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.
Preséntovos a Jane. O seu é un embarazo de alto risco. Ás 24 semanas de xestación ingrésana en repouso no hospital, para monitorizar as súas contraccións prematuras.
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.
Non parece moi leda. Iso é, en parte, porque require que o persoal técnico e experto lle poña eses cintos pesados para monitorizar as contraccións uterinas. Outra razón pola que Jane non está leda é porque está preocupada. En concreto, está preocupada polo que pasará despois de estar dez días hospitalizada. Que ocorrerá cando estea na casa? Se tivese que dar a luz tan cedo sería devastador. Como muller afroamericana que é ten o dobre de posibilidades de dar a luz prematuramente ou de que o neno naza morto. Así que Jane ten dúas opcións: permanecer en repouso no hospital, prisioneira da tecnoloxía ata dar a luz, e pasar o resto da vida pagando a factura ou volver á casa despois de dez días e agardar que todo vaia ben. Ningunha das dúas opcións é tentadora.
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?
Cando dei en pensar en historias así e comecei a escoitar historias coma esta, empecei a preguntarme a a min mesmo: Hai algunha alternativa? Hai forma de ter os beneficios dunha monitorización de calidade coma a que temos nos hospitais mentres estamos na casa facendo vida normal?
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.
Con isto na cabeza, animei ao meu grupo de investigación a asociarnos con algúns científicos enxeñosos xuntarnos con eles e facer chuvias de ideas. Despois dun longo proceso, xurdiu unha visión, unha idea dun dispositivo que se puidese levar como se fose unha xoia ou que se puidese poñer coma un apósito. Despois de moitos intentos e tribulacións, e anos de esforzo, fomos quen de chegar a este parche electrónico flexible elaborado seguindo o mesmo proceso ca os chips dos ordenadores; salvo que a electrónica transfírese dunha oblea semicondutora a un material flexible que pode comunicarse co corpo humano.
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.
Estes sistemas teñen o grosor dun pelo humano. Poden recoller o tipo de información que queiramos, cousas como o movemento corporal, a temperatura corporal, os ritmos eléctricos do corpo e máis cousas. Tamén podemos deseñar estes sistemas para que integren fontes de enerxía e poidan ter capacidade de transmisión sen fíos.
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.
Ao empezar a construír este tipo de sistemas, comezamos a probalos en nós mesmos no noso grupo de investigación. Contactamos tamén con algúns socios clínicos de San Diego e probámolos en diferentes pacientes e en diferentes condicións clínicas, incluíndo futuras mamás coma Jane.
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.
Velaquí unha foto dunha muller a piques de dar a luz no hospital, co cinto convencional para monitorizar as contraccións uterinas. Ademais, poden verse aí os nosos parches. Esta foto amosa as ondas pertencentes ao pulso fetal onde as vermellas son as que rexistran os cintos convencionais e as azuis corresponden coa estimacións dos nosos sistemas electrónicos flexibles e os nosos algoritmos.
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.
Nese intre chocamos os cinco mentalmente. Algunhas das cousas que imaxinabamos, comezaban a concretarse e estabamos véndoo alí nun contexto clínico.
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."
Mais había un problema: a maneira de fabricar estes sistemas. Era moi ineficiente, cun rendemento baixo e moi proclive a erros. Ademais, falando co persoal de enfermaría do hospital, animáronnos a asegurarnos de que funcionaban cos adhesivos médicos que se empregan no hospital. Tivemos unha revelación e dixemos: “Un momento. Mellor ca facelos funcionar con adhesivos imos ver se os podemos integrar neles e resolver así o problema da fabricación”.
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.
Nesta foto vese como puidemos integrar os sensores nunha cinta adhesiva despegándoos dunha oblea. Continuar co noso traballo de investigación permitiunos tamén introducir circuítos integrados en adhesivos flexibles para, por exemplo, amplificar e dixitalizar sinais, procesándoos e codificándoos para a transmisión sen fíos. Todo isto integrado nos mesmos adhesivos médicos que se empregan no hospital.
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.
Cando chegamos a este punto presentáronsenos outros retos relacionados tanto coa enxeñaría coma coa usabilidade, para estar seguros de que podiamos facelos sinxelos de usar.
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.
En moitos debates sobre saúde dixital crese e transmítese a idea de que podemos dixitalizar os datos, transmitilos sen fíos, envialos á nube e unha vez alí extraer información valiosa para interpretalos. De feito pódese facer todo iso, se ignoramos os desafíos enerxéticos. Pensemos en Jane un momento. Ela non vive en Palo Alto nin en Beverly Hills. Isto significa que temos que considerar a tarifa de datos e o custo que supón para ela enviar datos continuamente.
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.
Hai outro desafío máis que a moita xente do mundo médico non lle resulta doado de abordar. É que Jane non confía plenamente no colectivo médico. Ela e xente coma ela, os seus devanceiros, non tiveron boas experiencias nas mans dos médicos e do hospital ou das compañías de seguros. Por iso temos que pensar na privacidade. Jane pode que non se sinta cómoda cos seus datos procesándose na nube. Jane non é parva, le as novas. Sabe que se o goberno federal pode ser hackeado ou as empresas da «Fortune 500», tamén pode selo o seu médico.
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?
Con isto en mente tivemos unha revelación. Non podemos ser máis listos ca todos os hackers do mundo pero si podemos presentarlles un albo máis pequeno. Que pasaría se no canto de ter eses algoritmos de interpretación funcionando na nube, os fixésemos funcionar neses pequenos circuítos integrados incorporados nos adhesivos?
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.
Cando integremos todas esas ideas significará que podemos pensar nun futuro, onde alguén coma Jane poderá facer unha vida normal, estar controlada sen que teña que ter outro traballo para pagar o plan de datos. Tamén poderemos responder algunhas das súas preocupacións pola privacidade.
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.
Neste punto sentiámonos realizados. Logramos isto, comezamos a atallar o tema da privacidade, e cremos que este capítulo está case pechado. Todos felices para sempre, non si? Pois non tan rápido.
(Laughter)
(Risos)
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.
Unha das cousas que temos que lembrar é que Jane non confía moito no colectivo médico. Cómpre lembrar que hai crecentes disparidades en materia de saúde e hai desigualdades na xestión adecuada da atención médica. Iso significa que a simple imaxe de Jane e os seus datos, --incluso se ela está cómoda deixando que se transmitan á nube, deixando que un médico interveña, se cómpre-- non é toda a historia.
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.
Así que comezamos a cavilar en ter intermediarios de confianza entre persoas como Jane e os profesionais da saúde. Por exemplo: comezamos a asociarnos con igrexas e procuramos persoal de enfermaría que sexa membro delas, que veñan desas comunidades de confianza, para que actúen como defensores e asesores de saúde de xente coma Jane.
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.
Outro elemento ao noso favor son as compañías de seguros, cada vez máis interesadas nestas ideas. Estanse dando conta de que quizais é mellor pagar un dólar agora por un dispositivo poñible e un asesor de saúde que pagar dez despois cando o bebé naza prematuro e remate na unidade de coidados intensivos neonatais, unha zona das máis caras do hospital.
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.
Este foi un longo proceso de aprendizaxe. Este proceso repetitivo de avanzar e atacar un problema, non estar cómodos de todo co resultado, e identificar o seguinte problema, axudounos a seguir neste camiño de tentar non só innovar coa tecnoloxía senón asegurarnos de que a poida usar quen máis a precisa
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.
Outra cousa que aprendemos neste proceso, que obriga ter moita humildade, é que a tecnoloxía avanza cada vez máis rápido e temos que pensar que quen usa esta tecnoloxía son persoas, e darnos conta de que teñen unha cara, un nome e unha vida. No caso de Jane, afortunadamente, dúas.
Thank you.
Grazas.
(Applause)
(Aplausos)