>> From the Library of Congress in Washington, D.C. ^M00:00:05 ^M00:00:16 >> Sandra Charles: Good morning and welcome to this lecture on [inaudible] Telemedicine, but with a whole lot more girth to it. We are pleased to have Professor Auffret here from -- talking to us about artificial intelligence and we're hearing so much. I get at least three or four emails a day talking about different aspects both of AI and Telemedicine, just all the different terminology and all the different ways in which this is being used in health services and in aging services in particular. So I was more than happy to join Dr. Steen and the Science Division in bringing Professor Auffret here and I know you're in for a treat. We'll be all so much more edified when this is over and be able to speak about the whole topic. And not only that, but we'll be more encouraged and energized to go do more research or read more about it because it's not a passing fad. It is where we are and where we are going. So I will ask Dr. Steen to introduce our speaker and I'd say sit back and be ready for a wonderful program. Thank you so much. I encourage you -- this is actually a part of our Health and Wellness Programming for the month of May, and it's sort of the opening lecture which we always dedicate to some aspect of aging and health. And then next door will be the various providers that you can ask questions on a variety of things. We have several area hospitals participating as well as individual pharmacies and providers. So we hope this day will prove for you to be much more energizing than you've had in a while in terms of thinking about and taking care of your health and wellness. So thank you so much for being here. I failed to introduce myself at the beginning. For purposes of the program I'm Dr. Sandra Charles, Chief of the Health Services Office and also Chief Medical Officer here at the Library of Congress. Thank you again and welcome. >> Thank you. ^M00:02:25 ^M00:02:30 >> Tomoko Steen: It's a great pleasure to [inaudible] Professor Auffret again. I'm Tomoko Steen, Science, Technology, and Business Division of here at the Library of Congress. Professor Auffret last year gave a very interesting talk on cybersecurity. And this was recorded, so, you know, please let me know. I'm happy to show you a URL and you can watch the talk as well [inaudible]. And we are so lucky to have Professor Auffret twice, and he is a Research Partnership Director at School of Business as well as he's Associate Director for the Center for Assurance Research and Engineering at the Engineering School. So he has undergraduate degree from Duke University. He's A.B. Duke [inaudible] and also MBA from the University of Virginia. And he's also PhD in Physics from American University/ So he has just broad range of background. And he has been Director for the MES Programs at the George Mason University. And also he's charity ranges quite broad from CIO, ICT, cybersecurity, so the team explained what's CIO and ICT, but it's so many, you know, discussion right now you're going to, you know, [inaudible] our aging population and this is a very important topic. So Professor Auffret is also [inaudible] for Healthy Information Technology Advisory Committee, and also worked with the World Bank and variety of important organizations including World Health Organization. And also he was a business executive for the MCI and British Telecom. He has also appointment with Duke University Center for International Development. And he is a Physicist in Residence at American University. So ICT. May be I just -- so many people ask me about what ICT when puts announcement. It's Information and Communication Technology. And, you know, many countries were facing such issues of aging, how to manage aging population. So today's lecture is going to review and analyze and status in the potential of ICT for healthcare in aging populations. And it's a wonderful topic to discuss and he has a broad range of connection internationally so that his topic is going to cover America's, Europe, Africa, and Asia. So before [inaudible] please join me in welcoming Professor Auffret. >> Jean-Pierre Auffret: Thank you, Tomoko. ^M00:05:45 [ Applause ] ^M00:05:49 Where did my pen -- thank you. Thank you all for joining and thank you Dr. Charles. As Tomoko said, the talk is going to range from healthcare to aging society to technology to policies. And policies help introduce technologies into a society for healthcare. So it will be quite a broad range, and I'm looking forward to the discussion afterwards, including from a special guest, Yuki Memora [assumed spelling], who's also very active in the aging society topic and hosting a Washington Innovation Network here in Washington. So, welcome, Yuki. Shoot. Just kind of to review then, going to have some background on aging society and the technology landscape, some of the challenges in what's actually needed to spur innovation in the field, and then a little look, short look, at National ICT Policies and National Aging Policies and Strategies. Before we start, I wanted to play a short video. Just have a couple of these from Japan on some of the introduction of technology into assisted living facilities. So a range of experimentation in Japan, both with the rapidly aging society looking to further care for seniors but also to be a world leader in silver technologies, to be able to export these technologies to other countries around the world. We'll play this short video on some of the applications at this one nursing home, and I think it gives a pretty good feel for the range of possibilities. ^M00:07:27 ^M00:07:38 [ Inaudible Conversations ] ^M00:08:03 >> This [inaudible] has an unusual [inaudible] trainer. [Inaudible] by a robot named [inaudible]. It's one of many iconic aids the staff uses, including [inaudible] to help care for it's elderly patients. [Inaudible] reports, this [inaudible] in Japan. >> Japan's population is rapidly aging and it's workforce is shrinking. So it's facing this new shortage of nursing care workers to care for a growing number of elderly. And it's planning to turn to robots to help fill this gap. >> Following [inaudible] Japan's population [inaudible]. There's been decades of [inaudible] robots as friendly and useful. People seem [inaudible] they think these are the human touch. >> And science has made a robotic bed that splits in half and half. Half of it turns [inaudible] wheelchair. Cyberdyne has made an exoskeleton that you can wear attached to your lumbar area that helps workers lift like people from their beds. And probably the cutest robot is a robotic seal called [inaudible], which is used in [inaudible] and he can respond to touch, speech, light. >> Tokyo sees this as a big business opportunity, and companies have joined them in investing million of dollars in robot R&D. But they're also eyeing potentially a bigger prize, sending these homegrown robots overseas, especially to other nations with populations [inaudible]. ^M00:09:46 ^M00:09:51 >> Jean-Pierre Auffret: So as you can see, a lot of potential and possibility for robots and technologies with seniors, but also a range of issues in regard to like innovation and scaling and adoption [inaudible] -- ^M00:10:02 So as you could see, a lot of potential and possibility for robots and technologies with seniors, but also a range of issues in regard to innovation and scaling and adoption. And we'll cover some of those during the course of the talk. ^M00:10:17 ^M00:10:23 Aging isn't just limited to Asia Pacific. It's a worldwide phenomena, aging societies. So many of the European countries across Asia Pacific including Japan, Korea, Singapore, Taiwan, China itself because of some of their policies over the years, some of the South American countries like Argentina and Chile, and some of the Middle Eastern countries, too, and North African countries such as Algeria and Iran, all aging quite rapidly. And over the coming years going to be approaching 25-30% or even 40% in Japan's case, of the population being 65 years and older. So significance aside all challenge, and for many countries the risk is of becoming older before they become developed or richer. So for a country like Japan or Korea or some of the European ones which are very successful economically, have public health infrastructure in place, their much in better circumstances for aging society than a developing country that doesn't have public health yet or, indeed, has a relatively low GDP as some of the developing countries do. We'll see in a little bit, too, it's also a phenomenon in Africa where some of the African countries projected not to have 40% of their population, but up to 20% of their population age 65 and older by the year 2050. So aging oftentimes is depicted as homogenous, or one view, of what aging is or what aging means. But, really, aging is quite varied. Many seniors now and over the years quite active well into their 60s, 70s, 80s, and 90s -- active in society, active working. Other seniors, more and more, are trying to age in place and there's different policies around the world for that -- to be able to stay living in their homes longer as a way to stay engaged. But also too many seniors do have fragility issues and then some also have memory issues. So very broad range of seniors and a very broad range of technologies which are applicable to each of the groups or circumstances of the seniors. And we'll also see that, how the technologies are being tailored, including fostered and promoted by the U.S. Government for different types or circumstances of seniors. One thing which is a major challenge worldwide, and we'll talk about some of the other challenges of aging in addition to health, is this question of poverty. Seniors oftentimes, and in many countries, don't have pensions or something has happened to the pension such as municipal bankruptcy, or a country doesn't have a pension system yet, and when the senior's no longer working then then don't have a regular income. One other thing which is happening in many countries is a change of culture. So many countries traditionally have had a cultural support system where the young care for and support the parents and the grandparents and the elderly. That is changing in many countries now, including in Asia Pacific where sometimes the youth moves to the larger cities, but the seniors remain in the rural areas, and there's not the contact or support that that might have been in previous decades. One other issue, too, is with the rapidly aging society, instead of having six or seven or eight younger people supporting the seniors through pensions or care, in some countries it's moving to three to one or two to one, two people in the workforce supporting one senior person. So the support system may or may not be there from country to country. So aging varies across the world, and aging, too, varies across the U.S. but by county and city. Some counties and cities much more older than others. On this slide here, darker blue is a higher percentage of a county with a population of age 65 and over including with a disability, so having both. You can see many counties have a bluer shade and are older than others. Oftentimes these are in rural areas. I grew up in Florida which has an interesting population dynamic. It's both a very large senior population but also quite young and somewhat limited in the middle over the years. So you can see some of these counties quite rural, quite limited incomes. With some of the healthcare policy we've had or some of the circumstances with those rural hospitals closing and support systems not being what they might be, and so here, too, in the United States, aging can be a challenging issue. One other note on disparities in health. There's the -- have many of you heard about or read about the stroke belt? Also a major public health issue. So there's a band across northern North Carolina, southern Virginia going across into Kentucky, and the population there has incidents of stroke at a much earlier age and much higher preponderance than across the rest of the country. So it's a little bit unclear as to the causes of that. Some mix of probably genetics and diet. But there, too, there's a disparity of incidents. And we'll come back to that when we talk about fragility for seniors. Here's another chart. This one is population over 65 by county. So you see some of the very popular retirement areas in Palm Springs, also Florida, but also quite varied across the country. Oftentimes younger working-age move to where economies are more dynamic, but true around the world. But here, too, in the U.S. Do quite a lot with APEC. APEC, Asia-Pacific Economic Cooperative, a multilateral organization of 21 or 23 countries around the Asia Pacific Region, and here, too, you can see the vast differences in percentage of aging. And also vast differences in type of economy and level of development of economy. So quite striking the projection for year 2050, the right-hand column. Japan projected 42.5% of the population 65 and older. Korea, which has had the lowest birthrate for many years now, 41.5%. Really quite interesting. Thailand, a middle income country, at 37.1. So it really varies across the world. So impact on society and social inclusion, productivity, all those types of things related to demographics. These also quite striking type of maps -- this is year 2000 on the upper map, darker brown the code is more aged like 25 or 30% or over, 65 and older. But the bottom map, world map, is 2050. And you can see that the shift in colors over the years. Not very many countries would [inaudible] dark browns. If you can bear with me in 2050 [inaudible] not others. Oh, yes. Thank you. [Inaudible] gave a talk last year in Argentina. It was partially related to productivity in the workforce. So Argentina, a middle income country, although with a somewhat sad political history and sadly back in the news again recently. But here, too, you can see that the shift in population and the increasing number of elderly, decreasing size or stable size of the workforce. So a challenge for Argentina to increase productivity to help address their debt issues to be as dynamic as they could be with their economy. And think this is the most -- really quite amazing chart in regards to demographics. So China with the highest population in the world, but not for very much longer. So quite rapidly aging with the one child policy over the years. Relatively soon and into the 2040s and 2050s the India workforce going to be much, much, much larger than China. So great ramifications for China in regard to competitiveness and productivity. I didn't bring any charts on this, but China, the most rapid adopter in manufacturing, one of, of robotics. And partially it's to remain competitive. Partially, too, it's with -- in regard to their aging issue. ^M00:19:43 [ Inaudible Conversations ] ^M00:19:48 Okay. One of the challenges I mentioned is the this issue of workforce and productivity, and we'll come back to health in a second. So the Korean population somewhat flat and will be declining a little bit over the coming years as their population ages. Their productivity as a country has been flat or decreasing. They're of a size where it's quite challenging economically, so they're not as large in population-wise as a U.S. or a Japan. They have about 50 million people. So for Korea to maintain competitiveness in the face of a flat or declining population is a great challenge for them. Also, too, they have structural limitations from policies. So the retirement age is quite low in Korea. They're working to develop policies and approaches to -- so people can stay in the workforce. Traditionally what's happened is someone will retire from a very skilled or skill-oriented job and not really have anything to move to that's comparable, and might end up doing something that is not taking advantage of their talents. So they're trying to address that. They're also trying to address some of the employment challenges that they have. They're dominated by the very large conglomerates such as the one Samsung is in. Limited opportunity for youth. And so there's an office right here on Gallows Road. It's related to the Korea U.S. Science Technology Center. But what it does is it enables Korean companies the opportunity to come here to the U.S. to further their exports or look to see if the U.S. is a good market for them. And then the Korean government also has 14 offices around the world for recent Korean university graduates to go overseas to get a couple of years of university -- work experience before coming back to Japan. So Korea, in that middle size, and it's going to be quite a challenge as that they -- the society ages. Pensions, too, can be a great challenge worldwide. So some countries don't have pension systems developed yet. Others have quite robust pension systems that are under-funded. This was a news headline from Stockton, California, a number of years ago when their city went bankrupt. And so there was a risk to both the pensions of their former municipal employees but also that the healthcare benefit that the city was purchasing for retirees. So pensions can be a big, big, big challenge and a big issue both for developed and developing. A couple of other notes on major trends before we focus more on the technology in healthcare that are related to aging. One is urbanization. Many of the young move to the outskirts of the larger cities in developing countries, the larger mega-cities. Lagos, for example, has grown from about 500,000 population to about 20 million over the course of the last several decades, so really rapid growth in a country like Nigeria. But many, many cities around the world. Countries struggle to provide city services, provide jobs. It's also -- help address social inclusion issues. And so with aging, it's just adds to the challenge or compounds the challenge. One interesting phenomena in Japan, very recently. So Professor Obio [assumed spelling], a colleague of Yuki's. Over many years, the youth were moving to the cities and the elderly were staying in the rural areas. Now more and more of the youth are looking to the rural areas for their livelihoods, and there's been a little bit of a pendulum shift in Japan but with, I think, a lot of benefits for a more heterogeneous society in the rural areas. Here's a slide showing the recent change of the preponderance of population living in cities. So, of course, here, it's been many, many decades since -- the crossing point is when the more than 50% were living in cities. So many, many decades here and in Argentina and Europe. But worldwide, only fairly recently that that the cities have become the main hub of livelihood in many, many countries. And this also really kind of interesting from a map standpoint. This is 1970. Darker color brown is more higher percentage urban. And then this is 2030. You can see many, many more countries have a higher percentage of urban living, but also the red circles are larger cities, like over 10 million in size. So big shift in how people live and related to aging. And then other big shift related to aging is chronic illness. So also only recently was a shift -- that from worldwide mortality go from the preponderance being communicable diseases to the preponderance being chronic illness. And so with aging -- with seniors living longer, and with improvements in healthcare, more and more of a challenge of chronic illness. But also this is true worldwide, not just with seniors. With chronic illness, it's a much different type of healthcare than with communicable disease, much more focus on continuity of fit care, engaging of allied health, role of diet, role of adherence to medical recommendations, and a much more important role of health literacy on the part of the population. To show that it's quite international, India, for example, has a very high like occurrence of diabetes, one of the highest in the world. And interestingly enough, the higher occurrence in the world of Hepatitis C is Egypt. And it came about from a public health failure. The Egyptian Government was -- they had a parasitic Nile River disease, and they were trying to inoculate the population against this in the '60s, but they were using dirty needles. And so now they have a really major Hepatitis C incidence in Egypt. But there, too, chronic illness being a worldwide issue. And here -- this was a diabetes. And you can see darker green is higher incidents of diabetes. So Mexico, Libya, Saudi, Arabia, India, fairly high. Quite varied around the world of that. Okay. So what's happening in technology that's really a plus or an opportunity for healthcare and for seniors and for staying connected and for living, aging in place, and living longer, and more engaged in active lives. A lot of it has to do with the mobile phone and with sensors, as with a lot in our society. So the advances have been quite remarkable, and the opportunity quite remarkable, too, for really connecting people with services that they didn't have access to before. So just in 2015, already 7 billion mobile phone subscribers, more than one for every person on the planet. And it's not just -- it's worldwide. It's developing countries and developed. A little bit less so in rural areas, and a little bit less so in some countries. But these mobile phones with the power of computers providing services that weren't really forecastable 10 or 15 or 20 years. Also, too, this -- the more and more increasing number of connected devices and sensors as we'll see for assisted technology really providing capability that wasn't there before in the whole mobile app inroads. ^M00:28:23 [ Inaudible Speaker ] ^M00:28:29 One kind of note which I think is neat in regard to how rapidly technology changes and how it's difficult to forecast where it may be in 10 or 20 years -- these are just pictures, but -- of status storage, transmission speed, and processing power. But just to show how far we've come, the first one -- so say you can go into a computer store and buy a several terabyte storage like near where I live, where we live. It's like 30 or $40 or $50 for like three terabytes, and it's the size of a book. The first commercially available gigabyte storage was just 1980, so not that long ago in many ways, and it was 550 pounds, the size of a refrigerator, and cost $40,000. And it was marketed by IBM. So from this and one gigabyte of $40,000 to about this for multiple terabytes from $50 has been the change. And so that change is continuing. And so the underlying cost of storage, the variable cost, is going to be almost zero shortly. The processing speeds similarly. So now it's six, seven, or eight going in cycles a second in a computer on research. Kind of a coincidence -- the first lunar lander and also the first Apple computer were both 2000 cycles a second. So from 1970 to today, from 2000 to 8 billion, and that's advancing, too. And then the transmission speed -- the first transatlantic cable from 1957 could only handle about 36 simultaneous calls. And now it's billions and billions of calls on a fiberoptic network. So with those trends continuing, just as you couldn't really foresee the capability of the iPhone if you were back in 1990, you can't really foresee what the computers or the phones will be doing in 2025. You have an idea of what the applications might be in regard to [inaudible] with cars and sensors or with videos and images and holograms, but the specific applications you can't really -- it's hard to visualize. This is a neat resource that comes out every fall from ITU, a Measuring Information Society. The blue line that's going up towards 100% is mobile phone subscriptions, so about 100 mobile phone subscriptions per 100 people around the world. The really dark blue one that's quite steep on the right -- that's mobile broadband subscriptions. And you can see that's increasing more rapidly than mobile phone, so probably in several years we'll be up to 70, 80, 90 mobile broadband subscriptions per 100 population around the world, developed and developing countries. So great, great, great change. And this, too, I think is another background on what's possible, what technology. For Mexico's to the left, shows the percentage of the population in Mexico that is banked or has bank accounts. The right shows the percentage of the population with a mobile phone. So much, much, much higher. So Mexico, one of the countries where these types of apps, where you can do banking through the phone like M-Pesa in Kenya, really making inroads. So instead of having traditional bank accounts, going to one of these phone-based bank systems and really providing access. And so -- also for health, too. Of course, the whole smart city playing a big role in aging society as we'll talk about as well as the smart grid, so really changes in how electricity is provided. I didn't include a slide, but Africa, for example, just in the last 20 years and projected out to 2020 the amount of power which has been brought online, and related to the phones, or enabling the phones, has really led to major shifts. One other video I want to play before we talk more about health is not all technology has to be really leading edge. And it's possible to do things in health with technology that is somewhat dated such as SMS. And there's some wonderful examples around the world including here in the U.S. of using SMS-type technology to really further health outcomes and benefit seniors in a way just as much as some of the more advanced robotic or AI technologies. So this is a really neat initiative in Tanzania with Novartis and IBM. ^M00:33:22 [ Speaking in Foreign Language ] ^M00:35:03 [ Music ] ^M00:35:08 So the idea is that the mortality from malaria is very high for children under the age of five without treatment. And Tanzania there having very, very high incidence of malarial medicine stock-outs in rural clinics. And so with Novartis and IBM and a telecom [inaudible] developed a system where the clinician would just send a text message in once a week on her inventory level. And if the inventory was low or nearing a stock-out, it would be replenished. And they went from 80% or so stock-outs to a very, very small number with the corresponding benefit for the children and for children's health. There's a number of amazing examples similar to this. Pharmaceutical counterfeiting is rampant in some countries. And an almost similar system in one or two of the West African countries is you don't buy the medicines from a pharmacy like we do here, like a CVS. It's more from a small shop. But just a code on the side of the medicine that you can type into your -- send a text message with your phone and it validates it that it's real. So here we have a new law that's going to take effect early 2020s on a pharmaceutical traceability. And the -- what the legislation calls for is the ability to trace a pharmaceutical all the way from manufacturing plant to when we actually pick it up at the pharmacy. And so much more advanced than this text message idea. But some of the pharmaceutical companies are looking at block chain for that, for example. Okay. So technology doesn't need to be advanced, but, of course, a lot of the technologies are advanced including with robotics with a lot of promise for seniors but a lot of promise for society and a lot of risk also. The Asian Development Bank puts out an annual report in the spring, and it just came out this year. And they have a fascinating chapter on the job impact in developing Asia countries from robotics. It was quite a, I thought, sophisticated study because they had the downside risk industry by industry, from country to country. They also had the upside potential of access to the job markets. And then they also looked at a forecasting when robotics would be adopted industry by industry based upon the cost, the economic opportunity as well as the technological capability. But many robots used for different applications. The one on the bottom right is an English-speaking robot in Korea which is really a popular teacher. The upper left is the more traditional view of industrial robots. But you can see by comparing the two, that the robots are quite different. So robots are becoming more non-tethered. But the one on the left is tethered and stationary. More mobile and non-tethered, more autonomous and more interactive and in some ways more "intelligent," in quotes. So through all of that, much greater interaction with humans and individuals. And so many more risks for the individual. Many more societal implications and public policy implications as these larger and faster robots are interacting on a day-to-day basis. So there's a lot of studies which are really quite interesting on the use of robots and humans together as to whether or not a human plus a robot has greater capability than a human on its own or a robot on its own. In one of the studies which gets quoted a lot is a chess study. So pairing -- this is from several years ago -- pairing the chess-playing programs that the real top ones and the not quite top ones -- with chess-playing humans, really, really top ones and not so top ones. And the winning teams from the experiment were -- it wasn't that the best human or the best robot or AI. It was the one that worked best together. And you can see that's going to be a factor in many fields. So, for example, medical diagnosis -- the IBM Watson does commercials quite -- or commercials about Watson quite often. Doctors are using Watson at Cleveland Clinic I believe. But there it's an interaction of what the AI tells the doctor and what the doctor interprets and what the -- what information that the Artificial Intelligence provides to the doctor so the doctor can make a judgment over how accurate it is. ^M00:40:11 One kind of aside on that. It's a major, major issue that this question of artificial intelligence and transparency. Here in the U.S., but also in Europe, and there's a really interesting case with Zillow. Does anyone follow that case? So many of you probably use Zillow or seen it. So Zillow is a home and condominium site. And one of the things it has on there in order to draw traffic is it has an algorithm that generates what a house is worth or valued or would go for on the open market today. And so you can go on there any day and type in a property or your own address and see what it's valued at. It also has a chart for historical estimates as well as for the neighborhood. And so an attorney saw that her house was being undervalued on Zillow, a very, very nice house, high-priced house, and it was hindering her ability to sell it. And so she sued Zillow and -- but Zillow didn't -- and so the judge wanted to see how Zillow operated and how Zillow came up with the estimate of what the house was worth. But Zillow said it was a trade secret, how it was doing it. So the judge had to make arrangements to hire an expert, but the plaintiffs paid, to review the system in order to make a judgment. So that works in the cases when it's an algorithm or can work, but in these issues -- circumstances with machine learning that the AR or the machine gathers information from the Internet and then slowly over time develops an insight and a view. It's much harder, if not impossible, to know how the machine came up with its recommendation or solution. But the laws now in Europe -- there's a transparency law and algorithms that you have to be able to show how a computer arrived at a decision. And also, too, that there's laws so that someone can ask for a human to make a choice instead of a machine. So as an example, a university hypothetically could use a computer to decide who's admitted, really quite possible. And some jurisdictions have experimented with computers as to whether or not someone should be paroled or whether or not they'll be at risk if they're paroled. So the -- a lot of the policy orientation is what recourse does an individual have because you can't really depose the computer necessarily, and then so what recourse is, and how do you know how it made its choice? And then what can you really do about it? Or even, for example, if a autonomous vehicle caused an accident when you go -- and if someone was going to sue the insurance company, you can't really depose it, or how do you find out about it? This is actually in interesting picture, too. So this is an assisted robot for Japan. So with a rapidly aging society, limitations on the number of health workers to assist -- so this one to help lift someone out of a bed and move from one bed to another or when a bed is being made. You can imagine the legal risk on something like that. As it turns out in the U.S. that there are -- every year there's an incidence of people being, patients being dropped in hospitals, too. So -- but that one being adopted in Japan. And I think we would see something like that here over time also. One of the arguments from the autonomous vehicle providers is that the autonomous vehicle will be safer than a human driver. But that's not the view of all the car companies. Toyota, for example, their view is more that the autonomy is assistive. And so there's a range of circumstances where visibility and rain, when the autonomy is really helpful. But not at all times necessarily. This is a very famous Japanese robot, Chihira Kanae, from Toshiba. One thing to note is Japan's going to be really highlighting robots for the 2020 Olympics, including at Narita. But there's different cultural views of what a robot should look like. So, in Japan they have the video reference Paro for the autism and aging, a very cute and attractive seal. This robot looks much, much different. So this one looks as if a human. So there's cultural differences on that. So I think in the U.S., this is a broad generalization, but for the most part, our robots are idealized to some extent, and less human looking. But some countries, they do have robots that are a little bit more human looking. So, again, cultural differences in robots. Here's a initiative here from the U.S., from HHS. Research -- I think this was from last year, the announcement request for proposal for robotics with Alzheimer's assistance. So many, many opportunities for research grants in -- at the end here, I'll discuss a little bit how our government tries to catalyze research. I have to be very cognizant of the time. Two other areas which the great [inaudible] impact for seniors, nonhealthcare, is one is autonomous vehicles. This is actually a drone in Rwanda. So Rwanda's very hilly. And so this commercial company to deliver fixed-wing drone, deliver medicines to rural areas because the roads aren't necessarily that good. And they do deliveries within two or three hours. They can get their order in and ship it out. But the point more in general is that autonomous vehicles, especially for seniors living in rural areas where they've lost the bus routes, which happens all over the world. Now with autonomous vehicles there's a way where the senior could actually have a vehicle that can bring them into town or they'd be much more mobile and more able to live and age in place. This is just kind of -- this is a autonomous drone in Dubai. I don't think I would get into one like that, but that's there. ^M00:47:13 ^M00:47:17 And then, too, the artificial intelligence becoming much more flexible. So chess, although very complex and complicated, somewhat limited in regard to its one application. But more and more some of the AI applications are quite flexible as to what they're doing and quite large ramifications, I think, for society. We use AI every day, most every one of us, in some ways. So, for example, someone going shopping on Amazon, and the recommendations that come from Amazon, sometimes they're a little bit creepy I think, the types of things that they do. But a lot of that is from AI and gathering information about a person and then utilizing it in a way to [inaudible] back a recommendation. There's a projection for Philippines that in the next two years they're going to lose 30% of their call center employees. So Philippines, a major industry with call centers. So you call from here and you get someone from Philippines quite often. So a lot of the first and second level that the levels with not the huge expertise, the projection is they're going to be replaced by automated assistants in the next years. So a very, very big issue for Philippines with job replacement and AI. And then the last thing [inaudible] trend, I think, is this open data issue that the data being available and the potential both for benefit for seniors but also for society in building businesses. So here in our area we have a quite robust open data, the federal government obviously, the counties, New York, too. Some of the really neat applications I think is what you can do with trending over time for seniors. There's a really neat company here locally. It's now possible to get from -- a [inaudible] from HHS much more quickly than years ago, information on Medicare and Medicaid payments and care. And it's six months or probably less now. And so local company here obtains the information from HHS, then they're able to do comparisons from region to region or from hospital system to hospital system and provide the information back out to enable the caregivers to hopefully provide better care. ^M00:50:00 Okay. So how is technology actually being used for aging? And it really varies by the type of -- where the senior is in aging. So again in place, an active aging type of technology may well be in exercise or an autonomous vehicle. Someone who's a little bit more fragile might be assisted for mobility or for sight or with chronic illness. Then, too, for memory care, such as with the Paro from Japan, the seal. So aging very, very, very different. And then also the government services vary too. The one on the right from New Jersey I think, a really important type of initiative in times of emergency to know where the seniors are, to know where the ones who have memory issues are so you're able to better evacuate. So it's a huge impact and benefit both to the senior themselves and to the city if you know where everyone in your city is who needs an oxygen tank in regard -- if the power goes off. So those types of things are big, big benefit. One of the things I think that -- really quite important in aging is this concept of fragility. There's probably 80 different models of how to define it now. But fragility both of movement, but also fragility of health -- inability to take a number of stresses to a person's system. So someone very young in their 20s, they can take multiple health stresses and be fine. But someone older is much, much more difficult. Fascinating study from Japan on seniors. And this is with fragility in movement. It's very, very -- their study found that it's very difficult if you move from quite active to limited mobility and fragile in movement, and then almost non-mobility to go back, to make your way back from very limited -- almost no mobility to fragile and fragile to active. So a lot of the interventions are to -- if someone is to prevent someone or help someone so they don't move to the next stage. And there's also models like this for cognitive fragility and the intersections of the two, more physical and more confident. But a lot of the technologies are oriented towards this type of idea that to help someone stay in an earlier stage, a more healthy stage, and help them move back or to the extent it's possible as they move further. Because everyone knows someone who's gone ill when they're in their 70s or 80s, and it's much more difficult recovery, much more challenging or a fall is much more challenging. This is a similar model for WHO on functioning and disability. It's quite a similar idea, but here it's the degree of societal participation and then functioning, physical and mental functioning in the intersection of the two. So the point being there's a great benefit from engaging societally or with family and a risk from social inclusion. And so -- and also a benefit from some physical activity. So what are some of the technologies? This is really a quite neat one I think. And this is an [inaudible]. Canada has, and Taiwan and New Zealand is actually a leader in this, have implemented these fairly widely in some cities. So enabling the phone or the cane with communications technologies to connect to beacons or sensors. So a lot of the sight-impaired now have GPS on the phone that can direct them to a place where there's GPS. But if in a very large building or a subway station, they don't have the GPS. But to put beacons in there and to communicate back with the cane or the phone or the eyeglasses as in Canada, and really help someone there with their mobility and their confidence to get around. And it can be really very, very lifechanging. There's a video, which I'm not going to show, of someone about 30 years old who -- in Canada -- who lost their sight through diabetes. And she now has these types of technologies and is really able to get around and do quite well. So a wonderful lady at NIH who also -- who lost her sight when she was about 25 and she afterwards moved -- started in information technology and, again, is able to do tremendously with the assistance of technologies. This is a second one, cognitive ability, which a lot of technology's very helpful with. Both continuing with -- to be engaged, but also some of the technologies more and more able to identify trends and patterns for early intervention. For example, with dementia or Alzheimer's. So I think with a lot that's being done nowadays, a lot of potential. One thing that's kind of interesting. A George Mason professor I work with has worked on this. The way someone uses their Smartphone is very unique. You can identify someone from the Smartphone usage. So, of course, the intelligence agencies are very interested in that sort of thing. But also, too, there's a thought that over time someone might have a change in Smartphone pattern usage, how they actually type on the Smartphone. And you can identify insipient dementia from that. So there's a number of projects like that both here and the U.S. but around the world. This is a DARPA Drive technology. Really tremendous potential for seniors for mobility and staying active. This is an exoskeleton. But many, many different ways of doing this. There's a number of technologies that haven't worked yet that I think are really interesting if they could work. Types of technologies that a senior could wear, very light, that would expand, for example, on a fall to make it less likely that a fall would be catastrophic. You're tied with sensors so you might have an iPhone. This is a local company here in Fairfax which is really kind of remarkable. So they have this -- the EyeGaze Technology has come a long way. At Consumer Electronics Show they had an exhibit, a company on exhibit this year where you could drive a car just by moving your eyes and steer it. This company here -- this is for someone who's had a really catastrophic accident and is paralyzed from neck down -- that they can -- someone can actually type and write by moving their eyes on this keyboard on this screen. And when they come -- and we've had several assisted technology conferences, and the company comes and gives a demo, and some of their customers come with stacks of books that they've written using this technology. So it's for someone in that sad circumstance. It's really lifesaving. It gives them a real path to life I think, in livelihood. A lot of the senior technology -- this is for [inaudible] you know, profession soccer players, but we [inaudible] this as senior technology with sensors. So this technology here, which is being adapted, is having a communications device in the soccer ball and having sensors around the stadium, and then also on each player having a communications device. So you're able to track the ball and all the players in real time. And then make judgments about how they're playing and how often they have to have the ball. So their golf technology -- if you ever watch gold on T.V. they have -- they can actually track the speed of the ball off the club, and they do it with baseball now, too, and follow the path. But this having a big impact. And then lastly, too, on chronic disease management, this is a Google initiative for diabetes. So being able to tell insulin levels from tears with a contact lens, communicating either to a phone or to a SmartGlass, and then being able to provide a warning if the insulin levels are -- or the patients are outside of some sort of control and that's -- so better care and more stability of blood levels. So, again, a neat thing that technology's making possible. So to wrap up, what are some of the major challenges of getting these types of technologies to seniors and to patients in general? What is the phone coverage and digital divide? So even though there's almost one phone per worldwide inhabitant, in some areas the phone coverage can be a little bit iffy, the broadband coverage. And so that can be a major, major issue. Health literacy could be a major issue and challenge, too. I think this goes both ways though. So there's -- health literacy is important for using the technology but the technology can help with health literacy. ^M01:00:02 There's a Georgetown company right there by the canal and they were -- they provide through Smartphones text messages to low income expectant mothers, about-to-be mothers. And their service was highlighted by President Obama and they're in many hospitals nowadays with this, and they've had -- they were able to demonstrate a benefit for both maternal health and infant health. So the messages are coming from pediatricians, so they're real healthcare providers. But they're able to demonstrate that type of benefit through the technology, and it's measurable. Doctor engagement also, too. This varies by culture. So in many or most countries' cultures there's a hierarchy that a doctor, being quite -- very, very well respected, obviously. But the technology changes the dynamic a little bit. And it changes it differently country by country. So in some countries the patient's very empowered and the doctors don't necessarily like that. In some other instances, the technology and the information the patient has may or may may not be all that helpful. One thing that's very much in the news is electronic medical records in patient reporting, and to what degree patient reporting is helpful to a doctor. And some of the better electronic medical records flag the provenance of the data as to whether it's from a real healthcare provider or from the patient. And one also interesting aspect of that is there's more and more consumer technology that people wear like Pit Bitz and things. Many, many, which are quite high quality. So the information is 7 by 24 as opposed to clinical trials where you go to the hospital once a week and you're tested. And so there's a couple of clinical trials -- one at Duke and one at Stanford -- to use commercially-available technology with 7 by 24 information and then seeing if you can make a judgement on a new other device or treatment. Some of the other issues -- I'll skip some. Obviously payer models. Reimbursement really, really important for any technology to be adopted. Here in the U.S., our laws changed last year. So, historically, for telemedicine -- for telemedicine to be reimbursed you have to be in a medically underserved area which was most often a rural area, or a city, a very, very urban inner-city-type area. But it changed last year, so it's much more reimbursable now to ---- for -- to -- back to the insurers. And also more -- Medicare and Medicaid more open to paying. Standards, obviously, interoperability. Market size has to have a financial benefit to private sector companies. And then adoptability. Some companies and some research projects are fantastic at engaging seniors and engaging the patients in design. Others not so. I think that's true with IT in general. Some of the IT development projects are fantastic in engaging users in advance. And then others not so much oriented that way, and the system is finished and might not be all that fit for a purpose. So engaging the users is very important. I'll wrap up in a second. This dual use idea is really quite interesting, too. A lot of commercial -- military technologies are being repurposed for aging and for assistive needs. Some of the hand motion technologies being adapted for autism and autistic children. Another need autism technology -- this is local also. For a severely autistic child they have 20 or 30 caregivers, so they have -- well, the parents, obviously. And then they have psychologists, they have language therapists, they have their teachers in the schools. So many physical therapists and many, many, many. And as they go through the course of the day, periodically a child like that might have a emotional incident or outburst. But they're somewhat predictable and the technology with this company here locally -- they try to connect the caregivers in the chain, and if an early-morning caregiver sees a sign, they'll flag it to the next ones so that they can react to -- interact with the child differently based upon how the child's day is going. So again, just phone technology but kind of neat. And lastly, policy is very, very important. Most countries now have national ICT policies. And then most have also ageing policies. It's the rare country where there's an intersection of the two, where there's a connectedness of the ageing and ICT. But tremendous potential. Japan is connected there. Theirs is quite well. But others are working on it. And then one last note here in the U.S. I think one of the -- two of the best things we do from a technology standpoint. One is the small business innovation research grant program which was the Alzheimer's and robotics grant was under that, for fostering commercialization of technologies through small businesses. It's a world leader. Many countries are trying to adapt it to varying degrees of success. But a small company with an idea or somebody with a prototype in an area of interest to the government, there's quite a bit of funding both to develop it to a trial and then to actually commercialize it. And another good, really good thing we do, I think, from a research standpoint is DARPA. We do many good things. But DARPA has been very successful. So a lot of the autonomous vehicles technologies today and around the world and here, many companies working on it. It started at DARPA only about 12 years ago with a DARPA Grand Challenge for teams to come and develop an autonomous vehicle that was able to drive through the Mojave Desert for 108 miles along cliffs and over hills and everything like that. In the first year, the winning team [inaudible] went eight miles. And then all of them had crashed by then. And so, just a number of years later, this technology really being adapted worldwide. And so the DARPA idea was two-fold. But they had a lot, there were a lot of initiatives on the different elements of a car. But there weren't initiatives to integrate them all together. And that the autonomous vehicles back then weren't military grade and couldn't go 35 or 40 miles an hour. And their view was, there weren't enough research teams or experts in the U.S. and by developing this challenge, that they foster interest in this and greatly increase the number of research teams. And so, in more recent DARPA challenges has been robotics the last several years. And so the first one, 2013 and '15, the robots were -- they bounded it for robots in natural disasters like nuclear relief. But the first year that the robots were very limited and couldn't go upstairs or couldn't really do much. And just in a few years, a lot of the technology rapidly advancing and cost is going to be coming down and much more available to people. So with that, thank you very much for coming. It's a fascinating area and an ageing society has many, many needs and especially with the intersection of ageing society and disability. So thank you very much. ^M01:08:25 [ Applause ] ^M01:08:31 >> Sandra Charles: Thank you for this. >> Jean-Pierre Auffret: Oh, thank you. >> Sandra Charles: That was most fascinating and informative. >> Jean-Pierre Auffret: Oh, thank you. >> Sandra Charles: Are there questions for Dr. Auffret? ^M01:08:37 ^M01:08:43 >> My name is [Inaudible]. Thank you for [inaudible] subject wide-ranging, still very concentrated, interesting as well as educational insight on the subject. Your presentation, very [inaudible] to look at several other aspects. One of it then is entrepreneurship. How entrepreneurship could provide [inaudible] in this sense. We, my group [inaudible] work at the sound [inaudible] last year. We were [inaudible]. With regards to that, look at how the [inaudible] could be entrepreneurial. It could be not [inaudible] more opportunities. I just wonder how you look at a [inaudible] rather than kind of the receiver of the technology as a senior citizen. ^M01:09:59 >> Jean-Pierre Auffret: Well, I think it's a very neat question because I think of -- >> Sandra Charles: Could you [inaudible]? >> Jean-Pierre Auffret: Oh, but the -- thank you. [Inaudible] that the question is about the potential for senior entrepreneurs developing technologies in addition to just being users. I think with increasing life expectancies that many seniors retire at 60 or 65 or 70 and will live to 90 or 95. So they have years for a full career ahead of them. And those that are able to remain active and vibrant and healthy, really would also benefit from an avenue or a path and have a tremendous amount to offer and a tremendous amount of insight. So I think that there's many senior entrepreneurs and I think that the potential is really great. And they also would bring insight to these types of technologies. But that the pensions too, I think, in social security also probably to some extent, what was designed when life expectancies were much less than today. And so with seniors living, population living so much to much greater ages, potential for second and third careers. On one other note, I think it does relate to the whole idea of careers is somewhat different now. Much less of it in the U.S. but many countries too, where someone works for one company for many, many years and also with the way technology changes so quickly. Industries seem to come and go also. And so most people, through the course of their lives even before 65, have three or four careers. So a really excellent question. ^M01:11:51 ^M01:11:55 >> Sandra Charles: Any others? >> Jean-Pierre Auffret: Okay. Well, thank you all for coming. >> Sandra Charles: Thank you very much again [applause]. >> This has been a presentation of the Library of Congress. Visit us at loc.gov. ^E01:12:08