The Dissection Room

Justin Cottle

Dissecting life, creativity, and the very idea of what it means to be human justincottle.substack.com

  1. 03-04-2024

    The Magic of the Alphabetic Principle

    Something borderline magical happens around the age of 5 years old… Squiggly black lines on a piece of paper or screen suddenly transform from being meaningless shapes into something incredibly powerful. I’m experiencing the magic as a parent right now. My 5 year old’s learning to read, and it’s one of the most beautiful things I’ve ever seen in my life. His mind is making connections he never knew possible, and the sense of empowerment that he feels is contagious, leaving me ready to jump for joy every time he reads something on his own. Equally impressive is how quickly it’s all come together. In the span of just a few weeks, I’ve watched him occasionally recognize letters in his name, to reading full on sentences with confidence. Here’s the thing — it really hasn’t been that quick. This is just the latest stage in a process that’s been happening deep inside his head since 6 months of age. I want you to picture a 6 month old baby, blowing raspberries, babbling, and experimenting with different sounds. Besides being frustratingly cute, these simple actions are laying the foundation for what’s to come - learning to read. You see, the brain is undergoing a rapid transformation. Neurons are firing and connecting at a blistering pace, forming pathways that will one day allow the child to make sense of the squiggles and lines we call letters. But it’s not just neuronal connections being made — the orofacial muscles are getting stronger, and the facial skeleton itself is making adjustments as teeth begin to come in, allowing for more sophisticated babbling. The child isn’t just making sounds anymore — they’re beginning to understand that these sounds have some meaning. They’re entering the world of the alphabetic principle. At its core, the alphabetic principle is the understanding that letters of the alphabet represent specific sounds in spoken language (unless the language is Chinese or Japanese, which use different but equally fascinating systems). It's the realization that these sounds, or phonemes, can be blended together to form words. A “phoneme” is a sound, or a group of different sounds. For example, the letter "B" makes the "buh" sound, while the letter "A" can make the "ah" sound. By saying “buh”, “ah”, “t”… you’re pronouncing the phonemes of the word “bat”. When you hear a child saying “mama”, “dada”, “bruhbruh”, you’re hearing them associate phonemes with meaning, specifically their parents and siblings, and other familiar people and things around them. But this is just the beginning of the alphabetic principle, and it only gets cooler from here. The Pre-alphabetic Stage The pre-alphabetic stage runs from birth to about 3 years old, although children are all different and there is some wiggle room in these age ranges. I want you to picture a toddler, around 3 years old, flipping through the pages of a colorful book. At this pre-alphabetic stage, they’re not making the connection between letters and sounds. Instead, they’re developing what’s known as phonological awareness - the ability to recognize and manipulate the sounds in spoken language. Specifically, they’re learning to identify syllables, clusters of syllables, and phonemes. One of the funnest methods to help a child identify syllables is to have them place their hand under their chin, and then say a word. Every time the mandible drops, that’s a syllable. Go ahead and do it yourself right now. It really is kind of fun. “Mama” has to two syllables, “papa” has two syllables, but “mom” and “dad” only have one syllable. As this is happening, the auditory cortex is processing the sounds the child hears from both their own mouths and the parent or teacher with them. This is crucial for distinguishing between different phonemes, and helps create powerful connections throughout the brain. At the same time, Broca's area in the frontal cortex is developing, which will eventually support the ability to produce speech sounds and engage in phonological processing. For a 3 year old, the orofacial muscles are also undergoing significant changes. The lips, tongue, and jaw are learning to work together to produce a wide range of sounds. This is absolutely essential for articulating the precise sounds needed for speech and, later, for reading. Partial Alphabetic Stage As the child enters preschool between the ages of 3 and 4, they’re entering the partial alphabetic stage. This is where they begin to recognize some letters and their corresponding sounds. Typically this lines up with the letters in their name. For example, if their name starts with an ‘S’, they’ll start to match the phoneme /s/ up with the letter. At the neurological level, the visual word form area (VWFA) in the occipito-temporal region is becoming more specialized in recognizing letters. This is where the brain processes the visual features of letters and words, allowing the child to identify and distinguish between different characters. But the child’s knowledge is far from complete. They may confuse similar-looking letters like "b" and "d" or struggle to blend sounds together smoothly. The orofacial muscles are also continuing to develop during this stage, allowing them to produce more precise speech sounds, which is crucial for accurately articulating the sounds associated with each letter. Full Alphabetic Stage By the time they reach kindergarten, they’ve entered into the full alphabetic stage. At this point, they’ve mastered most letter-sound relationships, save a few here and there. In the brain, the temporoparietal junction, or TPJ, and inferior frontal gyrus, or IFG, are now far more active during phonological processing and decoding. Decoding is where you look at a word, and break it down into its phonemes and syllables. The TPJ is involved in mapping sounds onto letters, matching them up in the child’s mind. The IFG helps to do this too, but it also processes the motor planning of speech. As the child learns to decode words by sounding them out letter by letter, the IFG helps to process and produce the necessary speech sounds. The orofacial muscles have also developed significantly by this stage, meaning the child can now produce all the sounds needed for speech and reading, including more complex consonant blends like "bl" or "st." Of course, this is assuming they have their front teeth. My son is currently missing his, which makes for some seriously adorable reading sounds. This full alphabetic stage is where my son is at right now, and the progress he’s made by blending phonemes is really cool to watch in real time. Something else you’ll see at this stage is something that doesn’t get near the attention it deserves — children beginning to “encode”. Encoding is the exact opposite of “decoding”, meaning that instead of breaking down a word into its phonemes, they learn to spell words by their sounds instead. For example, if a child was looking at a picture of a dog, the ability to sound out the phonemes — /d/ /o/ /g/, and then turn that into the letters d - o - g, would be encoding. Looking at the word “dog” and then sounding out each individual phoneme would be decoding. Consolidated Alphabetic Stage As the child progresses through elementary school, somewhere around the age of 7 they enter what’s known as the consolidated alphabetic stage. At this point, reading becomes increasingly fluent and automatic. They move away from decoding individual letters to recognizing larger chunks of words, such as prefixes, suffixes, and syllables. In the brain, a structure known as the putamen, as well as the cerebellum are now more involved in automatizing reading skills. This is building off of what’s known as “sight words”. During the full alphabetic stage, the child begins seeing certain words a whole lot more than other words. For example, the word “this” is everywhere. You don’t want to waste time and cognitive effort trying to decode it, so instead the child learns to just recognize it, and keep reading without slowing down. Over time, more words naturally become “sight words”, and others are actually encouraged by teachers to become “sight words”. Then, you also have the cerebellum contributing to the coordination and timing of the various processes involved in reading, such as eye movements, phonological processing, and articulation. The child’s orofacial muscles are now fully developed, allowing them to produce all the sounds of their language with ease. This automaticity in speech production further supports fluent reading, as they can quickly and accurately articulate the words they’re reading. It’s amazing how the human brain is perfectly adapted for reading. I truly believe that reading is one of the most important things anyone can do. It fosters creativity and empowers you to see the world through others’ eyes. Part of my goal with this Substack is to inspire others to read more, and if you’re anything like me, breaking down processes like this can be super helpful in motivating you to do that. Plus it’s just cool. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit justincottle.substack.com/subscribe

    9 min
  2. 23-03-2024

    The Realistic Future of Medicine

    I want you to imagine that the year is 2030, and you are a nurse entering a patients room that’s recovering from abdominal surgery… As you step through the door, the lighting is soft and adjustable, automatically adapting to the time of day and the patient's sleep cycle. You approach the bedside and glance at the large, wall-mounted display. The intelligent monitoring system greets you with a summary of the patient's condition. It highlights that the patient's vital signs have been stable throughout the night, with no significant abnormalities detected. The AI-powered system has been continuously analyzing the patient's heart rhythm, respiration, blood pressure, and oxygen saturation, providing real-time insights and alerts if any concerning patterns emerge. You remember when you had to manually check and record each vital sign, every few hours. Now, the intelligent monitoring system does this seamlessly, allowing you to focus more on patient care and less on documentation. Next to the bed, you spot the patient's IV line, connected to an advanced infusion pump. The pump is controlled by an intelligent agent that precisely regulates the flow rate and dosage of medications, ensuring optimal pain management and preventing any potential medication errors. In the past, you had to double-check each medication and rate, but now you can trust the system to administer the correct dosage at the right time. As you check the patient's surgical incision, you notice a small, non-invasive device attached to the skin nearby. The device uses advanced sensors to detect any signs of infection, such as changes in temperature or skin color, and alerts the medical team if there's a potential complication. This early warning system has dramatically reduced the incidence of post-operative infections in your hospital. You gently reposition the patient to prevent pressure ulcers, and as you do so, the smart bed automatically adjusts to distribute the pressure evenly. The bed also monitors the patient's movement and can alert you if the patient is at risk of falling. Before leaving the room, you take a moment to review the patient's electronic health record on the bedside tablet. The intelligent system has already updated the record with the latest vital signs, medications administered, and your observations. It also suggests potential interventions based on the patient's condition and evidence-based guidelines. With a satisfied smile, you quietly exit the room, knowing that your patient is in good hands, monitored and cared for by a seamless collaboration of human expertise and artificial intelligence. Healthcare, along with society at large, is changing. At the center of this change are advancements being made in artificial intelligence and specific applications of AI known as intelligent agents. These days we’re all familiar with artificial intelligence, but few seem to properly understand the potential that comes with its advancement. Even if research were to stop today, the progress that’s already been made is enough to revolutionize everything around you, and that includes everything inside of healthcare. Our goal today is to understand what an intelligent agent is, the different types of intelligent agents, the varying degrees of autonomy, and the incredible potential they have to reshape healthcare from the ground up. If you stick with me until the end, we’ll do some responsible speculation as I like to call it , and discuss what I personally believe to be the inevitable outcome of intelligent agent development — hive intelligence. We’ll view it from the lens of healthcare, but the implications of its existence will reach far beyond the realm of medicine. With that said, let’s start by asking ourselves a simple question: what is an intelligent agent? What Is Agency? Agency refers to the capacity of an entity to act in the world. It’s the ability to make choices, take actions, and shape one's own life and environment. An agent is: * Autonomous * Agents are capable of making decisions and acting on them without external influences * Intentional * Agents act with purpose * Rational * Agents are capable of reasoning * Morally Responsible * Because agents are rational and capable of making choices, they’re often held morally responsible for the consequences of their actions You are an agent. I am an agent. Healthcare workers of all types are agents. So what do we mean when we say “intelligent agent”? What Are Intelligent Agents? An intelligent agent is a software program or computer system designed to operate independently within an environment to accomplish predefined goals without requiring constant human guidance or intervention. Put simply, they’re software programs with a degree of agency, that have been designed to achieve a goal with as little human intervention as possible. They: * Exhibit Goal-Directed Behavior * Intelligent agents are designed to pursue specific objectives * Make Decisions * Intelligent agents select actions based on their current state, available information, and their predefined goals. * Interact With Their Environment * They need to do so in order to gather information and execute actions. * Adapt and Learn * Advanced intelligent agents can learn from their experiences and adapt their strategies to improve their performance over time. The “degree of agency” is predefined for an intelligent agent, but not for you. Philosophers would likely pick that statement apart, but for our conversation today it’s a perfectly reasonable approach to have. Yet there are obviously similarities between us and intelligent agents, and that’s intentional. Intelligent agents are meant to be extensions of us as people, and occasionally literal replacements. They navigate a digital world constructed by humans, so it’s only fitting that they’d resemble us at times. To achieve human goals without the help of humans, they need to have specific properties, otherwise they couldn’t do anything meaningful in our world. These essential properties are: * Autonomy * Their ability to operate independently and make decisions without direct human control is essential * Reactivity * Their ability to respond in a timely manner to changes in the environment is vital * Proactivity * Their ability to take initiative and exhibit goal-directed behavior is required * Social Ability * The ability to interact and communicate with other agents or humans is necessary Most of those are non-controversial, but autonomy tends to worry people a bit. How much agency do intelligent agents have? It’s an important question that comes with multiple answers… What Is Autonomy? When the goal is to offload tasks from human beings to a machine or software program, autonomy is essential. But there are varying degrees of autonomy in AI systems: Low Autonomy * These systems operate independently in limited, well-defined scenarios but require human intervention for most tasks. * Robotic Vacuum Cleaners * These devices can navigate and clean floors independently but require humans to empty the dustbin, maintain the device, and set up cleaning schedules * Automated Teller Machines (ATMs) * ATMs can perform basic transactions, such as cash withdrawals and balance inquiries, but require human intervention for tasks like refilling cash, resolving errors, or handling complex customer issues Moderate Autonomy * These systems can perform a range of tasks without human control but may still require human input for certain decisions or situations. * Self-Driving Cars In Controlled Environments * Autonomous vehicles that operate in limited, well-mapped areas, such as university campuses or industrial parks, can navigate and make decisions independently but may require human intervention in unexpected situations or when faced with new obstacles * Chatbots for Customer Support * Chatbots can handle a wide range of customer questions and provide solutions based on predefined scripts or knowledge bases. However, they may need human assistance for complex or unique issues that fall outside their programmed expertise High Autonomy * These systems can operate independently in complex, dynamic environments and may even be capable of setting their own sub-goals in pursuit of an overarching objective. * Advanced Autonomous Vehicles * Self-driving cars designed to operate in complex, real-world environments, such as city streets or highways, can make decisions independently, adapt to changing traffic conditions, and handle a wide range of scenarios without human intervention. But it’s far from perfect, and humans need to be paying attention and ready to take over at a moments notice * Autonomous Trading Systems * Trading algorithms that can analyze vast amounts of financial data, make investment decisions, and execute trades in real-time without human input. These systems can adapt to changing market conditions and continuously optimize their strategies to maximize returns. Still, humans need to keep a watchful eye in certain situations, because these are far from perfect Full Autonomy * The highest level of autonomy, where a system can perform all tasks and make all decisions independently, without any human intervention or supervision. * A fully autonomous system would be capable of setting its own goals, learning from its experiences, adapting to new situations, and continuously improving its performance. * We haven’t achieved this level of autonomy yet, but it’s something researchers are actively pursuing around the world . * Examples of hypothetical fully autonomous systems include: * Artificial general intelligence (AGI) that can match or surpass human intelligence across a wide range of domains, from scientific research to creative tasks * Fully autonomous driving, where the vehicle manages every aspect of driving with precision, and humans don’t need to pay attention at all, trusting the vehicle will resp

    26 min
  3. It's Different This Time

    21-03-2024

    It's Different This Time

    It’s different this time, it really is. Most healthcare workers are either too busy to pay attention to what’s happening in AI today, or are stuck in the past and have only experienced low quality AI. In today’s episode, we’re going to discuss why this is a mistake. Healthcare workers aren’t immune to the impact of AI, and they need to start preparing for significant changes to their job description in the next 5 years. ____ Timestamps 0:00 Why You Should Care 8:17 FDA Hurdles 9:39 History of Neural Networks: 1940’s - Present 19:12 AI & Medicine: 1940’s - Present 28:32 How LLM’s Can Impact Frontline Medical Works 35:42 The Incredible Potential of Autonomous AI Agents In Medicine ____ References Dermatology https://www.nature.com/articles/s41598-021-96707-8 https://news.mit.edu/2021/artificial-intelligence-tool-can-help-detect-melanoma-0402 https://www.jidonline.org/article/S0022-202X(20)31201-X/fulltext https://www.frontiersin.org/articles/10.3389/fmed.2020.00100/full https://www.mdpi.com/1660-4601/18/24/13409 https://journals.lww.com/idoj/fulltext/2023/14060/artificial_intelligence_in_diagnostic_dermatology_.4.aspx https://arxiv.org/abs/2311.01009 https://www.mdpi.com/2079-9292/12/6/1342 Ophthalmology https://onlinelibrary.wiley.com/doi/10.1111/ceo.13381 https://journals.lww.com/ijo/Fulltext/2020/68070/Insights_into_the_growing_popularity_of_artificial.22.aspx https://bjo.bmj.com/content/105/2/158 https://www.dovepress.com/artificial-intelligence-in-ophthalmic-surgery-current-applications-and-peer-reviewed-fulltext-article-OPTH https://www.frontiersin.org/journals/digital-health/articles/10.3389/fdgth.2022.889445/full https://ieeexplore.ieee.org/document/9716741 https://ieeexplore.ieee.org/document/10340746 https://www.cureus.com/articles/164004-artificial-intelligence-in-ophthalmology-a-comparative-analysis-of-gpt-35-gpt-4-and-human-expertise-in-answering-statpearls-questions#!/ https://ieeexplore.ieee.org/document/9674065 Pathology https://www.frontiersin.org/articles/10.3389/fmed.2019.00185/full https://gut.bmj.com/content/70/6/1183 https://www.mdpi.com/2075-4418/13/19/3115 https://www.mdpi.com/2072-6694/11/11/1673 https://www.nature.com/articles/s41571-019-0252-y https://www.frontiersin.org/articles/10.3389/fmed.2019.00185/full https://pathsocjournals.onlinelibrary.wiley.com/doi/10.1002/path.6168 https://jcp.bmj.com/content/74/2/73 https://ieeexplore.ieee.org/document/9745795 Cardiology https://www.sciencedirect.com/science/article/pii/S0735109719302360?via%3Dihub https://www.ahajournals.org/doi/10.1161/JAHA.119.012788 https://www.emjreviews.com/interventional-cardiology/congress-review/26886-2-j090122/ https://pubs.rsna.org/doi/10.1148/ryct.2021200512 https://www.nature.com/articles/s41569-018-0104-y https://www.sciencedirect.com/science/article/pii/S0735109719302360?via%3Dihub https://arxiv.org/abs/2310.12630 Neurology https://link.springer.com/article/10.1007/s00415-019-09518-3 https://linkinghub.elsevier.com/retrieve/pii/S0377123721001490 https://www.degruyter.com/document/doi/10.1515/revneuro-2021-0101/html https://pubs.rsna.org/doi/10.1148/radiol.2018181928 https://jkns.or.kr/journal/view.php?doi=10.3340/jkns.2022.0130 https://journals.salviapub.com/index.php/gmj/article/view/3158 https://www.eurekaselect.com/article/136533 This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit justincottle.substack.com/subscribe

    45 min
  4. Medical Imaging Is Changing... Forever

    13-03-2024

    Medical Imaging Is Changing... Forever

    Radiologists are in short supply. Backlogs are only continuing to build. With an aging population and burnout from COVID only making things worse, something needs to change or outcomes for patients will only get worse. In today’s episode, we discuss how Artificial Intelligence is assisting Radiologists and their midlevels in workflow, and soon with diagnostics as well. With hundreds of startups around the world using synthetic data generation to train AI models with a level of precision never before seen, the natural question to ask is, how will this impact radiologists within the next decade? ____ Timestamps 0:00 Intro 1:30 The Problems Facing Radiologists 14:37 The Hurdle of the FDA 18:05 Improving Radiology Workflow 21:15 The Data Availability Struggle 22:44 De-identifying Data 23:26 Synthetic Data 29:48 MONAI 30:37 The Beginning of the Future 38:24 Opthamology, Cardiology, Neurology 41:45 Last Thoughts ____ References World Population * https://www.worldometers.info/world-population/us-population/ Healthcare Provider Statistics * https://www.ama-assn.org/press-center/press-releases/ama-president-sounds-alarm-national-physician-shortage * https://www.statista.com/statistics/186269/total-active-physicians-in-the-us/ * https://www.bls.gov/oes/current/oes291071.htm * https://www.aanp.org/about/all-about-nps/np-fact-sheet#:~:text=There%20are%20more%20than%20385%2C000,NPs)%20licensed%20in%20the%20U.S.&text=More%20than%2039%2C000%20new%20NPs,academic%20programs%20in%202021%2D2022. * https://www.bls.gov/oes/current/oes291229.htm * https://www.statista.com/statistics/209424/us-number-of-active-physicians-by-specialty-area/ * https://www.zippia.com/radiology-assistant-jobs/demographics/ * https://www.google.com/search?q=can+an+rpa+interpret+radiology+exams&oq=can+an+rpa+interpret+radiology+exams&gs_lcrp=EgZjaHJvbWUyBggAEEUYOTIHCAEQIRigATIHCAIQIRigAdIBCDk0NzVqMGo0qAIAsAIA&sourceid=chrome&ie=UTF-8 * https://radiologybusiness.com/sponsored/1073/mmp/topics/healthcare-management/business-intelligence/radiology-assistants-users Radiology Backlog * https://radiologybusiness.com/topics/healthcare-management/healthcare-economics/large-volume-radiologist-reporting-backlogs-urgent-global-issue#:~:text=The%20problem%20persisted%20at%20the,99%25)%20for%20chest%20radiographs. * https://www.rsna.org/news/2022/may/global-radiologist-shortage * https://www.aidence.com/articles/workload-in-radiology/ This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit justincottle.substack.com/subscribe

    43 min
  5. AI & Healthcare: The Landscape In 5 Years

    06-03-2024

    AI & Healthcare: The Landscape In 5 Years

    The next 5 years are going to be incredible. Still, it’s important to stay grounded and not feed into the hype. Chances are good that you’ve heard people question whether or not ChatGPT will replace doctors. The easy answer here is — no. But other models from Google can and will. In this episode, Justin discusses: * The shortage of Health Care Providers in the United States * Health Care Provider dependency on the medical version of Wikipedia — Up to Date * Google’s AI models: MedPaLM2, MedLM, and AMIE * The use of of AI as a collaborator * The most likely jobs within healthcare to be impacted negatively in the next 5 years * How patients will interact with AI models, leading to better healthcare outcomes ____ Episode Timeline 0:00 Intro 1:14 The Topics Discussed Today 4:15 Use This Episode Timeline to Scan Ahead to What Applies to You 4:42 The Shortage of Doctors In the US 8:22 The Purpose of Physician Associates and Nurse Practitioners 12:39 The Stresses of Being a Healthcare Provider 14:04 Wikipedia for Doctors 18:17 Brief Intro to LLM's 22:29 Meet the Mind Blowing MedPaLM2 27:46 Meet the New UptoDate — MedLM 30:17 Meet Your New Doctor — AMIE 33:39 The Problem for PA's and NP's 39:47 The Future of Medicine In Your Pocket ____ References Provider Statistics * https://www.ama-assn.org/press-center/press-releases/ama-president-sounds-alarm-national-physician-shortage * https://www.statista.com/statistics/186269/total-active-physicians-in-the-us/ * https://www.bls.gov/oes/current/oes291071.htm * https://www.aanp.org/about/all-about-nps/np-fact-sheet#:~:text=There%20are%20more%20than%20385%2C000,NPs)%20licensed%20in%20the%20U.S.&text=More%20than%2039%2C000%20new%20NPs,academic%20programs%20in%202021%2D2022. * https://www.bls.gov/oes/current/oes291229.htm World Population * https://www.worldometers.info/world-population/us-population/ Schooling References * https://extension.harvard.edu/blog/how-to-become-a-physician-assistant/#:~:text=To%20become%20a%20PA%2C%20you,for%20two%20to%20three%20years. * https://uthscsa.edu/medicine/education/ume/outreach/become-doctor * https://www.usmle.org/ * https://en.wikipedia.org/wiki/Physician_assistant * https://en.wikipedia.org/wiki/Nurse_practitioner * https://www.aanp.org/news-feed/explore-the-variety-of-career-paths-for-nurse-practitioners * https://www.usmle.org/scores-transcripts/examination-results-and-scoring#:~:text=*%20USMLE%20Step%201%20score%20reporting,of%20a%20three%2Ddigit%20score. Artificial Intelligence Models * https://sites.research.google/med-palm/ * https://blog.research.google/2024/01/amie-research-ai-system-for-diagnostic_12.html * https://cloud.google.com/vertex-ai/generative-ai/docs/medlm/overview#medlm-versus-palm * https://www.nature.com/articles/s41586-023-06291-2 This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit justincottle.substack.com/subscribe

    46 min

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Dissecting life, creativity, and the very idea of what it means to be human justincottle.substack.com