FCC revokes China Telecom America’s authorization to operate in U.S.

The Federal Communications Commission (FCC) issued an order which effectively ends China Telecom Americas’ ability to provide domestic interstate and international telecommunications services within the U.S.

In a release, the FCC noted that its order directs China Telecom Americas to discontinue any domestic or international services that it provides within sixty days following the release of the order. 

“Promoting national security is an integral part of the Commission’s responsibility to advance the public interest, and today’s action carries out that mission to safeguard the nation’s telecommunications infrastructure from potential security threats,” FCC said.

“Based in part on the recommendation of the Executive Branch agencies, the Commission found that China Telecom Americas failed to rebut the serious concerns of the Executive Branch about its continued presence in the United States.  In December 2020, the Commission launched a proceeding and established a process that allowed for China Telecom Americas, the Executive Branch agencies, and the public to present any remaining arguments or evidence in the matter,” FCC added.

The FCC said that China Telecom Americas, a U.S. subsidiary of a Chinese state-owned enterprise, is subject to “exploitation, influence, and control” by the Chinese government and is highly likely to be forced to comply with Chinese government requests without sufficient legal procedures subject to independent judicial oversight. 

“Given the changed national security environment with respect to China since the Commission authorized China Telecom Americas to provide telecommunications services in the United States almost two decades ago, the Order finds that China Telecom Americas’ ownership and control by the Chinese government raise significant national security and law enforcement risks by providing opportunities for China Telecom Americas, its parent entities, and the Chinese government to access, store, disrupt, and/or misroute U.S. communications, which in turn allow them to engage in espionage and other harmful activities against the United States,” the FCC said.

“Although it is not necessary to support these findings and conclusions, the Order finds that the classified evidence submitted by the Executive Branch agencies further supports the decisions to revoke the domestic authority and revoke and terminate the international authorizations issued to China Telecom Americas, and the determination that further mitigation will not address the substantial national security and law enforcement risks.

According to a report by the South China Morning Post, China Telecom Americas has been operating in the U.S. for almost 20 years. The company has said its target customers are “the more than 4 million Chinese Americans; the 2 million Chinese tourists visiting the United States annually; the 300,000 Chinese students at US colleges; and the more than 1,500 Chinese enterprises in America”.

“The FCC’s decision is disappointing. We plan to pursue all available options while continuing to serve our customers,” a China Telecoms America spokesperson told Reuters.

In April, 2020, the FCC warned it might shut down U.S. operations of three state-controlled Chinese telecommunications companies, citing national security risks, including China Telecom Americas as well as China Unicom Americas, Pacific Networks Corp and its wholly owned subsidiary ComNet (USA) after U.S. agencies had raised national security concerns.

The FCC noted that China Telecom Americas is subject to exploitation, influence, and control by the Chinese government.

This action also occurs at a time when overall cooperation between the U.S.A and the C.C.P. coincides with increasing friction in trade negotiations. It also contributes ex- President Trump's decision to 'make America great again' MAGA' . The decision by the FCC also allow American IT companies to regain position in mainland USA manufacturing. It also continues with the exclusion of. Huwaii products from the U.S.A.

Along with China's expansion effort in the South China sea by building a naval base using landfill, and threatening Tawain with repatriation to the mainland.

FCC revokes China Telecom America’s authorization to operate in U.S.: 

Engineers 3D-print personalized, wireless wearables that never need a charge

Rapid developments in material engineering, 5G and wearables are contributing to deliver health data information in real time.

Wearable sensors to monitor everything from step count to heart rate are nearly ubiquitous. But for scenarios such as measuring the onset of frailty in older adults, promptly diagnosing deadly diseases, testing the efficacy of new drugs or tracking the performance of professional athletes, medical-grade devices are needed.

University of Arizona engineers have developed a type of wearable they call a "biosymbiotic device," which has several unprecedented benefits. Not only are the devices custom 3D-printed and based on body scans of wearers, but they can operate continuously using a combination of wireless power transfer and compact energy storage. The team, led by Philipp Gutruf, assistant professor of biomedical engineering and Craig M. Berge Faculty Fellow in the College of Engineering, published its findings today in the journal Science Advances.

Current wearable sensors face various limitations. Smartwatches, for example, need to be charged, and they can only gather limited amounts of data due to their placement on the wrist. By using 3D scans of a wearer's body, which can be gathered via methods including MRIs, CT scans and even carefully combined smartphone images, Gutruf and his team can 3D-print custom-fitted devices that wrap around various body parts. Think a virtually unnoticeable, lightweight, breathable, mesh cuff designed specifically for your bicep, calf or torso. The ability to specialize sensor placement allows researchers to measure physiological parameters they otherwise couldn't.

Because these biosymbiotic devices are custom fitted to the wearer, they're also highly sensitive. Gutruf's team tested the device's ability to monitor parameters including temperature and strain while a person jumped, walked on a treadmill and used a rowing machine. In the rowing machine test, subjects wore multiple devices, tracking exercise intensity and the way muscles deformed with fine detail. The devices were accurate enough to detect body temperature changes induced by walking up a single flight of stairs.

Brain Devices

The technology can also be used to analyze brain physiology.  The brain presents several challenges.  It is behind the blood-brain barrier that prevents many substances, and medications from entering the brain fluid.  The mechanism is poorly understood.   Some sensory devices involve drilling a hole in the skull and implant a micro sensor with multiple needles that enter the brain with minimal damage to the cortex.  However this in itself creates artifacts in signals.  -

Despite the enormous efforts of clinicians and researchers, our limited insight into psychiatric disease (the worldwide-leading cause of years of life lost to death or disability) hinders the search for cures and contributes to stigmatization. Clearly, we need new answers in psychiatry. But as philosopher of science Karl Popper might have said, before we can find the answers, we need the power to ask new questions. In other words, we need new technology.

Developing appropriate techniques is difficult, however, because the mammalian brain is beyond compare in its complexity. It is an intricate system in which tens of billions of intertwined neurons—with multitudinous distinct characteristics and wiring patterns—compute with precisely timed, millisecond-scale electrical signals, as well as with a rich diversity of biochemical messengers. Because of that complexity, neuroscientists lack a deep grasp of what the brain is really doing—of how specific activity patterns within specific brain cells ultimately give rise to thoughts, feelings and memories. By extension, we also do not know how the brain's physical failures produce distinct psychiatric disorders such as depression or schizophrenia.  In other words we barely understand how the 'normal' brain works.

Tiny wireless devices

Optogenetics: Controlling the Brain with Light

In a 1979 Scientific American article Nobel laureate Francis Crick suggested that the major challenge facing neuroscience was the need to control one type of cell in the brain while leaving others unaltered. Electrical stimuli cannot meet this challenge because electrodes are too crude a tool: they stimulate all the circuitry at their insertion site without distinguishing between different cell types, and their signals cannot turn off neurons with precision. Drugs are not specific enough either, and they are much slower than the natural operating speed of the brain. Crick later speculated in lectures that light might have the properties to serve as a control tool because it could be delivered in precisely timed pulses, but at the time no one had a strategy to make specific cells responsive to light.

Meanwhile, in a realm of biology as distant from the study of the mammalian brain as might seem possible, researchers were working on microorganisms that would only much later turn out to be relevant. At least 40 years ago biologists knew that some microorganisms produce proteins that directly regulate the flow of electric charge across cell membranes in response to visible light. These proteins, which are produced by a characteristic set of "opsin" genes, help to extract energy and information from the light in the microbes' environments. You may recognize opsin from it's 'cousin' rhodopsin in the rods and cones of our retina. These  convert light energy into electrical impulses transmitted to the cerebral cortex via the optic nerves and the optic tracts to the cerebral cortex and other areas of the brain. 

Current optogenetics experiments, done in animal models, involve introducing a light-sensitive protein, which attaches to specific neurons in the brain. (delivered by viral vectors). A light stimulus is delivered to the brain with an LED under the skin or even of the surface of the skin.

Light emitting diode

The discussion of opsins goes beyond this blog I recommend reading the references at the end of the article.  It is not light reading.

Engineers 3D-print personalized, wireless wearables that never need a charge

 Optogenetic interrogation of neural circuits: technology for probing mammalian brain structures

AI in healthcare: The tech is here, the users are not - Damo Consulting

Much of this article comes from a podcast by Paddy Padmanabhan@PaddyPadmanabha

Since the beginning of the year, there has been a significant uptick across health plans, healthcare providers, and analytics firms utilizing AI to change how healthcare is delivered and how patients can be more engaged in their care.

"Medical records must become a living record that pulls in data real-time, follows your health, and displays it back to a physician in a useful form."

AI applications in healthcare are all over the map today. Data from my firm’s digital health intelligence database, DamoIntelTM, has identified a significant rise in the launch of AI use cases across clinical and administrative areas in 2020. An analysis of AI/ML applications deployed by the top 50 health systems across the United States identifies that AI-enabled solutions fall into multiple technology categories: machine learning, natural language processing (NLP), conversational interfaces such as chatbots, and robotic process automation (RPA). COVID-related use cases in clinical and administrative areas contributed to the growth in adoption of newer technologies such as chatbots in healthcare.

A focus on real-time interventions with AI-enabled solutions at the point of care

The biggest challenge for AI-enabled care is to deliver insights in real-time into the clinical workflow at the point of care. For example, voice recognition technologies are effective with lower-level tasks such as scribing doctor-patient encounters. However, they are yet to evolve into decision-support systems that deliver additional insights at the point of care for diagnostic and treatment decisions. 

On the other hand, solutions that can deliver real-time insights are yet to reach scale and broad-based adoption. An example is Stanford University’s smartwatch-based COVID diagnosis app, in partnership with Amazon, that analyzes elevated heart rates and other abnormalities for pushing real-time alerts to patients suspected of COVID infection. Dr. Michael Snyder, Professor and Chair of Genetics, is working to scale the solution with the aim of creating a continuous monitoring framework for health indicators at an individual level. His goal it to cover anyone, anywhere who has a smartwatch. Amazon has offered millions in cloud computing credits for similar diagnostic solutions for digital health innovators across the world.

Data collaborations to drive advanced real-time analytics

If there’s one new trend this year, it’s data collaboratives. Truveta, a consortium of 14 health systems launched in February, aims to pool patient data from all the member systems to drive advanced analytics for improved healthcare outcomes. Google has announced a series of partnerships with healthcare enterprises, including Mayo Clinic, Ascension Health, and Highmark. Use cases include but are not limited to data analysis for quality measures, benchmarking, and administrative reporting. In addition to its partnership with Google, Mayo Clinic has launched new data collaboration initiatives with AI startups, targeting data from remote monitoring devices. Highmark, a major health plan based in Pennsylvania, has formed a 10-year partnership with Christiana Care in Delaware to pool medical and claims data to drive better outcomes. Expect to see more consortiums as large payers and providers pool their datasets to drive efficiencies through advanced analytical insights.

Other trends that will drive the AI-enabled future of health care

• Increased innovation in AI-enabled applications following the CMS final rule that allows patients to access their medical information and share it with developers looking to build new digital health products and services.
• Hospital rooms of the future that will incorporate superior experiences driven by AI-enabled digital interactions among caregivers, patients and their families. An example is the $1.5 Bn investment by Penn Medicine in Philadelphia. Titled The Pavilion, this 500-bed facility comes with patient rooms featuring interactive 75-foot monitors on the walls. John Donohue, VP of Entity Services for Medicine, has been closely involved in the technology enablement aspects of the patient room of the future. He references Disney-inspired user experience design as a part of the 6-year project in the making.
• Analytics from remote monitoring devices. AI-enabled applications that ingest and analyze vast amounts of data from home monitoring devices and sensors will drive the next stage of the evolution of health care. As healthcare moves from hospital to home, expect heavy investments in analyzing data from remote sensors and monitoring devices. Amazon’s recently launched Amazon Care offering includes home-based care in addition to virtual care services as part of the overall package. Large health systems such as Kaiser Permanente and Mayo Clinic have also gotten into the game. They have announced investments in Medically Home, a tech firm that caters primarily to home-based care.

The patient is ready now – or is she?

While technologies and the computing infrastructure for AI-enabled care have matured, the adoption of AI-enabled care is driven by the varying readiness levels for the incumbents in the current healthcare ecosystem and concerns around the safety of AI-enabled care, specifically for complex clinical conditions. 

Patients are not sure about AI-enabled care either: a recent study points out that patients find chatbots intrusive and are hesitant to take medical advice from a bot. Administrative use cases for AI-enabled applications may deliver better ROI in the short term. Sachin Patel, CEO of Apixio, a healthcare analytics company acquired by Centene in 2020, attests to a 4x to 7x return on AI applications in financial operations such as risk adjustments.

My firm’s research indicates that over half of all hospitals in the country continue to use electronic health record (EHR) systems as the primary tool at the point of care. New, cloud-based, AI-enabled solutions continue to face challenges in integrating seamlessly into the clinical workflow at the point of care. Interoperability concerns and the challenges with standardization and normalization of healthcare data will continue to remain a significant challenge for AI-enabled applications. Further, standards such as ICD, SNOMED, and FHIR continue to evolve, representing a continuing demand for authoritative code change management and data normalization solutions validated by subject matter experts. New and emerging data sources, such as genomic data, will require additional guardrails around ethics and privacy prior to use in AI applications.

A final concern around AI in healthcare relates to the lack of visibility to how the algorithms are trained to work in healthcare, further exacerbated by systemic bias inherent in many AI applications. Despite advances in AI techniques, algorithms trained on a data set cannot be easily transferred to another data set, especially as the role of operational data and social determinants of health in population health risk assessment increases. As cloud platforms become the dominant data repositories for developing AI-enabled solutions, concerns around the privacy protections for the data will drive trust and consent required for advancing the adoption of AI tools. 

A bright spot for AI in healthcare is brisk pace of AI adoption in administrative functions. Health systems executives must expand the scope of these applications to cover new operational areas, including access and patient engagement, to drive efficiencies and improved quality of experience. Clinical leaders must continue to expand the use of AI applications cautiously and focusing on operational areas that don’t necessarily look to replace human intuition and judgment. An example of this is the use of AI to optimize schedules for chemotherapy at Penn Medicine.

As healthcare leaders look to accelerate the adoption of AI, they must also carefully weigh the costs and benefits of the efforts involved in developing and deploying AI solutions. The question always comes back to what we can do with insights we get back from AI applications. If we cannot move the needle based on the insights and information, clinical leaders must question the value of the program and the energy that goes into producing the insights in the first place. The key is to invest in areas where we can see demonstrated results and build it out from there. We are still several years away from a pervasive use of AI in core clinical aspects of healthcare. Until then, we simply continue to push the frontiers.

AI in healthcare: The tech is here, the users are not - Damo Consulting: The biggest challenges for AI-enabled care are delivering real-time insights into the clinical workflow and gaining acceptance from caregivers as well as patients. Innovative solutions continue to emerge.Originally published on CIO Online Since the beginning of the year, there has been a significant uptick across health plans, healthcare providers, and analytics…

Telehealth in the Post. Covid 19 era

The Covid 19 pandemic created many changes in health care.  Perhaps the most obvious one was the accessibility of telehealth caused by rules regarding distancing to prevent further spread of the virus.

Contrary to expectations medical offices and clinics were not overwhelmed with worried patients. Medical facilities quickly organized their office visit procedures, including personal protective equipment, careful scheduling, the use of text messaging to patients indicating when they could enter the office. Reception areas were emptied using the new format.

Online portals, and telemedicine removed the necessity for face-to-face visits unless absolutely necessary. Most practices that had adopted EHR in the past ten years were in good position to make a rapid pivot to the new norm.

CMS and private plans quickly began to reimburse for telehealth as well.  Although this may have increased reimbursements, the offsets for better care, and perhaps sicker patients more than offset this expense.  No facts have been released by insurers as yet.

UnitedHealth’s Optum To Broaden Telehealth Offerings In All 50 States

UnitedHealth Group’s Optum healthcare services unit has launched a virtual care business that is expanding telehealth across the U.S. with more specialized medical care providers and services.

UnitedHealth and Optum executives say they have already launched a product they are calling “Optum Virtual Care” that is live in all 50 U.S. states. The effort is “integrating physical care, virtual care, home care and behavioral care,” executives told analysts on a call with Wall Street analysts last week to discuss the company’s first quarter earnings and outlook for the remainder of 2021.

The move deeper into virtual care could have ramifications for smaller telehealth companies given the access to capital Optum has to expand and given UnitedHealth’s status as the nation’s largest health insurer and as a massive provider of medical care. On Monday, UnitedHealth rival Cigna’s Evernorth healthcare services business took a bigger step in the telehealth arena by closing on its acquisition of MDLive.

To compete, Walmart had to acquire telehealth business

“Walmart has had a slow roll out of physical clinics compared to other retail storefronts; they needed a partner to achieve national presence with their healthcare strategy,” Forrester Principal Analyst Arielle Trzcinski wrote in an email. “Without a comprehensive primary care and chronic care delivery model that met consumers in their homes, they would struggle to gain market share against others like Amazon Care that focus on convenience, as well as cost.”

Scottsdale, Ariz.-based MeMD was founded in 2010 by an ER physician, and offers virtual urgent care and behavioral health services. Currently, MeMD’s visits are priced at $65 for an urgent care visit and $230 for a psychiatry visit, according to its website.

Low-tech but high-value: Don’t stop reimbursing phone-only telehealth visits

At the start of the Covid-19 pandemic, the Centers for Medicare and Medicaid Services and private insurers made the timely decision to rapidly expand coverage for telehealth visits, throwing a lifeline to millions of Americans who needed ongoing medical care despite nationwide stay-at-home orders.

At the time, virtual visits done by video or by telephone were covered at the same rates as conventional, in-person office visits.

Since then, telehealth has become an indispensable part of the U.S. health care system, helping provide patients with safe access to medical care. While video visits have some advantages over telephone visits, they require access to technology, digital literacy, and broadband internet access that are far from ubiquitous. Telehealth access that includes telephone-only visits can help reduce certain health care disparities, as these low-tech visits provide access to essential health care for many whose alternative is no care at all.

A great concern is that payers will revert to old reimbursement restrictions for telemedicine visits. Those rules restricted telehealth visits to remote areas where physician access is limited.

This lifeline may be cut, as CMS has signaled it plans to end reimbursement for telephone-only visits when the public health emergency ends.