So I should stop, wait, just a little bit before I agree, right? Welcome everyone to Norwich University. For those of you that are guests and for our students and faculty and staff, welcome to Mack Hall. I know some of you probably haven't visited this beautiful facility here. And so if this is your first time, please have a look around not only the auditorium here, but the building as a whole. And so I want to welcome you to the Norwich University STEAM Symposium with the theme of health and human shaping the environment, treating disease, and changing culture through science, technology, and communication. STEAM is an integration of art and humanities into STEM. That's our science, technology, engineering, and mathematics. Norwich is celebrating its year of distinction, the final year of our bicentennial countdown, before embarking on a primary teaching and learning are vital to the success of graduates in a global society. STEAM inherently shares these principles and calls us to action to promote discovery and entrepreneurship through the STEAM disciplines. These lectures this afternoon and this evening are being streamed live to Norwich online students right across the globe. To the Norwich students in attendance or listening online, have you been inspired by the events of today? Think about the big questions, the ideas these talks have sparked in you, the opportunities to explore further. Norwich University's undergraduate research program provides support for students across all disciplines. The research and creative work in a collaborative and nurturing environment. Consider taking the next step and bring your idea to the Students for Scholars Symposium. Applications are due Monday, November 5th. You can email or contact Professor Amy Woodbury Tees to apply. Remember, innovation starts with an idea. So this is the first of three talks today. This one at two, there's one at three and one at seven. I encourage you to look at the program so that you can see the three talks that we have on our overall theme. So now I'd like to introduce our speaker for the two o'clock session, Dr. Stephanie Taylor. After Dr. Taylor received her MD from Harvard Medical School in Boston, she practiced pediatric oncology at the Dana-Farber Cancer Institute and did research in cellular growth mechanisms. Alarmed by the high number of patients acquiring infections during their inpatient treatment, she became determined to better understand the role of the built environment in patient outcomes. She obtained her master's in architecture right here at Norwich University and now works in the U.S. and internationally as a consultant for the design and operation of hospitals and other commercial buildings. Dr. Taylor uses medical records and other data on the psychology of building occupants to determine which building characteristics truly support human health. She has published in Nature, Science and other peer-reviewed journals, is distinguished lecturer for ASHRAE and a regular contributor to the engineered systems magazine. She lives right up the road here in Stowe, Vermont and I welcome Dr. Taylor. Thank you for joining us today. Thank you very much. Is this okay? Can you hear me? So one correction, it's the physiology of human health, not the psychology, but that was a very interesting misread because it tells me, and I will convey to you, it tells me how new this intersection of human health physiological data as a building performance metric is. So thank you for making that mis-speak. So also wherever you got that introduction from, you saved me from saying how I got here. You won't take it now, I'll give you this rate. Uh-oh, where's my buddy, the IT guy, it worked. So the building will see you now. So it's interesting that the title of this lecture series, or today anyway, is Worse Shaping the Environment, Human Health and the Built Environment and how we're shaping it, but what I'm beginning to learn in my work and what I want to convey to you is how the built environment is shaping us for better or for worse. So how many people in here are in the School of Architecture? Great. How about engineering? Students are busy somewhere else. What are some other schools that you're in? Could somebody tell me who didn't already raise their hand? Science and Math. Yeah. So any of the other engineering disciplines, civil, no? Okay, great. Well, it's wonderful to have you here and thank you for coming. So the building will see you now. As you already told, I got here originally just, I was seeing patients, pediatric oncology patients and I became really alarmed because too many of my patients were surviving their cancer, surviving chemotherapy only to die of these infections that people get when they go into the hospital. They used to be called nosocomial infections. Now they're called HAIs, healthcare-associated infections, things like MRSA, clostridium difficile. So as you can see by this graphic, too many of my pediatric patients were dying and it's not just kids. This gentleman is the dean of my son's medical school and he went in to have his knee meniscus trimmed. Four and a half months later, after almost dying from a MRSA infection, he came out without his meniscus, but without his whole leg below the knee. Does anyone here know anyone who's gone into the hospital, gotten into an infection? You or your family member? It's a very bad problem. So just so you don't think you're going to be here all afternoon listening to me, I just want to tell you kind of go over the four areas that I'd like to talk to you about, one, some health trends, two, one of the reasons that it's so exciting to be in this intersection of health and the built environment is that we have new tools so we can actually see at a much more detailed level what's going on. I'd like to show you some studies and then ask you where we should go from here. So getting started, something's going wrong. We spend all this money on healthcare and yet did you know that going into the hospital is the third leading cause of death in this country? If you didn't know that, raise your hand. And this is separate from the reason you go into the hospital. And it's not very widely publicized as you just demonstrated. Healthcare costs are out of sight. Maybe those two things are related. It's hard to tell because it's very difficult to get accurate numbers on the number of HAIs, healthcare associated infections. Many people, more and more people are coming down with these autoimmune and chronic inflammatory disorders. Autoimmune things like lupus, Lou Gehrig disease, amyotopic lateral sclerosis, people with chronic or inflammatory bowel syndrome. These are more and more becoming problems. Why is that? New infections, new infectious agents that we thought we'd sort of put behind us are coming back and new ones are emerging that are even more virulent. And not only antibiotic resistant infections but also new zoonotic infections, infectious agents that originate in animals. So why is this happening? In case you don't believe me about chronic diseases, this just looks at strokes, heart attacks, other cardiovascular disease, diabetes, hypertension, arthritis, high cholesterol, asthma. So this is the projected increase. So why is that? Why is this happening?  Did anyone get the flu? Was it bad? It's a very virulent strain. Vaccinations only prevented about 30% of the flu from last year. So here's a CDC graph showing last year. I grabbed this from the end of January and already you could see how much higher 2017-18 was from previous years. Baby boomers, so my age, were hit the hardest, although there were pediatric deaths were higher than the CDC's ever measured before. As a matter of fact, so living in beautiful Vermont, I have eight dogs. My husband doesn't even like dogs. So you know I love dogs. When I took one of my dogs to the vet, my vet said, you need to vaccinate your dogs against the flu. I was like, what? I've never heard that before. So it's not just me wondering what's going on. Mother nature is saying, what are you guys doing? What are you humans doing? Listen, you're supposed to laugh at this. What are we doing? Well, one thing we're doing is we're indoors most of the time. I can't speak for the cadets, how often you're out on exercises. But I live in beautiful stow. I ski. I do all the stuff that people like to do in stow. And I'm still indoors most of the time. So the indoor, the built environment has become our new environment. So let's take a look at the built environment. So the way things used to be, and then more and more the way things are, especially after the fuel problems in the 1980s, buildings began to be sealed. We don't have as much ventilation. So Ken Dickerman, who was responsible for all of the VA hospitals east of the Mississippi until he retired, said, we shape our buildings, then they kill us. Who believes that? It's alarming, right? And if you're going to make an alarming statement like that, it's really good to be able to understand if that's right or wrong. So everyone in architecture, when you think about a building, and I wish there were more engineers here, but what do we think about? Lead, leadership and energy and environmental efficient design focuses on energy costs, or decreased energy costs. We think about construction costs. We think about if you're building a building for manufacturing guitars, you're going to want that environment to preserve the wood. And who's familiar with ASHRAE, American Society for Yeah? So ASHRAE talks about occupant comfort, says we should address occupant comfort in buildings. So I ask you, if you're about to buy a car for yourself and your family, and you read up on the safety metrics, so you'd probably be interested in how much gas you consume, but wouldn't you also wonder what happens if you get in an accident? Are you or your family members going to survive? Or are you just going to worry about whether the paint cracks or the windows crack and how much gas? My guess is because of the immediate consequences of a car wreck, we're going to think about safety metrics of an automobile. When I bought my son his first car, when I was actually, I was a student at Norwich, I thought long and hard about the safety metrics. But in building performance assessments, we don't really think adequately about the human being. Most people don't. So let's take another look at what's indoors with us.  They're about 100 microns in diameter. And as everyone hopefully is breathing, you also have these little droplets coming out. This engineering or architecture students drawing away, probably after she used Revit. And as you can see, particles are coming off of her skin, going onto the surface. Then depending on the air circulation, they'll be re-suspended. I mean, we do live in a 3D world. It's not just surfaces. And you can see her digestive system is illuminated here because there are lots of microbes in there. If she had a gas problem, you'd see that in this video. Looks like she didn't. But you can see there's an active exchange between her body, the particles, and the microbes coming off of her, landing on surfaces, going into the air. And then depending on how your building is sealed, things that are on the outside will go in, and things that are on the inside may or may not come out. So what are those particles? What are those organisms? So microbes, I mean bacteria, viruses, and fungal organisms. So what are they? Are they good, bad, and different? So before several years ago, before like three years ago, if you wanted to assess the organisms, the bacteria, say, in your throat or on your skin or on a surface, what would you use? What? Microscope. Microscope, yeah. So how you take a swab, save your throat. You already have a sore throat, and then the doctor makes you feel worse by gagging you with a Q-tip. And then you plate it on a Petri dish and incubate it, grow it out. That's called tissue culture, right? So we still use tissue culture techniques to analyze what's going on in buildings, but we now have a whole new system called metagenomics, or PCR. Who's heard of polymerase chain reaction? Yeah. Oh, awesome, you guys. So we use PCR now, and you can actually see the DNA and RNA fingerprints of all the organisms in buildings, in the air, on surfaces, on our bodies and in our bodies. So now we have this whole technology called the microbiome. You heard of that, the microbiome of your gut. If you take antibiotics, you mess it up. So there's also the microbiome of the environment. So these new tools have completely revolutionized what we know about ourselves, our environment, and it's also turned the concept of hygiene upside down. Is anyone germaphobic? Did they want to admit you are? Eleanor.  Well, the good news is most of these organisms are good for us. The bad news is they're everywhere. As a matter of fact, before, so this red line shows the number of organisms that we could detect in tissue culture. The green line shows the number of organisms that have been revealed by metagenomics. And you can see, it's not that the number is increasing, we're just becoming aware of them. So remember, 2003, the human genome was finally sequenced. So now we now have a DNA map of our bodies. In 2003, we discovered that only 15% of diseases have a solely genetic basis. The other 85% is lifestyle and environment. So our environment is hugely important. So we've also learned that each of us, including me, is only, by cell number, I'm only 30% human. And that's after I go to the bathroom. The rest of me is bacteria and some virus organisms. Everyone in here is mostly microbial.  That's by cell number by volume or about a gallon or a gallon and a half of bacteria. But don't worry, because like I said, most of these are good for us. They help us digest food. They help control our allergies. They help us, our bodies learn what to be, what's ourselves and what's foreign. So they help control autoimmune disorders. It's only when the microbial communities in us and around us become very imbalanced do we, are those imbalances associated with disease. So if you're germ, if you're germaphobic, try to kind of quell that fear because most organisms are good for you. It's probably not too much of a stretch of thinking to think, okay, well, for each of the little ecosystem, then everyone in this room is shedding their organisms into this room. Everyone sitting here is putting organisms into the room. And conversely, people who were in here yesterday are sharing theirs with us. So which of the organisms that we leave in here are gonna survive and grow into their own communities? Because not all organisms survive. As a matter of fact, we now know that the indoor microbiome, so the microbiome, the indoor environment has less diversity than outdoors. Does anyone grow a garden in the summer here? See, you don't just grow one thing, right? Ecological systems like biodiversity creates a healthy system. But something we're doing in buildings is creating a very restricted microbiome. So this is just showing what I just told you in the graph. So this is showing a building with mechanical ventilation, an operable window, and this is the outdoor environment. And here we have the phylogenetic diversity, so the diversity of the bacteria, in this case, bacteria, in a building. So you can see if you have purely mechanical ventilation, you have a much less diverse microbiome. Not only is it less diverse, but if you look over here, here we have, now the X axis shows phylogenetic diversity and the Y axis shows how close those microbes are to pathogens, pathogens, genesis, pathology, to the organisms that cause disease. You can see, so if you're up here, that means you're highly pathogenic.  So you can see not only are the red dots from the mechanically ventilated buildings more pathogenic, not only are they less diverse, but they're also more pathogenic. So let's now take a look, because is anyone thinking, well, what is it that we're doing in buildings that's creating this situation? So we're talking about microbes right now, but these microbes definitely influence our health. Is anyone aware that your risk of cardiovascular disease goes up if you don't brush your teeth well? Have anyone heard that? So periodontal disease and the organisms that grow on tartar are now associated with whether or not you're gonna have an increased risk for a heart attack. So this whole concept of the microbiome, it's not just a bunch of bacteria that are somewhere else or only affect us if we have strep throat. These organisms are integral to our health. So let's take a look, let's ask the question, how are we gonna decide how to design and ventilate a building, design an operated building to support human health? So this is a hospital. So this is going beyond lead. This is going beyond thinking about energy consumption. This is taking a look at a building metric that's around occupant health. So somebody, if you wanted to design a study to see what the impact of a building is on occupant health, where would be a good setting for that? What would you wanna look at? I asked this question this morning in a class and one of the students said, well, you take a look at your budget.  And that's kind of where we are really. That was a good answer. But what's another approach to deciding how to design buildings? Some brave soul, yes, I love it. Added microbiologists to the building staff and what would they look at? Wow, that's great. So he said the biologists would look at the materials and indoor conditions and see what microbes are likely to flourish. I think that's great. So that almost that exact study was going on in the Chicago area. So a great place to do this sort of study is actually a hospital. So this is a hospital. A group was looking at a brand new hospital. It was Leeds Silver, had like 300 private rooms, 24 ORs, bone transplant, green roof. All the patient rooms were single. So a group had taken 10 patient rooms at a brand new hospital starting right before it opened. And they were monitoring the patient rooms.  And they were relating those parameters back to the microbes they found on surfaces and in the air. So they were doing kind of what you said. So I found out about this study and I'm like, hey, I wanna look at patient outcomes. I wanna look at these patient infections and see if patient infections are related to the patient room parameters. And they were like, okay, yeah, whatever. 10 minutes later I get 400 patient records in my email. I'm like, whoa, what about HIPAA? So much for privacy. I had to go address that after the fact. But hospitals are a great place to do this kind of study because my premise is start with measuring human health data. Start with the human, collect all kinds of data and then reflect that back on the building. And in a hospital, the patient is being, I don't know if anyone's ever been in the hospital, but they wake you up in the middle of the night, they do your blood pressure, your pulse, they draw blood. So take all of that data and apply it back to the hospital building. So maybe you're thinking, well that's great for hospitals, but most of us aren't patients when we go to school or go to work. And that's true. We don't go to work with an abdominal incision or with a central line in us most of the time. But what we've discovered in hospitals, what parameters in hospitals that affect patient outcomes were finding affect all of us, maybe to a less obvious degree in other buildings. So are you with me about the data? So in that study, we looked at these different things. This box is a patient room. So CO2, lighting, temperature. We monitored hand hygiene, room air changes, room traffic, indoor and outdoor relative and absolute humidity, outdoor air fractions and room pressurization. We also brought, took into account any flu season or anything that was going on in epidemiological outside of this hospital. So we had about eight million data points from the room monitoring. So we took all that data and then applied it to which rooms had patients who had got these infections. So of all those parameters, which ones do you think related to infections? We hear a lot about hand hygiene, right? We hope that is a good thing to focus on. What? All of them. All of them? Does someone say all of them? No more. Hand hygiene, lighting, air changes.  So we got these results back and we thought our statistician had made a mistake. We actually fired him. Got a new one. We didn't like what he said. It ended up that of all those parameters, dry indoor air in the patient rooms was the most associated with infections. So starting in January, going through the summer back to January, the blue line shows the average relative humidity in the patient rooms. The red line show the infections. So I said, look, you missed the fact that it's summertime, everyone's healthy. It's not the flu season. And the second statistician said, we used a multivariable linear regression test that isolated the independent variable. So this is separate from visitors, separate from seasonality. This is an independent variable. I was like, I didn't expect this. And you can see the relative humidity only varies from 32 up towards 40. You remember relative humidity is how close you are to complete saturation. So I still didn't really quite believe this. Wasn't what I expected, so I didn't believe it. So this was another study in an assisted living facility. It's much easier getting data from an assisted living facility because the business model, they want people to survive. In a hospital, you're in the business of sickness. So it's a little harder to tell what the business model is to sound a little cynical. But in an assisted living facility, longevity is aligned with a good business model. So we looked at four years of data and once again found that in that facility, so here we have average number of infections and here we have indoor relative humidity. And I don't sell humidifiers, by the way. That's not my business. So the blue line shows that gastrointestinal infections and the orange line shows that respiratory infections, they had an all-time low in this elderly population between 40 and 60% indoor relative humidity. So like what is with this 40%? Why is, because if you look back in this study, as you approach 40% or go right over it, the number of infections goes crashing down, which is good. This was an interventional study in a preschool that showed that 20% versus 45% in a school looking at the number of airborne particles that were infectious, how infectious and the number of children that were absent, you could see at 20% relative humidity, you had three times more kids missing school. Who's heard of that meningitis belt in Africa? Whoa, that's amazing. So there's this area in Africa where, oh, I don't know what happened to my text here, but bacteria spread through the air when the outdoor humidity is low. Once it exceeds 40% the epidemic ends. It's like, seriously, is water vapor that important? Apparently, according to these studies, it is. So then I got a call from Washington. I thought it was a spam call. I almost hung up on the person.  And he said, this is Dr. Gilligan from the GSA. I didn't know what the GSA was, but he probably did do. I do now. General Services Administration. So all the federal buildings in this country. And I don't have the data here because I don't want to go on and on. But Dr. Gilligan said, we were wondering why some of our office workers are stressed out and not productive. So we monitored the people. We monitored salivary cortisol levels, heart rate variability, how fast and the rate, the pattern of blinking. These are all signs of stress. And then we monitored the building. We put them together and we found that when the relative humidity in the offices was less than 35%, our workers are stressed out. Or if it goes over 60. And I was like, I'm hearing this again and again. But in the winter time, in Vermont especially, or in cold climates, what do you think the indoor relative humidity is, say, in the winter? Yeah. I mean, you take air out. So relative humidity is dependent on temperature. So you bring cold air from the outdoors. Maybe since cold air holds less moisture, the relative humidity outdoors might be 60%. You bring it indoors and heat it up and it plummets to about 20%. So is that good for us? It's kind of the conditions of the Sahara Desert. And maybe I love camels. I've never met one. I like animals. But is that good for humans? It looks like it's not. So why is dry air potentially bad? So who remembers the second law of thermodynamics? I won't ask you to explain it. So you can put your hand up. So it says that the universe is always moving towards increased entropy or towards equilibrium. So like, if you have a teenager, you clean up their room.  Then they come in and 30 minutes later, there's sort of an even veneer of clothes around. That's an increase in entropy. So if you're a nice hydrated human being in 20% relative humidity, what's gonna happen as the universe moves towards increased entropy, right? Yeah, it's not personal. Yeah, but the room is gonna, in trying to reach saturation is gonna take the moisture away from you, yeah. So it ends up that pathogens love dry air. We didn't know this until we had these PCR metagenomic techniques. We thought all those little things were just dead particles we didn't have to worry about. But in dry air, the pathogens, they're transmitted further. They go up into the air. They go through your ventilation system. They go around your building. They're more infectious. They're able, they're smaller, and your mucous membranes are dehydrated so they can get deeper into your lungs, into your bloodstream. And they evade surface cleaning. Actually, Dr. Dimick said at UCLA, UC Berkeley rather said dry indoor air is the most important variable in biological warfare. But we're not in biological warfare. We're not conducting that all the time. This just shows you how, again, I'm talking in your breathing. Droplets come out 100 microns. Depending on the moisture and the air they shrink. They desiccate to reach equilibrium. And at 20% relative humidity, they reach this tiny size called the droplet nuclei where they float through the atmosphere and they've actually been recovered 21 years later. Remember the increased infectivity? So this is a study looking at influenza A, H3N2. And look at this. So here we have 0% relative humidity up to 80. This is the infectivity. This is in animals of influenza A. So highly infectious, highly infectious, highly infectious. And then around 40%, it's like boom, infectivity comes down, virulence comes down of this virus. And many viruses, and most bacteria. Many strains, the infectivity goes back up at 60%. But there's a sweet spot, 40 to 60%. Which is great for humans. And it inactivates pathogens. So talking about new tools. So beginning of July 19, I mean 2018, we thought, okay, here's some bacteria that are in the air. They're alive. You can see there's some movement. They're kind of hanging out. And then this stain, this immunofluorescent stain, this particular one was perfected. This was published the end of July of this year. So these are airborne organisms. These bacteria have the ability to put this little pilli, this little hair out. It's about one 10,000 the width of a human hair. And they're scavenging DNA from other organisms that have become fragmented, release their particles into the air. So the red particles are DNA from other organisms. So these airborne organisms take the DNA, they bring it back into their nuclei. And if they can use it, it's kind of like an ATM machine, right? You can take whatever you need. What happens if that, those little red fragments carry antibiotic resistance? They're in the airborne state, these bacteria are drawing airborne, I mean, antibiotic resistant genes directly into themselves. So this is what the publication said. Antibiotic resistance can spread through the air. And yes, you should be terrified. Well, I don't want you to be terrified, but I do want you to understand how important the bill environment is to our health. So who remembers, who knows what horizontal gene transfer is? Or lateral gene. So lateral gene transfer is what I just showed you. Most of us think about vertical transfer. So this is like the tree of life, Darwin. Survival of the fittest. Say a bacteria survives in the antibiotic exposure, it mutates, reproduces and sets up a new community of antibiotic resistance. Well, that's vertical gene transfer. And it's fairly, it's slow compared to horizontal. We now know that we can share genes directly, horizontally. And guess what? It's not just within bacteria.  So this horizontal transfer occurs across species, across taxa. So it's a very rich environment that we live in. It's not just us against a few bacteria. We're sharing genetic material constantly. So let's quickly talk about humans. We talked about bacteria and viruses. Let's talk about humans in dry air. How do we do in a dry environment? So anyone like Cliff Notes, although don't raise your hand, you know, like the short version. So if you're falling asleep, we don't do well in dry air. Even mild dehydration, 1% at which point, you're not even thirsty yet, your urine hasn't even begun to get dark, is associated with all kinds of health problems. Our brain doesn't work as well. We get tired, we can't concentrate. We're more vulnerable to infections and asthma outbreaks. We get dry skin. Wound healing is slowed down. It affects our eyes. So this is actually, this is an image from a military study, looking at a 28-year-old who went 20 hours without having any oral hydration at 20% relative humidity. And at 1.5% dehydration, you can see his brain volume actually was decreased. This is an air in here, this is cerebral spinal fluid. Not only was his total brain volume diminished, but the neurotransmitter activity was diminished. So people take medication to raise neurotransmitter levels if you're depressed or anxious. But when you're combating a lack of water vapor in your environment, you have diminished versus the same person at a well-hydrated state. And this is just another image from that study showing it is reversible, so this isn't permanent, which is good. So this is the dehydrated state, and this is upon rehydration. But this very mild dehydration affects those things listed. Who gets tired in the afternoon and drinks water? Who feels, yeah. You will now. So it's hard to combat insensible fluid losses from respiration with oral rehydration. It certainly helps, but it goes into a different tissue compartment. So it's not like a water tank that you're draining and then filling up. Our lungs, there's a mucous membrane along our lungs, along our respiratory tract from our trachea down almost into the alveoli, the lung sacs. And in that mucous layer, these little hairs called cilia, who's heard of cilia? So the cilia are constantly washing upward, and they keep particles from settling deep into your lungs, because once stuff gets into your lungs, it's only one cell membrane away from your bloodstream, at which point that's not good if it's, say, bacteria. But at even 6% increased viscosity, those cilia can't work. And so stuff settles down into your lungs. Or if you smoke cigarettes, nicotine temporarily paralyzes cilia. This is a study in Australia showing that pilots who are in the air for more than six hours go from 2020 vision to 2060. So upon landing, this is kind of what they're seeing. So you're hoping autopilot kicks in. And this is just showing what happens to their corneas. So you know, as we age, it's a battle. You start out floating in amniotic fluid.  You're constantly fighting the effects of gravity and moisture. Do we really want to make this worse with our indoor environment? So if you deal with buildings, engineering, architecture, maintenance, people think humidity is a bad word. I don't even call it humidification. I call it indoor air hydration. They think mold, odors, aspergillus, legionella. So building people say buildings don't care about humidity, let's keep it dry. Now those of us who are in clinical medicine or biology are saying, wait a minute, we can't do that. That's really harmful to the occupants, to human occupants. Is this new information? No. Does anyone recognize this chart? This came out in 1985 with ASH rate. So bottom relative humidity, the black zone show problems from ozone, allergies, respiratory infections, viruses, bacteria at low humidity and then also at the high end chemical reactions, allergies, mites, mold, viruses and bacteria. And again, back from 1985, this 40 to 60% sweet spot was identified. But we don't really manage our buildings like that. At least not most of them. Unless the business model shows a positive ROI for humidification. If you're an NIH research animal, you're in 45 to 55% relative humidity. If you're an astronaut up in space, there's no moisture in space. You're gonna be in a space station that's at 45%. So this is known, but we don't do this. We don't manage our buildings with this in mind. And I think part of the problem is most of us normal mortals don't really have a price tag on our head. It's not clear how much we're worth. I mean, emotionally to our parents and to our children and siblings, hopefully. But we don't have a clear price.  We were way up in the Andes. Kathy Henkel knows my son. We were hiking up in the Andes and we came upon this small stone building with the village elders who had passed away. I hope this doesn't upset anyone. So these are the important people in the village who had died and they were put in these cheesecloth, like sacs, this looks like it's pottery. And look at this. There's a dehumidifier and a humidifier and a thermostat and a hygrometer in the middle of nowhere. And they were keeping the relative humidity between 40 and 60% if you look at this. It was at 59. But these people are dead. Aren't we worth humidification before that? Okay, so this is my segue into a business model. That hospital lost $15 million in one year from preventable infections that the patients got when they came into the hospital. So if you can decrease this, even by 20%, you're gonna be helping that hospital. And they tied up that many patient bed days with these infections. The cost of decreased employee productivity is huge for a business or for a school, the impact on learning from the indoor air quality. It's major. Remember the pilots? So this is interesting. I was flying on Delta a couple weeks ago. All of a sudden this came out and I was like, what is happening? It's humidification. Does anyone remember recently when those couple airplanes were grounded or sequestered because people got really sick? One was an Emirates, do you remember that? Well, the humidity level on airplanes are around 10% if you're lucky. And the flu virus is very, very violent at that relative humidity. And so three airplanes have their travel plans interfered with. So now airlines are humidifying. Change is hard. I don't know if any of you recognize this as change. You're young and optimistic. But thinking about the role of the building in our health is a change. It's a big change. We think about energy consumption. We think about aesthetic value, real estate value, materials. But we haven't really used health data as a building performance metric. Like starting with the health data and then deciding what we're doing right or wrong. If you're still not convinced, take a look at biology. This is a skull from an antelope that lives in a very nice humidity zone. It's around 40, 50%. So this is the shape of this antelope skull in a grassland. The first cousin that has evolved in a desert, the same animal, but just a different environment, has developed this, used all this calcium and the other bone matrix compounds and has evolved this large nasal cavity that's got a well-hydrated turbinates. So air comes in, it's slowed down. So I know you said ventilation, Eleanor. Ventilation's good, but it's not the only thing to get. Where's Eleanor? You're on your way out, no wonder I couldn't find you. So you slow down the air, humidify it and clear some particles. What? We're almost there. So here we have building professionals over here and clinical professionals over here or clinical biologists, health professionals. And we're in our own silos. We have our own language, we have our own set of acronyms. But if we could come together and work together and talk to each other, we could really improve the situation for people. And finally, my last slide is, this is me. I do a lot of skydiving. And a friend of mine, thankfully, not thankfully, caught me doing a face plant. So I say, working in silos, this is where we're going. In healthcare, we've made a real mess of things. We've got diseases, we've got antibiotic resistance, we have prices that are out of sight. But working together, we can soar. So I ask you to think about or to talk about now because we have five minutes. So this seminar is around interdisciplinary work. So I came to Norwich in my 40s to learn about architecture. It was hard, but it was wonderful. And I just had the most amazing experience here. So in your youth, how can you work with other people in different disciplines to begin to understand, in this case, human health, the built environment, the business metrics around a healthy human being? We now have body sensors so we can measure the chemical content of our perspiration. So could you take those body sensors and combine them with data from a building? So this intersection of buildings and health is just so fascinating and important. And it's just waiting for people like you to come in and figure out how we can combine the data, collect and combine data, and then manage and design buildings that really are focused on supporting our health. So if you have thoughts and you're brave, you can put them out there now or we can talk later. Or you can just think about it. Well, thank you very much. We have a few minutes for questions over there. He's saying, I think he's saying that this is great for hospitals, but in an office building, that's not gonna create a positive return on investment.  It's the salaries. So if you could increase productivity, decrease absenteeism by even 10%, you are gonna have an ROI that is beneficial. If you own the building, if you build the building and own it and then let someone else occupy it, it's gonna be less immediate. Which is often the case. 50% of the time. I mean, if the developer, develop buildings and you run out to business and whether or not the employee is 60%, 50% of time, it does not come out from your bottom line. So that is a big conflict in building something that should beneficial to human versus return on investment. So how can we address that, do you think? I don't think that you can change it because it's all about the dollar and cents. Unless there is a demand or unless there is a benefit to the developer to meet that demand, it could happen. So actually, along those lines, only if there's a benefit. So I'm proposing that we start not just leadership and energy and environmental design, but I'm calling it LIDO. Leadership in Designs for Occupant Health. What if we had a whole platform around rebates and certifying buildings, certifying designers, architects, certifying engineers, around building with health data? I think you're right because that's exactly the disconnect. I mean, I also agree that the Energy Star program was beneficial. I think that they might have disconnected, discontinued the program, but I have worked with Energy Star office in Vermont and it does encourage certain practice. I think we need to create incentives like that around building for human health because buildings are shelters, at least. Living in Vermont, I was doing it at Woodstone, all the resource. How do you manage your own environment for your personal territory? Oh, I wish you hadn't asked that. You know, not perfectly. I have eight dogs who pant a lot. They keep the microbiome very well diversified and I have those little humidifiers in pretty much all my rooms, which isn't great, but I also build a wet bulb, dry bulb, hydrometer and I monitor humidity and I also got this device for about $100 that monitors CO2 and VOCs and particles. So I'm beginning to collect data around in my own house about when, so far I can just tell what my husband's cooking for dinner, but so I'm beginning to collect data but to answer your question, I try to keep my home around 35% but I'm not very good at it. Yeah, I mean there are some. There's, of course I'm blanking on the name, but there are companies that monitor your indoor air quality and you can tap into it from on your phone, but I'll tell you this intersection of indoor air and human health is so undeveloped. It's waiting for everyone in this room to take advantage of this and develop your business around it because you will do well. One more question up there. Students like myself who are architectural majors to consider these things and the designs we do because I feel like we've got so much already on the table and it's sometimes overwhelming and also having to consider those codes and also consider human health actively like you just mentioned in your lecture. How can you suggest it's balanced or how can it be integrated into the education system? I mean you're asking great questions and why, and I know there are so many things out there, lighting, acoustics, views of nature, colors. So the way I focus my priorities is by looking at the health data and that's not that easy to get, but collect data, go back to your own homes or offices, monitor your environment, see what's related to your feeling sick or your kids being sick. So my philosophical answer is let data guide you to what the priorities are. In terms of teaching architecture students, Eleanor, you still here? You know, how do we do that? Yes. Yeah. Yeah, I mean, you're right, they're building materials that are hygroscopic, they hold onto moisture in micro pores so biofilms can't form and then they release, release that when it's dry. Eleanor, you don't even know it yet, but Kar and I were talking about you and I co-teaching a class next year. Well you guys, I should stop, but thank you for being a wonderful audience and talking and. In 2016, as executive vice president from Booze Allen Hamilton, where he worked for 26 years, he currently focused on mentoring startup companies and engaging in brain and neuroscience research areas. A love of music and singing combined with his entrepreneurial spirit led Mr. Thoet to becoming a co-owner of a Georgetown piano bar in Washington, D.C. in 2014. At Booze Allen Hamilton, Mr. Thoet has led groups in neural networks, advanced computational technologies, modeling, simulation, wargaming, rapid prototyping and alternative revenue streams and led markets including DARPA, DTRA, SOCOM and CDC. He led groups as many as 2,000 staff and 400 million in revenue. Mr. Thoet received both his bachelor's of engineering degree and his MS degree in computer science from the Stevens Institute of Technology in Hoboken, New Jersey. Between 2013 and 2016, Mr. Thoet served as a chairman of the Board of Trustees of the National ALS Association and is now serving as the chairman of the research committee and is passionate in his support for the work being done there. Bill currently serves as a mentor to the Washington, D.C. incubator, 1776, advisor to the University of Pittsburgh Brain Institute, advisor to the Aspen Brain Institute, advisor to startups, true genomics, intergalactic education, LLC and frontier and supports Booz Allen as a consultant. Welcome, Mr. Thoet. Thank you, thank you very much. So I learned something very new there about the importance of mid-range humidity for maintaining your health. I have mostly maintained high-range humidity for my cigars to actually harm my health. So now I know I have to find a little bit lower setting. So you heard a little bit about my background. I'm trained as an engineer and not as a biologist, but it made it very interesting when I retired and I refocused what I was doing with ALS Association to become basically the chairman of the research committee and advising the head of the research department and the research committee on what we should be investing in. So I thought I should learn a little bit about that. And it's very instructive as an engineer to go and learn biology because it works so differently than you think of from a top-down design. You are now dealing with an evolved system. And that's really relevant to this discussion because medicine is really hard. Actually treating diseases, curing diseases. We think we've done a really good job of that, but really other than things like diseases caused by diet and diseases caused by infectious agents, we haven't been very successful in actually defeating many of the diseases, especially genetic diseases. And so now in today's modern world, we're actually turning to technology. And I'm gonna focus specifically on technology used in treating illnesses or other efforts around brain disease or brain injury or brain malfunction. And some of the diseases, for example, that I'll talk about where we really don't have any good treatments, any biologically based good treatments, ALS, you've heard about that before, Lou Gehrig's disease. It's basically a gradual dying off and gradual is not gradual enough. Two to five years is typically the lifetime of a patient once they're diagnosed where the motor neurons die.    Alzheimer's disease, one of the most common brain neuromuscular diseases, spinal cord injury, blindness, deafness, epilepsy, post-traumatic stress disorder. There's a whole host of diseases that are out there that we really don't have very effective cures. Or even in many cases like ALS, very effective treatments at all. We can't really figure out how to extend the life of somebody. There are only two approved treatments, for example, now for ALS and they have very limited kind of impact on the patients. So we're often turning to technological solutions for these and I'm gonna cover several areas of it that go from the, oh, I kind of already knew we did that to, hey, wow, I can't believe we're doing that. So some of them are indirect interfaces and you all carry around an indirect interface now that will help you do things like communicate when your hands are tied up. You can speak to your computer and say, hey Siri, I was wondering if I said that in an audience like this whether everybody's phone would turn on and say what do you want. Mine didn't even, so good. But you have that capability now in your pocket and that's useful and variations of that are useful, for example, with various disabilities of people using computers. You'll notice on your computer you have disability settings for the computers. So you have voice control. What has been around for quite some time for the blind are braille monitors where they actually can run their fingers across the monitors and read text. So it's basically replacing their eyesight with their fingers and using just fairly simple technology for doing that. Where it becomes a little bit more challenging, I told you that one of the things that happens with ALS is you lose your voice. Well, if you lose your voice and you have full faculty with moving your hands or moving your body, you can use sign language. But ALS patients can't do that. So for years, many years ago, once people got into that stage, they were trapped. They were fully cognitive. They could hear and understand everything that was going on. They had a will to communicate and they had no ability to do that. Can you imagine how terrifying that would be? So they've developed technology. There are various forms of it. The most common form is eye gaze technology where you have a computer with a special infrared sensor usually that will actually detect where you're looking on a screen and they'll display a picture there. You usually have a keyboard or maybe even larger letters and or you can pick out individual words. And if you talk to an ALS patient in later stages, you'll ask them a question and you'll wait for a little while and you'll see them just moving their eyes around and text will come and then they hit this sort of the return button with their eyes and then it will speak for them. In fact, most of the time, if you've heard Stephen Hawking's give lectures, that is a computerized voice that he operates a device like that using a muscle on his cheek. That was the only muscle that he had that he could really control and he actually dictated many books by just twitching that one muscle and then converting it to speech. One of the things ALS Association is doing now is we're working with a company that actually captures your speech at the early stages of the disease. So instead of having the computerized voice like Stephen Hawking's, you have your own voice that you maintain and that is very important to people. So that technology is very interesting. I like telling stories which is why I don't have slides. I met a guy that started a company called Not Impossible Labs. And he had met an ALS patient who used to be a graffiti artist. And the guy had gone to the stage where he was bedridden, he couldn't move his arms, he couldn't use his art anymore. So the whole idea behind Not Impossible Labs is to actually go and rapidly prototype a solution for an individual and then hope somebody else does it for the world. What they did is they actually connected an eye tracking device to another device that somebody else had built where you can basically do virtual graffiti. It's a laser device that will draw graffiti on a building and he was able to for the first time in five years actually do art again on the whole side of a building. So very interesting application of that. There are other devices that are, so that's just basically taking something that's typically used for something else where you gaze, twitching a muscle and using it for a new purpose. There are other cases, for example, most of you have heard of cochlear implants where people who are deaf, they're cochlea, which is actually what produces, processes a sound and converts it to electrical impulses in the brain, doesn't work on many individuals. And they replace it with an electronic device that allows them to actually understand speech, understand some sound. The devices though are pretty rudimentary. They may have a couple of tens of different frequencies that they feed into the brain, whereas the cochlea, human cochlea has about 3,500. But, and if you go online and actually search for cochlear transplant playing or something like that, you can actually hear a recording of what somebody with a cochlear transplant hears. And it's not what you hear right now. You would hear very fuzzy, you'd hear overtones and some very strange sounds, but you could figure out what I was saying. And it's a remarkable technology that can go a long way.  And there's a very strong deaf community who believes that the culture that you get from being deaf and talking with your hands shouldn't be denied to somebody who is deaf. And there's an interesting book that I would recommend calling He Can Hear Me Whisper. And it's about a mother who's making the decision about one of her children to get a cochlear transplant for her third child who's deaf. They've actually worked on artificial retinas where they've actually put a sensor array in place of retina where people have lost the retina. Very rudimentary, maybe about 60 pixels. So they can tell light from dark, they can avoid walking into walls, but they can't really read or do much with it. But obviously that technology is gonna move. A more interesting thing that basically addresses the same problem is somebody developed a Lawson shape thing, basically a lollipop that you put on your tongue has electrical stimulation on it in a 20 by 20 grid. And you wear sunglasses, and the sunglasses actually have a sensor in it, and they convert what you see into that 2020 grid and give you an electrical pulse on your tongue. And people can learn to see with that. They don't taste with it, they actually start perceiving that they're seeing. So it's really interesting, there's a quote by one of the early developers of the neuroanatomy of sight, and said, the eyes don't see, the brain sees. So people see with this, there's a blind climber who is the only blind person to have climbed every tallest peak in all seven continents. And he uses this now, he can double the speed of climbing because he can see where the handholds are with his tongue, which is kind of interesting. Didn't do it in Everest because it was too cold and it would have frozen into his mouth because it's at 29,000 feet, but he uses it regularly. So one of the things that there's a story on him that is, I think it's just called seeing with your tongue, and the story relates that the most important thing, even though he could climb and all that, is he could actually see his son smile, which he had never seen. So very interesting technology with only 20 by 20 pixels, it's amazing, you can do that, and it's amazing that the sense of taste can be used to actually generate an image. So patients use this regularly, there's a device that you can buy for $10,000 called BrainPort V100, and they learn how to quickly find doorways and elevators, walk through rooms, read letters and numbers, can pick out cups and forks at the dinner table and that sort of thing. I was gonna relate this story because as I was writing this, my wife and I came out here early and went up to Montreal and we were wandering around looking for a place to eat. We ate at a place called Au Noir, which is one of those places where you eat in the pitch black and all of your waiters are blind and it was a really unique experience, I highly recommend it, you can kind of get a sense of what it's like even for an hour to not be able to see it all and to actually have to function in some ways. We never got up from the table, they warned you against that. There are also devices that are used that will take visual input and will actually give you an auditory output and blind people can learn to see with their ears. There's actually, reputedly, a guy, so this isn't a device, he clicks with his tongue and he says he can echo, locate with it and make his way around the room. One of the other things that's really important in ALS, although there's eye tracking technology, many patients can't use it for, it's complicated if you wear thick glasses, it's complicated if you're gonna be going outside, it doesn't work reliably. Even though the ALS patients don't have enough strength to lift their hand or their finger, there's still some rudimentary nerve impulses and there's a company that was started by an MIT graduate, it's now funded by the ALS Association and also the DOD, which is kind of interesting and the ALS Association funded it because if you think about moving your finger up but don't have enough strength to do it, it can still detect that and it can use that, one, for an emergency call or two, to actually control a typewriter or communication and so people who are locked in, who can't use eye gaze technology for a variety of reasons, now have a way of being able to communicate with the world, interestingly enough, the other application of it is for the special forces. When you're out on the special forces, you don't wanna be shouting to each other and you don't wanna have to take out a device and type in and special forces are very used to making hand motions but if you're too far away from each other, you can't see that, they're actually using the technology to detect and code different hand motions for people who are fully capable of operating it. I'm gonna go from that area, so these are all areas where we're using one sense as a substitution of another sense or detecting something that's already going on. There are other things that are more invasive that are sort of where things are going, the cyborg kind of view of things. There are some of those things that are being done today experimentally, some of them being done routinely. I had the opportunity at the University of Pittsburgh Brain Institute to actually go into a brain surgery for a guy who had Parkinson's, advanced Parkinson's. He was awake during the operation, they drilled two small holes in his brain and he was sitting lying down in a chair and they lowered electrodes into his brain and you could hear the neurons firing where the electrodes were and it was very interesting because one, you think a brain surgery is a major procedure, the guy walked away the next day, he was there for one day, walked away and one of the big issues with a lot of the brain surgeries is that people think it's a lot scarier and more dangerous than it is and so it's a last resort for Parkinson's patients. Well they actually discovered that if you lower an electrode in there and go into an area called the subthalamic nucleus which is about a quarter of an inch on a side, that's where one of the problems is and if you send a signal in there at about 100 hertz that part of the body stops shaking and I was there to witness it, you could hear them lower the cable down, I mean it's a little tiny micro wire down and you could hear the brain firing, they actually played it on the audio and then all of a sudden it changed and it sounded like the motion he was making and they said that's the spot and they measured the distance, pulled it out, dropped another wire down to the exact same distance, turned on the juice and said, sir, try to screw in, make a motion like you're screwing a light bulb with your left hand and he was like this, now with the right hand and he was like this, one second, just turn it on and it did that well and they tuned it afterwards. So it was an amazing experience to watch that but just think about how much that changed his life. He was at a point where he could no longer walk, he could no longer function in society and this will work for a long time.  So I'm gonna tell a story that's similar to the last kind of thing, a non-invasive procedure, there was a very invasive procedure that they discovered by actually trying it with macaques, they can actually induce Parkinson's and macaques and then basically look at ways to treat them and they discovered this approach, the deep brain stimulation and even if you talk to the physician, Dr. Richardson who did it said, we don't really know why it works but it works, so it's good. So because they don't know why it works, I think they might discover something with this. The same guy from Not Impossible Labs, Nick Eveling, was working with somebody who was deaf who wanted to go to rock concert, loved music, then became deaf and so he built the device, it would take music and then stimulate vibrators on his arm and put it on both wrists and voila, it worked. The guy had a much greater experience but Nick found out that people who could hear, it actually added to the whole experience. So he went over to a friend of his who had Parkinson's and was a former jazz pianist and was playing music and put these devices on him and his tremor stopped and he sat down with these devices on him and played the piano for the first time in 10 years. And I've now connected Nick Eveling to Dr. Richardson, next time he does an operation, he's gonna put a device on somebody and see what it actually does in the brain. They don't know why it works and they're now looking for FDA, they're doing a clinical trial and looking at FDA approval. So it's pretty amazing technology, hopefully being able to have the same net effect but not having to have an invasive procedure. So that's pretty neat. The other area that is even more invasive, you actually have to take a little section of the brain off, is one where they're actually training people to use a chip that's actually embedded in the brain on the motor cortex. These are people that are paralyzed from ALS or from spinal injury. And they can interpret the signal, they've actually figured out, they've done enough research to know what the motor cortex wants the body to do. So they can read the signals, they can read the intent, they can have a computer program translate that and then drive a robotic arm. So I met a woman at the University of Pittsburgh named Jan who had been paralyzed from the neck down from an autoimmune disease of the spinal cord and she hadn't been able to, she'd been quadriplegic for 10 years. And she was entered into the program. They basically put the device in, put a little thing on the top of her head that they screw the wires in and interpret the results and then drive a robotic arm.  And then she said fist pump and we did a fist pump and she was able to control seven degrees of freedom of this robotic arm, move individual fingers, move the joints and all of that, which was pretty amazing. So she was able to do pretty good tasks as long as she could very well see what was going on because she didn't have any sense of touch at all. So they more recently actually took a chip on somebody who was injured in an automobile, I think it was actually a motorcycle accident, he was paralyzed from the neck down and put in two chips, one chip where his sensory cortex was and one chip where his motor cortex was. So he could actually feel what he was touching, not just see it and he could get a lot better coordination. The problem with this operation today, so this is something I got very excited for the ALS Association because as I said, ALS causes patients to lose ability to move, lose ability to breathe, a lose ability to speak. This could reintroduce movement. Most of the people who get later stages of ALS when they lose the ability to breathe just sign up to go peacefully when they can't breathe anymore. About 90% of them do that and that's because their quality of life is so bad they have to be cared for for everything, they can't move, literally can't move a muscle. So they choose to die instead of to live and that obviously is tragic in its own right, but it keeps the ALS population very small which makes it unattractive to, it's all about money, as was mentioned earlier, it's less attractive to the pharmaceutical interest to spend money because there aren't enough patients to pay for the outcomes. So, if you actually gave a better quality of life for these people, this is how I became on their board, connecting them there, then they may make a different choice and instead of living to two to five years, they may live 10 years and if they live 10 years, that means there's three times as many patients that could get treatment, three times as many people who go to clinical trials, three times as many people to pay the bills for the drugs once they create them. So it's a good virtuous cycle. One of the problems and it's surprising that they can't get the money to do this is if you put a device on somebody's head that goes through their scalp and through their skull, that's a real problem after a while. All those infections that were mentioned in buildings, any little thing, brain infections are really, really bad things, but any kind of infection on a site like that. So they generally limit you to about a year with the device installed. And they're now developing what I would call Bluetooth for the brain where they'll actually have communication technology installed subcutaneously. No port like that. It powered similar to how DBS or how a pacemaker would be powered that would actually communicate the information externally and then you could use that data to drive a computer screen, drive a robotic arm, drive an automated house that you could open the refrigerator door with your mind, that sort of thing. But they're still looking for funding for that. It seems like a really good next step in that technology to be able to do that. So some of the other areas that are sort of in the forefront. And again, I talked to the chief scientist who does this, Steven Schwartz. It was kind of interesting in that he said that, apparently, we don't really know this for sure, but apparently when you pick up something with your hand and you're sensing how big it is, how your hand fits around it, et cetera, a lot of that's not being done by the brain at all. The hand itself, the physical design of the hand is instrumental in having it operate. And so he's doing research into the physics, the mechanical physics of the hand and how to improve that. Because even with this technology of being able to control a robotic arm, the feedback systems are not as effective as a human hand. One of these technologies were funded initially based on the military. There was a program called Revolutionizing Prosthetics. And what was happening with people coming back from Iraq and Afghanistan is they have great body armor which keeps them alive. But there were unprecedented amount of people living with lost limbs and especially upper limbs. And so they developed a technology, they started a program.  And that's pretty much what everybody used. I talked to, Dean Kamen came and talked to it at Booz Allen. Dean Kamen is the guy who invented the Segway. He's not the one that bought it and then drove over the cliff. That's a different guy. But Dean Kamen is the guy who invented that. If you go to some of the places with the Coke machine, the electronic Coke machine where you can pick any combination of things, his company developed that, they developed the insulin pump. So he told us about this project. He said, this is a very important project for a very few set of people. It's very expensive. But DARPA asked him, gave him a year to do it, to build a robotic arm that is as dexterous as a human arm, same weight, that can be powered on a power pack you can carry around your waist. And that is totally activated by your own neurons. Or muscles in the part of your arm there. And they actually developed that technology. Somebody who had lost both arms 30 years before came in, tried the arm out, was able to pick up a grape without breaking it and feed himself with it. And it was such a profound experience, not only for him, but more so for his wife. When she went to pick him up and they started taking the arm off, she said, no, you have to leave the arm on. I've had to feed every meal to my husband for the last 30 years. And either he stays here or the arm comes home. So you can see what kind of profound effect that technology has. But again, the technology is very expensive. Unless you mass produce it, I think it costs $100,000. But it's FDA approved. So they've made some real advances there. DARPA's also got some programs. Again, their focus is on the military. The D for DARPA stands for Defense, Defense Advanced Research Project Agency. And they're always looking to go two steps beyond what anybody has done before. I talked to Justin Sanchez, who leads the biotechnology office there. And they're working on a variety of things involving the brain.  And he talked about a program. There's a program called RAM.  It's actually a program aimed at improving memory for people who have had traumatic brain injuries or other things. And there's a video online, if you look up RAM and DARPA, you'll see a serviceman who was asked to repeat, memorize and repeat 12 words. And he struggles on the first one, the second one, the third one. And then they activate this stimulation and he just reads them out just one after another and kind of looks afterwards like he's shocked. And he said, wow, that was so easy. I don't know how he did that. So they're developing that technology. They're developing other technologies which are not implantable technologies to better understand the brain, but they're also looking at better interfacing to the brain. One of the things they're looking at is being able to read, typically right now, we can read high level activity of the brain in a variety of ways. We can read it through an EEG where you put a bunch of electrodes on your head, but each electrode is sensing hundreds or thousands of cells at a time. And so you don't have very specific activity that are going. So you can't really drive it. You can do some interesting devices like, if I show you a screen and it's got the letter A and the A is blinking twice a second and the B is blinking three times a second, I can actually detect which thing you're looking at through the brain waves. And so there are devices that are being built to actually use that for locked in patients to actually let them communicate. But they wanna actually read a million neurons at a time, write information in to 100,000 neurons at a time and interact in full duplex up to 1,000 at a time. So those are technologies they're working on and that's really to better understand speech and vision and to create alternative ways for people to communicate. There's a program called Neuro Function Activity, Structure and Technology, NeuroFast, that basically maps how the brain operates and they're basically trying to build computer models of how the brain works because we don't really understand it very well. And then there's Elon Musk. Everybody heard of Elon Musk? So Elon Musk and Stephen Hawking's both declared that the biggest threat to the existence of humankind is artificial intelligence. And they claim that with the advances in artificial intelligence, the Moore's law of increase in speed of computers that we will become irrelevant in some time in the not too distant future intellectually to the machines that we create. And so he actually bought a company. I think he bought it for the name. He's got a lot of money, so I think he could do that. And then they developed a technology it's called Neural Link. And the concept is to build an implantable device.  And they're actually doing experiments now on rats where one rat can learn a task and the other rat can do it without actually having ever learned it because they're communicating. So that's the future. And his basic idea there is to change that dynamic of artificial intelligence becoming greater than human intelligence by pooling human intelligence by being able to have people communicate directly to each other through these devices. So that is a pretty quick overview of the technologies that are out there. I'm sure I haven't covered everything but I hope to have a lot of questions. We had some great questions earlier in the classes. So any questions? Sure. It's in fairly early stages at this point. So he asked if the RAM technology is just a DARPA or just a military thing. Usually when DARPA does it in the early stages, it's pretty exploratory. So they've just done some high level experiments. It's not proof for clinical trials or anything like that yet. Who else over there? And there's a mic up there too that you can use. Sorry about that. So you mentioned several things like the being able to sense what people want. So like the robotic arm or the being able to figure out what people want and make that mechanical movement happen. Do you think we could ever do that with, and if we could, how far away it would be for people who were completely paralyzed to be able to give them some sort of means to move their body without them being able to do it with their muscles? So well, I think there are actually two solutions that are being looked at now, and some of them are operational. One of them is actually using their muscles. So somebody who's had lower spinal injury that can't walk, there's essentially a walking pacemaker that will send signals to your own muscles and it's kind of like a Frankenstein gate. It's not very sophisticated, but it enables people to actually walk. And that's the technology. So one of the things that DARPA was looking at, how do you take the technology from $100,000 to a lot cheaper, is you have to find a lot larger population that could use a technology. And so paralysis, the inability to walk, et cetera, is a much more common thing than you might think. There are millions of people who have some level of that. And their view was that if you designed an exoskeleton to be driven, that that's something that could be mass produced and then could directly hugely lower the cost instead of a million dollars to get something like that, it could come down to a couple of thousand dollars or a few thousand dollars. So that's in their mindset. And their mindset is also to being able to read more of the neurons. One of the things I didn't mention when I was watching the brain operation, and this happens a lot in university hospitals, not only did they operate on this guy and fix his Parkinson's with the deep brain stimulation, by the way, it doesn't cure it, it just fixes that symptom. They also, with permission, put electrodes on the surface of his brain in the speech center and had him walk through some speech exercises so that they could start to map that part of the brain and what is driven, what drives what in terms of your speech muscles so that they could potentially at some later point put a device there and have you be able to speak when you are paralyzed, for example. Sir? So it seems like that we're cheap chasing after the high-tech resolution and high-tech solution is not reachable by the average people, unless you are the 1% you can't afford a hundred thousand dollars for robotic arm. Any thought, I mean any research that goes for more low-tech that is more beneficial to the population right now without having a, you know, being a millionaire but it seems like that keep chasing for this holy grail, we always chase it, but yeah, people are dying, let's say the ARS people are dying, but we're still waiting for that. Well, I think the view is, so the answer is yes and DARPA is one of them, but it's a very, very difficult signal processing problem. Once you get outside the skull it's very hard to isolate individual neurons. There are technologies, if you're in an MRI machine they can tell which parts of the brain get activated interestingly enough because when you actively think it uses so much energy, your brain uses 20% of the energy of your body. It uses five times as much as the average of the rest of your body, it uses most of the energy and to do that it needs blood flow. So if you use a part of your brain very quickly, milliseconds later, the blood flow increases there to replenish the neurons that fire so there's a feedback mechanism and they can actually detect that blood flow in what's called a functional magnetic resonance imagery so you can actually see which parts of the brain are activated when somebody's thinking about different things so they use that to actually try to understand some of the speech centers and other things like that. The problem with all of those is it's very expensive equipment or you have to put it directly on the brain. There are techniques as I mentioned before the technique of being able to see that I'm looking at something that's blinking at a certain rate. You can use EEG kind of technology which is relatively inexpensive. Just wear kind of a hat with a bunch of electrodes in it. Detect and process that signal and you can tell that somebody's looking at the thing that's blinking at three hertz instead of five hertz. But you can't do individual neurons, you can't really figure out down at the level of moving a human hand or moving fingers it's very difficult to do that. There are devices that are similar to the device that I talked about reading the person's speech cortex where you just put electrodes on the surface instead of actually going in. So they're reading larger fields and they've been able to drive robotic arms with those but the analogy would be when I'm trying to move my arm thinking about move my big toe because that's where that electrode happened to be. If I'm trying to move my elbow I think about lifting my left knee. So the technology isn't very good because it's not localized. So that's the biggest problem with that is the technology for actually reading the brain down to the detail is very expensive and so you're gonna have to have an operation or and the technology for the robotic arm that'll be cheap someday. Take for example artificial knees. We have a friend that's gonna have an artificial knee operation in a couple weeks and from what I've seen about artificial knee operations a lot more traumatic than the brain surgery that I witnessed 700,000 people a year get those and the cost about $30,000 but insurance covers it. So you wanna lower the cost you need more people doing it and if you wanna lower it even farther then have insurance companies pay for it and that means it's subsidized by the people that are not getting the surgery. Hi, that was fascinating. So I was just reading three weeks ago in Nature about a group I think it's Harvard Med School in Stanford where they actually took a specific ratio of three growth hormones and they were able to reconnect a spinal cord injury in a mouse and have the transmission of electrical impulses. And the problem they found was that if the mouse had been paralyzed for some time the muscles, the neuromuscular junction didn't respond to the electrical stimuli. That's again something that can be addressed but what I'm wondering is as research moves forward and hopefully is successful with actually stimulating the regrowth of nerve tissue which has been very impossible to date. Will that create, I mean it seems like there's competition between creating artificial impulses that perceive that recognize what's going on your brain and then transmit it to something actionable and actually regenerating nervous tissue. Yeah, I think we'll find that so if, and you know this as well as all the neuroscience students here. If you have a spinal cord injury, the axon is cut. It's basically a meter long. It's cut somewhere in the middle. The brain cell typically dies or at least it folds up. There's no way, and the connection was made as an embryo as this cell stretches out as the body is created. So the difficulty is not today we can actually reintroduce and we've actually found that you do grow new neurons. There was a view for a long time that you don't grow new neurons. You can introduce those. I had a friend of mine who was on the ALS board who had ALS, who had stem cells that were, the technology was originally developed to actually heal spinal cord injury. But I think the problem is not that the cells don't form. How do they know to connect to that neuron all the way down to the toe muscle? That is the difficult part, I think. And I think that for traumatic injuries like that it will be very difficult to regrow them in a living human, but I think there'll be technology so that I can understand what's going on there and Bluetooth it down and still use their own muscles. My view of this technology is not that you have a robotic arm is that you reanimate your own arm using your brain and then bypassing the neural connection that's been destroyed with an electronic connection. It's fascinating. I was thinking when you were speaking, I hope my Labrador is never get hold of opening the refrigerator with their thought process. Yeah. So Bill, when you're at Booz Allen, you lead an interdisciplinary team. When you've gone around and seen all this, what's the profile of the people you've been working with? If these students want to get into that line of work, number one, and number two, how diverse were the teams between biologists, to engineers, to people in humanities?  That's a good question. And I answered a question in one of the classes today about what takes to be successful in the business world. And I think a lot of people, certainly me included, when I left college, I thought, well, I learned all this stuff and I'm just gonna go and I'm just gonna sit down and apply it and do exactly what I was, it's like taking an exam, I'm gonna go look at a client's problem, apply those principles and I walk away and problem solve. And that's not one how the world works and that's not how jobs work either, is that you learn all kinds of new, that you learn more when you get out of college than you learn to get in. But what's important that you learn in college is how to think about problems. It's about problem solving, not electrical engineering, not humanities, it's about looking at the world and figuring it out. I ran a group that did modeling simulation and war gaming for many years and then don't let the war gaming name fool you. Most of the time it wasn't about war, although we did war games. It was about, for example, business competition. It was about strategy development, which company should we acquire? So we did all of these different kinds of games and to do them, you needed people who were experts on the field. So we did games about changing the industry, the reducing the CO2 footprint of the recreation industry. So travel, tourism, all of that. So you had to understand that business model. You had to understand power systems. You had to understand the mindset of the travelers who go in there. So you needed a lot of people. So we had people that were former military. We had people who were psychologists. We had people who were experts in each of the different areas that all had to work together to kind of create this kind of experience of actually playing a strategic future around something that each of the individual players didn't know everything about, but collectively you would get them to work as in that environment. Amazing things happened. The Berlin Wall fell in 1985 in a war game in Booz Allen. East and West Germany reunited. The Warsaw Pact fell away from the Soviet Union and the CIA walked out of the game because they said it's ridiculous this could never happen in the real world. So, any other questions? Any other questions? Yes ma'am. So when you ask that question you are speaking to the choir, but I may be a single voice. I have been pressuring the ALS. So not only is it unnatural for charitable organizations to work across areas like Alzheimer's and we know that there's very similar kinds of processes involved with Alzheimer's, Parkinson's and ALS, but we've stovepiped too much and in fact we've even stovepiped within the ALS community. There are probably 20 or so large, largest size charitable organizations. One of the things I did as chairman right after the ice bucket challenge I tried to establish collaboration for a cure where all of us would work together on something and it's been like pushing a rope. It's challenging and it's challenging even with my own organization let alone with the other ones who look at it as competitive. And I said, look at your mission statement, look at our mission statement. How are those competitive? They're cooperative. We're moving in the same direction but it's just a hard people problem to deal with. It's not a hard technical problem. What we have achieved in that is and what has really been achieved I think in the scientific community is better sharing of information. The internet has been unbelievable for studying biological sciences so anytime anybody does a protein-protein interaction study it's entered into a database and everybody can see it. And so the thousands and thousands of studies are not just published papers. All the data behind them, all the results of those are available for somebody so they can build on top of it. All right, one last question up there, sir. Going back to your comment about the economics of research. It would seem to me that the because of the impact of the text phones and internet and so forth that the greatest advance in sort of the brain technology interface is going to occur in the area of communications. So we're going to continually sort of miniaturize the device we carry in our pocket until eventually it's a thought that we have that we can then send that thought in some kind of a digital way to somebody else without actually having to use our mouths or voices to communicate. Right and that is a little bit of the concept behind NeuralLink is not only so that is just a how do we improve communication but Elon Musk is taking the idea a step farther and saying it's actually going to change the way we think and the power of our thoughts because we're not going to think in our brain and then communicate to another one at a very low data rate. So if you communicate, me speaking, I'm speaking at a few hundred bot, the image that's going into my brain is going in at mega, megabits per second. So there's no way for me to communicate to you at megabits per second but my brain can interpret at that rate. The whole view is that you could actually build a system that allows brains to communicate to each other at the rates at which you can process information which would be transformative. Okay, let's thank Mr. Thode. Thank you Bill. Thank you.