Cochlear Center Seminar Series - January 2023

here um as always I'll go for a few logistical clients and I'll give a brief intro to to Jeremy and Peter after having here Dr walson but I don't think really any introduction if I'm going to give a brief one and then we'll go into the um we'll go action to the seminar um all right so Logistics um as always uh [Music] uh um if you're join us in person we'll do a q a afterwards there's closed captioning provided in Zoom for those who are online uh seminar is being recorded and then if you're already by zoom and there any questions or concerns uh you can chat in some monitoring the chat constantly uh or you can directly email the email addresses all being put in the chat right now as well um so this is getting toward the tail end of our seminar series for this year and um we're really thrilled to have Jeremy and and and Peter here uh but I want you next month we're having one of our actually our only version of this year like our second version this year um Alejandro Cabela Lopez who um who uh uh who is known um uh to us through uh for Pablo Martinez uh we'll be talking uh uh a virtual talk about some of the work he's been doing around hearing and occupational health um then in March uh we have David Green who you guys may know he's a he's actually um a social entrepreneur one of the mccarthur fellowship many years ago for his work pioneering sort of a social Enterprise around how you deliver Vision Care uh in India and has been moving a little more into hearing now for the last several years as well um and finally in April really excited for our research day you guys know we've been here for several years but our first in person almost several years ago and then when virtual lash was of a hybrid digital going back fully in person again uh we're really excited to have the vet swim pool who is sort of follows along I would say um uh David Greensville where he's an audiologist really a phenomenal researcher who's also social entrepreneur found a company called herex now which may have heard of which we actually use our products a lot of our research um he'll be joining us from South Africa uh we're mixing of the day usually the past as you guys may know in the mornings we had the source Center faculty getting the overview talks of what they've been doing and then there's a keynote there's a closer session after all the trainees and then dinner that night this were mixing up so the morning talks will be actually not only by core faculty anymore they'll be just won by by Carrie Neiman who'll be talking about the here study which is relevant to uh the vet but then we're inviting a lot of our collaborators who've previously are working with us right now to deliver talks so they'll be um uh Justin galloup who was an ENT surgeon at Columbia who uh has developed a sort of a trial which is similar to achieve but a little different I'm talking about that uh Sarah Memo from UMass Amherst who was previously one of her fellows here has been doing a lot of intervention work for how you deliver a hearing intervention in the pace communities which is basically um sort of Independent Living order adults but in a sort of a subsidized program run by the government but how you deliver hearing communication issues or how you tackle that in the community and finally um Nicole Rooney who's coming from University Arizona who's focused on how you develop how you train from the tourists Community Healthcare workers on the Mexico Arizona border delivery hearing here so the theme uh for the research day which is around sort of intervention classically outside the box outside the booth per se and really then headed up by then by uh by debt um and for the new talk um and then you guys are here you guys will be hearing more about that in the next few weeks because there'll be registration links going out it's only going to be in person we will record people can't really makeup it won't be live streaming personally for a whole day of lunch and breakfast and and different activities so stay tuned for that um all right so um I I promise I'll give a brief intro and the reason why I think it's important is because Jeremy I don't know if you remember Jeremy was um one of the first uh people I met uh when I was coming on faculty uh 13 years ago and Jeremy voice were considered to be sort of The Godfather of everything uh gero science geriatric related because uh German you really got me started actually so um Jeremy got me set up at KOA Center Asian Health many years ago when I was looking for academic home because I was sort of a black Cuban ENT I was interested in broader EPI and aging there was no one else doing it uh certainly not ENT so Jeremy got me started at KOA many years ago I think Jeremy has served in a similar role for many many other faculty and trainees over the years as sort of the person in all all roads lead back to Jeremy in many ways um so Jeremy is a professor of geriatric medicine in in the department of um apartment medicine but in the division geriatrics he's also the pi of the older American Independence Center which was how I got involved with them through many years ago and now he's also the co-pi with with Peter of the artificial intelligence and technology collabs which we hear a lot more about Peter abadier similar a associate professor of geriatric medicine I'll take many roads also lead back to Peter over the years too and if you don't remember the first I ever met you was in the because of the basement of Jeremy's house when you had I think a holiday party and so first I met you and your kids I still remember this it was like over a decade ago but I'd always throw every name I remember being your first time when your kids were very very rambunctious I remember um so um Peter and Jeremy are historically and traditionally based on the Bayview campus which we hear all about where a lot of Asian research happens so we're really thrilled they were willing to come over here and enjoy this person Jeremy says his first time this building actually over three years since before the pandemic so um welcome back Jeremy thank you all right thanks guys foreign thank you Frank thanks uh for inviting us um I I think uh I remember praying very well from early on because I saw so much potential in his work and and how important it was in our older patients so to hearing loss and and all those sort of questions related to that and how it connected to the brain and cognitive decline and all sorts of other things so I spent most of my career uh working on the syndrome of Frailty which is a late life condition of of that decline that we have worked to diagnose over the years and I've sort of used as a research model to figure out some of the biology that underlies uh Frailty and late late decline so over the years as Frank mentioned I've worked to kind of aggregate people together and on important topics in aging and um I think the human aging project that I'm going to talk about is really a a huge group effort of pulling all sorts of people in from across schools at Hopkins and focusing on some of the important issues in aging really in the biological and Engineering space for the most part um so first I'll just a quick big picture of aging and I'll talk about the human aging project and sort of the biology engineering and clinical translation arms of that and then Peter's going to talk about more of the engineering Alliance that has come along in the last couple years and is really starting to pop as well so um we certainly welcome collaborators and there's some opportunities that I'll talk about at the end for people to apply to so um so as as you all know the worldwide population is rapidly aging uh across across the world so I don't I didn't think I'll really get into that much but what we've noticed um in in geriatrics practice for a long time as you see these kind of this period of Life uh where people are declining uh there's still maybe cognitively intact and maybe having start to have some functional impairment but we're always trying to figure out what it is that's driving people into this later life stage of being more disabled more more dementia uh and uh sort of loss of Independence so we've come at it from a biologic standpoint and from a more recently an engineering standpoint to try to figure out um ideologies but also to think about Care Management treatments Etc so this is a way that we often describe it that read the the black lines there or the ages of death you see in 1900 the black line of the peak was in the early 70s and in 2016 for women it was in the 80s mid 80s and that red and pink shaded area is sort of the period of life where people are beginning to have functional and cognitive decline and what we are trying to do is to try to push that back so imagine you know people living out into their 80s and 90s and making trying to make sure that they have as much Independence and functional capacity cognitive capacity as possible we're not trying to get people to live forever but to help them have a great um latter third of life I guess in college so the human aging project is something we've developed in the last few years it's really a transdisciplinary multi-school organization that really supports a Federation of Aging focused research programs and Scholars students from medicine public health engineering nursing and increasingly business as well it's sort of built around these basic pillars of biology engineering and clinical translation so taking biology and biologic discoveries related to aging and figuring out what it is about biologic aging that makes older people get so many illnesses what makes them Drive some of the declines same with engineering order more on a sort of a care hair planning maybe some Diagnostics but also helping take care of older people in their homes or wherever it might be the focus really is on healthy aging and sort of improving Health span lifespan and Wellness so two terms that have emerged in geriatrics and aging research over the year the recent years of this gyro science initiatives really focusing on age age-related biologic changes and um kind of again tracking them into preventive or treatment strategy strategies for chronic diseases that are common in older adults also geriatric syndoms like Frailty sarcopenia mild cognitive impairment hearing loss could certainly go into that category because there's probably a lot of common biologic Pathways that are driving all of these outcomes that we see and then zero Tech initiatives using Ai and engineered Technologies to to help with Diagnostic and also with support for caregiving services and again with the eye of improving the health span over time so we think Hopkins has been uniquely suited to this kind of program and that we have these translational programs that bridge world-class aging research programs to biology and bioengineering programs we've worked to kind of bring that together closely we have these great Partnerships and public health nursing business school and then more recently business partners and the Giants Hopkins Tech Ventures Group which is down the street here eager to work and invest in these spaces we found that there's been a lot of in interest from the community and from from uh Venture capitalists and to try to kind of get into the space because they see the potential of of some of these uh areas of Investigation so we're at Bayview uh again which is on Eastern Avenue about two miles from here um and really it's been the home of geriatric medicine almost all of the Aging clinical work is done there and also the um a lot of the research that we do in biology and increasingly in engineering we're probably going to have a new facility over there in the next few months and then connecting these things to Patient populations we have a big register you have about 600 older people that volunteer for studies they come in for a whole range of things and we tried to bring them together there and this is just a high level view of it the hospital is there there's all these different programs from the human aging project to the biology of healthy aging program education center memory and Alzheimer's disease treatment center PACE program which has older people coming in from the community for like a daycare center where they get lots of health care and other support and many other programs and importantly at the top there you see that biggest building that's the National Institute on Aging they have their program an extramural program or sorry intramural program on the Bayview campus so a huge group of scientists lab-based scientists clinical scientists working there and and collaborating many of them are in the division of geriatrics with us um so just again big picture of the kinds of work we're doing in the um in the human aging project so we've been really lucky to get all of these big grants over the years and so I underline the areas that we've been able to kind of fold together so the pepper Center that Frank talked about we the focus is on Frailty trying to figure out what the underpinnings are of Frailty and how to better manage it so that's the older Americans Independence Center and again the focus focus is on Frailty uh resiliency is another one so we've we've been trying to identify what characteristics make some people older people respond um uh better to treatments and to clinical treatment so imagine an 80 year old coming in for a stressful medical procedure like a surgery a knee replacement surgery for example and some people do really well afterwards and some people do really poorly and we're trying to figure out what the biologic differences are so we can kind of head off some of that stuff so that's a big Grant in that area Peter will tell you about the aitc we have a group that's working on vaccines they did a lot of work during covet and trying to figure out why it is that older people don't respond as well to covert vaccines or to influenza vaccines while they get sicker when they actually get the viruses what's different about their immune system so that's another big area and then working with folks on the Homewood Campus of bioengineers thinking about cell shape so imagine a cells age they change their shape and it actually really changes the way they function so it's not just that they're older they're actually there's some modifications happening in some of the proteins that kind of I think like they're kind of wrinkling up in a way and the genes that get expressed out of them are become very different and so that Grant is uh focused on on trying to understand and then we have a training uh program as well so last this launched in really in 2021 I mentioned Sean Center on aging and immune remodeling the hap Scholars which is a program for mid-career faculty gerotech incubators that Peter will talk about in the aitc um the hap scholar system is example of the kinds of people and science we're supporting you see this kind of wide variety of people from medicine uh engineering nursing um the top row there like Alex for example is working on Parkinson disease but we see a lot of similarities as people age their gait becomes a little bit more parkinsonian you probably have noticed Joe Biden walking and he's got a little bit of a shuffling gate and it doesn't have any full-bone signs of Parkinson's that are obvious to somebody watching but there there's probably some aging related changes that are similar so Alex is helping us think through that and maybe ways to to help prevent some of the gates that make people more likely to fall for example uh Rasika is a great genetic epidemiologist with a joint appointment in public health and she's really an expert at pulling together all these Olmec platforms so metabolomic proteomic genetic genomic data and sort of making sense out of it in a complex disease States but increasingly related to aging Thomas Cujo is working on social isolation in older adults and and how that changes their biology and makes it more vulnerable and then the the bottom row there nursing uh medicine and Engineering these three are working on the gero tech initiative that Peter will tell you about and then the newest Scholars Esther L works on delirium hiromi Sasaki works on mitochondria biology here on this campus at Sean Lang I mentioned about the vaccine studies so yeah this is really not all that relevant but we are working towards getting this new engineering space and and some New Foundation money to really boost up some of the biologic studies and I'd be happy to come back and talk to talk more about that but um importantly the new engineering programs and that's probably where there's the most overlap with the things that that you all are thinking about or working on and I'm going to turn it over to Peter uh to talk about that we've got these programs a nice big Grant to help us roll this out and we were very lucky we got we got this along with UMass and UPenn for the first three Awards in the country so Peter thank you Dr Lynn for inviting us and uh honored to be with you here uh as you have seen I am a geriatrician I'm a clinician trained in taking care of older adults I also have a second appointment in the School of Engineering I have absolutely zero credentials in the School of Engineering but it sounds cool and I thought my dad who's an engineer how hard Could It Be I'm now a professor in the School of Engineering and I didn't even need to go through the School of Engineering um so I'll tell you how I got there and I want to start first by putting this picture in your heads uh have you guys seen redwood trees before redwood trees are the tallest trees on Earth 35 stories high and as an engineer I can tell you that in order to build a building that high you need one third and foundation so you need whatever five six uh stories down in in Foundation but truth is those threadwood trees have only roots that are five to six feet deep so how do they stay standing is they you will never see a redwood tree solo they always come together so it's a tribe of redwood trees they build their strength from the roots they enter twinkle they come together and they support each other providing strength to each other and this is exactly what we're trying to achieve here in the human aging project and this is what's relevant uh to to this presentation is that we would love to build that uh interconnected network of redwood trees clinical geriatrics doesn't have to have all the engineering and hearing and everything done in geriatrics but our strength is from working with you and so with that I will highlight things that would love to see more from you coming to that to work with us on that so um as Jeremy mentions uh during the past 100 years to have seen increased number of older adults that are living to middle of their 80s and 90s and with that gain on the life on the lifespan uh Frontier came some opportunities and I'll call them opportunities because as the longer they live uh that we started to see more syndromes that comes with aging with living longer incontinence Frailty uh multimorbidities polypharmacy you see a lot of medications transitions of care lifestyle social isolation you name it those are all areas that are fertile and ready to put a lot of work on on the other side there was an explosion of AI and Technologies and somehow there was no direct flow from the capillary from the Venus to the arterial sign or using this figure to show that even though that there is a capillary network but platform doesn't organically happen and why is that because of many reasons first is that clinicians geriatricians and they view you guys live here Engineers live in Homewood campus the crosstalk doesn't happen organically so this is one reason that this doesn't doesn't occur others unrealistic expectations we think Engineers can build anything and uh that's not true in Practical Technologies and I'll use a quick example so this is an example from the advanced physics lab they were showing this thermometer that can measure body temperature to the seventh decimal and as a clinician this sounds interesting but completely irrelevant I mean I don't even know what to do with uh the the 97 so to give me six digits after that I don't even know what to do with it so those are kind of things that we try to avoid when we bring teams to work together so this artificial intelligence and technology collaboratory is one of three centers Nationwide we are here at Hopkins the second is a new pen and more focused on dementia and the third is a new mass and this is more industry and Technology built up platform it's as the goal the overarching goal of the aitc is exactly red with three uh metaphor build and ecosystem allow uh redwoods from different schools engineering nursing medical school to come carry business school to come together and build that system that allows us all to serve older adults why and this is more important because there is nothing more noble than serving older adults so this is the rationale for building this bring everybody and put them to develop new technologies this is a huge deviation from previous Nia efforts to put grants Nia in general is a a vasel they don't want to put any risk in order to get a grant you need to prove by 95 that everything is going to work exactly how we told them that's going to work and I said we tried that we want something different we want Technologies now in two to five years we want to see more stuff in the market for the service of older adult switches this you have to take a huge risk in order to get that accomplished so this is the basic um our Center is the three copies myself Jeremy and Dr ramachalapaho is described as the father of AI Dr shilaba was talking about artificial intelligence back in the 70s when people didn't even know what computers were so this is an exaggeration but to that to that extent our Center has uh eight cores and those course are uh directed by a clinician and an engineer each score most of the course are directed by a clinician an engineered to be true to the principle that we want both the clinical and Engineering aspects in each of those course and I'll take you quickly but you can see some of the uh of uh that our colleagues and faculty from the school of medicine and the School of Engineering and I'll go through them in one in one minute I want to show this figure because it's important that to see the structure and that we built the aitc to go through the different course and I'll take you through the process of finding a problem to developing a pilot because I think this is relevant to you when you start thinking about how can I work with the aitc that you will find this very helpful later on but we have basically the Pilot Course A and B A is Alzheimer's dementia and pilot core B is aging we have a networking and mentoring Port led by Dr Phil fan uh who is a care business school Professor technology identification and training course led by Alicia arbai and Dr Mathias uh who is an engineer data integration and quality all technologies have data component in it so that idea that any technology to be developed have to speak one language so that in five years from now we have no issues with data harmonization and I is going through a lot of trouble now to try to make for jumping stop to metabolomics to talk to physiomics whatever it is so in order to be ahead of the game we need to develop this one language that everything feeds into uh stakeholder engagement core led by Dr Nancy Sean Bourne and Thomas kuju who is basically uh driving the initial selection of areas of importance to work on and I'll go through that in a second I direct with Dr Ramesh Lab at the clinical translation validation I'll show you in a few seconds we work with multiple centers and this is just an example of some of the centers I would love to have the cochlear Center there we work with the Alzheimer's disease Research Center the older American Independence Center the officer because in different parts so Iowa is one of those rural health centers that are part of our aitc because the Nia Institute clearly we don't want something we don't want an academic experiment we want real stuff that is can be used at Rural America as well uh robotics Sensations language of speech and processing the Malone Center Palazzo centers contributed to this and what are we looking for so technology is basically we use vague terms technologies that will help increase independence of older adults it can move from Diagnostics so early identification of older adults to Patient Care and engagement to caregiving and Workforce and this is emphasized in our goals of the center to system management and administration so things if you think of Designing a place that is more friendly for older adults so that they can achieve their goals of Independence that's part also of the interest of the center uh so those are the two of course uh I want to take you through this and bear with me as I explained this so the first thing is that Alicia and uh I'm sorry Dr Nancy schoenborn and Thomas Cujo will get together with key stakeholders his stakeholders are patient advocacy groups representatives from different disease organizations Alzheimer's disease uh any of those organizations that are focused on older adults um groups of advocacy in in the country and come up with a list of things that are really important for older adults rank them and start building our areas of interest and the first RFA those are the areas we want to see new technologies developed for older adults this moves to the second quarter so once we come up with that list and identify top areas that we want to see in the first year moves to the technology identification and training board this is led by Dr Alicia arbagi a geriatrician and Dr Mathias who is an engineer and their goal is that they will take the first lesson and identify new AI technologies that can be married to that list not only that but identify Engineers companies clinicians that work in those areas to create a database that allow us to keep building our troops then we move to sending a request for proposal this is the areas we are interested in some of the technologies that we would love to see developed more goes through the admin core because for proposal goes Nationwide and then we score and rescore the applications to identify winning applications a winning application can be going to physical aging which is frailty directed by Dr Walston and Dr Suchi Saria or Alzheimer's disease directed by Dr najim de haq and Dr Quincy Samos and Dr Estero those are real world Pilots what about technologies that are not yet very well developed well there's something called clinical translation validation you have an idea you have something that looks promising but it's not ready yet for piloting we have in-house Studio that we use to develop the new technologies for older adults and currently we're working with Dr Lin and uh and uh to to to to put hearing as part of that in-house studio so I will show you some of the very very early development of that in-house Studio uh we were in extensive networks we have the School of Public Health we have also Kerry Business Schools really involved because any technology if you think about it that if you want this to go in the market in two to five years you know uh Finance is market analysis development all that has to be figured out early on so we have Consulting teams that were included sometimes um I talked about the Precision medicine analytic platforms all the technologies have to be able to connect to the common data and Dr Chris shoot has been instrumental in driving that harmonization of data um a lot of speech and Robotics and sensing so I'll spare you the details but I'll give you some examples of the interest how thirsty it is the field for working for older adults so when we send the first RFA application and the second so so far we had two rounds of applications accepted and funded a few of them UMass got 146 you pay 151 our JHU 195 applications from Academia and does Academia Hopkins and outside Hopkins industry and startup companies that want to develop new technologies for older adults that is someone made me very very very happy that we are able to have such an impact and of course was even more happy that we have much more than you can and U.S um so some some of the examples of the initial Pilots that uh that funded so device to enhance deep sleep and older adults I want to show you this because this was an internally developed it went through some of the translation validation and then I made it because it was uh successful it made it to get a full pilot from the aitc robots to assist caregivers through early detection of agitation and behavioral changes you know Alexa can see you Alexa can hear you Alexa can do much more if you allow it to do more people that I think as has a future balancing gate devices uh and of course this is right at the core of of hearing uh virtual reality engagement tools social isolation is a big deal for older adults especially nowadays with uh with covid and uh and all all people stuck at home virtual uh smartphone diagnosis cataract very very interesting way to use AI to diagnose cataracts using a cell phone and then I program in the emergency department identified to develop to identify high-risk older adults a few of those this is an AI based facial expression analysis software and that it is integrated with an autonomous navigating robots that will visit nursing homes and detect education so you can imagine this thing moving around and just uh seeing people around and detecting agitation so uh I'll tell you a little bit more about this Sequoia this is about that observes uh behaviors through the Apple watch and it provides fall and wondering alerts and this is a virtual reality platform so this is our artificial intelligence and Technology collaboratory I'll move to the general Tech incubators program but before I confuse you the AI TC is meant to sponsor research Nationwide or faculty or companies from Academia go to the Grassroots students because I believe that our students are the best students the general Tech incubators program is meant to bring students from four schools School of Medicine Gary business school and School of Engineering and the nursing school to form motor units working together to develop technology so you can see see the difference between the two yeah ITC is more for developed Technologies General Tech is meant for students that have interest in working in aging and then put them to work together in teams and come up with a technology for older adults we have some thematic areas including fault prevention remote monitoring and those more of a guidance not really set and concrete so we are interested in Technologies for older adults but just to help them fall into some of the funding buckets after they develop the Technologies uh we we developed those thematic areas um it's directed by four uh directors from the school of medicine myself School of Engineering in najim De hark School of Nursing Brian uh Hanson Dr Brian Hansen and from Kerry business school Kevin and Frank and it is funded through uh the human aging project that has the center for Innovative medicine and the School of Engineering and you know Hopkins once they put money on we know that they need business so this is why I wanted to mention that each unit is made of three to five engineering students a resident or a student a medical student a nursing student and a business student and it goes in multiple phases so the first phase engineering students working with the medical student and identifying an area they want to work on but I'll let one of the engineering students tell you about that in a second and it's mentored by faculty mentors this is an example of our first team five Engineers Christina Janice summer Josh are Engineers Rachel is was an Osler resident that worked together to develop this first Geotech incubator and I don't know if that's what foreign important you need to be assessing four really main quadrants the clinical needs the commercial needs the technical design and feasibility and the Strategic and organizational structure of the team you're working with um or the financing and resources you have and so this is my amazing team I'm comprised of Christina Janice Summers Spencer and Rachel and I'd now like to kind of tell you about the process and our average day when we started working with the Geotech incubator program so Dr abedir and our terrific advisors gave us the opportunity to go into over 20 clinical or nursing sites from the emergency room nursing homes and memory clinic and so on and so forth inpatient clinic and every day our day would look something like this we would go in Shadow clinicians physical therapists nurses and jot down a lot of notes and trying to identify problems they were facing or pain points then at the end of the day we would compile all those notes mind map no Solutions and mind mapping was a process for us to really understand what is going on and really process all the problems we were observing and it gave us an opportunity to dive for do further research into the field and also gather more insight then from mind maps we would formulate needs and needs are just a refined way of stating problems so you can design towards that problem in a very very uh focused way and so this is an example of one branch on our crazy mind maps that would look kind of like Roots so if you can see here from left to right is the process of us really extracting um the whys and understanding the root cause behind an issue so this was from a caregiver interview I had this past summer in the emergency room and talking to that caregiver I learned that the caregiver was spending 16 hours a day taking care of his mom and they were working night shifts in order to keep her out of nursing homes and they were just so frustrated with the caregiver Assistance programs in Maryland that they actually were looking into moving to other states and so we kept on asking why why why and formulated this need that older adults need a way to receive help in their homes in order to prevent hospitalizations and admittance to nursing homes this is one need of over 200 that we actually developed over the summer despite of the jarotek incubator program and so where are we now out of all those needs we ended up focusing in on cognitive decline on the memory Clinic was one area that we were constantly in and really personally gravitated towards and saw a lot of issues and specifically we're focused on enhancing sleeps to improve cognition in older adults and the reason why I sleep in the geriatric population is a complicated issue it's fragmented less synchronized they spend less time in it and they spend less time specifically in deep Sleep which is the phase of sleep where you feel more restored in fact this phase of sleep deep sleep are also known as slow wave sleep is responsible for memory consolidation hormone regulation a variety of other physiological factors and there's a growing body of evidence connecting slowly sleep to dementias and Alzheimer's and the current intervention landscape space that we observed while in the memory Clinic is their Pharmaceuticals there's sleep hygiene and there's other forms of stimulation that weren't very affected Pharmaceuticals pose a lot of problems because this population's on already a lot of pharmaceuticals and so you have risks of Adverse Events sleep hygiene doesn't really directly enhance this phase of sleep and so where we're focused on right now as that project we're actually prototyping right now I just want to thank you all so much for the opportunity I'm going to hand this back to Dr abadir to present some of our work this is a program I'm incredibly passionate about and I just could not be more honored to be working with this Fantastic Team thank you all so much so I wanted to present this to show you that um the process itself and that's the excitement that you get from working with those Engineers it is interesting that they come to you with chips and wires and you feel like they built something in their garage but that started with an idea noticing a problem you know the dean of scope of engineering said that I want my engineering students that he said that they are the smartest in the country Whiting School of Engineering is the top engineering school I want them to go and unpolluted and unrestrained unfair problems and solutions I'm polluted I don't want you to tell them what's wrong don't tell them that this is the area that you need to work on well we do sometimes but under straight don't tell them how to fix it because quite honestly if you knew how to fix it you wouldn't have been in this issue so really excited to work with those uh with with the students and it just what I was asked once what how much hope you have in developing those Technologies and I shared a slide that I don't have here I asked each of the general Tech incubators to tell me why did they want to work in aging one of the groups came back with a slide of all the students carrying pictures of their grandparent or grandmother or a loved one and they said this is why we're doing this and I do see a lot of Hope and that when we have students that are that passionate in serving their older adults I think there's a lot of I'll end up in the last few slides with the in-house studio so we're building this in-house solution to develop new technologies and we have machines that are AI equipped to capture signals of aging and I'll take you through it quickly so this is working to say that you know that all naive thinking of a patient is all praying for all year or all art or old muscles is very naive the person is made of physical cognitive and psychosocial and they all talk to each other all those systems so working with Dr najim dehat Dr lauriano and Dr chenley zoo we are building this new lab that allows us to use wearables and not wearable Technologies to assess changes in aging so I want to show you this this is uh the working with also teams from the FDA and if you don't know FDA has their own research arm with interest in assessing how fast and picking up on early signs of physical decline in older adults so this is a map that allows people while they work on it to be assessed on their walking speed and that only how fast the person walked but it gives terabytes of data on hesitations that gave the shuffle where they are pressing where they are not pressing their balance a lot of that it's equipped with a camera on one side and the other to annotate the physical wearable signals so you can also see that the future that I want to build for you is that when you go visit your physician your primary care physician that there are cameras that are watching how fast the patient moved listening to the articulation assessing for hearing assessing for a visual eye movements and coming up with early prediction of things that can be worked on when a patient comes with a phone it's too late to do some stuff so if there is a way to in every visit get a more uh objective assessment of physical cognitive and psychosocial status of our older adults you end up with an early warning sign and ability to say I think you should go and see a physical therapist I think you should go and do a little bit more work with a nutritionist dietitian so this is this is what's the future is holding for us I think Ai and Engineering technologies will become more and more dominant force in driving our medical health care for older adults and with that I'll turn it back to Germany to highlight a few of the areas that would love to see more of you guys coming and knocking on our door thanks Peter um so as you can see we have this great sort of integrated program that stretches from biology to engineering and lots of opportunities so we just wanted to close and talk about them in a little supposed to see so we have a t-32 training grant for postdoctoral fellows so once people have their doctoral degree they can work in any of these sort of areas that we've talked about today as long as it's related to translational aging so taking and we've got fellows who are Engineers who are working on physical properties of cells and translating that into new treatments a person working on Alzheimer's disease drug development um people doing chronic inflammation work and new sort of Diagnostics in that space for example so all kinds of folks can fit in under that umbrella as Frank mentioned we have the older Americans Independence Center which is a facilitates studies related to Frailty but I think Frankie may have had pilot at one time or a junior and faculty award and we support ideas in the space related to Frailty so it can really be anything we have surgeons we have Public Health students we have our fellows too people in from engineering so a wide variety of people working as long as it's sort of focused on Frailty and either understanding the biology of it or thinking about ways to treat it and we have a pretty liberal thought process about getting people in and can help formulate those proponents so there's a fair amount of funding with those about 30 to 50 000 per year have scholarships are more for mid-career faculty again we're trying to Foster this kind of big Community um in in spaces that we think will rapidly grow and become programs of their own big big areas big problem areas that we want to see further developed and then finally Peter mentioned the aitc pilot Awards and the general Tech incubators program she's lots of resources there so if anybody's interested in that we're certainly happy to help facilitate development of those applications and and ideas that you might have into applications so with that I will close uh does as Peter mentioned intent kind of takes this big Symphony uh Ensemble to get get things together to work on Aging it's uh definitely not a single single instrument effort there's huge amounts of effort going on across the school you guys have done amazing work and hearing uh but again we're trying to pull everybody together and think bigger about how to kind of comprehensively solve some of these problems so thanks for your attention so I'll open up for any questions from the audience first right I'll prime one then because um so Jeremy and Peter I was out at the um the extreme Electronics Show a couple weeks ago right and I learned to terminal I learned a new term there which it really resonated with me so this idea of a digital twin did you guys read this term so it's weird this is the biggest thing so you know as you guys have CS the biggest Electronics in the whole world it's like 2000 people 150 000 people there and there's a whole section around digital Health right so it was a huge I mean it was a huge part of the whole CS was around digital Health right so different sensors for everything right so the term that was bandied around and I always find this is a disconnect between like what I see on the academic side and I go to extreme Electronics Show which is a whole another ball game and there was all these booze around digital digital twins right so I was like what is additional twins so the best analogy remember digital 21 is there which I was really fascinating so one of your thoughts on us you'll see someone wearing this is like and have you guys ever had a saltwater fish tank yeah so you know it's impossible right I mean it's always variables and your cnnity dies you're like 100 and YouTube yeah so and you're trying to monitor right so the analogy for this is like where saltwater tanks are going the last 15 years since our wife might try having one is now you have all these sensors embed in the tank then real time give you everything about the tank right so you can observe the tank in real time and because you want your sensors in the digital world it's a digital twin of this fish tank that allows you to predict things in real time and Earth like that right so the analogy for a digital twin from the tech space right now is the fact that we have all these sensors right so theoretically if you integrated all the sensors across different Platforms in the digital space you have a digital twin of yourself that's contouring all these parameters and stuff in real time that can potentially allow for a far greater degree of being well prediction or anticipation of things that happen before they happen right but the one thing that that comes up all these talks from digital twins is CS though is interoperability right so everyone has their own platform you know you can measure a hearing something you can measure your steps with this thing you measure always you can measurable way but they're always platforms that don't fully integrate into a true digital twin right so have you guys seen any in applications so far you talk about interoperability anything around their thoughts there because I I think that is the Holy Grail in many ways a true digital twin that allows for the digitizens I'll get one other side briefly and then I'll sorry I'm pandering around a little bit but so I think about caregivers I know I like but my wife is a caregiver of her parents and my mother is a caregiver for her like 100 year old grandmother right and the one thing I've noticed is that they are extremely sensitive they notice things before they happen it's because they integrate as a humans do we integrate all these different signals that they have they see how they behave what they're talking about and they're interviewing they're predicting in real time on a human level right so where is that going in the aitc space or the digitization digital health and prediction I mean is there anything on agency around that now or just general thoughts it was it was a the biggest paper I got from the CES show and how that's a huge hurdle um um so I I don't have a great answer to that and I'll tell you that we struggled with the different systems because for example some some of those monitors and signals will not allow you to work on so one of the main criteria for us to work on a technology that it allows us access to their platform so that we can build it and integrate it with the others you will see quickly that there are companies that are more interested in games some are interested in hearing some are interested in hard monitoring and we do believe that that to create that digital twin you need to be to be able to have all systems talk to each other it's not a person cannot be just seen as just Gates and facial expression can be motor it can be psychosocial also so there in in our attendance at working here and this is where Chris shoot becomes really critical is that all data has to be integrated in one platform that we have access to and that speaks the same language so that that eventually what we would love to have is like a dashboard that incorporates all of this because the clinician will not look at every different things it needs to give that a whole sum of that person as you see the person sitting in front of me and you can tell what's going on with them um so that's the first part of the knowledge I may also comment on that but in terms of early prediction one of uh one of the key features yes once you start having some thoughts and this happens really early in our auditions right they start to see that I'm not as uh as I used to be I was able to do a little bit more I will argue Frank that this is already you started to see some of those uh impact of Aging already there is a stage like the figure that Jeremy showed before this becomes evident and before the patients have those subjectives feeling would they call it that the subjective feeling of weakness although when you test them they are not uh the subjective cognitive deficit but I do believe that the computer can see much more than that and you have seen some of those uh next time you invite us I can show some of the videos of the computer assessment of neurocognitive function yeah a clock is not the clock drawing that we use for memory testing clinicians will just look at two or three things computer can see uh trillions of things in that it can see the hesitations that are shivering and behind it so the the simple test that gives you one or two things can be seen early on so that early signs that even if the patients didn't notice it yet can be observed a lot earlier is there a value for that I do believe that there is a value for that because this is the time that you still have Reserve that can be improved and worked on before the the damage sum there is a say that at the end of The Journey all Dimensions look the same right so the trick is how early can we do the prediction so that digital studio is more meant for that early learning and prediction when I presented it before with German people cringed when they thought about the camera watching them but you have to think about it from the healthcare aspect this is an opportunity to intervene um yeah the the platform I think is a great idea it's not we haven't seen anything come across that on our desk um one of the things we've tried to do in the human aging project we have a sort of a aging exam that is supposed to capture a lot of biology data as well as some of this integrated data that Peter talked about in the suite so at some point you know it in conjunction with clinical judgment hopefully we're going to be able to submerge that kind of data into something like a digital twin but having a lot more sort of diagnostic stuff with it so I do think Chris shoot in our program has thought a lot about integrating data and hopefully we'll be able to do that foreign close because of lack of knowledge so I have a question you know most of the data that she used are observational right so uh I think part of the problem is that my opinion because you can you can plug a lot I don't know much about artificial intelligence but uh you know it uses data that are available right in a lot of that data those data are observational so in epidemiology I'm like an ideology midday biology of course he used randomized trials to get around uh the limitations of observational data or you use uh study designs they have tried too many mimic mimic uh uh randomizer such as mandelier randomization instrumental the articles on yeah I think I think that's a good point and in fact to the sort of made me think about our resiliency studies where you often don't see any changes until you're actually putting a person under some kind of stress and then you see these perturbations in the system so we're you know like Peter mentioned the motion capture you know like the differences between moving and sitting still you see a huge amount of variability and so you know incorporating things like we were talking about into that I mean it may not be a drug trial but it'll be some kind of difference in the way people are moving or the way they're stating some sentences for example so thanks um so I have a sort of question sort of thought um so I guess I'm feeling that in this kind of artificial intelligence sort of context it would be really important to validate the results right and a sort of the thoughts on if you're talking about um different kind of um Industries Fields having the same language um being in a part of the whole system thing but they might have different levels of validation in them right because they have different variabilities and different Technologies in different fields we have like all a different level right how is that dealt with if we we're validating it using different methods and their own different level of validation so yeah so I I think okay so I can't agree more and I I think uh that the key of understanding the system is that we are a really close to Observation Center so each of those hand-picked Pilots we picked them based on novelty of the idea Innovation the implementation of AI but also this is why we have a clinician working or a clinician researcher working with the engineers so the validation part is part of their application the Milestones that they will set we have a very close monitoring progress reports that are spaced where we are closely watching how they are developing Technologies and providing direct feedback this is the another deviation from the Nia's standards you get a grant and then in five years you submit the yearly progress report we're really talking to them we meet with them we discuss the progress of the project we provide them with ideas we put them in contact with other people that can change their Technologies or validate the technology a little bit better so I think I think that that when you started about talking about validation have you guys played with shared gbt before okay have you tried to ask it to write something right it's awesome you've read a letter to Santa yeah it's very helpful right you feel like it's writing wonderful and then you go through it and you find that it was actually a lot of it are not entirely true or validated or anything so that's again a sign AI is developed by humans right and you can trust AI as much as you can trust students you always have to validate you always have to ask that question what did they what did he or what did the system get this information from could be an opinion of a person that throws it on something so that that that definitely is part of our monitoring and Milestones of watching how we use AI for the future I think the mics will pick him up I don't know the way to pass one last question is coming on time but Jennifer Oliva thank you Steph so there's a question from online and so you mentioned that Nancy and Thomas are running kind of a stakeholders group as part of this project and there was just a question about what which stakeholders are involved with that um so we depends on the project so imagine we have a virtual reality headset that uh they're gonna accompany is awarded a pilot for and we're going to use that to to use a stakeholder group to kind of test out the headset to see its comfortability to see if they would actually use it to kind of inform the company about the um directions where they where people would actually use it so that would be a group of people um you know in their probably 70s and 80s that would come in living in the community and would come in for that so there they're going to kind of pull people together depending on the individual's project so it could be people who who use walkers for example or have a lot of falling so they'll pull in five to ten people probably each time for that we also have a rural arm to this so one of the big pushes of this aitc was to help underserved populations get better access to health care and and work in the space so there's a Consortium in Iowa that we use and they'll also bring rural stakeholders into that and and then also Urban uh dwellers who who might benefit from things so as short that was a long answer all kinds of stakeholders mostly older adults but also maybe caregivers younger family members that are taking care of older adults they have constructed a full Advisory Board kind of thing for themselves that represents different sects but for each project they also go and recruit more of the history we have a registry through the pepper center with about 600 people in it people over the age of 65 who've signed consents to be in studies of any kind related to aging so we can pull from that pool there's a specific demographic we need 85 year olds who live in a retirement community identify them and try to bring them in at least contact them a little over so I want to thank Jeremy and Peter again foreign sign off now um the trainees you guys will be eating with Jeremy and Peter right afterwards again and I would use that time wise I mentioned between Jeremy and Peter they sort of I think Godfathers of I would say anything General Science Asian related so as you know good science noise about pulling together the right people so they'll be able to point you guys in the right direction if you have any questions on Where to go next thanks

2023-02-15 18:42

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