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AI thought knee X-rays show if you drink beer -- they don't December 11, 2024 Dartmouth College A new study highlights a hidden challenge of using AI in medical imaging research -- the phenomenon of highly accurate yet potentially misleading results known as 'shortcut learning.' The researchers analyzed thousands of knee X-rays and found that AI models can 'predict' unrelated and implausible traits such as whether patients abstained from eating refried beans or beer. While these predictions have no medical basis, the models achieved high levels of accuracy by exploiting subtle and unintended patterns in the data. Facebook Twitter Pinterest LinkedIN Email Artificial intelligence can be a useful tool to health care professionals and researchers when it comes to interpreting diagnostic images. Where a radiologist can identify fractures and other abnormalities from an X-ray, AI models can see patterns humans cannot, offering the opportunity to expand the effectiveness of medical imaging. But a study in Scientific Reports highlights a hidden challenge of using AI in medical imaging research -- the phenomenon of highly accurate yet potentially misleading results known as "shortcut learning." The researchers analyzed more than 25,000 knee X-rays from the National Institutes of Health-funded Osteoarthritis Initiative and found that AI models can "predict" unrelated and implausible traits such as whether patients abstained from eating refried beans or beer. While these predictions have no medical basis, the models achieved surprising levels of accuracy by exploiting subtle and unintended patterns in the data. "While AI has the potential to transform medical imaging, we must be cautious," says the study's senior author, Dr. Peter Schilling, an orthopaedic surgeon at Dartmouth Health's Dartmouth Hitchcock Medical Center and an assistant professor of orthopaedics in Dartmouth's Geisel School of Medicine. "These models can see patterns humans cannot, but not all patterns they identify are meaningful or reliable," Schilling says. "It's crucial to recognize these risks to prevent misleading conclusions and ensure scientific integrity." The researchers examined how AI algorithms often rely on confounding variables -- such as differences in X-ray equipment or clinical site markers -- to make predictions rather than medically meaningful features. Attempts to eliminate these biases were only marginally successful -- the AI models would just "learn" other hidden data patterns. "This goes beyond bias from clues of race or gender," says Brandon Hill, a co-author of the study and a machine learning scientist at Dartmouth Hitchcock. "We found the algorithm could even learn to predict the year an X-ray was taken. It's pernicious -- when you prevent it from learning one of these elements, it will instead learn another it previously ignored. This danger can lead to some really dodgy claims, and researchers need to be aware of how readily this happens when using this technique." The findings underscore the need for rigorous evaluation standards in AI-based medical research. Overreliance on standard algorithms without deeper scrutiny could lead to erroneous clinical insights and treatment pathways. "The burden of proof just goes way up when it comes to using models for the discovery of new patterns in medicine," Hill says. "Part of the problem is our own bias. It is incredibly easy to fall into the trap of presuming that the model 'sees' the same way we do. In the end, it doesn't." "AI is almost like dealing with an alien intelligence," Hill continues. "You want to say the model is 'cheating,' but that anthropomorphizes the technology. It learned a way to solve the task given to it, but not necessarily how a person would. It doesn't have logic or reasoning as we typically understand it." Schilling, Hill, and study co-author Frances Koback, a third-year medical student in Dartmouth's Geisel School, conducted the study in collaboration with the Veterans Affairs Medical Center in White River Junction, Vt. Story Source: Materials provided by Dartmouth College . Note: Content may be edited for style and length. Journal Reference : Cite This Page :
Pep Guardiola admits he is questioning himself after Man City lose to JuventusTrump Says U.S. Will Impose Massive Tariffs On Mexico, Canada And China From Day 1
Homeland Security shares new details of mysterious drone flights over New Jersey A New Jersey lawmaker from part of the state where several mysterious drones have been spotted in recent week says the devices appear to avoid detection by traditional methods. Assemblywoman Dawn Fantasia was among state officials who met Wednesday with representatives from the Department of Homeland Security. She says lawmakers were told the drones have dodged detection by helicopters and radio. Fantasia says DHS described the devices as up to 6 feet in diameter and sometimes traveling with their lights off. The Morris County Republican made the comments in a post on X shortly after she and several other state and local lawmakers met with state police and Homeland Security officials. Juan Soto gets free luxury suite and up to 4 premium tickets for home games in $765M Mets deal DALLAS (AP) — Juan Soto gets free use of a luxury suite and up to four premium tickets behind home plate for regular-season and postseason New York Mets home games as part of his record $765 million, 15-year contract. The Mets agreed to provide personal team security for the All-Star outfielder and his family at the team’s expense for all spring training and regular-season home and road games, according to details of the agreement obtained by The Associated Press. New York agreed to assist Soto’s family for in-season travel arrangements, guaranteed he gets uniform No. 22 and included eight types of award bonuses. Rape allegation against Jay-Z won’t impact NFL's relationship with music mogul, Goodell says IRVING, Texas (AP) — NFL Commissioner Roger Goodell says a rape allegation against rapper Jay-Z won’t impact the NFL's relationship with the music mogul. Jay-Z's company Roc Nation has produced some of the NFL’s entertainment presentations including the Super Bowl halftime show. A woman who previously sued Sean “Diddy” Combs alleging she was raped at an awards show after-party in 2000 amended the lawsuit Sunday to include an allegation that Jay-Z was also at the party and participated in the sexual assault. Jay-Z says the rape allegation made against him is part of an extortion attempt. The NFL teamed up with Jay-Z’s Roc Nation in 2019 for events and social activism. The league and the entertainment company extended their partnership a few months ago. Ohio politician proposes make flag planting a felony after fight in Michigan rivalry game An Ohio politician has seen enough flag planting. Republican state Rep. Josh Williams said Wednesday on social media he's introducing a bill to make flag planting in sports a felony in the state. His proposal comes after the Nov. 30 fight at the Michigan-Ohio State rivalry football game when the Wolverines beat the Buckeyes 13-10 and then attempted to plant their flag at midfield. A fight ensued and police had to use pepper spray to disperse the players. Former Oklahoma quarterback Baker Mayfield famously planted a flag in the middle of the field at Ohio State after the Sooners beat the Buckeyes in 2017. Gastineau confronts Favre in documentary for his 'dive' on Strahan's record-breaking sack Former New York Jets star Mark Gastineau confronted Brett Favre last year at a memorabilia show and angrily accused the Pro Football Hall of Fame quarterback of deliberately going down on a record-breaking sack. The tense exchange is shown in the new ESPN 30 for 30 documentary “The New York Sack Exchange." It chronicles the Jets’ fearsome foursome defensive line of the 1980s that included Gastineau. Gastineau set an NFL record with 22 sacks in 1984, but Pro Football Hall of Famer Michael Strahan broke the mark when he sacked Favre in 2002 in a game between the Giants and Packers. Many have accused Favre of purposely taking the sack so Strahan could set the single-season record with 22 1/2. What happens next with Alex Jones' Infowars? No certainty yet after sale to The Onion is rejected Lawyers in the Alex Jones bankruptcy case are now in discussions on what could happen next after a federal judge in Texas rejected the auction sale of Jones’ Infowars to The Onion satirical news outlet. The next steps remained unclear Wednesday as the judge ordered the trustee who oversaw the auction to come up with a new plan. Judge Christopher Lopez in Houston rejected the bid late Tuesday, saying there was too much confusion about The Onion’s bid. The bankruptcy case was in the wake of the nearly $1.5 billion that courts have ordered Jones to pay for calling the Sandy Hook Elementary School shooting in Connecticut a hoax. Sandy Hook families had backed The Onion’s bid. NFL and Nike extend their partnership with a 10-year deal, will focus on growing the sport globally IRVING, Texas (AP) — The NFL’s desire to become a global powerhouse is no secret. Nike is committed to helping the league continue expanding its worldwide reach. The league and the apparel giant announced Wednesday a 10-year partnership extension. The NFL and Nike will focus on working together to grow the game’s global reach, increase participation, develop new talent, and expand the football fan base. Nike, the world’s largest supplier of athletic shoes and apparel, has been the NFL’s exclusive provider of uniforms and sideline, practice and base layer apparel for all 32 NFL teams for 12 years. George Kresge Jr., who wowed talk show audiences as the The Amazing Kreskin, dies at age 89 NEW YORK (AP) — George Joseph Kresge Jr., otherwise known to TV watchers as the mesmerizing entertainer and mentalist The Amazing Kreskin, has died at age 89. Kreskin’s friend and former road manager, Ryan Galway, says he died Tuesday at his home in Caldwell, New Jersey. Kreskin launched his television career in the 1960s and remained popular for decades, appearing with everyone from Merv Griffin to Johnny Carson to Jimmy Fallon. Fans would welcome, if not entirely figure out, his favorite mind tricks — whether correctly guessing a playing card chosen at random, or, most famously, divining where his paycheck had been planted among the audience. He also hosted a show in the 1970s, gave live performances and wrote numerous books. Albertsons sues Kroger for failing to win approval of their proposed supermarket merger Kroger and Albertsons’ plan for the largest U.S. supermarket merger in history has crumbled. The two companies have accused each other of not doing enough to push their proposed alliance through, and Albertsons pulled out of the $24.6 billion deal on Wednesday. The bitter breakup came the day after a federal judge in Oregon and a state judge in Washington issued injunctions to block the merger, saying that combining the two grocery chains could reduce competition and harm consumers. Albertsons is now suing Kroger, seeking a $600 million termination fee, as well as billions of dollars in legal fees and lost shareholder value. Kroger says the legal claims are “baseless.” Keynote Selena Gomez spotlights prioritizing mental health during Academy Women's Luncheon LOS ANGELES (AP) — While surveying a room packed with Hollywood’s most influential figures, “Emilia Pérez” star Selena Gomez took center stage at the Academy Women’s Luncheon to spotlight a critical issue: Prioritizing mental health and supporting underserved communities often left behind in the conversation. The singer-actor has been public about her mental health struggles, revealing she had been diagnosed with bipolar disorder. Gomez was the keynote speaker Tuesday at the event held at the Academy Museum of Motion Pictures with attendees including Ariana Grande, Olivia Wilde, Amy Adams, Pamela Anderson, Rita Wilson, Ava DuVernay and Awkwafina.
Police arrested a 26-year-old man on Monday in the Manhattan killing of UnitedHealthcare’s CEO after they say a Pennsylvania McDonald's worker alerted authorities to a customer who resembled the suspected gunman. The suspect, identified by police as Luigi Nicholas Mangione, had a gun believed to be the one used in Wednesday’s attack on Brian Thompson , as well as writings expressing anger at corporate America, police said. Here are some of the latest developments in the ongoing investigation: Mangione was taken into custody at around 9:15 a.m. after police received a tip that he was eating at a McDonald’s in Altoona, Pennsylvania, about 85 miles (137 kilometers) east of Pittsburgh, police said. People are also reading... Mangione was being held in Pennsylvania on gun charges and will eventually be extradited to New York to face charges in connection with Thompson’s death, said NYPD Chief of Detectives Joseph Kenny. In addition to a three-page, handwritten document that suggests he harbored “ill will toward corporate America,” Kenny said Mangione also had a ghost gun , a type of weapon that can be assembled at home and is difficult to trace. Officers questioned Mangione, who was acting suspiciously and carrying multiple fraudulent IDs, as well as a U.S. passport, New York Police Commissioner Jessica Tisch said at a news conference. Officers also found a suppressor, “consistent with the weapon used in the murder,” the commissioner said. He had clothing and a mask similar to those worn by the shooter and a fraudulent New Jersey ID matching one the suspect used to check into a New York City hostel before the shooting, Tisch said. Kenny said Mangione was born and raised in Maryland, has ties to San Francisco and that his last known address is in Honolulu, Hawaii. Mangione, who was valedictorian of his Maryland prep school, earned undergraduate and graduate degrees in computer science in 2020 from the University of Pennsylvania, a university spokesman told The Associated Press on Monday. He learned to code in high school and helped start a club at Penn for people interested in gaming and game design, according to a 2018 story in Penn Today, a campus publication. His social media posts also suggest that he belonged to the fraternity Phi Kappa Psi. They also show him taking part in a 2019 program at Stanford University, and in photos with family and friends at the Jersey Shore and in Hawaii, San Diego, Puerto Rico, and other destinations. The Gilman School, from which Mangione graduated in 2016, is one of Baltimore’s elite prep schools. Some of the city’s wealthiest and most prominent people, including Orioles legend Cal Ripken Jr., have had children attend the school. Its alumni include sportswriter Frank Deford and former Arizona Gov. Fife Symington. In his valedictory speech, Luigi Mangione described his classmates’ “incredible courage to explore the unknown and try new things,” according to a post on the school website. He praised their collective inventiveness and pioneering mindset. Mangione comes from a prominent Maryland family. His grandfather Nick Mangione, who died in 2008, was a successful real estate developer. One of his best-known projects was Turf Valley Resort, a sprawling luxury retreat and conference center outside Baltimore that he purchased in 1978. The father of 10 children, Nick Mangione prepared his five sons — including Luigi Mangione’s father, Louis Mangione — to help manage the family business, according to a 2003 Washington Post report. The Mangione family also purchased Hayfields Country Club north of Baltimore in 1986. On Monday, Baltimore County police officers blocked off an entrance to the property, which public records link to Luigi Mangione’s parents. A swarm of reporters and photographers gathered outside the entrance. Luigi Mangione is one of 37 grandchildren of Nick Mangione, according to his obituary. Luigi Mangione's grandparents donated to charities through the Mangione Family Foundation, according to a statement from Loyola University commemorating Nick Mangione’s wife’s death in 2023. They donated to various causes ranging from Catholic organizations to colleges and the arts. One of Luigi Mangione’s cousins is Republican Maryland state legislator Nino Mangione. A spokesman for the lawmaker's office confirmed the relationship Monday. Police said the person who killed Thompson left a hostel on Manhattan's Upper West Side at 5:41 a.m. on Wednesday. Just 11 minutes later, he was seen on surveillance video walking back and forth in front of the New York Hilton Midtown, wearing a distinctive backpack. At 6:44 a.m., he shot Thompson at a side entrance to the hotel, fled on foot, then climbed aboard a bicycle and within four minutes had entered Central Park. Another security camera recorded the gunman leaving the park near the American Museum of Natural History at 6:56 a.m. still on the bicycle but without the backpack. After getting in a taxi, he headed north to a bus terminal near the George Washington Bridge, arriving at around 7:30 a.m. From there, the trail of video evidence runs cold. Police have not located video of the suspected shooter exiting the building, leading them to believe he likely took a bus out of town. Police said they are still investigating the path the suspect took to Pennsylvania. “This just happened this morning," Kenny said. "We’ll be working, backtracking his steps from New York to Altoona, Pennsylvania,” Kenny said. Associated Press reporters Lea Skene in Baltimore and Cedar Attanasio in New York contributed to this report. 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Ensuring a reliable supply of critical battery raw materials will be crucial to the global push to net-zero, especially with demand for battery electric vehicles (BEV) picking up pace towards the end of this decade, a new report by McKinsey finds. By 2030, McKinsey estimates that worldwide demand for passenger cars in the BEV segment will grow sixfold from 2021 through 2030, with annual unit sales increasing to roughly 28 million from 4.5 million during that period. Such a projection, the consultancy says, means that the industry is “likely to confront persistent long-term challenges” in keeping with demand. In particular, its reports highlights that automotive OEMs are giving more attention to reducing Scope 3 emissions from material usage, which contribute a large portion of what batteries emit. As a result, battery materials sourcing has become ever more important for battery producers. Based on the latest estimates, McKinsey’s analysis projects that demand will outpace base-case supply for certain materials, requiring additional investment and leading to fear of shortages and price volatility, among other challenges. Supply shortages looming Based on current market observations, battery manufacturers can expect challenges securing supply of several essential battery raw materials by 2030, McKinsey’s report finds. Battery makers use more than 80% of all lithium that is mined today, and that share could grow to 95% by 2030. With technological advancements shifting in favor of lithium-heavy batteries, lithium mining will need to increase substantially to meet 2030 demand, McKinsey says. For nickel, fears of a shortage prompted by the shift to BEVs have already triggered significant investments in new mines, particularly in Southeast Asia, but even more supply will need to be brought online. McKinsey’s report suggests the possibility of a slight shortage in 2030 as the battery sector continues to vie with steel and other sectors for Class 1 nickel. While the share of cobalt in battery chemistry mix is expected to decrease, the absolute demand for cobalt for all applications could rise by 7.5% a year from 2023 and 2030, McKinsey estimates, adding that shortages of cobalt are unlikely, but its supply will be driven by nickel and copper since it is largely a byproduct of their production. Meanwhile, the supply of manganese is projected to grow moderately through 2030, but an increasing demand for battery-grade material is likely to outpace supply, requiring the development of new refineries. To account for a rapid adoption of LFP (lithium iron phosphate) technology, McKinsey’s study models the 2030 supply and demand balances with two scenarios. Under the base case, only about 20% of the HPMSM (high-purity manganese sulfate monohydrate) supply will meet the requirements of battery applications (30% if all announced projects are realized), which themselves will account for only about 5% of total demand for manganese. In a world where the rapid adoption of LFP technology is coupled with a lower growth in EV production, the demand of battery materials could look different: Global trends Although overall demand for batteries and raw materials is increasing rapidly, supply is — and will remain — largely concentrated in a few naturally endowed countries, including Indonesia for nickel; Argentina, Bolivia, and Chile for lithium; and the DRC for cobalt, McKinsey says. Meanwhile, the refining typically takes place elsewhere, often in China (for cobalt and lithium), Indonesia (nickel), and Brazil (niobium). This value chain setup, according to McKinsey, poses additional considerations for regions such as the European Union and the United States, both of which have high demand for imported materials and often rely heavily on single-country sources. For example, the European Union imports 68% of its cobalt from the DRC, 24% of its nickel from Canada, and 79% of its refined lithium from Chile. Supply chain transparency Moreover, although supply concentration for materials such as refined nickel, cobalt and lithium are knowable, complete visibility into the origin of raw materials is sometimes unattainable. This is the case with high-purity manganese, of which more than 95% is produced in China and minor volumes come from Belgium and Japan; graphite, of which almost all is refined in China; and anode production, on which China has a near monopoly. Limited transparency into the origins of battery raw materials supply also poses broader ESG concerns and attention. For instance, the EU Batteries Regulation aims to make batteries sustainable throughout their entire life cycle, from material sourcing to battery collection, recycling and repurposing. As a result, McKinsey believes the pressure to address ESG concerns will likely increase moving forward. Recent supply chain disruptions, such as those affecting magnesium, silicon and semiconductors in from 2021 to 2023, have increased buyers’ needs to boost supply chain resilience for critical battery raw materials. Buyers’ risks of import dependency are further heightened by recent trade restrictions introduced by exporters, including China’s export controls on some materials (such as synthetic graphite and natural flake graphite products used in BEVs) and Indonesia’s ban on nickel ore exports.
PLAINS, Ga. (AP) — Newly married and sworn as a Naval officer, left his tiny hometown in 1946 hoping to climb the ranks and see the world. Less than a decade later, the death of his father and namesake, a merchant farmer and local politician who went by “Mr. Earl,” prompted the submariner and his wife, Rosalynn, to return to the rural life of Plains, Georgia, they thought they’d escaped. The lieutenant never would be an admiral. Instead, he became commander in chief. Years after his presidency ended in humbling defeat, he would add a Nobel Peace Prize, awarded not for his White House accomplishments but “for his decades of untiring effort to find peaceful solutions to international conflicts, to advance democracy and human rights, and to promote economic and social development.” The life of James Earl Carter Jr., the 39th and longest-lived U.S. president, ended Sunday at the age of 100 where it began: Plains, the town of 600 that fueled his political rise, welcomed him after his fall and sustained him during 40 years of service that redefined what it means to be a former president. With the stubborn confidence of an engineer and an optimism rooted in his Baptist faith, Carter described his motivations in politics and beyond in the same way: an almost missionary zeal to solve problems and improve lives. Carter was raised amid racism, abject poverty and hard rural living — realities that shaped both his deliberate politics and emphasis on human rights. “He always felt a responsibility to help people,” said Jill Stuckey, a longtime friend of Carter's in Plains. “And when he couldn’t make change wherever he was, he decided he had to go higher.” Carter's path, , pitted moral imperatives against political pragmatism; and it defied typical labels of American politics, especially caricatures of one-term presidents as failures. “We shouldn’t judge presidents by how popular they are in their day. That's a very narrow way of assessing them," Carter biographer Jonathan Alter told the Associated Press. “We should judge them by how they changed the country and the world for the better. On that score, Jimmy Carter is not in the first rank of American presidents, but he stands up quite well.” Later in life, Carter conceded that many Americans, even those too young to remember his tenure, judged him ineffective for failing to contain inflation or interest rates, end the energy crisis or quickly bring home American hostages in Iran. He gained admirers instead for his work at The Carter Center — advocating globally for public health, human rights and democracy since 1982 — and the decades he and Rosalynn wore hardhats and swung hammers with Habitat for Humanity. Yet the common view that he was better after the Oval Office than in it annoyed Carter, and his allies relished him living long enough to see historians reassess his presidency. “He doesn’t quite fit in today’s terms” of a left-right, red-blue scoreboard, said U.S. Transportation Secretary Pete Buttigieg, who visited the former president multiple times during his own White House bid. At various points in his political career, Carter labeled himself “progressive” or “conservative” — sometimes both at once. His most ambitious health care bill failed — perhaps one of his biggest legislative disappointments — because it didn’t go far enough to suit liberals. Republicans, especially after his 1980 defeat, cast him as a left-wing cartoon. It would be easiest to classify Carter as a centrist, Buttigieg said, “but there’s also something radical about the depth of his commitment to looking after those who are left out of society and out of the economy.” Indeed, Carter’s legacy is stitched with complexities, contradictions and evolutions — personal and political. The self-styled peacemaker was a war-trained Naval Academy graduate who promised Democratic challenger Ted Kennedy that he’d “kick his ass.” But he campaigned with a call to treat everyone with “respect and compassion and with love.” Carter vowed to restore America’s virtue after the shame of Vietnam and Watergate, and his technocratic, good-government approach didn't suit Republicans who tagged government itself as the problem. It also sometimes put Carter at odds with fellow Democrats. The result still was a notable legislative record, with wins on the environment, education, and mental health care. He dramatically expanded federally protected lands, began deregulating air travel, railroads and trucking, and he put human rights at the center of U.S. foreign policy. As a fiscal hawk, Carter added a relative pittance to the national debt, unlike successors from both parties. Carter nonetheless struggled to make his achievements resonate with the electorate he charmed in 1976. Quoting Bob Dylan and grinning enthusiastically, he had promised voters he would “never tell a lie.” Once in Washington, though, he led like a joyless engineer, insisting his ideas would become reality and he'd be rewarded politically if only he could convince enough people with facts and logic. This served him well at Camp David, where he brokered peace between Israel’s Menachem Begin and Epypt’s Anwar Sadat, an experience that later sparked the idea of The Carter Center in Atlanta. Carter's tenacity helped the center grow to a global force that monitored elections across five continents, enabled his freelance diplomacy and sent public health experts across the developing world. The center’s wins were personal for Carter, who hoped to outlive the last Guinea worm parasite, and nearly did. As president, though, the approach fell short when he urged consumers beleaguered by energy costs to turn down their thermostats. Or when he tried to be the nation’s cheerleader, beseeching Americans to overcome a collective “crisis of confidence.” Republican Ronald Reagan exploited Carter's lecturing tone with a belittling quip in their lone 1980 debate. “There you go again,” the former Hollywood actor said in response to a wonky answer from the sitting president. “The Great Communicator” outpaced Carter in all but six states. Carter later suggested he “tried to do too much, too soon” and mused that he was incompatible with Washington culture: media figures, lobbyists and Georgetown social elites who looked down on the as “country come to town.” Carter carefully navigated divides on race and class on his way to the Oval Office. , Carter was raised in the mostly Black community of Archery, just outside Plains, by a progressive mother and white supremacist father. Their home had no running water or electricity but the future president still grew up with the relative advantages of a locally prominent, land-owning family in a system of Jim Crow segregation. He wrote of President Franklin Roosevelt’s towering presence and his family’s Democratic Party roots, but his father soured on FDR, and Jimmy Carter never campaigned or governed as a New Deal liberal. He offered himself as a small-town peanut farmer with an understated style, carrying his own luggage, bunking with supporters during his first presidential campaign and always using his nickname. And he began his political career in a whites-only Democratic Party. As private citizens, he and Rosalynn supported integration as early as the 1950s and believed it inevitable. Carter refused to join the White Citizens Council in Plains and spoke out in his Baptist church against denying Black people access to worship services. “This is not my house; this is not your house,” he said in a churchwide meeting, reminding fellow parishioners their sanctuary belonged to God. Yet as the appointed chairman of Sumter County schools he never pushed to desegregate, thinking it impractical after the Supreme Court’s 1954 Brown v. Board decision. And while presidential candidate Carter would hail the 1965 Voting Rights Act, signed by fellow Democrat Lyndon Johnson when Carter was a state senator, there is no record of Carter publicly supporting it at the time. Carter overcame a ballot-stuffing opponent to win his legislative seat, then lost the 1966 governor's race to an arch-segregationist. He won four years later by avoiding explicit mentions of race and campaigning to the right of his rival, who he mocked as “Cufflinks Carl” — the insult of an ascendant politician who never saw himself as part the establishment. Carter’s rural and small-town coalition in 1970 would match any victorious Republican electoral map in 2024. Once elected, though, Carter shocked his white conservative supporters — and landed on the cover of Time magazine — by declaring that “the time for racial discrimination is over.” Before making the jump to Washington, Carter befriended the family of slain civil rights leader Martin Luther King Jr., whom he’d never sought out as he eyed the governor’s office. Carter lamented his foot-dragging on school integration as a “mistake.” But he also met, conspicuously, with Alabama's segregationist Gov. George Wallace to accept his primary rival's endorsement ahead of the 1976 Democratic convention. “He very shrewdly took advantage of his own Southerness,” said Amber Roessner, a University of Tennessee professor and expert on Carter’s campaigns. A coalition of Black voters and white moderate Democrats ultimately made Carter the last Democratic presidential nominee to sweep the Deep South. Then, just as he did in Georgia, he used his power in office to appoint more non-whites than all his predecessors had, combined. He once acknowledged “the secret shame” of white Americans who didn’t fight segregation. But he also told Alter that doing more would have sacrificed his political viability – and thus everything he accomplished in office and after. King's daughter, Bernice King, described Carter as wisely “strategic” in winning higher offices to enact change. “He was a leader of conscience,” she said in an interview. Rosalynn Carter, who at the age of 96, was identified by both husband and wife as the “more political” of the pair; she sat in on Cabinet meetings and urged him to postpone certain priorities, like pressing the Senate to relinquish control of the Panama Canal. “Let that go until the second term,” she would sometimes say. The president, recalled her former aide Kathy Cade, retorted that he was “going to do what’s right” even if “it might cut short the time I have.” Rosalynn held firm, Cade said: “She’d remind him you have to win to govern.” Carter also was the first president to appoint multiple women as Cabinet officers. Yet by his own telling, his career sprouted from chauvinism in the Carters' early marriage: He did not consult Rosalynn when deciding to move back to Plains in 1953 or before launching his state Senate bid a decade later. Many years later, he called it “inconceivable” that he didn’t confer with the woman he described as his “full partner,” at home, in government and at The Carter Center. “We developed a partnership when we were working in the farm supply business, and it continued when Jimmy got involved in politics,” Rosalynn Carter told AP in 2021. So deep was their trust that when Carter remained tethered to the White House in 1980 as 52 Americans were held hostage in Tehran, it was Rosalynn who campaigned on her husband’s behalf. “I just loved it,” she said, despite the bitterness of defeat. Fair or not, the label of a disastrous presidency had leading Democrats keep their distance, at least publicly, for many years, but Carter managed to remain relevant, writing books and weighing in on societal challenges. He lamented widening wealth gaps and the influence of money in politics. He voted for democratic socialist Bernie Sanders over Hillary Clinton in 2016, and later declared that America had devolved from fully functioning democracy to “oligarchy.” Yet looking ahead to 2020, with Sanders running again, Carter warned Democrats not to lest they help re-elect President Donald Trump. Carter scolded the Republican for his serial lies and threats to democracy, and chided the U.S. establishment for misunderstanding Trump’s populist appeal. He delighted in yearly convocations with Emory University freshmen, often asking them to guess how much he’d raised in his two general election campaigns. “Zero,” he’d gesture with a smile, explaining the public financing system candidates now avoid so they can raise billions. Carter still remained quite practical in partnering with wealthy corporations and foundations to advance Carter Center programs. Carter recognized that economic woes and the Iran crisis doomed his presidency, but offered no apologies for appointing Paul Volcker as the Federal Reserve chairman whose interest rate hikes would not curb inflation until Reagan's presidency. He was proud of getting all the hostages home without starting a shooting war, even though Tehran would not free them until Reagan's Inauguration Day. “Carter didn’t look at it” as a failure, Alter emphasized. “He said, ‘They came home safely.’ And that’s what he wanted.” Well into their 90s, the Carters greeted visitors at Plains’ Maranatha Baptist Church, where he taught Sunday School and where he will have his last funeral before being buried on . Carter, who made the congregation’s collection plates in his woodworking shop, still garnered headlines there, calling for women’s rights within religious institutions, many of which, he said, “subjugate” women in church and society. Carter was not one to dwell on regrets. “I am at peace with the accomplishments, regret the unrealized goals and utilize my former political position to enhance everything we do,” he wrote around his 90th birthday. The politician who had supposedly hated Washington politics also enjoyed hosting Democratic presidential contenders as again. Carter sat with Buttigieg for the final time March 1, 2020, hours before the Indiana mayor ended his campaign and endorsed eventual winner Joe Biden. “He asked me how I thought the campaign was going,” Buttigieg said, recalling that Carter flashed his signature grin and nodded along as the young candidate, born a year after Carter left office, “put the best face” on the walloping he endured the day before in South Carolina. Never breaking his smile, the 95-year-old host fired back, “I think you ought to drop out.” “So matter of fact,” Buttigieg said with a laugh. “It was somehow encouraging.” Carter had lived enough, won plenty and lost enough to take the long view. “He talked a lot about coming from nowhere,” Buttigieg said, not just to attain the presidency but to leverage “all of the instruments you have in life” and “make the world more peaceful.” In his farewell address as president, Carter said as much to the country that had embraced and rejected him. “The struggle for human rights overrides all differences of color, nation or language,” he declared. “Those who hunger for freedom, who thirst for human dignity and who suffer for the sake of justice — they are the patriots of this cause.” Carter pledged to remain engaged with and for them as he returned “home to the South where I was born and raised,” home to Plains, where that young lieutenant had indeed become “a fellow citizen of the world.” —- Bill Barrow, based in Atlanta, has covered national politics including multiple presidential campaigns for the AP since 2012.