Steven Schwaitzberg: A universal translator for surgeons

22,608 views ・ 2013-01-24

TED


Please double-click on the English subtitles below to play the video.

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Translator: Timothy Covell Reviewer: Morton Bast
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So I want to talk to you about two things tonight.
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Number one:
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Teaching surgery and doing surgery
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is really hard.
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And second,
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that language is one of the most profound things
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that separate us all over the world.
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And in my little corner of the world,
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these two things are actually related,
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and I want to tell you how tonight.
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Now, nobody wants an operation.
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Who here has had surgery?
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Did you want it?
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Keep your hands up if you wanted an operation.
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Nobody wants an operation.
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In particular, nobody wants an operation
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with tools like these through large incisions
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that cause a lot of pain,
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that cause a lot of time out of work or out of school,
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that leave a big scar.
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But if you have to have an operation,
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what you really want is a minimally invasive operation.
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That's what I want to talk to you about tonight --
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how doing and teaching this type of surgery
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led us on a search
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for a better universal translator.
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Now, this type of surgery is hard,
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and it starts by putting people to sleep,
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putting carbon dioxide in their abdomen,
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blowing them up like a balloon,
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sticking one of these sharp pointy things into their abdomen --
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it's dangerous stuff --
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and taking instruments and watching it on a TV screen.
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So let's see what it looks like.
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So this is gallbladder surgery.
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We perform a million of these a year
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in the United States alone.
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This is the real thing. There's no blood.
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And you can see how focused the surgeons are,
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how much concentration it takes.
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You can see it in their faces.
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It's hard to teach, and it's not all that easy to learn.
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We do about five million of these in the United States
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and maybe 20 million of these worldwide.
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All right, you've all heard the term:
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"He's a born surgeon."
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Let me tell you, surgeons are not born.
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Surgeons are not made either.
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There are no little tanks where we're making surgeons.
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Surgeons are trained one step at a time.
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It starts with a foundation, basic skills.
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We build on that and we take people, hopefully, to the operating room
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where they learn to be an assistant.
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Then we teach them to be a surgeon in training.
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And when they do all of that for about five years,
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they get the coveted board certification.
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If you need surgery, you want to be operated on
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by a board-certified surgeon.
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You get your board certificate,
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and you can go out into practice.
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And eventually, if you're lucky, you achieve mastery.
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Now that foundation is so important
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that a number of us
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from the largest general surgery society in the United States, SAGES,
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started in the late 1990s a training program
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that would assure that every surgeon who practices minimally invasive surgery
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would have a strong foundation of knowledge and skills
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necessary to go on and do procedures.
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Now the science behind this is so potent
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that it became required by the American Board of Surgery
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in order for a young surgeon to become board certified.
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It's not a lecture, it's not a course,
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it's all of that plus a high-stakes assessment.
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It's hard.
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Now just this past year,
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one of our partners, the American College of Surgeons,
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teamed up with us to make an announcement
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that all surgeons should be FLS (Fundamentals of Laparoscopic Surgery)-certified
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before they do minimally invasive surgery.
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And are we talking about just people here in the U.S. and Canada?
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No, we just said all surgeons.
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So to lift this education and training worldwide
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is a very large task,
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something I'm very personally excited about as we travel around the world.
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SAGES does surgery all over the world, teaching and educating surgeons.
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So we have a problem, and one of the problems is distance.
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We can't travel everywhere.
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We need to make the world a smaller place.
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And I think that we can develop some tools to do so.
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And one of the tools I like personally is using video.
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So I was inspired by a friend.
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This is Allan Okrainec from Toronto.
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And he proved
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that you could actually teach people to do surgery
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using video conferencing.
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So here's Allan teaching an English-speaking surgeon in Africa
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these basic fundamental skills
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necessary to do minimally invasive surgery.
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Very inspiring.
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But for this examination, which is really hard,
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we have a problem.
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Even people who say they speak English,
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only 14 percent pass.
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Because for them it's not a surgery test,
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it's an English test.
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Let me bring it to you locally.
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I work at the Cambridge Hospital.
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It's the primary Harvard Medical School teaching facility.
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We have more than 100 translators covering 63 languages,
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and we spend millions of dollars just in our little hospital.
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It's a big labor-intensive effort.
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If you think about the worldwide burden
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of trying to talk to your patients --
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not just teaching surgeons, just trying to talk to your patients --
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there aren't enough translators in the world.
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We need to employ technology to assist us in this quest.
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At our hospital we see everybody from Harvard professors
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to people who just got here last week.
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And you have no idea how hard it is
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to talk to somebody or take care of somebody you can't talk to.
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And there isn't always a translator available.
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So we need tools.
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We need a universal translator.
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One of the things that I want to leave you with as you think about this talk
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is that this talk is not just about us preaching to the world.
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It's really about setting up a dialogue.
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We have a lot to learn.
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Here in the United States we spend more money per person
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for outcomes that are not better than many countries in the world.
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Maybe we have something to learn as well.
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So I'm passionate about teaching these FLS skills all over the world.
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This past year I've been in Latin America, I've been in China,
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talking about the fundamentals of laparoscopic surgery.
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And everywhere I go the barrier is:
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"We want this, but we need it in our language."
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So here's what we think we want to do:
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Imagine giving a lecture
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and being able to talk to people in their own native language simultaneously.
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I want to talk to the people in Asia, Latin America, Africa, Europe
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seamlessly, accurately
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and in a cost-effective fashion using technology.
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And it has to be bi-directional.
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They have to be able to teach us something as well.
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It's a big task.
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So we looked for a universal translator; I thought there would be one out there.
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Your webpage has translation, your cellphone has translation,
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but nothing that's good enough to teach surgery.
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Because we need a lexicon. What is a lexicon?
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A lexicon is a body of words that describes a domain.
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I need to have a health care lexicon.
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And in that I need a surgery lexicon.
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That's a tall order. We have to work at it.
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So let me show you what we're doing.
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This is research -- can't buy it.
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We're working with the folks at IBM Research from the Accessibility Center
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to string together technologies to work towards the universal translator.
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It starts with a framework system
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where when the surgeon delivers the lecture
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using a framework of captioning technology,
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we then add another technology to do video conferencing.
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But we don't have the words yet, so we add a third technology.
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And now we've got the words,
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and we can apply the special sauce: the translation.
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We get the words up in a window and then apply the magic.
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We work with a fourth technology.
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And we currently have access to eleven language pairs.
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More to come as we think about trying to make the world a smaller place.
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And I'd like to show you our prototype
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of stringing all of these technologies that don't necessarily always talk to each other
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to become something useful.
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Narrator: Fundamentals of Laparoscopic Surgery.
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Module five: manual skills practice.
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Students may display captions in their native language.
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Steven Schwaitzberg: If you're in Latin America,
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you click the "I want it in Spanish" button
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and out it comes in real time in Spanish.
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But if you happen to be sitting in Beijing at the same time,
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by using technology in a constructive fashion,
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you could get it in Mandarin or you could get it in Russian --
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on and on and on, simultaneously without the use of human translators.
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But that's the lectures.
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If you remember what I told you about FLS at the beginning,
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it's knowledge and skills.
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The difference in an operation
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between doing something successfully and not
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may be moving your hand this much.
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So we're going to take it one step further;
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we've brought my friend Allan back.
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Allan Okrainec: Today we're going to practice suturing.
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This is how you hold the needle.
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Grab the needle at the tip.
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It's important to be accurate.
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Aim for the black dots.
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Orient your loop this way.
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Now go ahead and cut.
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Very good Oscar. I'll see you next week.
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SS: So that's what we're working on
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in our quest for the universal translator.
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We want it to be bi-directional.
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We have a need to learn as well as to teach.
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I can think of a million uses for a tool like this.
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As we think about intersecting technologies --
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everybody has a cell phone with a camera --
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we could use this everywhere,
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whether it be health care, patient care,
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engineering, law, conferencing, translating videos.
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This is a ubiquitous tool.
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In order to break down our barriers,
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we have to learn to talk to people,
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to demand that people work on translation.
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We need it for our everyday life,
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in order to make the world a smaller place.
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Thank you very much.
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(Applause)
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