Cloud technology’s impact on epidemiology research and public health

How do the latest technologies impact epidemiology, clinical research, and public health? What kind of progress has there been in collaboration, open data, and citizen science? And in what ways can digital health appropriately supplement healthcare with the human touch? We will get the answers to these questions and more in this episode with Christine Ballard, a professionally trained epidemiologist specializing in clinical research and a Research Advocate at Oracle for Research. Christine has her Master of Public Health and is currently pursuing her Ph.D. in pharmacoepidemiology at UNC Chapel Hill. Her vast experience includes stints as an assistant professor and clinical research roles at Wake Forest Baptist Health, the University of Rochester Medical Center, and the New York State Department of Public Health. You can learn more about Oracle for Research here: http://www.oracle.com/research   --------------------------------------------------------   Episode Transcript: 00;00;00;00 - 00;00;24;21 What challenges do epidemiology researchers face in getting solutions to the public? What kind of progress has there been in collaboration, open data and citizen science? And in what ways can digital health appropriately supplement health care with the human touch? We'll get the answers to these questions and more on this episode of Research in Action, brought to you by Oracle for Research.   00;00;24;23 - 00;00;57;18 Hello. Welcome back to another episode of Research in Action, brought to you by Oracle for Research. I'm Mike Stiles, and today we have Christine Ballard with us. Christine is a professionally trained epidemiologist, specialized in clinical research. She has her master of public health and is working on her Ph.D. and pharmacoepidemiology at UNC-Chapel Hill. Her rather vast background includes stints as an assistant professor and clinical research roles at Wake Forest Baptist Health, University of Rochester Medical Center, and the New York State Department of Public Health.   00;00;57;20 - 00;01;26;08 She's currently a research advocate at Oracle for Research. And we're going to learn what those research advocates do and get into a lot more. Thanks for being with us, Christine. Thank you so much, Mike. I can't wait to dive into this. Oh, yeah. I'm looking forward to it as well. And I am going to ping you with questions about clinical research, epidemiology, pharmacoepidemiology as I keep tripping over that word, probably where is what kind of shape health care is in.   00;01;26;09 - 00;01;48;12 We're going to talk about that and some other stuff. But first, what got you as a person interested in this line of work? Kind of give us a little history lesson on Christine. You know, growing up, I lived in rural upstate New York, so I lived right outside of Rochester, right up on Lake Ontario, in a really small town of Albion, New York.   00;01;48;14 - 00;02;17;09 And, you know, there really wasn't a lot there in terms of researchers and health care access, to be quite frank. And, you know, I was diagnosed with type one diabetes at a really young age. I was diagnosed at eight and it I had a couple options When I got diagnosed, I could either face it head on or I could kind of sorrow in getting diagnosed and, you know, kind of letting it take over my life.   00;02;17;09 - 00;03;05;17 And I chose truly to jump two feet in. And I was so interested in being kind of up to date with all of the newest, latest, greatest technology and research updates. And I would find myself as a young kid trying to Google once Google became available, what certain words meant and really kind of educating myself about it. But quickly, growing up in a small town, not having that research access and really not having access to health care providers that even necessarily were familiar with that technology, my parents got me connected with the University of Rochester, and that's where I had a lot of my care growing up.   00;03;05;20 - 00;03;34;21 And really got to to learn and grow as as a kid alongside some of the brightest scientists in the field and it truly inspired where I wanted to go and was so excited when I entered college at the University of Rochester and really getting to work more hands on than you would as an eight year old kid and really just fell in love with the field.   00;03;34;21 - 00;04;06;24 And so I didn't know what epidemiology was even entering college and quickly kind of figured it out. During my studies. You know, like a lot of kids at the University of Rochester, you kind of go in premed, everyone's going to med school. And unfortunately I got rejected many times. And so when I got my MPH, I really fell in love with that and really getting the opportunity to dive into AP research.   00;04;06;24 - 00;04;59;01 And I did a little bit of that at the New York State Department of Health, but really got to spread my wings at the University of Rochester in the Department of Neurosurgery, really exploring health outcomes for patients and really understanding how do we make patients first in research and it kind of set me on this journey. So this past year, I got accepted into UMC Chapel Hill's PHARMACOEPIDEMIOLOGY program, where I get the opportunity to start to understand how pharmacy or pharmacology so all of the treatments that patients are receiving impact their care in certainly looking for ways to continue to always drive patient care and continuing to accelerate new discoveries.   00;04;59;03 - 00;05;23;28 And I absolutely love it and love that. Oracle's giving me the opportunity to do both things, work full time, and also be a full time PhD student. Yeah, I think that's kind of common. I've known several friends from high school who, you know, their path into medicine was a result of something that they experienced themselves, whether it was getting put back together after a car wreck or a disease that they have.   00;05;24;01 - 00;05;50;24 How does your personal health journey with Type one diabetes influence the way you approach research and your job at Oracle now? Because it is kind of a different lens than someone who's just coming at it. Purely academic, purely scientific. Yeah, I think I kind of have to wear both hats to be totally honest, but I think the way that I approach clinical research is really with patients in mind.   00;05;50;29 - 00;06;32;17 Patients have so much knowledge and experience that they can kind of engage in that research process and really understanding how to combine the patient perspective with the traditional research perspective has really been super rewarding and really engaging and allows me to bring my experience as a patient and certainly as a patient advocate forward. And now with Oracle get diving headfirst into the health care space, it really allows me to kind of bring a bit of that perspective to our researchers as well.   00;06;32;19 - 00;07;05;27 And always talking about the new discoveries that they're doing. But how can we relate it back to improving patient care and accelerating discoveries, understanding really how digital health can also revolutionize the way that we've been doing that versus I was that kid that would always bring Excel sheets to doctor's appointments. But I think, you know, I think digital health really is the opportunity to combine new technologies with accelerating the way that we're doing research, which I'm really excited about.   00;07;06;04 - 00;07;30;22 Well, you were talking about how when you were younger, you were making yourself an expert in your condition and probably, you know, seeking answers rather aggressively. Were you happy with the degree to which you were being listened to or did you just keep running up against a brick wall? MM That's a really good question. I have to say I was so lucky as a kid.   00;07;30;26 - 00;08;05;09 My physician was or I should say my nurse practitioner was a type one diabetic herself, which honestly gave me a completely new perspective on life and on the trajectory of the disease. To have somebody who's treating your condition, who is super busy as all of our advanced care practitioners and our MDs are so busy all the time, to see her living a life like that truly impacted where I wanted to go.   00;08;05;13 - 00;08;41;06 Going forward, I will say there were times where I felt like it would not just with my diabetes care, but, you know, with health care in general where you're experiencing something or feeling something and you're like, just listen. And I think that's really where being able to have that patient interaction and research is going to be really critical to understand the unique nuances of health things present in individuals because everybody is different, which I think is really going to help accelerate discovery a lot a lot more as well.   00;08;41;09 - 00;09;11;01 Well, what exactly is a research advocate, especially as it relates to being one for a company like Oracle? Why? Why is that important to advancing research? I think each one of us take on a slightly different role, but really the research advocate is to work alongside researchers to help them navigate huge corporations. And, you know, a lot of us are used to navigating the academic setting because that's what we're familiar with.   00;09;11;01 - 00;09;45;22 That's what we've experienced. But when you throw in a huge company like Oracle, you kind of get a little overwhelmed. And so as a research advocates role, I can I've got the research experience and have navigated the academic setting, but I also have the experience navigating industry through Oracle and so it's really helping the researchers translate what they're doing for their research and how that translate in the academic or nonprofit setting to the industry setting and helping them.   00;09;45;22 - 00;10;14;15 If there is projects that I can help with, we do everything from digital humanities to quantum physics and everything in between. And I am certainly not an expert in everything, but in the health care and the clinical research in the epidemiology space. If there are research areas that I can really work alongside researchers and help them accelerate what they're doing, that's really my role with Oracle for Research.   00;10;14;17 - 00;10;49;10 What attracted me to Oracle for Research was that ability to have that collegiate experience and also provide that researcher to researcher experience as well. A lot of times you get assigned somebody that may not have a research experience or may have heard the word research, but really hadn't lived it with their career. And so I was so excited to be able to kind of bridge that gap, especially coming from academia into Oracle, which was a bit of a learning curve for me.   00;10;49;10 - 00;11;16;23 But to really help, help the researchers get what they want done for their projects and be able to help make really impactful changes to their given fields. But even though you have plenty of laurels to rest on, like you said, you're at the same time getting your PhD and Pharmacoepidemiology at USC. Not an easy thing to do. What is that and what kind of research are you doing?   00;11;16;23 - 00;11;47;04 And and how is that? How does that help us get toward something we can bring the public health as a whole? And so if any of you ask that I or Mike, I feel like I talk to my my parents, they're like, what is it that you do? My dad's just like, I don't know. She's in school. So Pharmacoepidemiology is really the the marrying of pharmacology and pharmaceutical science with epidemiology.   00;11;47;04 - 00;12;31;23 So looking at how patient treatment impacts their overall health outcomes. And so really with that, I've been excited to explore different types of therapy is that are already available on the market to really look at how can we use or repurpose drugs for treating rare diseases and in my focus has been in brain tumors. And so not only with UNC-Chapel Hill and doing all of my PhD work, but I've really been able to dive in with a lab in focus on my own research, looking at how do we improve patient outcomes with brain tumors.   00;12;31;26 - 00;13;09;07 And we do that through a whole host of different tools. Some of it is real world data, and that could be real world data from registries like the Medicare SEER Registry, as an example, where we look at brain tumors or any sort of cancers, and then also be able to take a look at prevalence, meaning the number of cases in total of a certain cancer or looking at incidence, the number of new cases of a certain type of cancer or utilizing other electronic health record data.   00;13;09;08 - 00;13;36;17 So look at continuum of care for health and then also doing firsthand collection of data through clinical trials or clinical research studies that are initiated either by industry or by clinicians. And so really the field of clinical research is is huge. My PhD touches a little bit on that when we take a look at just the treatment side of it.   00;13;36;20 - 00;14;26;05 But my hope ultimately coming out of this Ph.D., I guess what I dream to do is really be able to marry some of my genomic experience using genomic data to also drive precision medicine with our pharmacology, to really be able to start to make an impactful transition for patient care. And my specialty and my focus has really been brain tumors to date, but certainly really interested in the rare disease in oncology space because I think there's a lot of a lot more work that we can do to be able to continue to spread awareness about these different types of cancers, but also a ton of headway to really improve patient care.   00;14;26;07 - 00;14;52;04 Yeah, and you touched on the fact that, you know, the health care overall seems to be driving toward more personalized approaches to treating people. We are all individuals, like you said, Lord knows I like to think I'm special. I don't know. But there are so many environmental and biological variables in the research equation. The kind of research you're talking about sounds incredibly complex to me.   00;14;52;04 - 00;15;20;07 So what epidemiologists have to deal with in terms of procedure and ethics as they do research and try to get something usable out there for the public. That's a loaded question. So with epidemiology, there's a whole host of things to look at. You know, growing up in undergrad and certainly in my graduate studies, the focus has really been on the bio psycho social model, really looking at all effects that could impact a person's health.   00;15;20;07 - 00;16;02;13 So as you touched on environmental, biological, psychological effects, mental health, all of these really contribute to an overall person's wellness. And so epidemiologists have to look across a multitude of different factors to really understand the certain disease that they're studying. I can tell you in the brain tumor space, we've looked at across a multitude of factors, including environmental, including pharmaceutical, including biological, including mental health, to really understand where we can make the biggest impacts.   00;16;02;15 - 00;16;40;14 And then thinking about the ethics associated with research, everything has to be done in certain there's all sorts of procedures that you have to follow. But thinking about our clinical research and our clinical trial data, where we're collecting real world data from patients, it's incredibly important to make sure that the patients are in agreement with sharing their data with the researchers and really understand what the study is looking at and what the benefits or maybe no benefits may be for their particular care.   00;16;40;16 - 00;17;08;02 And so I think, you know, having those procedures in place ensure that the patients are protected, which is truly key. But it certainly is something that I think all of us really strive to hold ourselves accountable for is making sure that patients are front and center as they are truly the ones that are contributing this data. And in allowing us to do the work that we're doing.   00;17;08;05 - 00;17;35;01 Well, I do want to ask about clinical trials because modern medicine means, I assume, collaboration across a range of medical professionals. So how does an epidemiologist work, supplement or partner in clinical trials? What does that interplay usually look like? You know, I've been so fortunate in my career to have supportive physicians and clinicians to work alongside with, but I am not a medical professional.   00;17;35;01 - 00;18;05;19 I don't have my my M.D., I don't have my R.N., I don't have my my degree and physician assistant. So I don't have the firsthand knowledge of treating patients. And so really, epidemiologists are in that supportive role to help drive research. But allowing us to have that interaction with clinicians is key to be able to make sure that the questions we're asking are relevant to patient care.   00;18;05;21 - 00;18;41;05 And what we're finding also is relevant to patient care, because really that's ultimately what we're all trying to do is is improve patient care. So depending on the setting that you're in depends on what your team may look like. But I can say that a lot of times as part of my research teams, we have a physician or some sort of clinician on our team alongside an epidemiologist, a biostatistician who is far better at doing statistical analysis than me.   00;18;41;07 - 00;19;18;06 Sometimes computer scientists who may be helping with the coding, although I do a lot of my own statistical programing myself, but sometimes we'll have the luxury of having a computer scientist on there and then obviously having an IRP that oversees it. An IRP is an institutional review board that makes sure the decisions that we're making in terms of the design of the study and how we're conducting a study is done in an incredibly ethical manner and meets all of the standards that we should.   00;19;18;09 - 00;19;39;22 And so having that oversight is also really helpful to make sure that, again, patients are front and center and we're we're doing the best science we can for regular listeners. I know I keep bringing up Amy Docs or Marcus on the show. She's a Pulitzer Prize winning journalist from the Wall Street Journal and she was a guest. We talked about her book, We, The Scientists.   00;19;39;28 - 00;20;07;16 But it's such a compelling look at patients, scientists, doctor collaboration and how that citizen science is being used in the fight against rare diseases. It's a truly new way of thinking that still honors scientific rigor. What are your thoughts on citizen science and is it gaining traction? I mean, we talked a little bit about it earlier about patients being listened to more, but this kind of kicks it up a notch.   00;20;07;19 - 00;21;01;02 Yeah, her book was fantastic and certainly very insightful of how citizens science should be done in the health care space. In this day and age, all of us have all sorts of devices that are collecting data about all of our lives. I know I'm wearing an Apple Watch and I'm sure many of our listeners are as well. And what I think is interesting is, you know, several years ago, before citizen science in health care really became a thing in the diabetes landscape, folks were using technology to continuously record their glucose readings to be able to get more of a handle on avoiding hypoglycemia, meaning high blood sugar or hypoglycemia, meaning a low blood sugar level   00;21;01;04 - 00;21;45;00 to really help improve their overall care and improve their health outcomes. And so thinking of citizen science, it makes sense to make that leap from what a lot of folks are already doing by tracking their steps or tracking their EKG monitors, tracking their blood glucose level, etc. to be able to incorporate that into that holistic picture of what their daily lives look like from a care standpoint, it certainly helps give physicians a clearer picture of their life, of what they're doing in their day to day life, but also be able to provide more, more personalized care.   00;21;45;03 - 00;22;20;13 But in the research space, it gives you a multitude of data points that otherwise wouldn't have been able to be collected without a huge burden on the patient. And so one of the things I think we have to consider with citizen science is how do we make citizen science approachable for everybody that wants to engage, to engage, and then also be able to allow patients an easy time to find those engagements if they can.   00;22;20;15 - 00;22;48;14 And so when I was at Wake Forest Baptist Health, one of the interesting studies that they did in partnership with Oracle was the Community Research Partnership for COVID 19. And so it really provided patients who, during the heart of the COVID pandemic, maybe at home, working from home to collect data and let us know how they're feeling about everything.   00;22;48;14 - 00;23;12;15 So how are they feeling about the Thanksgiving holiday? How are they feeling about seeing people? When it came time for that Thanksgiving holiday, what were their daily symptoms? Did they receive a vaccine? If they didn't, Why? If they were comfortable sharing that, to be able to understand how do we start delivering care that fits a multitude of different needs?   00;23;12;18 - 00;23;45;18 We were so fortunate with that study to have thousands of patients that were so diligently collecting those pieces of data or sharing those pieces of data with us on a daily basis for over two years. And so seeing that sort of project really starts to open up your mind to what else can we do in the rare disease space in particular, I think that patients are so eager to be able to make advances.   00;23;45;20 - 00;24;19;20 But also if you take a look at traditional data sets that we may use to do analysis for rare diseases, the data is so small that it makes it really difficult to make meaningful discoveries. And so by having patients that are eager to engage, that are advocating on behalf of themselves, or a lot of times others that they're caring for, it provides a whole new perspective that as a researcher I may not have even considered.   00;24;19;23 - 00;24;53;22 And so I think it's really exciting to see how do we start to bridge that gap between patients and scientists. I think we've done a start with that. I think the Robert Wood Johnson Foundation has started to do some of this or other phenomenal grant organizations that have bridged the gap between traditional research grants by having a focus with patient advocates on those particular grants committees or their project committees to really start to bring that in.   00;24;53;22 - 00;25;32;04 And we're starting to see health care bridged the gap as well by creating patient advocacy groups and patient support groups to be able to do that. But I think, again, digital technology is really making that difference and providing apps that can provide that support in a positive manner to patients wide and far. So you may not have your next door neighbor who may be in the same boat, but you can log on to your phone and have somebody who at a couple clicks of a button that may be able to be there to support and really create those those communities for years.   00;25;32;04 - 00;26;02;06 I can say in the diabetes space, we certainly have done that successfully. But being able to bring that to research I think is really making a difference, but also making an option for treatments to truly develop an unapproachable manner for patients. Because if I have to tell you, you've got to do these 35 steps to get to what what would improve your health, you'd probably look at me and go, When do I have time to do all of that?   00;26;02;06 - 00;26;33;06 And so really taking that into consideration and having that first hand patient knowledge is truly going to be key, I think, for continuing to improve our health overall. Well, it is actually technology that's enabling these types of new interactions, especially cloud technologies. You went through a lot of the main benefits of digital health. I know I'm going to floor everybody with this statement, but technology has its drawbacks too, so we can't lose sight of ethics, safety, efficacy.   00;26;33;06 - 00;27;19;01 And I think people still see health care as an in-person human engage. But so in what ways can or does digital supplement that human touch without replacing it? What's the right balance? I think technology has the ability to bridge the gap between inpatient care in not inpatient care, especially in situations where obtaining inpatient care is incredibly difficult. Growing up in a rural, underserved community, my parents would take half a day or full days off of work to take me to Rochester for care, and I was so fortunate that my parents had the ability to do that with their jobs.   00;27;19;04 - 00;27;57;28 But not everybody does. And so really having an opportunity to provide high touch care in a digital setting allows for folks to get access to care that they may not have. It also allows for huge improvements in care. I know in Rochester, for instance, they've got a mobile stroke unit that was having the ability for paramedics to connect with neurologists in the field to be able to reduce the door to needle time with stroke patients, which is critical because time is brain.   00;27;58;01 - 00;28;22;00 And so instead of having to get carted from your house to the emergency room and then do diagnostics to determine if you're having a stroke, that could all be done in the field. And so, yes, there needs to be oversight. Yes, there needs to be some some sort of standards. And yes, there needs to be ethical reviewing of this technology.   00;28;22;00 - 00;28;57;08 But the huge advancements that technology is is truly making for folks is is phenomenal in certainly making health care a bit more approachable. I've always struggled with the whole concept, especially coming from a middle class, underserved health care, almost health care desert in some aspects. It's so nice to be able to make that connection for patients that may have that specialty care offer without having to take hours or days off of work to get it.   00;28;57;13 - 00;29;28;28 And so being able to connect physicians to physicians or patients to physicians outside of their typical catchment area, I think is what's driving improvements in health overall as well. Well, every research, discipline and project is unique, but aren't there some commonalities when it comes to okay, pretty much everybody can use a technology like this. What are some of the biggest technology roadblocks and benefits that you see today's researchers dealing with?   00;29;29;01 - 00;29;58;25 MM I think one of the biggest blocks for research is truly getting access to high powered computing resources that they that they now need because we're collecting data and more and more and more data, it's important to have high powered computing resources to analyze it. I often joke with with researchers when I first started out, I remember getting what we called big data back then.   00;29;58;27 - 00;30;33;17 You know, it was a couple million lines of rows and my poor little laptop that was probably, you know, five years old just could not handle that. But those few million rows now are few billion rows and so it's important to have those high power computing resources to truly be able to analyze the data effectively and efficiently. And that's what I've loved about my role is really being told to give out those resources to help researchers at least break down that barrier.   00;30;33;19 - 00;31;13;05 I think some of the other barriers from a patient perspective is the multitude of different apps that are out there, the multitude of different like telehealth platforms, you name it, you know, we've got it. And how many times have we had to say to somebody, unmute yourself on Zoom as an example, over the last three years? And so I think one of the things that we've kind of got to start putting our heads around is how do we create a fully immersive research platform and what does that look like for patients, I think is I can't even tell you if you told me today, I have to download these five apps and then do this   00;31;13;05 - 00;31;31;08 and that, you're going to lose me. And I'm in the in the field, right? So think about our everyday patients that you're having to say download these five apps and click this and log stuff here. It would be nice if it was all at one click of a button, and I think we're probably not far off from that.   00;31;31;10 - 00;31;58;16 I would say I hope that we're all thinking about that in the same way, but I think that's truly going to make at least getting access as a patient to participating in research a bit more accessible, especially in the technology space. And then for researchers thinking about how can we accelerate the collaboration beyond our typical walls of our institution is also going to be key.   00;31;58;16 - 00;32;21;17 And I think technology getting away from having to share data sets on prem to being able to put things in cloud is really the wave of the future to allow researchers from around the world to collaborate, to really drive change together as well. Well, I know Oracle's been thinking a lot about research data. Like you said, it's a ton of data already.   00;32;21;17 - 00;32;41;27 It's only going to grow exponentially. That's great. We can do a lot with that data, but there is the complexity of it and regulations. So how do you see the data landscape for health care and clinical research? Are we more than we can handle or are we at just right? Hmm. I don't think we're at more than we can handle.   00;32;42;00 - 00;33;29;14 I think what's going to be really key and I think Oracle is certainly becoming a leader in this space is really to connect with the industry standards in working together with researchers to define what those standards should be as we continue to accelerate more and more data growth. I think that with all of our wearables and with all of the multitude of ways that citizens science projects can can continue to grow, we've got a lot of data, but there's also a lot more that we can collect and a lot more that we can continue to grow both both as researchers and as as patients and research participants.   00;33;29;17 - 00;33;58;11 And so I think together with patients and with industry standards and with ethics review boards, everybody can come together as to really define what those standards should look like, both within our own countries as well as internationally, so that we can all start to really make progress together. I can say, I think in the research space and this is one of the things I love the most is, you know, research doesn't really happen in a box.   00;33;58;13 - 00;34;35;19 You certainly can sit in for all room and talk to nobody and you make some small progress. But I think really benefit to research is truly through those collaborations. And so I think as industry continues to dive into this and we get new industry partners like Oracle for the cloud, you know, having them be able to be front and center in helping to learn about what needs to be done in the data space to ensure we're keeping patient data secure is in mind is incredibly important.   00;34;35;19 - 00;35;05;28 And so I, I think we can see that through some of Oracle for research is partnerships with like the Research Data Alliance as an example of really wanting to extend working groups to figure out how do we best treat genomic data, which is something that the industry is just starting to get into. Genomic data is a whole host of tons of data, but truly something that standards haven't been fully developed yet for that.   00;35;05;28 - 00;35;30;23 And Oracle's leading the charge with the research data alliance at trying to define what those standards could and should be. And I think that's going to be where we need to continue to go in the future. So closed data and open data are different things. Thus the two different names, Discovery Research thrives on open data for Explorer and reproducibility.   00;35;30;23 - 00;35;59;28 But for whatever list of reasons, data sharing in the research community is still kind of limited. Why is data sharing important for things like aligning with you? Say the fair principles, all these new NIH policies that are coming out? Yeah, so let me kind of define pain in the health care space or what allows data to be open and what allows data to be closed, because I think that's really important for listeners.   00;36;00;05 - 00;36;46;00 So open data is totally de-identified data. And what I mean by that is in the United States, we've got a principle called Hippo, and there's a, I believe, 20 some odd identifiers that include names, date of birth addresses, dates of service, etc. that can be used to identify patients. And with that, because we want to keep patient identity incredibly secure, because we don't want to share personal data when data is shared in an open space, all sorts of identifiers are stripped from the data so that you cannot track a patient back.   00;36;46;00 - 00;37;13;00 So I can't look at a data set and go, Yeah, that's me, you know. And so that is one data set includes data that is some in-between of that. And that's really defined by an individual institution or organization of what they feel their standard should be. And there's use cases for both for open data and for close data.   00;37;13;02 - 00;37;38;26 Open data is so important for reproducibility because I should be able to take a data set that Mike, you've ran an analysis on and be able to use it to repeat it so that I can say, Yep. Mike, you're your results are right and I'm going to take this algorithm and I'm going to now apply it to a new data set, and it should function the same way.   00;37;38;28 - 00;38;08;02 And that's where I think NIH is really getting at, is to be able to ensure that the research that's being done is done in an open manner so that folks can truly be able to collaborate and grow from what folks have already done. You can continue to accelerate that forward. Closed data is also super important depending on what the researcher is, is trying to determine.   00;38;08;05 - 00;38;35;15 So for instance, if we want to look at a health exposure in a given area, we may need to use closed data to look at a patient's zip code or a patient's census track to really hone in on environmental factors, for instance, in a given vicinity to be able to determine what do we need to do from a public health intervention to reduce that particular exposure.   00;38;35;18 - 00;39;18;08 So really, depending on the institution, will define what may be in that closed data set for that particular research question. We would have to have zip code, but that's something that we probably don't want to share as part of open data. So I think that's where the nuances are going to be. I think we have a lot to figure out in terms of what those standards are for open and closed and how we can come together as researchers and industry to be able to make continue make data open and accessible to people, but also keeping security and patients rights and wants protected as well.   00;39;18;08 - 00;39;41;21 And so I think that's something that Oracle is certainly exploring. And I know a multitude of folks are also exploring. And I think NIH, by putting in these new principles, are truly is truly taking a step in this direction as well. And it'll be interesting to see how we can kind of grow from there over the next couple of years.   00;39;41;24 - 00;40;02;27 Well, I can't let you go without asking about A.I. and the use of these large language models For all the accompanying caution and fear they do show promise you've probably been thinking about, okay, what does this mean for scientific research? What excites you about AI and what makes you a little nervous? Well, I'll start with what makes me nervous.   00;40;02;27 - 00;40;32;20 I think I can do a lot of things and I think we've seen I do a lot of things. And I think one of the the thing that makes me the most nervous about AI is some of the assumptions that can be inherently baked into AI models that are unintentional consequences of a particular model that may have folks come to the wrong conclusion about a certain disease or a certain entity.   00;40;32;22 - 00;41;15;10 But I certainly think AI has a whole of use cases in the health care space that can truly start to add a little new element of precision medicine to given patient care. We've got researchers that are using AI to improve image detection in colonoscopy, in MRI's, to really start to take some of the nuances which radiologists do an incredible job, but to be able to give them another tool to help them as they're reviewing more and more MRI's and all sorts of radiography in a given day.   00;41;15;13 - 00;41;43;16 And so I think AI is going to have a new set of tools for us to be able to do that from the research space. I am excited about AI being able to provide a standardized way of, for instance, analyzing tumor volumes on based on MRI's and looking at time series progression, some tumor volumes to be able to understand how a particular treatment is improving or not.   00;41;43;18 - 00;42;07;27 Particular tumor growth. So I think there's a whole host of of use cases, but I think we all need to be a little cautious and certainly look into the nuances of particular models and algorithms before we we kind of jump to fit in to make sure that we're not inadvertently making assumptions that may not be great for research overall.   00;42;07;29 - 00;42;33;02 Well, Christine, thanks so much for taking the time to be with us. Really good stuff. And what we've talked about is write down our listeners, Ali, But if they want to learn more about what you're doing or get in touch with you, can they do that? Absolutely. So folks can certainly reach out to me on LinkedIn. I’m Christine Pittman Ballard on LinkedIn, and I look forward to connecting with you all as well.   00;42;33;04 - 00;44;44;10 Very good. Well, if you are interested in how Oracle can simplify and accelerate your research, check out Oracle dot com slash research and join us again next time on Research in Action.