USCTIMES
NOVEMBER 2016 / VOL. 27, NO.9
BRAIN MATTERS
Decisions, Decisions ...
Artificial Intelligence
Brains on the Brain
You have a choice — the good, the bad and whatever's most satisfying, page 4
Think a computer can think like a human? Think again — and then think again, page 8
Aphasia researchers harness machine learning in the search for better prognoses, page 12
USC TIMES / STAFF
FROM THE EDITOR USC Times is published 10 times a year for the faculty and staff of the University of South Carolina by the Office of Communications & Public Affairs, Wes Hickman, director. Managing Editor Craig Brandhorst Creative Director Bob Wertz Designer Brinnan Wimberly Illustrator Justin Carrier Contributors Dan Cook Chris Horn Page Ivey Photographers Kim Truett Ambyr Goff Adrienne Cooper Printer USC Printing Services Campus correspondents James Raby, Aiken Kerry Jarvis, Beaufort Cortney Easterling, Greenville Shana Dry, Lancaster Jane Brewer, Salkehatchie Misty Hatfield, Sumter Annie Smith, Union Tammy Whaley, Upstate Jay Darby, Palmetto College Submissions Did you know you can submit ideas for future issues of USC Times? Share your story by emailing or calling Craig Brandhorst at craigb1@mailbox.sc.edu, 803-777-3681.
WHAT WERE WE
THINKING?
This month we’re trying to get inside your head — almost literally. As in, we called in the psychologists and neuroscientists, even the philosophers. As in, we headed over to Palmetto Health Richland and fired up the fMRI. As in, we started with a few questions about what’s happening between our ears and ended with the answers before your eyes. Welcome to the brain issue. It was a good idea, and it yielded a great issue, starting with Justin Carrier’s imaginative cover illustration, which was loosely inspired by our feature on the possibilities and limitations of AI, “Artificial Intelligence: It’s Not What You Think,” page 8. After all, when it comes to your computer, it really isn’t. Thinking, we mean. Or is it? We asked Siri and still weren’t sure, so we asked theology and ethics professor James Cutsinger, and got a more satisfying and nuanced answer. You know, because he’s a human. “Think for Yourself ” starts on page 10. We also had a few AI-related questions for George Khushf, director of USC’s Center for Bioethics. Khushf is part of a movement to bring ethical considerations into the research and development of new technologies before we introduce unforeseen ethical dilemmas into our daily lives. It’s called anticipating consequences, and it starts on page 11. But most of this issue isn’t about AI at all. It’s about living, breathing humans — you know, the ones who think and feel and have actual brains between their ears. It’s with that in mind that we’ve republished the @UofSC web story “Brains on the Brain” this month. If you’ve already read about Julius Fridriksson’s promising aphasia research online, super — enjoy the rest of the issue. If you haven’t, we encourage you to do so now, starting on page 12. See, this issue is also about making decisions, and we’re not just talking about which article to read now, which to save for later. The decision might also come down to savory versus sweet as you’re placing your McCutchen House Pie Day order in anticipation of Thanksgiving or — Wait, what? There’s pie? Well, yes, there’s pie — see Times Five, opposite page — but please, try to pay attention just a little bit longer. We don’t want you to make a hasty decision when you don’t even have all the facts yet. How about check in with the folks at the Institute for Mind and Brain first and learn a little more about the way we make choices, then make the one most likely to satisfy. “Decisions, Decisions …,” starts on page 4.
Make a good one,
CRAIG BRANDHORST MANAGING EDITOR
The University of South Carolina does not discriminate in educational or employment opportunities or decisions for qualified persons on the basis of race, color, religion, sex, national origin, age, disability, genetics, sexual orientation or veteran status.
VOL. 27, NO.9 3
Easy as Pie BUYING TIME Purchasing retirement service can be an important factor in your retirement planning. Human Resources is offering a seminar that will provide an overview of strategies you can use to buy time in the state retirement system. Participants will learn what services can be purchased, such as maternity leave, leave without pay, military service or previous state or federal service. An overview of the South Carolina Deferred Compensation Program will also be included. The class is 12-1:30 p.m., Nov. 16, at 1600 Hampton St., suite 101, To register, visit the Human Resources website and look under “Training and Professional Development.”
One of the year’s tastiest events returns in November. The annual McCutchen House Pie Day is set for 11:30 a.m.-1:30 p.m., Nov. 22. This year’s selection includes the signature McCutchen House chocolate walnut pie ($12 each) and the tomato mini-pie kits ($15 for 13 kits). Order online at the College of Hospitality, Retail and Sport Management website, hrsm.sc.edu. Pies can be
Hello, Fellows! USC Connect is seeking applicants for its Faculty Fellows program. Fellows serve as advocates for integrative learning, including Graduation with Leadership Distinction, and
picked up on the Monday or Tuesday before Thanksgiving. Walkup purchases
are an integral part of the USC Connect team.
can be made on Nov. 22, but ordering is recommended because the pies
Fellows work with a small group of students in
frequently sell out. All pickups will in the parking lot behind McCutchen House.
e-portfolio development and on assessment of learning and have the opportunity to engage with colleagues on scholarship in integrative learning. Applications can be found online at the USC Connect website under “Initiatives” in
STOP, DROP AND ENROLL
the “About” section of sc.edu. The deadline to apply is Nov. 15.
Due to Hurricane Matthew, the Public Employee Benefit Authority is extending the 2016 open enrollment period. Subscribers have until Nov. 15 to submit open enrollment changes. Any changes made during this time will be effective Jan. 1. During the open enrollment period, you may make the
NEXT YEAR LAST YEAR?
following changes:
If you’re planning to retire in 2017, you will want
• Change from one health plan to another plan.
to sign up for the “Applying for Retirement” class set for 9 a.m.-1 p.m., Nov. 18. This free course
• Enroll or drop dependents from your coverage.
will teach you about options for continuing
• Enroll in or drop the vision coverage.
and will provide information about how sick
voluntary benefits and Medicare requirements leave and annual leave affect retirement
• Enroll in or drop the insurance MoneyPlus pre-tax premium feature. • Enroll or re-enroll in the MoneyPlus medical spending or dependent care accounts. Changes can be made by visiting www.peba.sc.gov. Look for the Fall 2016 Benefits Advantage newsletter for what’s new this year.
benefits. You will receive a personal estimate of retirement benefits and individualized assistance completing the necessary forms to initiate the retirement process. To register, visit the Human Resources website and look under “Training and Professional Development.”
4 USCTIMES / NOVEMBER 2016
DECISIONS, DECISIONS... FOR RESEARCHERS AT THE INSTITUTE FOR MIND AND BRAIN STUDYING DECISION-MAKING, CONTEXT IS KEY. BY DAN COOK
I
t’s 4:15 p.m. on a workday, and the salad you had for lunch isn’t cutting it. You’re trying to rein in the urge for a candy bar when a co-worker starts to speculate about what exactly is in the center of a Twix bar. All of a sudden your willpower crumbles. Sometimes the decisions we make are trivial. Other times, they are more important — such as what career to pursue, who to marry or what should be done to help an elderly parent. Most of us would like to make these decisions rationally, but that can be hard to do. Regardless of the decision, context and emotion play a role. The question of how context can affect our decision-making is a major theme in the work of Doug Wedell, chair of the Department of Psychology and director of the Institute for Mind and Brain. “My interest in decision-making started with the goal of understanding how judgment and choice are driven by the context of what’s going on,” says Wedell, who has been at USC since 1989. “One of the hallmarks of rationality is consistency; a rational decision-maker has to be able to maintain their standards and keep a steady, consistent approach. So if in one situation I prefer A to B, and then in the next situation I prefer B to A, that is considered irrational — assuming the context changes in an inconsequential way.” But where is the line between an inconsequential change and a consequential one? How will people’s decisions change in response to subtle changes in context? And what, precisely, is going on physiologically and neurologically as we make our decisions? These are the questions that Wedell seeks to answer. It’s an area of inquiry that involves lots of behavioral research and has real-life implications for many fields, including business and economics.
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Let’s Compromise Along with associate professors Svetlana Shinkareva and Matthew Rashotte, postdoctoral fellow Jongwan Kim and other researchers from the Institute for Mind & Brain, Wedell explores such questions as how the framing of choices affects decision-making; how altering the tempo of music affects our subsequent musical preferences; how people make judgments about probability; and how faces and other stimuli affect our decisions. Through this research, Wedell has developed quantitative models that help explain judgment, decision and memory processes. Underpinning Wedell’s work are the insights psychology has brought to decision theory. In 2002, psychologist Daniel Kahneman was awarded a Nobel Prize in economics for his work documenting the ways in which humans often deviate from the rational actor models that once dominated economic theory. “He and Amos Tversky were famous for introducing all of these biases that economists kept trying to shoot down,” Wedell says. “These biases have become much more recognized.” Doug Wedell demonstrates eye-tracking technology Several studies Wedell has worked on have documented the with postdoctoral fellow Jongwan Kim at the Institute for Mind & Brain. central tendency effect, or “the tendency to prefer the compromise alternative,” Wedell explains. On a graph, the central tendency appears as data clustered around a central value. One example of the central tendency effect comes from Wedell’s work with decision-making scenarios, in which he gives subjects a binary choice and then introduces a third option — one that almost no one would choose but that might affect a subject’s choice between the two original choices. In one example, subjects are given a choice between a high-priced, high-quality watch and an inexpensive, lower-quality watch. In that scenario, many people are reluctant to pay for the more expensive watch. When the choice set is altered to include an even higher-priced watch that’s only so-so in quality, however, people find the first high-priced watch much more attractive. Working with Rashotte, Wedell has also looked at how our music preferences change when the tempo of a song is altered — and how, again, our brains gravitate toward the compromise. “With digital manipulation, you can change the tempo of a song without changing its other characteristics,” Wedell says. “So, what if I play a song very slowly? Once you have been given this slower one, you tend to prefer something that is somewhat slower than the original. Once you have been given a super fast one, you prefer something slightly faster.” With the notable exception of people’s political views, Wedell says, the central tendency shows up lots of places. “It seems to be ubiquitous,” he says. “If I show you faces and I manipulate the distance between their eyes to show you wide-eyed people, suddenly you prefer things that are slightly wider. There’s a saying in one of the old articles on this: ‘what’s average is good.’ We usually don’t think that, but the average of several faces tends to be viewed as more attractive than the individual faces. One possible explanation is that we tend to move toward the norm, the central tendency.”
6 USCTIMES / NOVEMBER 2016
Emotions in Check?
"THERE IS A ROLE FOR EMOTION IN DECISIONMAKING. IT ISN’T NECESSARILY, 'BE MR. SPOCK, BE MR. DATA.' ON THE OTHER HAND, MAKING DECISIONS ON A WHIM IS FOOLISH."
It’s been hundreds of years since philosopher and mathematician Blaise Pascal put forth the idea that there are two types of mind, the mathematical and the intuitive. Nonetheless, mapping out the precise relationship between our rational and emotional modes of decision-making still leaves plenty of room for research. In his most recent research, conducted with Shinkareva and Kim, Wedell has been exploring how emotion — or “affect” as it’s referred to in psychology — is induced through musical and/or video stimuli. Researchers gather a variety of physiological data ranging from participants’ skin conductivity to how their heart rates, cheek muscles, eyebrows and pupils respond to stimuli. Then they map which areas of the brain are responding from functional Magnetic Resonance Imaging (fMRI). In one study involving graduate student Jack Gao, researchers are looking at what happens when subjects receive one type of emotional cue from music but another one from video. “How do you resolve that?” Wedell asks. “Is there a sensory bias where you shift toward the video or shift toward the music? There was some early work that suggested it was a visual bias, but we find more recently that it is mostly a bias toward whatever is negative — whatever is negative tends to capture your attention.” Unlike the central tendency, negativity bias plays out in the political realm, too, Wedell says: The reason we see so many negative political ads is that, psychologically, they work. Wedell, Shinkareva and graduate student Christine Weber are also studying emotion in decision-making is in a series of studies in which subjects are presented with various household products including plates, dinner sets, towel sets and cushions, and given various stimuli that might affect their feelings about the items. “What we have shown in our early work on this is what’s called evaluative conditioning,” Wedell says. “So if I just pair these items up with positive music — we were using classical music that’s either positive or negative [with highertempo, major-key music serving as a positive stimulus] — after as little as five trials, when you are asked to pick the products, you will pick the ones associated with the positive music.” In a follow-up study, researchers are looking to drill down further by giving subjects relevant facts about the products. “What happens when we actually give you information about a product’s durability, its ease of use, its value, etc.? Do you ignore that?” Wedell asks. “Or does it subtly affect you so that you only focus your attention on the attributes that are consistent with your prior belief? That’s what we believe.” Ultimately, Wedell says, there’s a role for both rationality and emotion in decision-making. “It’s not clear which one is better,” Wedell says. “We might say, ‘Well, you really shouldn’t use emotions’ — but if you are deciding where you are going to live or who you are going to marry and it doesn’t feel right, these are consequential decisions that have an element of emotion.’ I could say, ‘The
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expected utility is higher for you to marry this person versus that person,’ but nobody’s going to buy that. And indeed, it has been shown that emotion is a really key element to making good decisions.” From Lab to Boardroom If presenting subjects with music, video or consumer products and measuring their reactions seems a bit removed from real-life decision-making, rest assured that researchers are taking their work to the outside world, too. Wedell teaches a course in decision-making that attracts students from accounting, marketing, management, psychology and public health. “The interdisciplinary nature of decision-making shines through,” Wedell says. Wedell is particularly involved with accounting, a field that’s had an image problem ever since the U.S. economy collapsed in 2008. “Accountants used to feel pretty good about themselves and their decision-making,” he says. “Now they are getting slammed because of some of their practices.” One question he has looked at is how to remove bias from the audit process. Part of the challenge of helping people make better decisions, Wedell says, is in how to present information to them. “If you go to the marketplace for health insurance, it’s really hard to make a good decision — you almost have to be an expert,” he says. “People in public policy need to look for ways to enable anyone to make a good decision.” That, of course, raises the question of how we even define a “good” decision. “What is the optimal decision? Economists tend to spend a lot of time on this,” Wedell says. “But for many of us, what’s optimal is not really the key — it’s what is satisfying.” For Wedell, the recurring interest in decision-making comes from trying to gain more detailed insights into how our brains process information, the extent to which that process varies from person to person and the broader societal effects that can result from poor decision-making — as seen in, say, the housing crisis that led to the Great Recession. “Often, I am just trying to understand human nature,” he says. “And, I am interested in the consequences.” T
Svetlana Shinkareva, associate professor in the Department of Psychology, and Doug Wedell, chairman of the department, share a light moment at the Institute for Mind & Brain. Shinkareva and Wedell have collaborated on research aimed at better understanding the links between emotion and decision-making.
"THE IDEA THAT ECONOMISTS HAVE THAT THE ECONOMY IS GOING TO DO FINE WHEN EVERYONE ACTS IN THEIR OWN SELF-INTEREST DOESN’T SEEM TO ACTUALLY HOLD WATER. PART OF THAT IS BECAUSE PEOPLE AREN’T REALLY GOOD AT PROJECTING LONG-TERM CONSEQUENCES OF THEIR ACTIONS. THEY GO FOR THE SHORT-TERM GAIN. WELL, OFTEN THE SHORTTERM GAIN WILL LEAD TO A LONG-TERM DISASTER."
8 USCTIMES / NOVEMBER 2016
Artificial Intelligence It’s Not What You Think
BY CHRIS HORN
I
f you’re concerned about robots with artificial intelligence conquering the world anytime soon, just watch a video of the latest RoboCup, the annual international robotics soccer competition. The tournament, which represents current robotic and AI technology, features squads of plodding, humanoid robots whose spastic play is downright laughable. But don’t laugh too hard. The engineers developing these robots have a stated goal of fielding a team that can compete with the World Cup winners — the human ones — by 2050. Artificial intelligence-equipped computers have already surpassed human performance in several arenas: chess, trivia, image recognition and speech recognition. “A number of people have expressed concern about AI taking over the world. Even Stephen Hawking has expressed that opinion, even the guy who runs Tesla,” says Michael Huhns, a distinguished professor emeritus of computer science at USC whose research has focused on various aspects of AI. “But I don’t think that will be a concern within anyone’s lifetime.” A group of scientists from major institutions like MIT, Harvard, Microsoft and Berkeley agree. Last year they wrote the first installment of the One Hundred Year Study on Artificial Intelligence, “Artificial Intelligence and Life in 2030,” a crystal ball prognosis of how AI will affect life in a typical North American city. Their verdict? “The frightening, futurist portrayals of Artificial Intelligence that dominate films and novels, and shape the popular imagination, are fictional. In reality, AI is already changing our daily lives, almost entirely in ways that improve human health, safety and productivity. Unlike in the movies, there is no race of superhuman robots on the horizon or probably even possible.” Moreover, while the scientists recognize that AI has the potential to be abused, they see a much larger upside, with new technologies improving safety, education and quality of life. Significant advancements in machine learning have surged in the past 20 years, and in many subtle ways humans are already ceding control to those devices, Huhns says. Think of debit card readers, personal assistants such as Siri and Alexa, and the dozens of sensors on modern cars that assist in driving.
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"You can study thinking by Those are mostly innocuous examples of smart machines. But the autonomously driven cars that Google and Tesla have been testing for several years bring a new level of complexity. “It’s impossible to program for every situation, so an autonomously driven car will have to make decisions like we do,” Huhns says. “The computer has to decide, ‘Do I drive over a cliff and kill my driver to avoid hitting pedestrians in the road?’ If there’s a 90-year-old and a toddler in the road, which one would the autonomously driven car choose to run over if there was no alternative?” USC computer science professor Marco Valtorta points to the fatal crash of an autonomously driven car this summer in which Tesla’s navigation system failed to distinguish a tractor-trailer rig crossing a Florida highway. “The car’s visual recognition system was trained to expect underpasses — which is what the trailer crossing the road might have resembled — more commonly than a semi turning around on a highway,” Valtorta says. The death of the Florida passenger was tragic, of course, but the overall track record of self-driving cars is pretty darned good. And Valtorta and Huhns say the AI technology fueling that trend will improve even more over time. It won’t ever be perfect, they say, but the technology doesn’t have to be perfect to do far better than human performance — the determining factor in most of the 38,000-plus traffic fatalities last year in the U.S. But forget about self-driving cars and robots for a moment. How far has AI advanced in really cool stuff such as computers that think like humans? “We’re not so far from computers with personality,” Huhns says. “Some can express emotion and sound sympathetic or happy. They can even make sounds of laughter, depending on the sophistication of the programming.” For example, if an AI-programmed computer heard you say the word “funeral” or “cancer,” it could respond in a lower, more measured tone, sounding more sympathetic than happy. “There’s logic involved, not thinking, per se, but some reasoning ability,” Huhns says. And that’s the thing: what we think of as “thinking” is still beyond the grasp of AI. Consider Watson, IBM’s computer that famously competed on “Jeopardy!” The computer appeared to be pretty smart, Huhns says, “but if you asked it the same 10 questions, again and again, it would process them the same way 10 times. And if you talked with Watson, each sentence would be a discrete interaction, not the thread of a larger overall conversation.” It boils down to what thinking is. “You can study thinking by modeling the brain, that’s what neuroscientists do, or you can study properties of thinking, like aerodynamicists study flight,” Valtorta says. “While we don’t have a clear understanding of thinking, we do know that context is important, the idea of bringing to bear what we already know to a situation.” An example of that is found in language processing. If someone says, “The laptop didn’t fit in the backpack because it was too small,” we know that “it” refers to the backpack, not the laptop. That kind of context can be programmed, as well as a sense of probability, Valtorta says. Both are integral components of thinking, but they don’t give an AI-equipped computer the full measure of human thinking, with all of its subtle nuances and discernment.
modeling the brain, that's what neuroscientists do, or you can study properties of thinking, like aerodynamicists study flight." - MARCO VALTORTA
“We’re not so far from computers with personality. Some can express emotion and sound sympathetic or happy. They can even make sounds of laughter ..." - MICHAEL HUHNS
10 USCTIMES / NOVEMBER 2016
Think for Yourself
A
"Even Big Blue, which can beat Gary Kasparov at chess, is still just going through the motions that were programmed into it ... There is a threshold that technology cannot cross." - JAMES CUTSINGER
BY PAGE IVEY
dvances in artificial intelligence have allowed machines to draw conclusions using complex algorithms and mind-bogglingly large data sets. But what’s the limit when it comes to artificial intelligence? Could a machine ever become our intellectual equal — and if it could, would we have an ethical responsibility to treat it the same way we treat our fellow humans? Theology and ethics professor James Cutsinger dismisses the entire premise. “If you could — but you can’t — create a machine with self-reflective awareness, then you would have to accord to the machine all the rights that you accord to humans,” says Cutsinger. “That would be the ethical conclusion you’d reach. But that ain’t gonna happen.” Cutsinger, who delves into such questions of self-reflective awareness in his class called “The Mind’s Eye (I),” points out that a computer isn’t even as smart as the programmers who program it. As an example of artificial intelligence’s limitations he points to one of the most powerful machines produced at IBM, which is sometimes colloquially known as “Big Blue.” “Even Big Blue, which can beat Gary Kasparov at chess, is still just going through the motions that were programmed into it,” Cutsinger says. “It’s not really smiling, thinking, ‘I’m going to beat Gary.’ There is a threshold that technology cannot cross.” And when it comes to “intelligence,” the difference is more than just a matter of semantics. It’s also a matter of what we’re expecting a machine to do. “If intelligence means the ability to add up a column of numbers or to draw conclusions from premises or using an algorithm to predict some sequence of things, then a machine can be just as intelligent as we are and do it a lot faster,” Cutsinger says. However, there’s another school of thought called eliminativism, which argues that there is no such thing as consciousness, even in human beings, and that all mental tasks can be replicated by something that duplicates the neural transmissions in the brain. But if there's no such thing as consciousness, Cutsinger says, then we're just machines ourselves, and “thinking” is simply manipulating bits of data. “Some people would say whatever we are doing on the inside of us, some machine could replicate,” he explains. “They would argue that what you and I think that we’re doing when we’re reflecting or introspecting or looking back on our lives or into our futures, kind of standing apart from ourselves and looking at ourselves objectively, that’s all illusion. It’s just kind of a mirror game inside our cerebral cortex, neurons firing and doing really weird things.” So, could a computer consume all the philosophical and theological material that Cutsinger has read over the years and write coherently about these subjects? “A machine could come up with some really complicated synthesis of all the books that it has read, but the synthesis wouldn’t lead to a new philosophical insight,” Cutsinger says. “That would be insane. Obviously, I’m just asserting that here. Proving it takes time. But it can be proven — not to machines, of course. Only to human beings.”
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Anticipating Consequences
T
BY PAGE IVEY
he history of technological advances is filled with unintended consequences. The
ability to move people quickly from place to place by car or truck led to traffic jams as people moved farther away from their jobs. The airplane that lets us fly around the world in little more than a day also can be used to drop bombs on distant targets and even as weapons themselves. Philosophy professor George Khushf thinks we can get better at preemptively managing some of those negative consequences. But he acknowledges that the issues get murky when we consider something like artificial intelligence. “Typically, people want to know the risk profile associated with some discrete intervention in the world,” Khushf says, who also is director of the university’s Center for Bioethics. “But you cannot modularize emerging technologies like that. One development plays off another.” When the technology gets dropped in society’s collective lap with little consideration for the potential ethical concerns, it can lead to many unforeseen consequences. Khushf says this results in a reactive kind of ethics. Instead, he suggests we take a proactive approach. Consider social media, which lets us reconnect with old friends but is likewise a tool for bullying or spreading propaganda. “Companies creating these new social worlds draw on the research of information scientists, psychologists, neuroscientists and others to create a kind of artificial intelligence that monitors and regulates the activities of those who use the social media,” Khushf says. “The challenge is then to get them to further expand these research teams to include ethical analysis oriented toward anticipating broader social risks, so these too can be proactively managed as part of the research and development process. We would like to see ethics incorporated into the process as the research is being conducted.” And that is what Khushf does. He works with health care organizations, engineers, scientists, doctors and others to help identify ethical issues early so they can be managed as part of the development process for any new technology. That was, in part, the idea behind a study panel that met at Stanford University in 2015 and, this year, released the first of an anticipated series of reports on the developments of artificial intelligence. A version of the panel is expected to meet every five years and includes experts in AI from academia, corporate labs and industry, as well as tech-savvy scholars in law, political science, policy and economics. The goal of the One Hundred Year Study on Artificial Intelligence is to help policymakers and developers gauge AI’s impact on society, particularly North American cities. The panel’s first report was released in September. Those associated with the project say having social scientists involved is key. “Historically, we have been very slow making sense of these ethical issues around emerging technologies,” Khushf says. “We need a different process of reviewing these issues as the technologies are being developed.” T
"We can anticipate risks and potential negative effects. We would like to see ethics incorporated into the process as the research is being conducted." - GEORGE KHUSHF
12 USCTIMES / NOVEMBER 2016
BREAKTHROUGH BREAKOUT
BRAINS ON THE BRAIN
COLLABORATION: GRANTED
Fridriksson has been landing grants for aphasia research since he arrived at Carolina in 2001, but an $11.1 million research grant from the National Institutes of Health promises to push ome nights, Julius Fridriksson lies awake just thinking about his research his team’s research to the next level. — but losing a little sleep doesn’t faze him. For a researcher charged with In addition to funding related projects at overseeing a large team, a large lab, multiple patient studies and millions of Johns Hopkins University, the University of dollars in federal grants, those solitary midnight hours provide fresh perspectives. California Irvine and MUSC, the grant will “I actually cherish those moments,” says Fridbrain injury typically corresponds to particular enable the expansion of several promising pilot riksson, who directs the University of South types of aphasia, small variations can result studies started in Fridriksson’s lab. Carolina’s Aphasia Laboratory and was named in radically different symptoms, and not all “My main project here at USC is focused the SmartState Endowed Chair of Memory patients respond to the same therapies. on chronic patients who had a stroke a year and Brain Function in May. “A lot of people “Aphasia ranges from very mild — difficulty ago, or even longer,” says Fridriksson. “We do wake up and complain that they can’t stop coming up with the right words, what you a very intensive work up, look at all aspects thinking about work. I actually like it. It’s would call 'tip-of-the-tongue' syndrome — of their brain structure and function, and use personal time to reflect.” to more severe forms where the person is both behavioral data and brain imaging data to And these days, Fridriksson has a lot on almost mute and/or has a difficult time predict outcome.” which to reflect. His lab, which is housed understanding other people when they speak,” Fridriksson can’t do all that alone, of course, within the Department of Communication Fridriksson explains. and is backed by a team that includes SmartSciences and Disorders at the Arnold School Even in its mildest forms, aphasia is a devasState Endowed Chair of neuroimaging Chris of Public Health, is home to some of the most tating diagnosis, and the consequent frustraRorden and School of Medicine neurology ambitious clinical studies to-date on aphasia, a tion experienced by patients only compounds chair Souvik Sen, as well as MUSC neurologist communication disorder caused by damage to its impact on quality of life. Leo Bonilha. the left hemisphere of the brain, typically as a “The chief complaint that we get from Initially, Sen sees each patient who enters people with aphasia is that they know what result of stroke. the study and conducts the neurological work; they want to say; they just can’t get the words The disorder affects approximately 1 million Rorden oversees the brain scans at the Mcpeople in the United Causland Center for States, according to Brain Imaging at PalSome people think that the right hemisphere the National Institute takes over for the function that was lost. We think that metto Health Richon Neurological Disland and uses machine orders and Stroke, and it ’s the residual areas of the left hemisphere that have learning technology incidence is even high- to be retrained . to predict the relative er in South Carolina, effectiveness of various therapies based on the out,” says Fridriksson. “A family member will which is part of the so-called Stroke Belt. type, location and severity of brain injury. say, ‘Well, he’s lost his memory.’ No, he can But while the need for more effective Over the next five years the study will inremember that this is a magazine or that’s a therapy and more accurate prognoses is high, volve approximately 150 patients. “And that’s chair; he just can’t remember the word for Fridriksson says progress has been relatively a very large patient sample when it comes to magazine or for chair. In most people those slow. That’s partly because of the compliaphasia treatment studies,” Fridriksson says. words are still intact, the person just cannot cated nature of the brain and partly because “Most are in single digits when it comes to pull them out.” language processing is itself such a complicated number of patients enrolled.” function. Moreover, while the location of a BY CRAIG BRANDHORST
S
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MAGNETIC RESONANCE IMAGE SEARCH
One of the most promising aphasia treatments involves targeting the left hemisphere with electrical stimulation in an effort to enhance therapeutic retraining of uninjured tissue. It’s complicated stuff, but the premise is simple: engage a patient in a language task and see which parts of the brain become activated, as indicated by a sudden influx of blood. Those areas could potentially be retrained to take over language tasks performed by other areas prior to injury. “What are the parts of the brain that take over the functions of the parts that were lost?” Fridriksson’s asks. “This is something that has been debated for about 150 years, since that first case described speech impairment as related to left frontal lobe damage. Some people think that the right hemisphere takes over for the function that was lost. We think that it’s the residual areas of the left hemisphere that have to be retrained.” But to locate those areas, you first need good pictures. You also need someone to interpret those pictures and analyze what amounts to millions of data points. Enter Rorden, a Cambridge-educated neuropsychologist who spent the first part of
his career studying the effects of injury on the brain’s right hemisphere. Early on, he also had the good fortune to be at the University of Nottingham when Sir Peter Mansfield received the Nobel Prize for echo-planar imaging, and so got first-hand experience with the world’s first 3 Tesla MRI scanner, which Mansfield and his colleagues built. “It allows you to see a 2-D slice of the brain almost instantaneously,” he says. “Where it used to take us eight minutes to take a picture of the brain, we were seeing the whole brain every three seconds. It was a dramatic revolutionary advance.” When he met Fridriksson, though, the right brain expert quite literally switched sides. “I can help Julius take really good pictures of the brain, and help him understand what those pictures say to decide if brain stimulation can perhaps aid in recovery,” he says. “As a psychologist, I can also help him tweak his therapies.” Rorden is also well-versed in machine language and probability, which the team hopes can help them process data in much the same way that a search engine like Google does. “We’ve been provided with these tools that are really impressive, but we can get inundated with data and still not quite know how to put
it all together,” he says. “The idea is to train an algorithm on a very large number of data sets, find the patterns and try to work out why some people are getting better and others aren’t.” A BETTER PROGNOSIS
Both Fridriksson and Rorden are quick to point out that not all aphasia patients can benefit from therapy. For those who likely won’t, however, there is at least the comfort of a more accurate prognosis. “If you have some kind of catastrophic diagnosis, whether it's stroke or heart disease or cancer, you want to know what the future holds,” says Fridriksson. “The decrease in quality of life is not just the event; it’s the uncertainty, the nagging feeling. Everybody is devastated when this first happens. I at least want to be able to give a good prognosis.” But what about those patients who truly can benefit from targeted therapy? “It could make the difference between having to live in a nursing home or getting to be discharged and live at their own home,” Fridriksson says. “It could make the difference between staying at home or going back to work or back to school." T
14 USCTIMES / NOVEMBER 2016
SYSTEM EFFECT
SCHOOL OF MEDICINE
Taking it to the next level The concept of the USC School of Medicine working with Palmetto Health isn’t new — in fact, there’s been a strong relationship between the two entities for many years, with Palmetto Health serving as a primary teaching hospital for USC medical students. In April, however, the partnership took a big step forward with the creation of the Palmetto Health-USC Medical Group. The combined medical group creates the largest multispecialty medical group in the Midlands, and brings with it new opportunities for patients, faculty and practicing physicians. As the health care delivery system evolves, partnerships like this one are
crucial, says Les Hall, executive dean of the USC School of Medicine and CEO of the newly formed group. “We are moving toward new ways of organizing and delivering health care,” Hall says. “Instead of fee-for-service, in the future employers or insurers will say, ‘Here are X number of dollars to take care of Y number of patients.’ In that model, you have to have comprehensive services that you can control. With a comprehensive network, you can control quality and cost. You can offer a higher-value product for patients.” By partnering, the School of Medicine and Palmetto Health will be able to enhance their individual strengths and gain access to each other’s areas of expertise. “It is expensive to recruit and employ physicians, and it was clear that neither USC nor Palmetto Health was in a position to create a comprehensive group on its own,” Hall says. “For the last few years, the School
BY DAN COOK
of Medicine has employed about 200 physicians — which might sound like a lot, but there are schools that have 2,000 or 3,000.” With the combined Palmetto Health-USC Medical Group, the number of physicians rises immediately to more than 500 physicians and advanced care providers, with more coming. The partnership vastly expands the number and range of specialties available to patients, enabling them to move more easily from one provider to the next without having to go outside the system, or even outside the city, for their care. Already, the Palmetto Health-USC Medical Group has moved to streamline medical records to “help patients navigate the system in ways that are more user-friendly,” Hall says. While patients will benefit from comprehensive services and streamlined care, the partnership is also a boon to the teaching and research missions of the university.
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“We have already seen a substantially larger number of Palmetto Health physicians that have applied for and received teaching appointments at USC,” Hall says. “We have also seen new trials launched and an increased interest in the expansion of clinical trials. We believe that we will see more in the future.” Ultimately, the combined Palmetto Health-USC Medical Group aims to serve the community with a higher level of patient-centered care. “The single biggest impact in the community is that this is allowing us to build a comprehensive group that will be able to care for most health care needs that citizens in the Midlands might have without them having to travel two hours,” Hall says. “If you have a family member who needs to be hospitalized or who needs a procedure, having that care close to home will lead to better outcomes for everybody. We will see increasingly that Columbia is becoming a medical destination. That is already happening.” FoodShare brings fresh produce to underserved communities Beverly Wilson has been interested in food for a long time, but it’s only recently that it’s become her job.
“I have always loved good food,” says Watson, co-founder and director of FoodShare South Carolina. “I loved to play with food when I was little and get in kitchen with my mom and cook.” About a decade-and-a-half ago, that love of food led Watson to start a bulk-buying group in her neighborhood. The idea worked, but Wilson eventually came to a realization: While the families in her neighborhood had ready access to fresh produce — whether through the bulk-buying group or a trip to the grocery store — many families don’t. “I thought, ‘Wouldn’t it be cool to do this for low-income families?’” she recalls. That’s when Wilson — who holds a master’s in public health and was working at the School of Medicine as a research coordinator — reached out to Carrie Draper, director of policy and partnership development at the Arnold School of Public Health’s Center for Research in Nutrition and Health Disparities. Together, Wilson and Draper started looking for partners who could help make a food-access program a reality. They found them: in addition to the university, partners include the City of Columbia’s Department of Parks and Recreation, the Columbia Housing Authority, EdVenture Children’s Museum and Richland Library.
Beverly Wilson, second from left, packs produce boxes with FoodShare volunteers. Photo by Michael Dantzler.
The result is FoodShare South Carolina, which launched 18 months ago. For $20 per week — or $10 for those using SNAP (Supplemental Nutrition Assistance Program) — participants receive a box of fresh produce along with recipes on how it might be used. The program focuses on the 29203 ZIP code, which has a median household income of less than $20,000 and suffers from some of the highest health disparities in the country. The first week FoodShare was operating, it distributed 24 boxes. Now, the program averages roughly 300 boxes per week. Participants can sign up at several locations; boxes are picked up at the Bellfield Cultural Arts Center on Grant Street. “When we started, I was doing this on the side,” Wilson says. “Now this is my full-time job.” What has enabled Wilson to turn the program into her full-time job is a commitment on the part of the School of Medicine to address health issues through nutrition, part of what Wilson describes as a growing trend of lifestyle medicine that focuses on addressing such issues as nutrition and physical inactivity. “The School of Medicine sees the value in treating food as medicine,” Wilson says. “That is really our theme now: Fresh food is medicine — it can change the trajectory of your entire life.” T
ENDNOTES
When we decided to put out an issue on the brain, we didn’t know that the Institute for Mind and Brain would be hosting a timely conference on the subject. The Oct. 14 “Neuroscience of Attention” conference brought together guest speakers along with top university researchers, postdocs and graduate students. Following are some highlights of ongoing faculty research efforts.
Troy Herter, member of the
Jessica Green, assistant professor
R. Davis Moore, assistant professor
John Richards, Carolina Distinguished
Rehabilitation Sciences Division
of psychology, hypothesizes a
of exercise science, is working with
Professor in the Department
and assistant professor in the
correlation between reading ability
researchers from Northeastern
of Psychology, is the principal
Department of Exercise Science,
and attentional control. Her research
University and the University of
investigator on an NIH-funded study
is finding that improvements in
confirms a link showing that even
Montreal to examine the long-term
of sustained attention in infants.
skilled eye movements lead to better
within a high-functioning university
impacts of concussions. Contrary to
Sustained attention, he notes, is
performance of motor tasks, and he
population, variations in reading
traditional clinical practice, Moore
characterized by a period of alertness
is looking for ways to optimize those
ability are highly predictive of strong
says it is now increasingly understood
and attentiveness in which an infant’s
improvements. “Motor learning isn’t
performance on attention tasks. “To
that concussions “can and do lead
heart rate decreases and the child is
just about how we move our arms
be able to read fluently you have to
to persistent deficits in brain and
able to process stimuli more quickly.
and our legs and interact with our
not only sustain attention on your
behavioral health.” In a recent
He’s especially interested in how the
environment; it’s also about how we
task, but you also have to be able
paper, Moore shows that both adults
infant brain processes faces and has
gather information,” Herter says. “I
to efficiently shift your attention
and children suffer persistent and
developed a testing method that
argue that visual search is a skill in
through space in an orderly manner,”
detrimental effects from concussions,
identifies activity in five areas of
itself — it is a motor skill that we learn
she explains.
particularly in attention-related areas
the brain.
and that contributes to our overall ability to learn and perform new motor tasks.”
of the brain.