Please meet Jane. She has a high-risk pregnancy. Within 24 weeks, she's on bed rest at the hospital, being monitored for her preterm contractions.
Hemen duzue Jane. Arrisku altuko haurdunaldia du. 24 aste ostean ospitaleratuta dago kontrakzio goiztiarrak monitarizatuak izateko.
She doesn't look the happiest. That's in part because it requires technicians and experts to apply these clunky belts on her to monitor her uterine contractions. Another reason Jane is not so happy is because she's worried. In particular, she's worried about what happens after her 10-day stay on bed rest at the hospital. What happens when she's home? If she were to give birth this early it would be devastating. As an African-American woman, she's twice as likely to have a premature birth or to have a stillbirth. So Jane basically has one of two options: stay at the hospital on bed rest, a prisoner to the technology until she gives birth, and then spend the rest of her life paying for the bill; or head home after her 10-day stay and hope for the best. Neither of these two options seems appealing.
Ez dirudi oso zoriontsu. Teknikoek eta adituek uteroko kontrakzioak monitorizatzeko gerriko pisutsu horiek jartzen dizkiotelako. Eta, arduratuta dagoelako. Zehazki ospitalean 10 egun pasa ostean gertatuko denak arduratzen du. Zer gertatuko da etxera itzultzean? Hain goiz erditzea, suntsitzailea litzateke. Afroamerikar emakumea denez, aukera bikoitza du erditze goiztiarra edo fetuaren heriotza izateko. Beraz Janek bi aukera ditu: ospitaleko ohean geratu, teknologiaren mende, erditu arte eta bizitza osoa faktura ordaintzen pasa; edo 10 egun ostean etxera joan eta dena ondo ateratzea espero. Bi aukera horietako ezein ez da oso erakargarria.
As I began to think about stories like this and hear about stories like this, I began to ask myself and imagine: Is there an alternative? Is there a way we could have the benefits of high-fidelity monitoring that we get with our trusted partners in the hospital while someone is at home living their daily life?
Horrelako istorioetan pentsatzen dudanean, eta horrelakoak entzutean, neure buruari galdetzen diot: Ba ote dago alternatibarik? Posible ote da ospitalean dugun bezalako kalitatezko monitarizazio baten onurak izatea etxean eguneroko bizitza egiten dugun bitartean?
With that in mind, I encouraged people in my research group to partner with some clever material scientists, and all of us came together and brainstormed. And after a long process, we came up with a vision, an idea, of a wearable system that perhaps you could wear like a piece of jewelry or you could apply to yourself like a Band-Aid. And after many trials and tribulations and years of endeavors, we were able to come up with this flexible electronic patch that was manufactured using the same processes that they use to build computer chips, except the electronics are transferred from a semiconductor wafer onto a flexible material that can interface with the human body.
Ideia honi bueltaka, nire ikerketa taldea zientzialari batzuekin elkartzera animatu nuen, eta guztiok bildu eta idea-jasa bat egin genuen. Prozesu luze baten ostean, bisio bat, ideia bat, izan genuen: soinean eraman zitekeen zerbait, bitxi baten modukoa, edo tirita bat bezala jar daitekeena. Eta estuasun eta ahaleginez beteriko urteen ostean, txaplata elektroniko malgu honetara heldu ginen. Konputagailuetako txipak sortzeko erabiltzen den prozesu berarekin fabrikatzen dira, baina, kasu honetan, osagaiak olata erdieroale batetik giza gorputzarekin komunikatu daitekeen materiale malgu batera pasatzen dira.
These systems are about the thickness of a human hair. They can measure the types of information that we want, things such as: bodily movement, bodily temperature, electrical rhythms of the body and so forth. We can also engineer these systems, so they can integrate energy sources, and can have wireless transmission capabilities.
Sistema hauek ile baten lodiera dute. Guk nahi dugun informazioa bil dezakete. Esaterako, gorputz mugimendua, gorputzeko tenperatura, gorputzeko inpultso elektrikoak, eta horrelakoak. Sistema hauek energia iturriak barne hartzeko ere diseina ditzakegu, eta haririk gabe igortzeko gaitasuna eman.
So as we began to build these types of systems, we began to test them on ourselves in our research group. But in addition, we began to reach out to some of our clinical partners in San Diego, and test these on different patients in different clinical conditions, including moms-to-be like Jane.
Honelako sistemak eratzen hasi ginenean, guregan eta gure ikerketa taldean probatzen hasi ginen. Baina gure bazkide ziren kliniko batzuekin ere kontaktatu genuen San Diegon, eta egoera kliniko desberdinetan zeuden gaixoekin probatu genituen, Jane bezalako etorkizuneko amekin ere bai.
Here is a picture of a pregnant woman in labor at our university hospital being monitored for her uterine contractions with the conventional belt. In addition, our flexible electronic patches are there. This picture demonstrates waveforms pertaining to the fetal heart rate, where the red corresponds to what was acquired with the conventional belts, and the blue corresponds to our estimates using our flexible electronic systems and our algorithms.
Hau unibertsitateko ospitalean erditzera doan emakume bat da, eta uteroko kontrakzioak ohiko gerriko baten bidez monitarizatzen ari zaizkie. Horrez gain, gure txaplata elektronikoak ere hor daude. Irudi honetan fetoaren bihotz taupaden uhinak ikus daitezke, marra gorria ohiko gerrikoaren bidez lortutako datuek sortzen dute, eta urdina, gure sistema elektroniko malgua eta gure algoritmoak erabiliz egindako estimazioek.
At this moment, we gave ourselves a big mental high five. Some of the things we had imagined were beginning to come to fruition, and we were actually seeing this in a clinical context.
Une horretan, bosteko handi bat eman genion geure buruari. Imajinatu genituen gauzetako batzuk fruituak ematen hasi ziren, eta hori testuinguru klinikoan ari ginen ikusten.
But there was still a problem. The problem was, the way we manufactured these systems was very inefficient, had low yield and was very error-prone. In addition, as we talked to some of the nurses in the hospital, they encouraged us to make sure that our electronics worked with typical medical adhesives that are used in a hospital. We had an epiphany and said, "Wait a minute. Rather than just making them work with adhesives, let's integrate them into adhesives, and that could solve our manufacturing problem."
Baina artean bazen arazo bat. Sistema hauek fabrikatzeko modua ez zen batere eraginkorra, errendimendu baxua zuen eta erroreak sortzen zituen. Gainera, ospitaleko erizainekin hitz egitean, aholkatu ziguten gure elektronikak ospitalean erabiltzen ziren itsasgarri medikoekin funtziona zezatela. Epifania bat izan genuen, "Itxaron une bat. Itsasgarri horiekin ongi lan egiteaz gain, goazen itsasgarri horietan barneratzera, eta horrela gure fabrikatze arazoa konpontzera."
This picture that you see here is our ability to embed these censors inside of a piece of Scotch tape by simply peeling it off of a wafer. Ongoing work in our research group allows us to, in addition, embed integrated circuits into the flexible adhesives to do things like amplifying signals and digitizing them, processing them and encoding for wireless transmission. All of this integrated into the same medical adhesives that are used in the hospital.
Hemen ikus dezakezue sentsore horiek zinta itsasgarrian barneratzeko dugun gaitasuna olata batetik askatuz. Ikerketa lan gehiagok, gainera, seinalea anplifikatzeko eta digitalizatzeko itsasgarri malguetan zirkuituak barneratzea, ahalbideratzen digu, seinalea prozesatuz eta haririk gabeko transmisiorako kodifikatuz. Guzti hau, ospitalean erabiltzen diren itsasgarri berdinetan barneratuta.
So when we reached this point, we had some other challenges, from both an engineering as well as a usability perspective, to make sure that we could make it used practically.
Une horretan, beste erronka batzuk agertu ziren, ingenieritzaren eta erabilgarritasunaren ingurukoak, erabiltzeko praktikoak zirela ziurtatzeko.
In many digital health discussions, people believe in and embrace the idea that we can simply digitize the data, wirelessly transmit it, send it to the cloud, and in the cloud, we can extract meaningful information for interpretation. And indeed, you can do all of that, if you're not worried about some of the energy challenges. Think about Jane for a moment. She doesn't live in Palo Alto, nor does she live in Beverly Hills. What that means is, we have to be mindful about her data plan and how much it would cost for her to be sending out a continuous stream of data.
Osasun digitalari buruzko eztabaida askotan jendeak sinisten eta onartzen du datuak digitaliza ditzakegula, haririk gabeko moduan transmititu ditzakegula, hodeira bidali, eta bertan, berau interpretatzeko beharrezko informazioa atera. Eta, izatez, guzti hori posible da, energiaren arazoa alde batera uzten badugu. Oroi gaitezen Janetaz. Ez da Palo Alton bizi, ez eta Beverly Hillsen ere. Beraz, kontuan izan behar dugu zein datu tarifa duen, eta zein den beretzat uneoro datuak bidaltzearen kostua.
There's another challenge that not everyone in the medical profession is comfortable talking about. And that is, that Jane does not have the most trust in the medical establishment. She, people like her, her ancestors, have not had the best experiences at the hands of doctors and the hospital or insurance companies. That means that we have to be mindful of questions of privacy. Jane might not feel that happy about all that data being processed into the cloud. And Jane cannot be fooled; she reads the news. She knows that if the federal government can be hacked, if the Fortune 500 can be hacked, so can her doctor.
Beste erronka bat ere badago, medikuntza arloan lantzea erosoa ez den bat. Izan ere, Janek ez du erabateko konfidantza medikuengan. Berak, bera bezalakoek, bere arbasoek, ez dituzte esperientzia atseginenak izan ospitaleetan eta medikuen eskuetan, edo aseguru konpainietan. Beraz, pribatutasunari buruz pentsatu behar dugu. Posible da Jane eroso ez sentitzea bere datu guztiak hodeian prozesatzearekin. Eta Jane ez da tuntuna; berriak irakurtzen ditu. Badaki gobernua hackeatua izan badaiteke, edo Fortune 500-eko konpainiak, baita bere medikua ere.
And so with that in mind, we had an epiphany. We cannot outsmart all the hackers in the world, but perhaps we can present them a smaller target. What if we could actually, rather than have those algorithms that do data interpretation run in the cloud, what if we have those algorithms run on those small integrated circuits embedded into those adhesives?
Eta hori kontuan hartuta, ideia bat izan genuen. Ez gara munduko hacker guztiak baino azkarragoak izango, baina helburu txikiago bat aurkez diezaiekegu. Zer gertatuko litzateke, datuen interpretazio egiteko algoritmo horiek hodeian burutu beharrean itsasgarrietan integratutako zirkuitu txikietan burutuko bagenitu?
And so when we integrate these things together, what this means is that now we can think about the future where someone like Jane can still go about living her normal daily life, she can be monitored, it can be done in a way where she doesn't have to get another job to pay her data plan, and we can also address some of her concerns about privacy.
Horrela, gauza hauek guztiak bateratzean, ondorioa da orain pentsa dezakegula etorkizunean Jane bezalako pertsona batek, bizitza normal bat izaten jarraitu eta monitorizatua izan daitekela. Bere datu-tarifa ordaintzeko beste lan bat bilatu beharrik gabe, eta pribatutasunari buruzko ardurak ere kontuan izanez.
So at this point, we're feeling very good about ourselves. We've accomplished this, we've begun to address some of these questions about privacy and we feel like, pretty much the chapter is closed now. Everyone lived happily ever after, right? Well, not so fast.
Une honetan, geure buruarekin oso gustura gaude. Hori lortu dugu, pribatutasunari dagozkion hainbat gai konpondu ditugu eta uste dugu atal hori ia itxita dugula. Aurrerantzean denak pozik bizi izan ziren, ezta? Ez hain azkar.
(Laughter)
(Barreak)
One of the things we have to remember, as I mentioned earlier, is that Jane does not have the most trust in the medical establishment. We have to remember that there are increasing and widening health disparities, and there's inequity in terms of proper care management. And so what that means is that this simple picture of Jane and her data -- even with her being comfortable being wirelessly transmitted to the cloud, letting a doctor intervene if necessary -- is not the whole story.
Oroitu beharreko gauzetako bat lehenago esan bezala, zera da, Jane ez dela asko fio medikuetaz. Gogoan izan osasunaren inguruan aldeak handitzen ari direla, eta ezberdinatsunak daudela mediku zaintza egokien inguruan. Horrek esan nahi du irudi arrunt hori, Jane eta bere datuen irudia, haririk gabe datuak hodeira igortzearekin eroso egon arren, beharrezkoa denean medikuaren eskuhartzea onartu arren, ez dela istorio osoa.
So what we're beginning to do is to think about ways to have trusted parties serve as intermediaries between people like Jane and her health care providers. For example, we've begun to partner with churches and to think about nurses that are church members, that come from that trusted community, as patient advocates and health coaches to people like Jane.
Beraz, orain egiten ari garena bide barriak lantzea da Jane eta bere medikua bezalako pertsonen artean konfiantzazko bitartekariak eduki ahal izateko. Adibidez, elizekin elkartzen hasi gara, elizako kide diren erizainak bilatzen, konfiantzazko komunitateetatik datozenak, eta gaixoaren babesle eta aholkulari bihurtzen ditugu.
Another thing we have going for us is that insurance companies, increasingly, are attracted to some of these ideas. They're increasingly realizing that perhaps it's better to pay one dollar now for a wearable device and a health coach, rather than paying 10 dollars later, when that baby is born prematurely and ends up in the neonatal intensive care unit -- one of the most expensive parts of a hospital.
Alde dugun beste gauza bat aseguru etxeak horrelakoetan gero eta interes handiagoa dutela da. Ohartzen ari dira, hobe dela orain dolar bat ordaintzea, soinean eraman daitekeen gailu bat eta osasun aholkulari batengatik, gero 10 dolar ordaintzea baino, haurra modu goiztiarrean jaiotzean, eta jaioberrien zaintza intentsiboen unitatean amaitzean; ospitaleko unitate garestienetako batean.
This has been a long learning process for us. This iterative process of breaking through and attacking one problem and not feeling totally comfortable, and identifying the next problem, has helped us go along this path of actually trying to not only innovate with this technology but make sure it can be used for people who perhaps need it the most.
Guretzat ikaskuntza prozesu luze bat izan da hau. Aurrera egin eta arazoei aurre egiteko prozesu errepikakor honek, non ezeroso sentitzen ginen eta hurrengo arazoa identifikatzen genuen, bide hau egiten lagundu digu, teknologia honekin berrikuntzak egiteaz gain, gehien behar dutenek erabili ahal izatea ziurtatuz.
Another learning lesson we've taken from this process that is very humbling, is that as technology progresses and advances at an accelerating rate, we have to remember that human beings are using this technology, and we have to be mindful that these human beings -- they have a face, they have a name and a life. And in the case of Jane, hopefully, two.
Prozesu honetan ikasitako beste ikasgaia, oso apalgarria, zera izan da: teknologiak exponentzialki aurrera egiten duen honetan teknologia honen erabiltzaileak gizakiak direla kontuan izan behar dugula, eta jakin behar dugula pertsona horiek aurpegi bat dutela, eta izen bat, eta bizitza bat. Eta Jane-en kasuan, espero dezagun bi bizitza.
Thank you.
Mila esker.
(Applause)
(Txaloak)