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.
Molimo upoznajte Jane. Ona ima visoko rizičnu trudnoću. U 24. tjednu trudnoće ona je na mirovanju u bolnici, pod nadzorom zbog prijevremenih kontrakcija.
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.
Ne izgleda najsretnije. Dijelom jer su potrebni tehničari i stručnjaci da joj postave nezgrapne pojaseve koji prate kontrakcije maternice. Dijelom jer je zabrinuta. Posebice je zabrinuta jer ne zna što će se dogoditi nakon desetodnevnog mirovanja u bolnici. Što će se dogoditi kad dođe kući? Prijevremeni porod bio bi poražavajući. Kao afroamerikanka ima dva put veću mogućnost prijevremenog poroda ili rođenja mrtvog djeteta. Dakle, Jane u osnovi može birati između dvije mogućnosti: ostati u bolnici na mirovanju, biti rob tehnologije sve do poroda, a zatim provesti ostatak života plaćajući bolničke račune; ili pohitati kući nakon bolničkog boravka i nadati se najboljem. Ni jedna od ove dvije opcije se čini privlačnom.
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?
Počeo sam razmišljati o sličnim situacijama i zanimati se za slične slučajeve Počeo sam razmišljati i pitati se postoji li alternativa? Na koji način bi mogli uživati prednosti visoko pouzdane kontrole koju nam pruža povjerljivo bolničko osoblje u vlastitom domu dok živimo svakodnevnim životom?
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.
Imajući to u vidu, ohrabrio sam ljude u istraživačkom timu da se udruže s vrhunskim stručnjacima iz područja materije i pozvao ih sve zajedno na "oluju mozgova". Nakon dugog procesa, došli smo do vizije, ideje nosivog sustava koji bi se možda mogao nositi kao komad nakita ili zalijepiti kao flaster. Nakon brojnih testiranja i pokušaja i godina nastojanja, uspjeli smo realizirati fleksibilnu elektronsku naljepnicu koja je proizvedena koristeći iste procese koji se koriste za izgradnju računalnih čipova, osim što je elektronika iz poluvodičke podloge prebačena na fleksibilni materijal koji se može povezati s ljudskim tijelom.
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.
Ovi sustavi su otprilike debljine ljudske kose. Oni mogu mjeriti vrste informacija koje želimo, kao na primjer: tjelesno kretanje, tjelesnu temperaturu, električne ritmove tijela i tako dalje. Isto tako te sustave možemo projektirati, tako da mogu integrirati izvore energije, i imati i bežične prijenosne mogućnosti.
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.
Dakle, kad smo počeli graditi ove vrste sustava, istovremeno smo ih počeli testirati na sebi u našoj istraživačkoj grupi. Osim toga, povezali smo se s nekim od naših kliničkih partnera u San Diegu, i testirali ih na različitim pacijentima u različitim kliničkim stanjima, uključujući buduće mame kao što je 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.
Ovo je slika trudnice u labaratoriju naše sveučilišne bolnice na pračenju trudova maternice putem konvencionalnog pojasa. Osim pojasa, nosi i naše elektroničke naljepnice. Ova slika pokazuje valove koji se odnose na otkucaje bebinog srca, crveno se odnosi na ono što je izmjereno konvencionalnim pojasem, a plava odgovara našim procjenama dobivenih korištenjem naših fleksibilnih elektroničkih sustava i naših algoritama.
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.
U ovom trenutku, čestitatali smo sami sebi. Neke od stvari koje smo zamislili počele su se koristiti, i zapravo ih vidimo u kliničkom kontekstu.
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."
No, tu je još jedan problem. Način na koji smo prozvodili ove sisteme pokazao se neučinkovit, imao je nizak prinos i bio je sklon pogreškama. Uz to, razgovarali smo s medicinskim sestrama u bolnici, koje su nam savjetovale da provjerimo da naša elektronika funkcionira s tipičnim medicinskim ljepilom koje se koristi u bolnici. Sinulo nam je i rekli smo: "Pričekaj minutu. Umjesto da ih pravimo tako da rade s ljepilom integrirajmo ih u ljepilo, i to bi mogalo riješiti naš proizvodni problem. "
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.
Ova slika koju vidite ovdje je naša sposobnost da ugradimo ove cenzore unutar jednog komada ljepljive trake jednostavno ljušteći ih s podloge. Zahvaljujući konstantnom radu našeg tima moguče je, izmedu ostalog, ugraditi integrirane krugove u fleksibilno ljepilom da bi radili stvari kao što je pojačavanje signala te njihova digitalizacija, njihova obrada i kodiranje za bežični prijenos. Sve ovo je integrirano u istim medicinskih ljepilima koja se koriste u bolnici.
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.
Kad smo došli do ove faze, pojavili su se drugi izazovi, iz inženjerske perspektive kao i iz perspektive upotrebljivosti, morali smo biti sigurni da ćemo ga moći koristiti.
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.
U mnogim digitalnim zdravstvenim raspravama, ljudi vjeruju i prihvačaju ideju da možemo jednostavno digitalizirati podatke, bežično ih prenositi, poslati ih u oblak te u oblaku izdvojiti značajne informacije za interpretaciju. I doista, možete sve to učiniti, ako vas ne brinu neki energetski izazovi. Razmislite na trenutak o Jane. Ona ne živi u Palo Altu, niti na Beverly Hillsu. To znači, da moramo razmotriti njen plan podataka i koliko će je koštati da šalje kontinuirani tok podataka.
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.
Postoji još jedan izazov o kojem nije svima u medicinskoj struci ugodno razgovarati. A to je, da Jane nema previše povjerenja u medicinske ustanove. Ona, ljudi poput nje, njeni pretci, nisu imali najbolje iskustvo u rukama liječnika i bolnica ili osiguravajućih društava. To znači da moramo uzeti u obzir pitanje privatnosti. Možda se Jane neće svidjeti ideja da se njeni podatci obrađuje u oblaku. A Jane se ne može prevariti; ona čita vijesti. Ona zna da, ako savezna vlada može biti hakirana, ako Fortune 500 može biti hakiran, može i njezin liječnik.
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?
I tako s tim na umu, sinulo nam je. Ne možemo nadmudriti sve hakere na svijetu, ali im možda možemo smanjiti mogućnost djelovanja Što ako bi mogli, umjesto da algoritme koji čitaju podatake šaljemo u oblaku te iste slati u male integrirane krugove ugrađene u samim naljepnicama?
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.
Nakon što smo povezali te stvari zajedno, sada možemo razmišljati o budućnosti gdje netko poput Jane može normalno živjeti svakodnevni život, ona može biti praćena, na način da ne mora imati dodatni posao kako bi to platila, možemo riješiti neke probleme glede privatnosti.
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.
Dakle, u ovom trenutku, smo jako zadovoljni sami sobom. Postigli smo ovo, počeli smo se baviti nekim pitanjima o privatnosti i osjećamo se prilično kao da smo zatvorili jedno poglavlje. živjeli su sretno do kraja života, istina? Pa, ne tako brzo.
(Laughter)
(Smijeh)
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.
Moramo uzeti u obzir, kao što sam spomenuo ranije, da Jane nema previše povjerenja u medicinske ustanove. Moramo uzeti u obzir zdravstvene nejednakosti koje se šire i rastu, a tu je i nejednakost glede pravilnog upravljanja skrbi. To znači da ova jednostavna slika Jane i njezinih podataka - čak i ako se ona osjeća ugodno da se oni bežično prenose u oblak, s mogućnosti liječničke intervencije - nije cijela priča.
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.
Dakle, počeli smo razmišljati o tome kako doći do pouzdanih posrednika između ljudi poput Jane i davaoca njihovih zdravstvenih usluga. Na primjer, počeli smo surađivati s crkvama i razmišljati o medicinskim sestrama koje su vjernici, i dolaze iz pouzdane zajednice, kao o zaštitnicama i zdravstvenim trenerima pacijentima poput 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.
Još jedna stvar koja radi za nas je da su osiguravajuća društva, sve više, privučena nekim od ovih ideja. Oni su shvatli da bi možda bilo bolje platiti jedan dolar sada za nosivi uređaj i zdravstvenog trenera nego plaćati 10 dolara kasnije, kada se dijete prerano rodi i završi na neonatalnom odjelu intenzivne njege -- jedanom od najskupljih u bolnici.
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.
To je bio dug proces učenja za nas. Ovaj iterativni proces rješavanja problema kada se nismo osjećali ugodno, i identificiranja sljedećeg problema, pomogao nam je napredovati tako da zapravo ne pokušavamo samo inovirati s ovom tehnologijom već da budemo sigurni da je mogu koristiti oni kojima je najpotrebnija.
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.
Još jedna lekcija koju smo naučili iz ovog procesa je da je on u drugom planu, jer unatoč ubrzanom ritmu napredovanju tehnologije, moramo imati na umu da su ljudska bića ta koja je koriste, moramo biti svjesni da ti ljudi - imaju lice, imaju ime i život. U slučaju Jane, nadamo se, dva života.
Thank you.
Hvala vam.
(Applause)
(Pljesak)