Trillion
     
Total $5.507 Trillion
     
S&P 500 1/31/20 $26.720 Trillion
     
MAGFA 21%  


The next Meet the Author event will be February 14 in Palm Coast, Florida. Additional author events will be held in Florida during the 1st quarter of 2020 and then more back in Connecticut in the Spring. The table below shows events scheduled so far. Details on upcoming events will follow. Questions to [email protected]


Date

Event

Time

Location

June 11, 2020

Meet the Author

7:00 PM

Ridgefield Library
472 Main Street, Ridgefield, CT 06877

May 15, 2020 (to be rescheduled)

Meet the Author

1:00 PM

Founders Hall
193 Danbury Rd, Ridgefield, CT 06877

Arpil 15, 2020

Origins of the Internet   with Doug Maine and John Patrick

7:30 PM with Zoom

Virtual Playhouse
by Bedford Playhouse 
Bedford, NY

March 19, 2020 (to be rescheduled)

Community Forum

11:30 AM

AdventHealth Palm Coast 
60 Memorial Medical Pkwy
Palm Coast, FL 32164

February 14, 2020

Health Attitude with John Patrick

8:30 AM

Senior Provider Information Network
2 Corporate Dr.
Palm Coast, FL

February 6, 2020

Tech Talk 9 with John Patrick

1:00 PM

Hammock Dunes Club
Palm Coast, FL
Private event: Request invite
Mail to [email protected]

November 14, 2019

Meet the Author

1:00 PM

New Fairfield Senior Center
33 CT-37
New Fairfield, CT

October 9, 2019

Housatonic Habitat for Humanity Robotics Night

5:30 PM

Crowne Plaza Hotel
18 Old Ridgebury Rd
Danbury, CT

August 29, 2019

Meet the Author

5:30 PM

The Boiler Room
Hawley Silk Mill
8 Silk Mill Drive
Hawley, PA

Picture by Active Implants LLC

There are many posts in this blog about knee surgeries and replacements. One of the problem areas is the meniscus, a C-shaped piece of rubbery yet tough cartilage which acts as a shock absorber between your shinbone and thighbone. A meniscus tear can occur if you suddenly twist your knee while bearing weight on it. The knee is the largest joint in the body, and a meniscus tear can result in swelling, popping, limping, giving way, and a lot of pain. Like many issues, age can be an issue contributing to meniscus tears.

A privately held medtech company with headquarters in Memphis, Tennessee, Active Implants LLC, develops orthopedic implant solutions designed to complement the natural biomechanics of the musculoskeletal system. The company’s goal is to allow patients to maintain or return to an active lifestyle. The current focus of Active Implants is to gain clinical validation for its NUsurface® Meniscus Implant, the first artificial meniscus. The target market is to replace a meniscus which is damaged or deteriorating.

The NUsurface meniscus implant is designed for patients with persistent knee pain following medial meniscus surgery. The artificial meniscus is made from medical-grade polymer and other unique materials. Because of the composite structure and design, the artificial meniscus does not require fixation to bone or soft tissues. The NUsurface Implant design mimics the function of the natural meniscus and redistributes loads which are transmitted across the knee joint.

The NUsurface device is already being marketed in Belgium, Germany, Israel, and Italy. The U.S. FDA has designated the NUsurface implant as a “breakthrough device”. According to the Active Implants website, two clinical trials of the NUsurface® Meniscus Implant were fully enrolled as of June 2018. One trial is called SUN (Safety Using NUsurface®) and the other VENUS (Verifying the Effectiveness of the NUsurface® System). Final approval by the FDA is expected this year. If approved, it will be the first artificial meniscus in the United States.

As I wrote in Robot Attitude: How Robots and Artificial Intelligence Will Make Our Lives Better, we are continuing the journey where more and more non-biological items are being inserted in humans. At the same time, biological-like items are going into robots. When we reach the singularity, it will be very difficult to tell the difference between human and non-human beings. 

Source: First ‘Artificial Meniscus’ Wins FDA Breakthrough Device Designation | MDDI Online

Another of Elon Musk’s companies, spaceX, continues on a roll like Tesla. Wednesday morning there was a beautiful launch of a Falcon 9 rocket. The rocket’s nine Merlin engines put 60 more StarLink satellites in orbit to expand the Internet service goals of the company. We will hear much more about this in coming months. After the stage 1 booster separated, it returned to Earth and made a perfect landing on a ship in the Atlantic Ocean off the coast of Florida. I was able to see the rocket from my terrace which is about  80 miles north. Atop the rocket were the 60 satellites and two fairing pieces, like a clam shell, which protect the satellites during the trip to space. A fairing is 43 ft long and 17 ft in diameter. It weighs approximately 4,000 pounds. After the two fairing halves tumbled back to Earth, a spaceX ship in the ocean with a huge net was able to catch one of the fairings. Truly amazing. The other fairing had a near miss at a second ship. A fairing costs about $6 million, so the attempts are  worthwhile. Isn’t it amazing American and Russian space agencies have not thought of re-using booster rockets and fairings after their many decades at space launches?


Tesla has now reached a market capitalization of $103 billion and Apple now exceeds $1.4 trillion. Microsoft is almost at $1.3 trillion. Amazon and Google are north of $900 billion and Facebook is approaching $600 million. Who would have thought these numbers would be possible?


The next Meet the Author event will be February 6 in Palm Coast, Florida. Additional author events will be held in Florida during the 1st quarter of 2020 and then more back in Connecticut in the Spring. The table below shows events scheduled so far. Details on upcoming events will follow. Questions to [email protected]


Date

Event

Time

Location

June 11, 2020

Meet the Author

7:00 PM

Ridgefield Library
472 Main Street, Ridgefield, CT 06877

May 15, 2020 (to be rescheduled)

Meet the Author

1:00 PM

Founders Hall
193 Danbury Rd, Ridgefield, CT 06877

Arpil 15, 2020

Origins of the Internet   with Doug Maine and John Patrick

7:30 PM with Zoom

Virtual Playhouse
by Bedford Playhouse 
Bedford, NY

March 19, 2020 (to be rescheduled)

Community Forum

11:30 AM

AdventHealth Palm Coast 
60 Memorial Medical Pkwy
Palm Coast, FL 32164

February 14, 2020

Health Attitude with John Patrick

8:30 AM

Senior Provider Information Network
2 Corporate Dr.
Palm Coast, FL

February 6, 2020

Tech Talk 9 with John Patrick

1:00 PM

Hammock Dunes Club
Palm Coast, FL
Private event: Request invite
Mail to [email protected]

November 14, 2019

Meet the Author

1:00 PM

New Fairfield Senior Center
33 CT-37
New Fairfield, CT

October 9, 2019

Housatonic Habitat for Humanity Robotics Night

5:30 PM

Crowne Plaza Hotel
18 Old Ridgebury Rd
Danbury, CT

August 29, 2019

Meet the Author

5:30 PM

The Boiler Room
Hawley Silk Mill
8 Silk Mill Drive
Hawley, PA

VotingSeveral House members have introduced a bipartisan resolution to modernize how Congress operates. It includes the ability to vote remotely or take part in hearings online. A California Congressman said, “Across the nation we see the development of new, innovative ways of conducting business to improve communication and connectedness. It’s time for Congress to learn to be more mobile and adapt to the times in which we live.” Amen.

What a great idea, although long overdue. Consider how the Senate votes. On January 21, the Senate held 11 votes related to amendments to a pending resolution. First, let me say I am not going to make a political pronouncement about whether the 11 votes should or should not have been passed. I want to comment on the mechanics of how they voted, not the politics. In the House, when a vote is called, it is over in a few minutes. The count is shown in real-time and members can modify their vote up to an announced cutoff. In the Senate, they vote the same way they did 150 years ago.

Our Senate uses the NBC (No buttons or clicking) method. The roll call is the controlling technology. Each vote starts with “Mr. Alexander”. Mr. Alexander then stands up and casts his voice vote. “Ms. Baldwin”, “Mr. Barrosso”, “Mr. Bennet, “Ms. Blackburn”, and the same for the other 95. After Mr. Young stands and casts his voice vote, there is a very long silence. Not sure what somebody is doing. I would hope all the votes were entered into some kind of app which then showed the totals, but it would not surprise me if they manually counted the votes and then had a second person double check. A long document is then presented to whoever is in charge, in this case the Chief Justice of the Supreme Court.

As I have written in Election Attitude – How Internet Voting Leads to a Stronger Democracy and in numerous posts, mobile blockchain voting is very doable. All we need to do is impose the political and technological will to overcome the fear and the protection of the status quo. It can be done and be secure, private, accurate, and verifiable. Much more so than paper ballots. In a closed chamber where all the 100 voters are in the room, a simple wired keypad application could easily handle the voting task. It would be a near instant vote count.

Every month I get an email from a software company called Smile. It includes a report telling me how many minutes I saved for the month as a result of using an app called TextExpander. I have the app on all my devices. When I type eatl, my device types on its own “Election Attitude – How Internet Voting Leads to a Stronger Democracy”. The time savings are up to an hour a month. Imagine how many hours the Senate could save if it had electronic voting.

Our Congress is the body of politicians who the tech industry is urging to develop regulations for artificial intelligence, facial recognition, cryptocurrency, and other critical and highly technical issues. Are the politicians, especially the Senate, up to it? You can guess how I would cast my vote on that question. The latest survey shows a job satisfaction of 9% for Congress. No surprise.

Hobby Attitude is the one! The final tally came in with 63% of the votes for Hobby Attitude. I have started an outline for the book and will update you from time to time on my plans and progress. Thanks for your interest.


One of Elon Musk’s companies, Tesla, continues on a roll. Tesla overtook Volkswagon as the world’s second most valuable carmaker behind Japan’s Toyota. Tesla’s stock has more than doubled in the last three months, with its market capitalization at $103 Billion as of the close on Thursday, exceeding that of Ford and GM combined. No stock can go straight up forever, but the short sellers have lost billions betting Tesla would stumble. Apple has now reached a market capitalization of $1.4 Trillion. Who would have thought Apple would become worth more than ten times the market cap of IBM?


The King Conservation District is a state environmental agency that encompasses Seattle and more than 30 other cities. The District is rolling out new technology will be used for a board of supervisors election. More than one million people will be able to vote from their smartphones. This is an historic event and, hopefully, will inspire other jurisdictions to begin pilot projects to enable Internet voting in 2022.


The next Meet the Author event will be February 6 in Palm Coast, Florida. Additional author events will be held in Florida during the 1st quarter of 2020 and then more back in Connecticut in the Spring. The table below shows events scheduled so far. Details on upcoming events will follow.


Date

Event

Time

Location

June 11, 2020

Meet the Author

7:00 PM

Ridgefield Library
472 Main Street, Ridgefield, CT 06877

May 15, 2020 (to be rescheduled)

Meet the Author

1:00 PM

Founders Hall
193 Danbury Rd, Ridgefield, CT 06877

Arpil 15, 2020

Origins of the Internet   with Doug Maine and John Patrick

7:30 PM with Zoom

Virtual Playhouse
by Bedford Playhouse 
Bedford, NY

March 19, 2020 (to be rescheduled)

Community Forum

11:30 AM

AdventHealth Palm Coast 
60 Memorial Medical Pkwy
Palm Coast, FL 32164

February 14, 2020

Health Attitude with John Patrick

8:30 AM

Senior Provider Information Network
2 Corporate Dr.
Palm Coast, FL

February 6, 2020

Tech Talk 9 with John Patrick

1:00 PM

Hammock Dunes Club
Palm Coast, FL
Private event: Request invite
Mail to [email protected]

November 14, 2019

Meet the Author

1:00 PM

New Fairfield Senior Center
33 CT-37
New Fairfield, CT

October 9, 2019

Housatonic Habitat for Humanity Robotics Night

5:30 PM

Crowne Plaza Hotel
18 Old Ridgebury Rd
Danbury, CT

August 29, 2019

Meet the Author

5:30 PM

The Boiler Room
Hawley Silk Mill
8 Silk Mill Drive
Hawley, PA


Virtual image of human heart with cardiogram

Heart failure has been in the news a lot lately. It used to be the disease of older people, but younger ones (40-50) are gaining. The negative trend for younger people is mostly related to lifestyle. For us older (and wiser?) people, nearly 10 percent of those over 65 are afflicted with some form of congestive heart failure (CHF). As a side note, my mother died from CHF. Inspired by memories of what she went through, I did some research on using home telemonitoring to prevent readmissions to the hospital, a phenomenon which, unfortunately, accompanies CHF. My doctoral dissertation about the research is here.

More than 25 million people around the world have CHF. It is a costly chronic disease. CHF has a variety of causes but it is usually the result of the heart being unable to pump blood effectively through the body. Detecting the disease early and efficiently can have a large impact on the total cost of healthcare. A lot of the cost is associated with tests. In the long run, I believe the solution will revolve around AI and data.

The good news is there is a growing amount of data. The introduction of Apple Watch and other mobile/wearable health devices are collecting continuous streams of data from millions of people. If the data is anonymized, meaning stripped of any personally identifiable information, and accumulated in publicly available databases, great progress can be made.

Medical research in Europe gives a clue as to the potential. If you read Robot Attitude: How Robots and Artificial Intelligence Will Make Our Lives Better, you know about artificial intelligence (AI). A subset of AI is machine learning (ML), which I explained in the book. One of the algorithms used in the field of ML is called convolutional neural networks (CNN). What the researchers have demonstrated with CNN is mind boggling. They have been able to identify CHF almost instantly by applying the algorithm to just one heartbeat from ECG data. The accuracy of the detection was measured across a very large database of known CHF patients and those without. The accuracy was 100%.

New Atlas, a nearly 20 year old technology website, reported,

Even more interesting is the possibility of wearable health monitoring devices being able to help doctors identify at-risk patients without having to examine them in clinical contexts. Using short ECG recordings to detect CHF, could pave the way for health wearables that constantly monitor patients in real-world conditions.

The research I have described was published in the journal Biomedical Signal Processing and Control and reported in New Atlas as “100% accurate AI detects heart failure from single heartbeat“.

I mentioned at the beginning of the article detecting CHF early and efficiently can have a large impact on the total cost of healthcare. In my opinion, AI tools are going to have a huge impact. Some studies have suggested the cost of unnecessary tests and procedures in American healthcare is as much as $1.5 trillion. Visit the waiting room at a Florida cardiology practice or a radiology imaging center and you will see rooms full of seniors waiting to get tests.

Consider the impact. If there are 50 million people without healthcare insurance or who are under-insured, and if the cost per year of their care would be $10,000 (the average for a Medicare patient), the cost to give them healthcare, would be $500 billion or just one third of the unnecessary cost. This does not include the cost of fraud, the billions spent on TV advertising which add no benefits to our health, the over-charging of medications, and other inefficiencies.

I am not suggesting we give free healthcare. I believe everyone should pay some fair portion of the cost, if possible. I am simply making the point the real problem with our healthcare system is not the insurance, who is in and who is out, etc. The #1 problem is the excessive cost of our healthcare compared to other developed countries. AI is coming to the rescue.

Two topics I have gotten a lot of feedback on in the medical field have been arthritis and hearing impairment. Hearing can be impaired for various reasons. In my case, I vividly recall using a backpack leaf blower in November 1995 at our summer home in Pennsylvania. Hearing protectors were not as common then as now. After blowing leaves for a couple of hours, the leaf blower ran out of gas. When it stopped, both of my ears were ringing. They have been ringing ever since, 24×7. I have learned to live with the ringing, and annual hearing tests confirm I am able to hear adequately.

Another reason for hearing impairment is aging. An article published by The University of Rochester Medical Center (URMC) reported, “Hearing impairment has long been accepted as a fact of life for the aging population – an estimated 30 million Americans suffer from some degree of hearing loss.” Count me and most of my friends in.

I have written here about various technology solutions such as cochlear implants and advanced technology to replace conventional hearing aids. Another bright spot is the Apple Research app. In partnership with the University of Michigan, Apple is examining factors which impact hearing health. The Apple Hearing Health Study is the first of its kind to collect data over time in order to understand how everyday sound exposure can impact hearing. The study data will be shared with the World Health Organization (WHO) as a contribution toward its Make Listening Safe initiative.

An alternative to new electronic technology may turn out to be biological. Researchers at the University of Rochester Medical Center (URMC) Department of Neuroscience. In a new study published in the European Journal of Neuroscience, scientists have been able to regrow the sensory hair cells found in the cochlea. This critical part of the inner ear converts sound vibrations into electrical signals which enables us to hear.

Scientists have known for a long time other animals such as birds, frogs, and fish have been shown to have the ability to regenerate lost sensory hair cells. For some unknown reason, humans cannot perform this regeneration. However, researchers are now discovering it is possible to activate and proliferate stem cells to become new sensory hair cells.  Repairing hearing is a complex problem and requires a series of events at a cellular level, but researchers now believe it is possible.

Despite the complexity, the progress seems stunning to me. I visited an expert in tinnitus (from the leaf blower) at Yale some years ago. He said, “There is no cure and there never will be.” I am 100% certain he is dead wrong. The progress in all aspects of medical research is stunning. I have been saying for years the medical progress in the next ten years will exceed what has been accomplished in the last 100 years. I continue to believe this.

Source: Study Points to Possible New Therapy for Hearing Loss – Newsroom – University of Rochester Medical Center

I hope everyone had happy and healthy holidays with friends and family. I look forward to sharing stories in the weekly e-brief beginning next week. One of my goals this year is to expand readership of the e-brief. Feedback is very positive and I hope you agree it would be nice to share it with more people. I will be making some changes to the e-brief format to make it easier to share. Happy New Year!

Key in Lock

One of my friends had his AOL account hacked this week. Unfortunately, I have had many friends to whom this has happened. Some people say it is weak security at AOL, but most experts would say the problem is a weak and or old password.

Make a New Year’s Resolution to get a password manager and clean up and organize all your passwords. You will sleep better and avoid the hassle of being hacked. There are many password managers available. I recommend 1Password. I have been using it for more than seven years.

1Password creates, stores, remembers, and automatically logs you into your websites. All of my passwords and those of my wife, more than 600 in total, are stored in the 1Password cloud. They are encrypted so if someone broke into the 1Password cloud and stole the passwords, the thief would not be able to use them. Our passwords are long, ugly, and impossible to remember.


Here is an example of one of my passwords:

jz#Ky68vJavWF*iAH#DbkepRUGavGy6L

I don’t think anyone will be guessing it. 


1Password will identify any passwords which are old and those which are duplicates. It is best to have no duplicate passwords. If one of the sites you use gets hacked and the bad guys get your password, you want to be sure it can’t be used at any of your other websites. It is easier to have a simple password like abc123 or something equally trivial. However, if you can remember it, it is not secure. I wrote a post about my experience with passwords five years ago you might find interesting (see Password Hell). Please put getting a password manager high on your list of New Year’s resolutions. If you want to compare some of the best password managers, take a look at PC Magazine‘s nice comparison chart called The Best Password Managers for 2020.

Hobby Attitude is the one! The final tally came in with 63% of the votes for Hobby Attitude. I have started an outline for the book and will update you from time to time on my plans and progress. Thanks for your interest.


One of Elon Musk’s companies, Tesla, is on a roll. There have been many skeptics and short sellers of the Tesla stock. 2019 was predicted by many to be a disastrous year for Tesla, but it wasn’t. Shares of the electric-car maker have gained almost 30 percent year to date. The market capitalization of Tesla is $78 Billion, more than twice that of Ford. Model 3 consumer demand and profitability are looking good. When I first drove my wife’s Model 3, I was sure it would be a winner. It accelerates like a jack rabbit and has a range of more than 300 miles. The amazing thing about it is all the things it doesn’t have. No transmission. No fluids except for windshield wiper. No engine with hundreds of parts. No muffler or tailpipe. Etc. The profitability of a $50,000 Model 3 has got to be impressive. Analysts are now saying Tesla should easily make its target of between 360,000 and 400,000 vehicles for 2019. That would mean a 45 percent to 65 percent increase from last year.


Apple has now reached a market capitalization of $1.3 Trillion. Who would have thought Apple would become worth ten times the market cap of IBM?


The next Meet the Author event will be February 6 in Palm Coast, Florida. Additional author events will be held in Florida during the 1st quarter of 2020 and then more back in Connecticut in the Spring. The table below shows events scheduled so far. Details on upcoming events will follow.


Date

Event

Time

Location

June 11, 2020

Meet the Author

7:00 PM

Ridgefield Library
472 Main Street, Ridgefield, CT 06877

May 15, 2020 (to be rescheduled)

Meet the Author

1:00 PM

Founders Hall
193 Danbury Rd, Ridgefield, CT 06877

Arpil 15, 2020

Origins of the Internet   with Doug Maine and John Patrick

7:30 PM with Zoom

Virtual Playhouse
by Bedford Playhouse 
Bedford, NY

March 19, 2020 (to be rescheduled)

Community Forum

11:30 AM

AdventHealth Palm Coast 
60 Memorial Medical Pkwy
Palm Coast, FL 32164

February 14, 2020

Health Attitude with John Patrick

8:30 AM

Senior Provider Information Network
2 Corporate Dr.
Palm Coast, FL

February 6, 2020

Tech Talk 9 with John Patrick

1:00 PM

Hammock Dunes Club
Palm Coast, FL
Private event: Request invite
Mail to [email protected]

November 14, 2019

Meet the Author

1:00 PM

New Fairfield Senior Center
33 CT-37
New Fairfield, CT

October 9, 2019

Housatonic Habitat for Humanity Robotics Night

5:30 PM

Crowne Plaza Hotel
18 Old Ridgebury Rd
Danbury, CT

August 29, 2019

Meet the Author

5:30 PM

The Boiler Room
Hawley Silk Mill
8 Silk Mill Drive
Hawley, PA


The gift giving season is over but still a good time to buy books from the attitude series. All are available on Kindle and Paperback. Health Attitude and Election Attitude are available as Audible. Amazon now has two Series pages featuring “It’s All About Attitude”. The Kindle page is here and the paperback page is here. Take a look!

Solar power has achieved continuous improvement in efficiency. The demand is strong as consumer and business interest grows. I would love to implement Elon Musk’s vision at my summer home in Pennsylvania. The vision would include Tesla roof shingles which look like regular shingles but which contain solar cells. they are now available for sale. The second part of the vision is the Tesla Powerwall, a 4 foot by 3 foot by 6 inch battery or two in the garage or on the back terrace. Also available for sale. The sun would produce electricity to power the house and any left over would go to the batteries. If there is a power failure or if the sun is not shining, the battery provides limited power for a limited time. All this is controlled by setting various parameters on a smartphone app. The final part of the vision, of course, is to have a Tesla car plugged into the house and be powered by the sun.

The one catch is where the summer home is located there are a lot of trees. Tesla did an analysis using High Definition satellite imagery and concluded there would be a 20% shortfall of the needed energy for the house produced by the roof. Not enough sun, whether caused by too many trees or too many cloudy days, is a major limitation for the solar power vision. Shingles with solar cells built in are getting more efficient and may soon be adequate for a majority of homes. However, what to do about rainy days and cloudy skies? The Powerwalls can cover part of the problem but not entirely.

The answer may be sending sunshine harvested by a satellite down to Earth. Science fiction writer Isaac Asimov had a vision of space solar power in the early 1940s. Now, 75+ years later, his vision may become a reality. A Naval Research Lab has done a proof of concept where a laser beam was able to transmit 400 watts of power, enough for several small household appliances, across thousands of feet of air. The Navy believes this could lead to sending power to drones during flight.

A series of technological breakthroughs and a new government research program suggest Asimov’s vision may be closer to reality than previously thought. The basic idea is a giant satellite in orbit would collect energy from the sun and convert it to microwaves or laser beams and then transmit them to Earth where the microwaves or laser beams would be converted into electricity. Because the sun never sets in space, a space solar power system could supply renewable power to anywhere on Earth, day or night, rain or shine.

Space solar power has been one of those 30 year out predictions which kept moving further out. But, things are changing. NASA and the Defense Department have gotten behind the idea. In October, the Air Force Research Lab announced a $100 million program to develop hardware for a solar power satellite. The time is right. The military would like to be able to electrify forward operating bases rain or shine. California wildfires have forced PG&E to kill power for thousands of residents on multiple occasions. Solar space energy could provide renewable energy through the clouds and smoke. 

Naval Research Lab electronics engineer Paul Jaffe has been leading the charge on this exciting opportunity. He nicely summarized the geopolitical implications when he was quoted in Wired saying, “With GPS, we sort of take it for granted that no matter where we are on this planet, we can get precise navigation information. If the same thing could be done for energy, it would be revolutionary.”

Earlier this year China announced its intention to become the first country to build a solar power station in space. Japan has considered space solar power a national priority for more than a decade. Now that the U.S. military has gotten behind the solar space power idea and put funding in place, the U.S. may pull ahead. My house in PA vision is going nowhere, but as a country, we may be getting close to a solar farm in the solar system.

Source: How to Get Solar Power on a Rainy Day? Beam It From Space | WIRED

The vote continues to favor Hobby Attitude at more than 60% with Algorithm Attitude at less than 40%. If you have not yet done so, please cast your one-click choice here. You will see a brief summary of what each book would be about. I will continue the survey until yearend, and then update you on my plans.


SpaceX continues to be on a roll. On Monday, December 16 at 7:10 p.m, SpaceX launched a communications satellite made by Boeing from Space Launch Complex 40 at Cape Canaveral Air Force Station, Florida. The satellite weighs 15,335 pounds, making it one of the heaviest satellites ever launched by SpaceX. The satellite was deployed approximately 33 minutes after liftoff. The launch actually included two satellites launched together. This is called a condominium launch. The satellites belong to Japanese operator Sky Perfect and a Singaporean startup called Kacific. The satellites will provide dramatically improved Internet and voice communications in much of Asia. Just minutes after the launch, the stage 1 booster of the Falcon 9 landed on a barge off the Atlantic coast. Really cool stuff. In Q1 2020, SpaceX plans to launch a “Crew Dragon” capsule with humans aboard. Exciting times ahead. We will all soon have a Space Attitude. If you want to watch a video of the launch, click here.


Don’t believe everything you read about Wisconsin dropping 200,000 people from voter rolls. This is not voter suppression. When people move from one voting jurisdiction to another, they often don’t remember to notify the appropriate people. The state gains access to a number of databases from government agencies and can detect that someone has moved. A judge then mandated the state remove such people from the voter registration database. A lot of the issue has to do with outdated online systems and reliance on paper forms where misspelled names and birthdates are not detected. In Florida where I live, they have a Moter Voter law. If you make a change to your driver license or car registration, they ask you if you are registered to vote and, if not, they do it on the spot. One other point in a much misunderstood topic of voting is any Wisconsin voter who has been dropped from the voter list improperly can register to vote on election day. All they have to do is show a proof of residence, like a utility bill.


Another Meet the Author event has been scheduled for May 15 in Connecticut. Additional author events will be held in Florida during the 1st quarter of 2020 and then more back in Connecticut in the Spring. The table below shows events scheduled so far. Details on upcoming events will follow.


Date

Event

Time

Location

June 11, 2020

Meet the Author

7:00 PM

Ridgefield Library
472 Main Street, Ridgefield, CT 06877

May 15, 2020 (to be rescheduled)

Meet the Author

1:00 PM

Founders Hall
193 Danbury Rd, Ridgefield, CT 06877

Arpil 15, 2020

Origins of the Internet   with Doug Maine and John Patrick

7:30 PM with Zoom

Virtual Playhouse
by Bedford Playhouse 
Bedford, NY

March 19, 2020 (to be rescheduled)

Community Forum

11:30 AM

AdventHealth Palm Coast 
60 Memorial Medical Pkwy
Palm Coast, FL 32164

February 14, 2020

Health Attitude with John Patrick

8:30 AM

Senior Provider Information Network
2 Corporate Dr.
Palm Coast, FL

February 6, 2020

Tech Talk 9 with John Patrick

1:00 PM

Hammock Dunes Club
Palm Coast, FL
Private event: Request invite
Mail to [email protected]

November 14, 2019

Meet the Author

1:00 PM

New Fairfield Senior Center
33 CT-37
New Fairfield, CT

October 9, 2019

Housatonic Habitat for Humanity Robotics Night

5:30 PM

Crowne Plaza Hotel
18 Old Ridgebury Rd
Danbury, CT

August 29, 2019

Meet the Author

5:30 PM

The Boiler Room
Hawley Silk Mill
8 Silk Mill Drive
Hawley, PA


The gift giving season is upon us. The attitude series presents a number of choices for parents, teenagers, and grandchildren. All are available on Kindle and Paperback with gift wrapping. Amazon now has two Series pages featuring “It’s All About Attitude”. The Kindle page is here and the paperback page is here. Take a look!

Picture by Biobeat Technologies LTD

The Apple Watch was introduced in April 2015. Skeptics came out of the woodwork and said the product was going nowhere. Since then sales of the Watch have skyrocketed. Estimates vary, but the latest forecast I have seen estimates 2019 sales will be more than 30 million watches, certainly way more than the Federation of the Swiss Watch Industry shipments.

One of the drivers for Apple Watch since the Series 4 was introduced in September 2018 has been the electrocardiogram (ECG) feature. The ability to get the FDA approved equivalent of a lead 1 ECG in 30 seconds has appealed to many people, especially those who have atrial fibrillation or would like to be able to know if it appears.

A question I am often asked is when will be able to check our blood pressure on our watch. There are numerous wireless blood cuffs which can take your blood pressure and save the results on your iPhone (I recommend Qardio). I suspect Apple will expand the Health app on the Watch so you can see all health-related data on your Watch. However, the Watch cannot (at least yet) take your blood pressure. Biobeat Technologies LTD (not to be confused with Biobeats, another healthcare startup), is a Tel Aviv, Israel startup about to be changing the game. The company is promoting a new watch which includes blood pressure monitoring with no blood cuff.

Biobeat’s sensors are based on plethysmography technology. Plethysmography measures changes in volume in different areas of your body. It is typically used to test how much air is in your lungs after you take in a deep breath. Biobeat’s watch has sensors which can detect how much blood is in the veins under your wrist. The company also has a version of the watch technology which you can stick on your chest and measure your blood pressure.

The company said its products are now FDA approved and feature a cloud connectivity capability which allows your blood pressure to be sent electronically to a caregiver or healthcare provider. But wait, there’s more!

In addition to Continuous Blood Pressure, Biobeat claims its watch sensors can detect Mean Arterial Pressure, Pulse Rate, Respiratory Rate, Blood Saturation, Stroke Volume, Cardiac output, Cardiac Index, Heart Rate Variability, Pulse Pressure, Systemic Vascular Resistance, One Lead ECG (patch only), Sweat, Movement, Skin Temperature, Sleep Lab, Calories, and Time. Details are a bit sketchy, but the company claims they have FDA approval for blood pressure, pulse rate, and oxygen saturation vital signs. They further claim they have approval for all nearly twenty measurements in Europe.

Battery life for the watch is 3 days and, for the patch, 10 days.  Time will tell if Biobeats is the breakthrough in passive and continuous vital sign tracking it claims to be. The watch has a one year warranty but, if you read the BIOBEAT TERMS OF USE, you will see there is no warranty on the accuracy of its measurements.

Biobeats may be a bit ahead of itself, but I am a believer. I wrote a journal article about mobile health (mHealth) called “How mHealth will spur consumer-led healthcare” published in July 2015. I believe mHealth options will continue to expand and will ultimately lead to lower healthcare cost and improved health for those who are chronically ill.

Disclosure: I am not an investor in any company mentioned in this article.

The vote continues to favor Hobby Attitude at more than 60% with Algorithm Attitude at less than 40%. If you have not yet done so, please cast your one-click choice here. You will see a brief summary of what each book would be about. I will continue the survey until yearend.


SpaceX continues to be on a roll. On December 5, they launched CRS-19. This is the Commercial Resupply Services’ 19th mission to the International Space Station. The payload included 5,700 pounds with dozens of research packages. The research will be valuable and can benefit humanity. The types of research to be conducted cannot be done on Earth. The Falcon 9 rocket put the Dragon capsule in orbit and it docked to the ISS a few days later. Just minutes after the launch, the stage 1 booster of the Falcon 9 landed on a barge off the Atlantic coast. Really cool stuff. In Q1 2020, SpaceX plans to launch a “Crew Dragon” capsule with humans aboard. Exciting times ahead. We will all soon have a Space Attitude.


Yoshua Bengio, Revered Architect of AI, Has Some Ideas About What to Build Next. You can read this very interesting article here. You can find other articles and videos about AI on the Robot Attitude companion site at robotattitude.info.


Another Meet the Author event has been scheduled for May 15 in Connecticut. Additional author events will be held in Florida during the 1st quarter of 2020 and then more back in Connecticut in the Spring. The table below shows events scheduled so far. Details on upcoming events will follow.



The gift giving season is upon us. The attitude series presents a number of choices for parents, teenagers, and grandchildren. All are available on Kindle and Paperback with gift wrapping. Amazon now has two Series pages featuring “It’s All About Attitude”. The Kindle page is here and the paperback page is here. Take a look!

Every day, there are stories in the media about climate change. I have seen none which would make one feel the problem is not real. Based on a new UN report, Axios wrote “Nothing is happening remotely fast enough to save humanity from facing the self-inflicted disaster of runaway climate change”. The issue is how real is the threat exactly and how soon will we see a catastrophic effect? The challenge is the subject consists of incredibly complex and interconnected parts. We really need better ways to understand the full picture and how various policy decisions and goals would affect the situation.

An independent, not-for-profit think-tank which grew out of MIT Sloan in Cambridge, Massachusetts, called Climate Interactive has a solution which allows us to see what is really going on. Their PhD researchers and experts in climate and in information technology have a long history of creating system dynamics models. I studied modeling many years ago in grad school, but the capabilities of computers today were not dreamed of back then. Today, Climate Interactive can create simulations and insights which can help people see the connections between variables and play out scenarios. The models can help us see what works to affect climate change and what the impact would be on issues such as energy, health, and food.

The name of the model created by Climate Interactive is En-ROADS. They have used it to brief dozens of US Senators, Representatives, and their staffers from both sides of the aisle using the simulation. The power of En-ROADS is two-fold: it is accessible and free to all, and simultaneously is grounded in cutting-edge climate, energy, and land science. The En-ROADS simulator has been under development for more than 10 years co-developed by system dynamics modelers at Climate Interactive and MIT. 

The En-Roads tool can test climate interventions and see the effect on mitigating global warming. Users can explore the dynamics in energy supply, land-use, transportation, carbon removal, and other variables. The idea is to take the emotion out of the discussion and focus on the driving forces and the policies which dictate their behavior. To see a two-minute video of En-Roads in action, click here and play the video. To interact with the model yourself, click here. It is pretty slick. You can apply the policies you believe in and see the actual impact.

 

A recent survey of a few thousand people showed concern about the environment is inversely proportional to age. Another way to say it is young people care more about it than older people. Maybe some older folks figure if, in 50 years, we run out of food and our cities are underwater, it won’t matter. Just kidding. I think we all care and would like to see a concerted effort by policy makers to take action and work together. Tools like En-Roads can elevate the discussion.

 

Reginald Merilus is an Air Force veteran and a communication studies Major at The University of Tampa in Florida. He says, “Smartphone voting is coming, let’s embrace it”. I could not agree more. The key question is when? The current strategy of the Secretaries of State, who control how we vote, most politicians, and a cadre of academics, who I call anti-Internet voting activists, are all convinced it is not possible to have secure elections without paper. I could not disagree more. Reginald offers a simple analysis,

Election Day 2020 is less than a year away and imagine that you’re sitting on your couch working on a research paper and it hits you: You forgot to vote today. In the midst of your hectic schedule, you forgot to drive over to the federal building to cast your ballot. Does that make you a bad person? Of course not. More and more has been added to your plate.

Our everyday lives have been transferred completely onto our smartphones. When was the last time you used a bank teller versus the ATM? Today’s youth are digital natives and expect technology to improve most aspects of their lives. In our workplaces, the line between work and home has been completely blurred. We send emails after office hours. We work on group projects away from one another. We livestream class discussions using Periscope. If we can use smartphones for just about anything, why not for voting in presidential elections?

Election Day in the United States typically falls on a Tuesday and is not a federal holiday. Holding elections at the beginning of the work week limits the amount of voters who can make it to the polls. We have an obsession with work in this country that deters some people from asking for time off to vote. Being able to cast a secure vote over an app would drastically increase voter turnout. 

Reginald believes the problem holding us back from a more modern way to vote is fear. I agree and did research into this for my book, Election Attitude – How Internet Voting Leads to a Stronger Democracy. I have been predicting the move back to paper will introduce new kinds of fraud, like someone bribing postal carriers to pick up ballot envelopes from certain neighborhoods and put them in a dumpster. Our smartphones can authenticate we are who we say we are. Properly implemented, they can provide elections which are secure, private, convenient, easy, error free, and verifiable. Reginald wraps it up really well,

The 2018 midterm elections have been recognized for its high voter turnout. In 2018, 40% of voters used either voting by mail or early voting. Showing again that a large percentage of voters find it more convenient not to head to the polls. Not due to disinterest but more so due to inconvenience. Young voters just starting a career might be afraid to ask for time off from work to vote. Here at The University of Tampa, we have students from all over the country who quite frankly, probably never had to mail in anything. This doesn’t mean that they’re lazy. “Honestly, it seemed like a huge hassle between classes and fraternity stuff,” said Alia Strukel, a student at UT. “If it’s safe and done right, yeah why not.” 

I understand the fears of mobile voting, but as Ralph Waldo Emerson said, “Fear defeats more people than any other one thing in the world.” So I’m taking the positive approach believing that what allows us to progress in innovation is learning from our mistakes in the pursuit of perfection.  Hopefully, we decide to pursue smartphone voting and not acquiesce to fear. So on Election Day in the near future, instead of stressing over making it to your polling location, you’ll be able to cast a vote from the comfort of your couch. 

Congress should pay more attention to what students have to say. They are very much in touch with many of the world’s key issues. Among them is voter participation for a stronger democracy, and how people vote.

Source: Smartphone voting is coming, let’s embrace it – Est. 1933

Picture from apple.com

In 2010, at age 65, after serving on a hospital board of directors for some years, I decided to go back to school and study healthcare. I received a doctoral degree four years later. During the final year, a requirement of the doctoral program was to conduct research and publish a dissertation. The title of my dissertation was Cardiac telemonitoring for the reduction of hospital readmissions for congestive heart failure patients.

One of the key elements of any research study is the size (referred to as the N) and statistical validity of the sample you study. For my study, in conjunction with a teaching community hospital, I identified 344 congestive heart failure patients who were assessed for inclusion in the cardiac telemonitoring study. Two hundred and eighty-eight patients were excluded for various valid reasons mostly involving nursing homes, 30 declined to participate, and 10 withdrew after having been included in the study. The result was an N of 16 patients who completed the study.

The result of the study provided significant insight to healthcare leaders. It provided a basis to develop new standards of care and lead to improved patient safety and a higher quality of care. The research could also result in improved quality of life for patients and their families. However, the goal of the study was to determine if home telemonitoring could reduce the number of hospital readmissions. My hypothesis was it could. Unfortunately, the N was not large enough to provide a statistically valid conclusion.

Millions of studies and articles occur. One study of studies said 85% of the studies were not helpful. There are numerous reasons why a study may be flawed. Bias can be introduced in the way study participants are selected. For example, one reason is a study may be trying to prove something and the study participants are paid. Another major reason a study may not have valid conclusions is the lack of a big N.

A federally funded, international study, with results released this past week, found no evidence patients with severe but stable heart disease who underwent heart procedures experienced lower rates of major, disease-related events compared to those treated with medications and lifestyle changes alone. The study randomly assigned 5,179 patients at 320 sites in 37 countries to receive one of the two treatment strategies. The study was more than twice as large as any previous study of its kind. Studies with a big N can be more valid, but they are expensive to conduct.

Enter Apple, showing its appetite for keeping us healthy (and selling lots of iPhones and Watches), which has announced a new model for research. This past week, Apple introduced three unprecedented medical studies, in partnership with leading academic and research institutions, which will reach more participants than has ever been possible. The studies will be available on the new Research app, which democratizes how medical research is conducted by bringing together academic medical institutions, healthcare organizations, and Apple iPhone users. Since hundreds of millions of people have already made iPhone apps a part of their everyday life, enabling them to participate in medical research is a natural. Participants will contribute to potential medical discoveries and help create the next generation of innovative health products. The Research app is free and available in the App Store.

With the Apple Heart Study conducted a year ago, the company demonstrated it could positively impact medical research in ways which help patients today and make research contributions which may benefit future generations. Instead of an N of a dozen or hundreds or even thousands, the potential now will be N = millions. There will likely be many studies which will appear in the Research app over time. The three new studies just announced include the following.

  • Apple Women’s Health Study: In partnership with Harvard T.H. Chan School of Public Health and the NIH’s National Institute of Environmental Health Sciences (NIEHS), Apple has created the first long-term study of this scale focused on menstrual cycles and gynecological conditions. This study will inform screening and risk assessment of conditions like polycystic ovary syndrome (PCOS), infertility, osteoporosis, pregnancy and menopausal transition.
  • Apple Heart and Movement Study: Apple is partnering with Brigham and Women’s Hospital and the American Heart Association on a comprehensive study of how heart rate and mobility signals — like walking pace and flights of stairs climbed — relate to hospitalizations, falls, heart health and quality of life in order to promote healthy movement and improved cardiovascular health.
  • Apple Hearing Study: Alongside the University of Michigan, Apple is examining factors that impact hearing health. The Apple Hearing Health Study is the first of its kind to collect data over time in order to understand how everyday sound exposure can impact hearing. The study data will also be shared with the World Health Organization (WHO) as a contribution toward its Make Listening Safe initiative.
Scientist replacing part of a DNA molecule

About three years ago, I wrote about CRISPR technology, not exactly a household name. CRISPR stands for Clustered Regularly Interspaced Short Palindromic Repeats. If you read the details about CRISPR, it might make your head hurt. It is really complex. CRISPR was discovered in 2007 when a yogurt company found a bacteria which could eliminate viruses. The technology has evolved dramatically over the last few years into a gene editing technique which may become a powerful tool for the cure of cancer. You will be seeing the term CRISPR more and more in the months ahead.

Laboratory experiments have shown it is possible to literally eliminate cancer tumors. Today’s chemotherapy treatments are aimed at killing the cancer cells. Sometimes it works and sometimes it does not. The side effects can be severe. The gene editing approach is designed to modify our DNA and have our body fight the cancer instead of the chemo. I think of CRISPR technology like video editing. A video clip consists of a series of video frames. A video editor enables you to remove frames which might be irrelevant or unappealing. You then save the modified video.

Some top experts are very optimistic CRISPR may become the cure researchers have been seeking for decades. Chinese scientists have performed CRISPR gene editing on humans and have claimed some success, but have revealed very little information about what they did and what the results were. The U.S. has been more cautious and concerned about patient safety. The concern is the editing may correct a defective gene mutation but, in the process, solve one problem and create some new unanticipated problem.

This week, researchers released data from the first study involving U.S. cancer patients who received cells genetically modified with CRISPR. The highly anticipated results are very preliminary, but scientists say the results are encouraging. The study focused on safety, not efficacy. NPR reported “This is a very important first step,” says Dr. Edward Stadtmauer, a professor in oncology at the University of Pennsylvania and the study’s principal investigator. “We hope this is the beginning of the next generation of engineering cells to help many different diseases and many different tumors.”

When I first wrote about CRISPR three years ago, it was very early in development. A gene-editing trial with a volunteer teenager in 1999 ended in his tragic death. This was a setback of years, but much has been learned. The University of Pennsylvania, where the trial took place, is being very cautious but is advancing the technology. Plans include a trial with 18 participants who have sarcoma, melanoma or myeloma. The end goal of the CRISPR technology is to create living drugs which can be put in our bodies to eradicate tumor cells. Although not imminent, what I have read and heard from experts suggests it is not far away to say cancer has finally been eliminated.

Read earlier story about Chinese Scientists To Perform First Ever CRISPR Gene-Editing Trial On HumansRead more about the role of genetics in the future of healthcare in Health Attitude: Unraveling and Solving the Complexities of Healthcare.

Book #7: The response to the Survey Monkey so far is 4%. That is a very good response rate for surveys. Thank you for that. You are helping me select the next book in the “It’s All About Attitude” Series. So far, the vote favors Hobby Attitude at 57% with Algorithm Attitude at 43%. Thanks again to all those who cast their vote. If you have not yet done so, please cast your one-click choice here. You will see a brief summary of what each book would be about.

The OCLC board meeting took place in Dublin, Ohio during Saturday, Sunday, and Monday. From there my wife and I flew to Boston and had dinner with one of our sons who works in Boston and our oldest granddaughter who is a student at Northeastern University. The following night we enjoyed the Boston Symphony Orchestra concert and then nearly froze walking back to the hotel. The next day we drove back to Connecticut.


Another Meet the Author event was held on Thursday at the New Fairfield Senior center. Audience participation was great and I was pleased to donate 100% of the book sale proceeds to the Senior Center. Additional author events will be held in Florida during the 1st quarter of 2020 and then more back in Connecticut in the Spring. The table below shows events scheduled so far. Details on upcoming events will follow.


Later that evening, I was fortunate to attend a Singularity University event at Ridgewood Country Club. Bob Reby, founder, president and CEO of Reby Advisors, a financial planning firm in Danbury hosted the event. Founded in 2008, the Santa Clara, California-based Singularity University promotes itself as a “global learning and innovation community using exponential technologies to tackle the world’s biggest challenges and build a better future for all.” Mr. Reby had a fireside chat with Dr. Sam Gandy, an international expert in the metabolism of the sticky substance called amyloid which clogs the brain in patients with Alzheimer’s. The discussion was very encouraging. I’ll write a future post about it.


Amazon now has two Series pages featuring “It’s All About Attitude”. The Kindle page is here and the paperback page is here. Take a look!

Amazon CEO Jeff Bezos, J.P. Morgan CEO Jamie Dimon and Berkshire Hathaway CEO Warren Buffett last January announced they were teaming up to tackle rising health-care costs. In the year the nonprofit company has been without a name, people have started calling it “ABC.” It’s now called Haven. Source: Amazon, JP Morgan, Berkshire Hathaway health-care venture named: Haven

In August 2018, The Wall Street Journal reported major tech companies had signed a commitment to “share the common quest to unlock the potential in health care data, to deliver better outcomes at lower costs.” The companies, convened at a White House event focused on healthcare technology. The group included Amazon, Google, IBM, Microsoft, Oracle, and Salesforce. Apparently, Apple was not at the meeting, but is quite active in healthcare, much of it centered around its cardiac monitoring program with the Apple Watch and the Apple Health app.  

The promise the companies made should help accelerate the emergence of a data-driven revolution in healthcare. Patients, providers, payers, and researchers all need easier and more compatible access to health records in order to enhance patient safety and lower the cost of healthcare. Unfortunately, healthcare data today is stored in silos at providers and payers. In large part, our healthcare data is locked up.

In theory, patients have access to their health data since the Obama administration distributed $30+ billion in incentives for the creation of patient portals and electronic health records (EHRs). The reality is quite different. Most people over 65 have multiple providers. Consolidation has occurred and many hospital networks have a range of services. However, some of the sub-specialty providers, such as urology and dermatology, remain outside of the networks. In addition, standalone practices in orthopedics and radiology have their own EHRs and portals. Another factor adding to the complexity is many people choose to get a second opinion or comparison shop on services such as radiology. The result of all this fragmentation is patients don’t have one patient portal, they have multiple. I have 15. Nobody in the team of providers has a total view, including the patient.

Healthcare records are incompatible between providers. Even worse, you can look at test results at one provider, but you can’t easily download or email information from a record to another provider. You also cannot sort or search your health data. The bottom line is EHRs have become a train wreck. It is a tie between patients and providers as to who dislikes EHRs the most. EHRs are a failed promise. We can’t live without them, we can’t live with them.

G. W. Bush hired a Chief Information Officer to fix this problem more than ten years ago. The CIO knew how to fix the problem but could not pierce the armor of special interest groups who wanted government to stay away from the issue. The CIO resigned in frustration. The current head of HHS, Alex Azar, is saying all the right things but is also having trouble getting past the special interest groups. The bottom line is government has been completely ineffective in solving the healthcare data and related cost problems. Now it is time to see what the tech giants can do.

I am optimistic the promise made by the companies mentioned above will be successful. There are a number of reasons for my optimism. First is healthcare cost has risen out of control to the point where it is nearly 20% of the economy. The tech companies are not startups. They have hundreds of billions in revenue and millions of employees which cost the companies billions of dollars for healthcare. They are motivated to solve the healthcare problem. The second reason for my optimism is technology. Cloud computing and AI have risen like a rocket ship. I believe they will be able to bridge the silos and make data access easier for all. Apple, for example, is making great strides to incorporate EHR data into its Health app.

Security technology has evolved to provide anonymity and protection of the data. Equifax and others have shown their incompetence in this regard, but the tech giants know how to do it. Lastly, mobile technology has advanced rapidly. With finger prints and face prints, they offer strong authentication. Mobile apps are easier to use. Banks, travel companies, food services, and many other segments have developed mobile apps which are easy to use and way better than their websites, except in healthcare. I expect Atul Gawande, CEO of the new Amazon/JP Morgan/Berkshire Hathaway healthcare company Haven, to become a shining light to help rally all the tech companies to work together. They are fierce competitors, but the motivation to solve the healthcare cost problem is huge. 

The Wall Street Journal said, “The Trump administration sees better use of health-care data as a key to unlocking savings and holding down costs while improving outcomes.” Seema Verma, Administrator of the Centers for Medicare and Medicaid Services, said, “We want to lean into technology and use it as a potent force to create more efficiencies in our system.” I believe the tech giants will help make this happen.

Another reason for my optimism is Atul Gawande. I first met Atul in 2012 at an event in New York held by The New Yorker. He gave a brilliant and inspiring talk. I have read all his books and follow him on Twitter. He is an incredible physician with superb communications skills. The following are the guiding principles Dr. Gawande stated for Haven:

  • We will be an advocate for the patient and an ally to anyone — clinicians, industry leaders, innovators, policymakers, and others — who makes patient care and costs better.
  • We will create new solutions and work to change systems, technologies, contracts, policy, and whatever else is in the way of better health care.
  • We will be relentless. We will insure our work has high impact and is sustainable. And we are committed to doing this work for the long-term.

Most of the politicians talk about healthcare coverage, but few talk about healthcare quality and cost, which are the real problems, especially cost. Congress continues to stand in the way of addressing the cost problem. Haven has the right vision and I believe others will join the effort.

Book #7: The response to the next book in the “It’s All About Attitude” Series survey has been very good. So far, the vote favors Hobby Attitude, but not by much. Algorithm Attitude is very close. Thanks to all those who cast their vote. If you have not yet done so, please cast your one-click choice here. You will see a brief summary of what each book would be about.

Meet the Author events will be held during the 3rd and 4th quarters of 2019 and the 1st quarter of 2020. The table below shows events scheduled so far. Details on upcoming events are below.


Wifigen’s crowdfunding campaign continues to gain momentum. The first customer of Wifigen has now made an investment! One early investor of $10,000 has invested an additional $5,000. There are just shy of 80 investors, and the total invested is very close to the $50,000 minimum goal. Investments have ranged from $250 to $15,000. Wi-Fi is great but, for owners of a cafe, deli, pub, coffee shop, restaurant, hotel, or other retail establishment, Wifigen can make it even better. Check out the status of the campaign and how to invest at Wefunder.
Amazon now has two Series pages featuring “It’s All About Attitude”. The Kindle page is here and the paperback page is here. Take a look!

(file photo) ( Getty/iStock )

Research scientists at the University of California San Diego have created a robotic lens which can be controlled by small eye movements. For example, a double blink can cause the lens to zoom in. This amazing innovation was made possible by the discovery of a natural electrical charge in the eye called an “electro-oculographic signal”. The new lens is made from polymers which can expand when an electrical current is applied. The lens has five tiny electrodes surrounding the eye which can act like muscles. When the eye blinks, the signal is applied to the lens and the lens responds by becoming more convex. The result is the lens in effect zooms in. 

Researchers hope this breakthrough technology will have the potential to lead to prosthetic eyes, adjustable eyes, an eye camera which could be controlled using just the eyes, or even controlled remotely. 

Source: Robotic contact lens that allows users to zoom in by blinking eyes revealed by scientists

I read The Singularity Is Near: When Humans Transcend Biology by Ray Kurzweil in 2006 and started writing about it in 2013. Robot Attitude has a section about the Singularity and Ray Kurzweil and describes how robots are becoming more like humans and we are becoming more like robots. The robotic lens is one more of many examples. If you are curious about the Singularity, read Robot Attitude: How Robots and Artificial Intelligence Will Make Our Lives Better.

I have been thinking for some time about the next book in the “It’s All About Attitude” Series. I have two ideas and would love to know your reaction, so I made a simple one-question SurveyMonkey. I would appreciate it if you take a minute and cast your one-click choice here.

Meet the Author events will be held during the 3rd and 4th quarters of 2019 and the 1st quarter of 2020. The table below shows events scheduled so far. Details on upcoming events are below.


Wifigen’s crowdfunding campaign continues to gain momentum. The first customer of Wifigen has now made an investment! There are more than 70 investors, and the total invested is approaching $50,000. Investments have ranged from $250 to $10,000. Wi-Fi is great but, for owners of a cafe, deli, pub, coffee shop, restaurant, hotel, or other retail establishment, Wifigen makes it even better. Check out the status of the campaign and how to invest at Wefunder.
Amazon now has two Series pages featuring “It’s All About Attitude”. The Kindle page is here and the paperback page is here. Take a look!

Photo by the University of Maine

The University of Maine has printed a 25-foot, 5,000-pound, fully seaworthy boat using the world’s largest 3D printer. The 70 feet long printer uses plastic polymer pellets to form the “ink” for printing. It consumes up to 500 pounds of it per hour. The boat was printed in one solid piece resulting from non-stop printing over 72 hours. It cost about $40,000 to produce.

The university’s Advanced Structures & Composite Center printed the boat but, more importantly, has demonstrated how the huge printer can create large prototypes which can be valuable for product development at companies in many industries. The printer can spur innovation and decrease time to market compared to older methods.

3-D printing is becoming ubiquitous. From a 25-foot boat to human implants, the technology is leading to lower costs, better products, and even longer human lives.

Source: You’re gonna need a bigger boat? UMaine has printer for that

 
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