Health Systems

H E A LT H SYST EM S

volunteer

HEALTH SYSTEMS mobilize suit

structural

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decreasing combined

extremely

purpose

rigid

structure

circulation

combination

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made

prefrontal

neuroscience

mitigation

compression

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movement

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case

implement

walking

Master in Design Engineering at Har vard

statistic

low

phone

wearable

point

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technique

mobile

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involved

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today

developed

store

vector

engage

limited

environment

negative

cost

family

staff

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maintain

strategically

make

emotional

social

improvement

deteriorate

active

environmental

delivery

physically

understand long

story

variety

connecting

rely

mental

service

strategy

emergency

significant

aging

insurance

local

research senior

provide

interactive

behavioral

year

turn

preference

population

cognitive

continent

life american

generate

adult

information

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tackle

deep

official

organization

epidemic

landscape

air

pollution

primary hypertension

smoke

visual

filtering continue

grow light

woman

annually role

cigarette smoking

cancer

double

indoor

cause

play locate

intake

salt

industry considered

alternative

Collaborative St ud io

lens analyze

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approach

Master in Design Engineering at Harvard Collaborative Studio Volume 1 (2017-2018)

outdoor

reduction

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attribute majority

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death

preventative

spectrum

enter

filter

pharmaceutical

growing

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status

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OPENING FROM THE EDITORS

1

SELF

10

NILE

11

In Celebration of Interstitiality

Maintaining health and social connection in old age

ANDREW WITT

APEIROGON

3

Designing Across Disciplines

JOCK HERRON

5

The Topic of Health Systems

FAWWAZ HABBAL The Design Engineering Pedagogy

25

Localized mental health spaces for the 21st century

AMBLE

31

Nerve and muscle stimulation garment for chronic arthritis

7

WITHIN SMOKE

37

Smoking's impact on private and public health

PATIENT

40

AFIA

41

Affordable, fast, intuitive, accurate viral STI testing

CODA

55

A therapeutic palliative care sanctuary for hospice patients

OLIVE

61

Moisture-detecting smartbelt for ostomy care

PAIR

67

5

SELF

The perfect pair of air shoes

PHARMA 2100 Global pharmaceutical funding

73

USER

76

MALCOLM TEN

77

DIGITAL SELF

142

OMNI INDI

143

Enhanced data collection for patient-reported outcomes

Improving health outcomes with a multi-layered, data-driven digital health service

MOMENT

ATÉLIER

91

Focus training through a multisensory chair experience

A creative agency, from your brain for your brain

SYNCSENSE

REMESYS

97

Motion sickness mitigation system for air travel

Reanimated emotional system

MOBILIZE

INSOMNIGRAPH

103

A concealable exosuit for improving walking efficiency

FLEXFIT

157

163

169

A framework for visualizing and quantifying sleep patterns across time scales

109

Socially connected physical activity for seniors

ANOPHELINE VECTORS

115

Visualizing environmental change with longitudinal disease vectors

CITIZEN

118

NODE

119

Reimagining emergency response for resilient cities

CHÚ Breathe fresh air everywhere

HEALTHCARE Spending vs. Outcomes

CLOSING

133

139

FROM THE DIRECTORS

171

STUDENT BIOS

173

MDE VOLUME 1

From the Editors Jenny Fan, Saif Haobsh, Kate Spies, and Kiran Wattamwar

In Celebration of Interstitiality Interstitiality is an exploration of in-betweenness. As the theme of this volume, interstitiality is as multifaceted as its definition: in architecture it appears as the interstitial space between buildings; biology, as the interstitial connective tissue between organs; media, as interstitial content between programming; art, as interstitial fiction falling outside the familiar boundaries of conventional genres.

As Master of Design Engineering (MDE) students, we live in the spaces in-between. We thrive in moving between design and science, between art and mathematics, between leadership and entrepreneurship. In practice, we have sought to create new connections and interventions between software and hardware, old and new, quiet and clamor.

Our program was established to train students to tackle complex, wicked problems. To rise to the challenge, MDE students have developed a certain comfort with not fitting into any single category. The diversity of backgrounds in our cohort creates an unconstrained space for each of us to explore, grow, and learn from each other.

1

This book is the culmination of the collaborative work created and refined over our first year in the MDE program through uncountable late nights, cups of coffee, and design critiques. Instead of letting the

HEALTH SYSTEMS

work of this year-long studio disappear, we document it here to advance the conversation beyond the confines of our schools, the Harvard University Graduate School of Design (GSD) and the John A. Paulson School of Engineering and Applied Sciences (SEAS).

The 21 projects in this book explore the topic of Health Systems. Over the course of one year, we designed across scales and disciplines to produce projects in four major categories: 1) data visualization and information design, 2) physical prosthetic and ergonomic products, 3) sensory therapies in the built environment, and 4) systemic health and wellness interventions.

The projects are clustered into five thematic groups: self, patient, user, citizen, and digital self. These themes emerged from a lexical analysis of the entire corpora of student work and were used to generate the visualizations on the cover and chapter dividers. These identifying units weave throughout the text as coded graphical elements, integrating each micro-theme with the broader exploration of health systems.

In our short time here, we have come to call this interstitial space our home. We invite you to join us on our journey and explore the innovation happening here.

LETTERS 2

MDE VOLUME 1

Andrew Witt Assistant Professor in Practice of Architecture, Harvard GSD MDE Collaborative Studio Instructor, Fall 2017 Andrew works on problems at the intersection of design, shape, constructibility, and assembly automation, with a focus on differential, topological, graph-theoretic, and multi-constraint optimization approaches to design problems.

Trained as both an architect and mathematician, he has a particular interest in a technically synthetic and logically rigorous approach to form. He has experience with large-scale construction automation, fabrication machine development, and commercial software development, including urban simulation of autonomous mobility systems.

Designing Across Disciplines In 1956, Walter Gropius, then Dean of Harvard’s Graduate School of Design, warned of the social challenges of narrowing expertise: "Our scientific age went to the extremes of specialization and has obviously prevented us from seeing our complicated life as an entity.

This common dissolution of context has naturally resulted in a shrinking and fragmenting of life."

3

INTRO

Gropius saw the role of the designer, in part, as a reintegrator of the elements of culture – technical, social, psychological – in response to the deepening fragmentation of social structure and personal experience brought by accelerating technical innovation. That urgent need for a holistic designer – one who dares to confront problems at once cultural, economic, and political – has only become more acute in the ensuing decades. Indeed, one may argue that the fundamental conditions of society have changed so markedly since Gropius that our problems now demand a reformatting of design itself in a way equal to the unprecedented problems at hand.

HEALTH SYSTEMS

The Master in Design Engineering program is just such a bold proposal to reformat the designer. Its aim is to empower omnivorous thinkers who are unconstrained by the boundaries of discipline or convention to create daring yet feasible solutions.

Equally conversant in color theory and electronics, macroeconomic policy and complex surface modeling, the MDE program sees making, thinking, researching, and provoking as elemental modes of designing. The students of MDE cross disciplines seamlessly, not only by fluently speaking the languages of both design and engineering, but by building an intuition for how those disciplines think, create, reason, and solve problems. They are designers who proceed by hypothesis, and who test these hypotheses by prototype.

And while technical and cultural proficiency is essential, what is indispensable is a point of view connecting imagination with technical know-how and urgent social needs. They are leaders of a new kind: leaders who make.

Through the laboratory of the studio, MDE students refine this hypothesis-driven approach and build the reflexive intuition in technical, critical, and economic dimensions in the media of our time: data, products, experiences. The students, through their projects, not only propose but show the future through their prototypes. These prototypical interventions are Archimedean points, fulcrums from which they hope to move the world.

Perhaps most critically, students practice learning fearlessly: entrepreneurially tailoring new skills to their problems, creating their own ecosystem of stakeholders, diving deeply into problems, and hacking – in the most sophisticated sense – new solutions.

Underpinning this specific pedagogy is an undeniable optimism for the future. It is an optimism born not from naivetĂŠ, but from a confidence in the remarkable power of convergent disciplines and the students' mastery of them. If humanity is to survive and thrive with the myriad global challenges ahead, we must train a generation of designers capable of meeting those challenges in all their complexity. These MDE projects showcase the fearless, rigorous, and optimistic birth of designers for our time and our challenges.

LETTERS 4

MDE VOLUME 1

Jock Herron Instructor in Architecture, Harvard GSD MDE Collaborative Studio Instructor, Academic Year 2017-2018 Jock is an instructor focused on food systems and health. He co-led the Smart Cities and Wellness project sponsored by the Humana Corporation and the Responsive Environments and Artifacts Lab at the GSD. He has served on the Steering Committee of the Worcester County Food Hub Initiative, and is currently working on a rotational grazing project in Central Massachusetts.

The Topic of Health Systems A distinguishing feature of the two-semester Collaborative Design Engineering Studio is that we, the instructors, choose the thematic domain and the students then identify consequential problems within the domain to develop ambitious but plausible solutions.

The latter – defining an important but concretely tractable problem – is much easier than the former.

5

INTRO

As instructors, our role is to guide and critique rather than to lecture or provide definitive answers, as the most fertile questions asked are open-ended and lack definitive solutions. We chose Health Systems (with an eye to aging) as the 2017-18 studio theme for several reasons, each consistent with our selection of the food systems topic in 2016-17 and mobility for 2018-19. First, health is a domain of systemic breadth and multiple scales, from cells to individuals to societal multitudes. Second, it embraces both the idiosyncrasies of human behavior and the more predictable constraints and opportunities of engineering logic. Third, by defining health broadly to include preventive as well as therapeutic interventions, it crosses more disciplinary boundaries than most any other thematic domain. Finally, the breadth and complexity of the domain makes collaborative teamwork essential.

HEALTH SYSTEMS

Both semesters encourage students to bridge gaps between academic disciplines and face the same high-stakes realities as real-world stakeholders. Engaging with practitioners as well as academic specialists and, importantly, prospective civilian beneficiaries is fundamental to the learning experience. Our aim is to promote a design intelligence which engages quantitative and qualitative thinking, incorporates computational, visual, experimental strategies and aesthetic methods, and engages meaningfully with constituencies well outside academia. But, it all begins with asking the right questions.

Success and failure are hard to assess. There are no straight lines to follow and more than a few seductive cul-de-sacs to draw a team off course. However, there are revelations along the way, and hard-earned ‘aha’ moments, which get teams back on track. The best indicator is the range and depth of the projects outlined in this book. In our view, for different reasons and in different ways, the project teams succeeded. They addressed important questions and developed ambitious and provocative solutions with follow-on potential. And we, the studio instructors, learned quite a bit along the way.

LETTERS 6

MDE VOLUME 1

Fawwaz Habbal Executive Dean for Education and Research, Harvard SEAS MDE Collaborative Studio Instructor, Academic Year 2017-2018 Prior to Harvard, Fawwaz was the Corporate Vice President responsible for research and product design at Polaroid Corporation, and also served as a Senior Research and Engineering Fellow. His current research interests include semiconductors and nanophotonics, and he is interested in a holistic engineering education that integrates multi-disciplinary learning, practical reasoning, and integrative thinking.

The Design Engineering Pedagogy The MDE program is developing during a time of change as digital technologies create cognitive innovations and enable new capabilities while at the same time adding to humanity’s long list of challenges, including several wicked ones. As with most tough problems, the new challenges involve complex systems, social dynamics, and intertwined feedback loops. Humanity is at a critical junction that calls for a unique set of problem-solving skills that are grounded in collaborative action and broad knowledge bases. The MDE program is training students to engage in such efforts.

7

INTRO

The intent of the MDE first-year studio is to provide the technical skills to support innovation and effective cross-disciplinary collaboration in addressing entangled systems. Through the MDE studio experience, students of contrasting backgrounds and talents work in teams and learn as a group, with several instructors from Harvard’s School of Engineering and Applied Sciences and Graduate School of Design serving as critics and advisors. Students are introduced to fundamental tools that enable transformative and integrative design, such as design thinking and problem-solving,

HEALTH SYSTEMS

project-based technical skills, leadership and management, and an appreciation of real-world socioeconomic, political, cultural, and technical contexts.

As instructors in the studio, we believe a narrow focus on intellectual knowledge neglects critical dimensions of problem-solving.

We embrace spatial and active learning as well as pictorial and visual interactions. A toolkit of networked objects and environments, soft and hard infrastructures, and strategic plans are applied to address challenges at a variety of scales.

The year-long studio centered on the theme of Health Systems.

Health is an area of concern to all human beings, spanning social and cultural factors such as equity and aging as well as topics in science and medicine. MDE students explored health systems from a variety of angles during the course of the studio, spanning scales, societies, and subject matter; their work is documented in this book!

The spirited MDE cohort truly built on each other’s skills and knowledge, borrowing and learning from each other’s expertise in engineering, aesthetics, business viability, and more to achieve a unique body of work. The reviews attracted a similarly diverse audience of critics, from researchers in Harvard’s psychology and anthropology departments to professors from the business, medical, and public health schools.

In this book, you will explore the achievements emanating from the new MDE curriculum and pedagogy. You will also have the opportunity to learn and engage with health systems, but perhaps more importantly, the students will have the opportunity to view their work through a new lens, a continued evolution.

LETTERS 8

pollution critical

medicare

million large

space

affect

current state

sleep public provide

world exercise

scaleresearch

elderly

arthritis

time

hospital

focus

simple

experience

device

personal user

designed

impact

livehealth

individual

long

physical

term

proďŹ le

location treatment

access

community create

improve

support muscle

generated

9

SELF

incorporate

S SELF The most basic unit of human systems are the individuals comprising the network. At the core, projects centered on self focus within, navigating the interplay between our mental, emotional, and psychological states.

Projects aim to understand the role of external and environmental qualities in concert with internal factors in shaping health.

S₁

NILE

A digital platform for aging individuals experiencing disconnection in community

S₂

APEIROGON

Individualized therapy space designed to address mental health in the 21st century

S₃

AMBLE

Easy-to-wear garment with strategic nerve stimulation for users with chronic arthritic pain

S₄

WITHIN SMOKE

Smoking's impact on private and public health

ABL ACC ACT AIM ALW ART BNF BSE CLN CMM CMP CPH CRE CRR CRT CTC CTY CTY DAT DCN DRC DSN DSS DTH DTL DTR DVC EXP EXR FCS FML GEN GTH GVN HLC HLT HMN HPP HSP ICP IMP IMR INC IND INF LCT LEV LNG LVE LYR MLL OTC PHY PLL PLT PPL PPU PRC PRJ PRS PRT PRV PSR PTN RSR RTE SCL SLP SMP SNS SPN SPP STT SYS TME TRK TRM TRT UND USR UTL VIS VSN WRL YER

11

SELF

human • muscle • motion • mind • physical • social • identity • emotion • sensory • personal • own • intimate

S1

NILE Maintaining health and social connection in old age Social isolation is a growing epidemic – one that has doubled since the 1980s to now affect 40% of American adults, especially seniors (Jain). Given that lifespans are predicted to increase toward 100 years and that the current population of seniors is expected to reach 90 million by 2050, social isolation for older adults may be one of the most critical challenges society faces (Population Reference Bureau).

How can aging populations best maintain their health and sociability to harness the gift of human longevity and change the narrative of aging from one of decline to one of growth and prosperity?

Nicki Adler, Jeronimo Beccar, Erin McLean, and Saad Rajan

MDE VOLUME 1 SELF 13

ABSTRACT As one grows older, the increased probability of encountering adverse life events and deteriorating physical ability can impede an individual’s ability to socialize, stay active, and explore. These events can disconnect an individual from the relationships and experiences which give life meaning. Nile aims to create a community to maintain physical activity for seniors who would otherwise encounter obstacles in doing so. The team designed and prototyped a digital platform for seniors to meaningfully engage with other seniors in guided, social-wellness activities at home.

Instead of attempting to replicate in-person interactions, exercise, or cultural experiences digitally, Nile introduces a new form of engagement altogether. By harnessing technology to augment the visual experience, the platform provides more targeted, condition-specific activities and feedback, and also dynamically groups individuals based on ability, interests, and location. The Nile platform enables even those who have limited physical or social mobility to playfully build meaningful connections and maintain wellness.

In 2060, almost 1 in 4 Americans will be characterized as a senior citizen based on current definitions.

Of this population, many will struggle with social isolation, immobility, or physical degradation. From a social isolation perspective, half of Americans above 85 currently live alone, and 40% of adults in America report feeling lonely on a regular basis (Jain). From a mobility perspective, a third of all people over the age of 65 report falls, annually (NCOA). Furthermore, 32% of adults report having at least one physical activity limitation; for those above 65 years old, it climbs to 60% (NCHS). Mobility is especially hindered by arthritis, as 1 in 2 people above 65 suffer from the condition (CDC).

HEALTH SYSTEMS

PROBLEM

Despite being a large and influential user group, the senior population is under-designed for by the consumer goods market. This diverse group faces highly unique conditions and life events which shape their lives, from losing a spouse to developing arthritis to suffering a fall. The common thread woven through the issues of increased social isolation, immobility, and physical degradation is eventual disconnection and overall declining quality of life.

Senior-focused health interventions need to address this disconnection head-on with a multi-pronged approach for “aging better�, targeting not only immobility and physical degradation but also social segregation. Wellness solutions should not only motivate to keep body and mind active but also provide access to actionable preventative health information, combat solitude, and overcome mobility limitations.

SOLUTION

� NILE PLATFORM

Nile offers diverse programming from yoga to cooking, activities that each involve general movement, social

NILE

An interactive digital portal allows participants to engage in activities while connecting with others in their community. Users can create profiles, adjust activity schedules, and engage directly with other users, allowing for organic connection within a space of wellness and experiential learning.

Nile is a digital platform that allows those experiencing disconnection to meaningfully engage with community members in guided social-wellness activities at home. Named for the longest river in the world and one which follows a winding course, the Nile platform aims to give older adults a sense of resilience, motivation, and personal power to navigate the circumstances of a long, fulfilling life.

14

MDE VOLUME 1

engagement, and a learning and wellness component.

Activities can be tailored to various physical ability levels and accompanied by guiding silhouettes or instructional diagrams. Nile also has many personal touchpoints, which include a concierge to ease setup and technical barriers, and a facilitator who guides the various activities and provides individual feedback.

The goal is to change the way society thinks about what’s possible in older age – to enable discovery and exploration regardless of age or physical ability.

When the user first plugs in the system and turns on the TV, Nile should immediately open, similar to ChromeCast or Fire TV Stick installation. At this step, the user meets their concierge, a live person who helps the user set up a profile, take a physical assessment, and create an activity schedule.

Returning users go directly to the home screen, the launching point for their profile, activity schedule, activity selection, and friend network. Future versions could include additional features.

↓ PLATFORM ARCHITECTURE

15

SELF

Nile is a layered platform based on curated activities modified with digital content to create an engaging environment for users.

During the discovery process, the team noticed a common habit for seniors at community centers to arrive early to an activity and stay late to socialize. To recreate that within the context of a video-based platform, users are able to join an activity 15 minutes prior to the start and view user introductions. After an initial orientation given by the facilitator, the remainder of class activity occurs in smaller groups of two or three.

Partners are guided through activities via a voiceover narrator. While supplemental information like timers, instructional silhouettes, etc. are available, the partner's video stream fills the screen, similar to a one-on-one conversation. While the facilitator may drop-in periodically to provide guidance, the emphasis is on encouraging partners to support each other in the activity.

Every activity concludes with a guided discussion session to connect what the users are doing in the system to the outside world. Before concluding an activity, the user has the option to add their partner as a friend on the system, enabling messaging and future class partnerships. Users may also be shown relevant

Methodology

HEALTH SYSTEMS

invitations to offline events held by partners such as the YMCA, and can even request a ride to the event if transportation is a limitation.

Research To better understand the challenges, desires, needs, and goals of senior adults ages 65 and older, the team did an extensive literature review and conducted in-depth user research. These findings informed the target personas and user journeys that guided the development of the product, and also shaped many of the feature decisions. Techniques included online surveys, interviews with elderly physical therapy patients, and expert interviews.

Online surveys (both multiple-choice and open answer) were conducted to uncover what types of activities seniors are regularly involved with, what techologies they feel comfortable using, and their general health tracking habits as well as what information sources they consult to make health decisions.

Interviews were conducted with elderly physical therapy patients at Spaulding Rehabilitation Network and several grandparents (age 65+) of classmates. The goal was to understand seniors' living situations, exercise and medication habits, daily challenges and concerns they faced with aging in place, as well as their dreams, goals, and values.

NILE 16

MDE VOLUME 1

Finally, the team also met with experts who work with seniors professionally, such as doctors, nurses, home care workers, and researchers. These experts included: •

Laura French: Geriatric Physical Therapist, Sharon Health Care Center

•

Drew Matsen: Physical Therapist

•

Ellen Langer: Harvard Psychologist and Researcher focused on aging, decision-making, and mindfulness

•

Dr. Brittany Ellis: Emergency Geriatrician

•

Dr. Peter Engel: Geriatrician

•

Dr. Zul Ramji: Family doctor

•

Amy Wyatt: In-home care provider, nutrition advisor

•

Kaitlyn Martin: ER nurse at geriatric hospital

•

Sofia Weid: Director, Research Development, Division of Internal Medicine, MD Anderson Cancer Center

•

Paul E. Fallon: Hospital & Healthcare Facilities Architect (MIT)

•

Stuart Himmelfarb: CEO of B3/The Jewish Boomer Platform

Survey and Interview Findings Health and Quality of Life The many uncertainties associated with physical, mental, and social decline are terrifying. Respondents were generally confident about their mental wellness, but less so about physical wellness.

A fourth of respondents had a major health event (self-defined) in the past year, and the fear of falling was especially salient as it often led to a downward spiral in physical and social well-being.

17

SELF

Major daily struggles included mobility, independence, physical appearance, and depleting social circles. Some struggled with organizing their day, daily aches and pains, and the fact that fewer peers are willing to take risks. Habit changes, particularly around sedentary lifestyles, were a perpetrator of many health issues, but it could be difficult to form healthy habits when one did not grow up with a healthy lifestyle.

Factors considered of high importance to quality of life included loved ones, a positive attitude, exercise and healthy eating; hobbies, travel, and doctor visits were considered less important.

Most respondents were homeowners intending to “age in place” in their own homes and communities, the favored policy by most health providers and policy makers to avoid the costly and less effective option of institutional care.

↓ PERSONAS Nile users can be identified in three primary categories, in addition to a myriad of secondary categories. Mary, Patti, and Bob are core users identified through research and in-person interviews

Most elderly people did not want a ton of health data available to them, as they found it overwhelming.

Meanwhile, family and caregivers often wanted as much data as possible about the elder. Most respondents had a strong self-image of youthfulness, sometimes accompanied by involvement in the digital world and social media. 56% of seniors had smartphones, and 20% have used fitness tracking.

HEALTH SYSTEMS

Technical Fluency

NILE 18

MDE VOLUME 1

Wellness Support Network Being social was a primary motivator to be active. As older adults began to lose friends and grow suspicious of strangers and harsh weather conditions, they looked for ways to engage safely with the world. Seniors with a greater disposable income could pay for in-home care services and retirement community homes, which decreased immobility and isolation.

In their health support network, there was no one individual who spearheaded multi-treatment plans for seniors and coordinated between doctors. People referred to doctors (84%), family (68%), and friends (44%) for health and wellness advice, with 55% getting comprehensive lifestyle recommendations.

In many ways, physical therapy about well-being and family provided positive reinforcement. However, only 20-30% of patients followed their physical therapy “homework.�

Feature Testing To better understand how Nile's features might fulfill the needs of seniors, the team observed user responses to prototypes of the experience. From the tests, the team gained several insights around the values, needs, and desired features of the platform.

For seniors, privacy is paramount. Though individualized feedback was appreciated, any communication around their performance and injuries should be done privately. Seniors felt comfortable with video communication, especially with others at the same ability level, though they did not love seeing themselves on the screen and preferred streamlined experiences without distracting visual information or too many users on screen at once.

19

SELF

Peer effects were enhanced by having a set time for events, which created a sense of urgency and accountability. The participants stressed that the ability to invest in building a community strengthened the platform, so keeping the same group and facilitator would be helpful to build trust and encourage repeat usage.

↓ NILE REMOTE DESIGN Early sketch based on simplicity and beauty.

The remote control for the Nile system was informed by research and designed to respect the needs of the older adult audience. It has an appropriate color contrast, easy-to-read labels, and large buttons for ease of use, especially in low lighting. The warm and welcoming appearance contrasts against the sleek, cold aesthetic employed by most tech devices, which felt intimidating for less technically savvy users.

HEALTH SYSTEMS

Remote Control

Console Device During the feature testing session, users expressed privacy concerns around the camera and microphone that are part of the Nile console. For this reason, the two most prominent buttons on the remote are the video and audio toggles for users to easily mute audio or video at the touch of a button. ↓ NILE REMOTE AND CONSOLE Designed to simplify user interaction with the Nile platform, the remote control and console take out any superfulous buttons in favor of accesibility.

NILE 20

MDE VOLUME 1

Results Implementation

4) Improving delivery efficiencies

Nile developed a five-phase go-to-market strategy.

Iterations will attempt to refine the user experience and improve profit margins. For unlimited classes, Nile will be priced at a flat rate of $50/month (based on an average entertainment spending of $200/month for seniors). Based on pilot demand, other pricing strategies such as lowering the minimum base rate per month or pricing per class instead could be considered. The facilitator-to-user ratio has a substantial impact on the costs. In the initial stages, it will be important to keep a lower facilitator ratio to ensure quality and relationship building for users. With more feedback over time, Nile could begin to increase the ratio as facilitators become more effective, improving cost efficiency.

1) Developing diverse programming Future versions of Nile will expand upon existing stretching and exercise programming to incorporate diverse activities, such as book clubs, virtual gardening, and more.

2) Building internal infrastructure Facilitators and concierges are a key resource in Nile’s value proposition, as they engage and build relationships with end-users to keep them coming back. Class sizes will be approximately 14 users to 1 facilitator and will operate from 6am to 10pm, though variable to reflect demand.

To create a strong internal infrastructure, Nile will hire and train 18 facilitators. The facilitators will be co-located in a studio facility where the live filming will take place.

3) Launching initial pilot

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The initial pilot will target a community of approximately 200,000 people with a large percentage of seniors. At an estimated market penetration of 1%, the pilot will launch with 2,000 customers to start. The goal of the pilot is to assess the perceived value and actual use of the service, such as whether it is most effective as (1) a postsurgery recovery plan, (2) a method of learning from facilitators and building new skills, or (3) a way of building relationships and connecting with community.

5) Building strategic partnerships at scale Depending on which needs surface as most important from the pilots, the team will seek out strategic partnerships. For postsurgery recovery users, the team could improve biometric monitoring and partner with physical therapists to develop content structured around recovery. As a learning tool, Nile could further diversify available content by transitioning to a marketplace model with crowdsourced instructors rather than maintaining in-house, salaried facilitators. If primarily successful for generating social connections, Nile could partner with organizations like the YMCA or AARP to host local events.

Ultimately, the goal for the platform is to help seniors build the emotional and physical strength and confidence they need to leave their homes and continue to connect with their communities.

The market demand for senior services is growing rapidly with the aging world population. However, there are no direct competitors providing the same value proposition as Nile. Many of the needs Nile addresses are currently spread across a variety of sources, including traditional pastimes, community centers, gentle exercises, on-demand, live classes, gamified movement platforms and tele-health, and video-based physical therapy. Each of these indirect competitors may focus separately on building relationships, improving wellness, and/or offering convenience. Nile stands out in a fragmented market by synthesizing a unique product specifically designed to create a sense of connection for seniors. As the world grays, there is strong potential to create impact amongst the target population and scale Nile across numerous markets.

HEALTH SYSTEMS

Impact

↳ NILE ECOSYSTEM A concierege initially helps you establish a profile and begin to create weekly activity schedules as well as connections in the community.

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↑ NILE AT HOME Easy set-up for use at home on your personal computer or television. Nile allows for a simple and clean home interface.

References 1. Jain, Sachin H. “Senior loneliness is a disease that can and should be treated.” Washington Post. May 9, 2017. Accessed from http:// www.washingtonpost.com/sf/brand-connect/wp/2017/05/09/ caremore/senior-loneliness-is-a-disease-that-can-and-should-betreated/?noredirect=on 2. National Center for Health Statistics (NCHS). “Disability and Functioning (Noninstitutionalized Adults Aged 18 and over).” Centers for Disease Control and Prevention. May 3, 2017. Accessed from https://www.cdc. gov/nchs/fastats/disability.htm

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3. “Arthritis-related Statistics.” Centers for Disease Control and Prevention. Accessed from https://www.cdc.gov/arthritis/data_ statistics/arthritis-related-stats.htm 4. National Council on Aging (NCOA). “Falls Prevention Facts.” Accessed from https://www.ncoa.org/news/resources-for-reporters/get-thefacts/falls-prevention-facts/

Our team was intrigued by the risks and rewards of living much longer lives, and inspired to challenge the dominant narrative of decline in old age. A myriad of facets are involved in creating a fulfilling 100-year life, from health and finances to intellectual stimulation and relationships, allowing for incredible design engineering opportunities.

After weeks of research, conversations, and exploration, we began to recognize the nuances of this incredibly diverse user group, which is often artificially lumped together. Common threads of social isolation, immobility, and physical degradation emerged regardless of the different conditions and life events leading to disconnection. Once we realized this key insight, the team was determined to solve the problem of disconnection: how might we create and maintain connection through innovative, unexpected means? We couldn’t bring a loved one back from the dead, prevent an accident, or reverse the aging process, but we could offer engaging social experiences that met the mobility capabilities of the individual, with the goal of building mental and physical confidence.

Our team had diverse backgrounds across design, engineering, and business. Despite overlapping tasks, these fields often have different vernacular, including the same words meaning entirely different things. We accordingly learned to invest time in developing processes for feedback and alignment. While this may have slowed the process, it ultimately produced a more cohesive and thoughtful prototype and product.

HEALTH SYSTEMS

Team Reflections

For us, this project was more than a design exercise or business plan. It was insight into how society fails to support many of those facing extreme challenges, and an opportunity to bring compassion to the problems they face. Everyone deserves the chance to participate in society and be a part of a community at each stage of their life. As such, we met people in the environment where they felt most comfortable, one which they have designed for themselves – their home. In pursuit of building a stronger safety net for disconnected individuals, we focused on designing experiences to help people fulfill an upper tier in their Maslow hierarchy of needs. While challenging, it was very worthwhile.

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human • muscle • motion • mind • physical • social • identity • emotion • sensory • personal • own • intimate

S2

APEIROGON Localized mental health spaces for the 21st century Apeirogon is a neighborhood enclosure designed to address mental health in the 21st century. As a localized access point in settings from urban to rural, Apeirogon provides an individual with a therapy enclosure to relax and manage immediate stress and anxiety using deep relaxation and cognitive behavioral therapy (CBT). The experience would consider three stages – decompression, therapy, and reintegration – in which noise, temperature, form, and lighting are manipulated to provide a personalized, impactful, and positive experience. The envisioned module is deployable and tailored for the environment in which it is called upon to serve. The goal is to provide easy access to mental health treatments to encourage the seamless integration of therapy into an individual’s daily routine.

Berto Ceballos, Saif Haobsh, and Kate Spies

↑ SCALED PHYSICAL MODEL Apeirogon is designed as a full scale space, but the initial implementation of the design is an alcove with a mapped projection surface, a camera for heart rate detection, cued auditory capabilities, and a smart system design for interacting with the space and initiating a guided program.

↲ PROJECTION MAPPING The modular representation of Apeirogon was created around the projection of three individual devices.

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Problem Therapy spaces are rarely designed to support the daily programs of individuals diagnosed with anxiety or other mental health disorders. Despite being a highly treatable condition, there are limited support structures for clinical treatment, environmental comfort, and healthy lifestyles that can help abate and manage anxiety. In the United States, anxiety disorders are among the most common mental illnesses, impacting the livelihoods and well-being of at least 40 million adults, or 18.1% of the population, every year (NIMH, Bystritsky, Kessler). It is estimated that only 36.9% of those suffering from anxiety receive treatment (AADA).

Including individuals who don’t seek help, are misdiagnosed, or are unaware they are coping with anxiety, the affected population could be much higher.

↑FULL SCALE VISION The full-scale design of Apeirogon includes a multi-room space allowing for a seamless program from decompression to therapy to reintegration.

↓KEY SENSES

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Noise, temperature, form, lighting, touch, and smell were all considered in the therapeutic experience.

Studies on the economic burden of anxiety disorders in the 1990s estimated the cost on the U.S. to be more than $42 billion a year, or almost one third of the $148 billion total mental health bill for the United States, with $22.84 billion of that associated with repeat use of healthcare services (Greenberg). Since then, that figure has continued to increase. Despite the prevalence of mental health disorders, many individuals struggle with finding a place to cope with anxiety attacks and other stressful situations.

HEALTH SYSTEMS

↑DETAILED SCHEMATIC Apeirogon program design focused on the individual user's experience; moving from a busy street, into a space of treatment, and finally back into the 'real world.'

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Solution

↑ ALUMINUM SEAM After cutting, etching, folding, and arranging the aluminum pieces, each seam was secured with rivets. The Apeirogon model incorporated over 500 rivets.

Apeirogon provides a model of deployable mental health management that can be readily accessed as a therapy space by those suffering from anxiety and other mental health disorders. The model presented provides the experience at the heart of Apeirogon: custom, biofeedback-driven treatment centered around a user’s need. The user can speak to Apeirogon and state whether they are stressed or anxious, and Apeirogon will begin a therapy to address their indicated need. The internal surface is customized to support three projectors upon which a myriad of therapies can be displayed. The guided imagery and supporting audio initially lead the user, but then begin to loop in the tracked biological data of heart rate and respiration to evolve the session as a true positive feedback loop. The biological data is monitored without impact to the user via a simple camera. Apeirogon is then able to provide quantitative data to the user following a therapy session and enables the user to mark improvement from day-to-day, month-to-month, and year-to-year.

Process

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The structure was designed to reduce the external impacts of sight, sound, and smell to create a safe space in which a personalized, layered therapy can be experienced. The experience contains visual and auditory elements. Biometrics will track the therapy and provide feedback for the user.

Apeirogon was fabricated using a conical extrusion of the alcove produced by a three-projector array. The deployable surface was translated to flat sheets of aluminum, cut and etched, then folded and riveted. The interior surfaces were made of low-density polyethylene and also cut, folded, and taped. Lastly, to produce the final iteration of the Apeirogon model, the camera, speaker, and projectors were installed and connected to a base computer.

HEALTH SYSTEMS

↓ UNROLL AND CUT

↑ PROJECTION MODELING

The conical extrusion was translated to flat sheets of aluminum which were etched, drilled, and then cut on a Zund machine.

Apeirogon as a realized space leveraged projection surface modeling from inception, allowing for seamless integration of the therapeutic experience.

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S3

AMBLE Nerve and muscle stimulation for chronic arthritis The Amble wearable legging incorporates electrotherapy from the hip to the ankle, and is designed to quell arthritic leg-joint pain while preventing muscle atrophy. Strategically placed electrodes administer nerve stimulation (TENS) and/or muscle stimulation (EMS) in an easy-to-use design. The garment wraps around the legs and secures via simple velcro closures, allowing users with chronic arthritic pain, limited balance, and decreased dexterity the ability to easily don the therapeutic device.

Nicki Adler, Berto Ceballos, and Julian Siegelmann

AMBLE

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Problem

↓ ACTIVATION POINTS

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TENS and EMS therapy points are evaluated in coordination with movement data to ensure electrode placement allows for both effective treatment as well as mobility and independence.

By the age of 65, half of all adults will suffer from arthritis, with effects ranging from mild to severe pain, joint strain, and muscular atrophy. Currently available treatment options include surgery, medication, and self-care such as exercise, heating/cooling pads, acupuncture, and electrotherapy. While surgeries can cost upwards of $20-50k per procedure and medication can cost $2,000 to $6,000 per year, self-care options are often patients' only choice, with the most expensive consumer electrotherapy unit available priced at around $400. While TENS and EMS technologies help to decrease pain and increase mobility, current applications can be intrusive, difficult to use, and are not widely available outside of the elite athletic community. To expand benefits to the arthritis care market, the team designed a simple, seamless, holistic product to combat pain, loosen stiff joints, and reduce muscle atrophy.

HEALTH SYSTEMS

Process

↑ LINES OF NON-EXTENSION Understanding gait and muscle movement was critical for designing a garment that stayed in place, was easy to don, and remained comfortable for the user.

The Amble wearable combines several components into a cohesive design for aesthetic, functional, and physiological purposes. The choice of therapy is informed by the challenges of arthritis. Heating and cooling are temporary solutions to soothe this discomfort, but lack long-term impact. Electrotherapy addresses both the short-term and long-term angles of the problem space. As such, TENS and EMS offer solutions, but they also have inherent limitations. Current therapies are designed for stationary use, are normally administered by professionals, and are used only by a narrow population set (i.e. athletes). Upon this foundation, the design of Amble focuses heavily on making these therapies available outside of the clinical space and integrating them into the lifestyles of its wearers.

AMBLE

The garment itself is developed for users with restricted movement, with a hassle-free design that wraps around legs while sitting or standing. The closing mechanism (grab loops and velcro) ensure the garment is simple to secure and adjustable for multiple sizes, enabling independent usage of the garment.

The electrodes are placed based on normal legging wear and require minimal adjustment after initially donning. The contours of the garment are designed around lines of non-extension, allowing the wires to remain clear of joints as well as closures, which prevents both breakage and user frustration. Finally, the sports-inspired spandex base offers a flexible and comfortable fit to the user.

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Solution Based on a survey of current solutions and opportunities, Amble uses electrotherapy as its primary treatment method. The Amble wearable incorporates electrotherapy at the hips and throughout the legs to build muscle and block pain. TENS (transcutaneous electrical nerve stimulation) blocks pain impulses from reaching the brain and increases local blood circulation, and is primarily used by arthritis patients seeking chronic pain management. EMS (electrical muscle stimulation) triggers muscle contraction and activates more muscle fibers than typical movement.

By combining these therapies, and by fixing the electrodes on the garment in order to strategically administer stimulation at joints, Amble removes the challenge of placing TENS and EMS electrodes and extends these technologies to the mass market for independent use. ↓ PRODUCT BREAKDOWN

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Amble leverages off-the-shelf electronics and couples it with custom fabrics and clothing design.

Amble is designed with age in mind, and is an invisible garment that can seamlessly integrate into its users’ lives. These design principles led to a wrap design in a flexible spandex material, making the garment easy to wear for users with chronic arthritic pain, who tend to have limited balance and dexterity. Using lines of non-extension to inform the design, the garment runs wires along parts of the body that do not stretch or contract, increasing comfort for its users.

HEALTH SYSTEMS

References 1. Helme RD, Gibson SJ. The epidemiology of pain in elderly people.

Clin Geriatr Med. 2001. Aug;17(3):417-31, v. Review. PubMed PMID: 11459713.

2. Pisters MF, Veenhof C, van Meeteren NL, Ostelo RW et al. Long-term effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a systematic review. Arthritis Rheum 2007; 57(7): 12451253. [PubMed] 3. Bremner LA, Sloan KE, Day RE, Scull ER, Ackland T. A clinical exercise system for paraplegics using functional electrical stimulation.

Paraplegia. 1992 Sep;30(9):647-55. PubMed PMID: 1408342.

4. IBERALL AS. THE USE OF LINES OF NONEXTENSION TO IMPROVE MOBILITY IN FULL-PRESSURE SUITS. AMRL-TR-64-118. AMRL TR. 1964 Nov:1-35. PubMed PMID: 14262984.

5. Understanding Knee Replacement Costs: What's on the Bill?" Https:// www.healthline.com. October 23, 2017. Accessed October 24, 2017. https://www.healthline.com/health/total-knee-replacement- surgery/ understanding-costs#1.

6. Doheny, Kathleen. "The Real Monthly Cost of Arthritis Medication."

Everyday Health. October 30, 2015. Accessed October 10, 2017. https://www.everydayhealth.com/news/real-monthly-cost-arthritismedication/.

7. Shirazi ZR, Shafaee R, Abbasi L. The effects of transcutaneous electrical nerve stimulation on joint position sense in patients with knee joint osteoarthritis. Physiother Theory Pract. 2014 Oct;30(7):495-9. doi: 10.3109/09593985.2014.903547. Epub 2014 Apr 3. PubMed PMID: 24697730.

AMBLE

8. Francini F, Maresca M, Procacci P, Zoppi M. The effects of non-painful transcutaneous electrical nerve stimulation on cutaneous pain threshold and muscular reflexes in normal men and in subjects with chronic pain. Pain. 1981 Aug;11(1):49-63. PubMed PMID: 6975459.

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S4

WITHIN SMOKE Smoking's impact on private and public health

↓ CHRONIC DISEASES Chronic diseases caused by cigarette smoke in the U.S. are broken down into specific categories, which total 480,000 deaths annually.

Carla Saad

Nearly 500,000 deaths in the U.S. every year are caused by cigarette smoking (CDC). Although policies such as smoking bans in public spaces and commercial building regulations have decreased smoking over the past twenty years, 15% of U.S. adults still smoke, putting themselves at risk for a variety of diseases (NBC News, CDC, Mayo Clinic). Among young adults (18-25) in particular, there has been an increased adoption of perceived alternatives such as e-cigarettes and vaping. Research indicates that vaping is still dangerous (Khakh et al.), but in what ways is it more dangerous, or potentially, safer than smoking?

This study examines the effect of cigarettes by investigating the three main chemical components of cigarette smoke: tar, nicotine, and carbon monoxide. This project also maps the effect of each component on the human body across three scales: individual smokers, second-hand smokers, and third-hand smokers.* *Third-hand smoking is the residual nicotine and other chemicals left on surfaces by tobacco smokers. These residues react with other pollutants over time in an enclosed space, creating toxic mixtures and causing diseases to inhabitants.*

← EFFECT ON SELF The effects on the individual smoker – what is commonly referred to as first-hand smoke – include heart disease, lung cancer, stroke, and more. The primary culprits are nicotine, tar, and carbon monoxide.

References

2. NBCNews.com. "Smoking Rates Have Hit a New Low." Accessed June 30, 2018. Available from https://www. nbcnews.com/health/health-news/only-15-percent-u-sadults-now-smoke-cdc-finds-n579646

3. Khakh, Chenab, Jason Jeong, and Nikhita Parandekar. "E-Cigarettes: A Shiny Alternative To Smoking?" The Cornell Daily Sun. March 27, 2018. Accessed July 03, 2018. Available from http://cornellsun. com/2018/02/05/e-cigarettes-a-shiny-alternative-to-smoking/ 4. Mayo Clinic. "The Dangers of Thirdhand Smoke." July 13, 2017.

Accessed July 03, 2018. Available from https://www.mayoclinic.org/ healthy-lifestyle/adult-health/expert-answers/third-hand-smoke/ faq-20057791

WITHIN SMOKE

1. Centers for Disease Control and Prevention. "Smoking & Tobacco Use." May 17, 2018. Accessed June 30, 2018. Available from https://www.cdc.gov/tobacco/ infographics/health-effects/index.htm#smokeless.

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PATIENT How do I receive care? With the abundant data and resources available to inform decisions on our well-being, navigating the health system has become a burdensome task. These projects survey broad data and construct comprehensive pathways to better health outcomes to aid in answering the question: how and where should I, a patient, receive care?

bank

P₁ connecting

AFIA

Affordable, fast, intuitive, accurate STI viral testing

P₂

CODA

Individualized therapy space designed to address mental health in the 21st century

P₃

OLIVE

A moisture detecting smart-belt for ostomy care

P₄

PAIR

The perfect pair of air shoes to correct gait and pressure for a better stride

P₅

PHARMA 2100

Mapping funding allocations of the global healthcare system to investigate the balance between preventative and chronic care

ABL ACC ACT AIM ALW ART BNF BSE CLN CMM CMP CPH CRE CRR CRT CTC CTY CTY DAT DCN DRC DSN DSS DTH DTL DTR DVC EXP EXR FCS FML GEN GTH GVN HLC HLT HMN HPP HSP ICP IMP IMR INC IND INF LCT LEV LNG LVE LYR MLL OTC PHY PLL PLT PPL PPU PRC PRJ PRS PRT PRV PSR PTN RSR RTE SCL SLP SMP SNS SPN SPP STT SYS TME TRK TRM TRT UND USR UTL VIS VSN WRL YER

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critical • intake • therapy • clinical • hospital • access • care • treatment • discharge

P1

AFIA Affordable, fast, intuitive, accurate viral STI testing 37 million people in the world have HIV, and this number continues to grow. Diagnostic attrition is a major cause for concern in many parts of the world, a situation in which patients enter the diagnostic pipeline, but drop out of their testing schedule prior to receiving a final diagnosis. AFIA addresses this problem by reducing detection time for HIV infections via a field-deployable, low cost, standalone kit. Currently, patients who are interested in being formally tested and who are unaware of their condition do not take the steps necessary to get tested or treated (if necessary). Even though testing is not to blame for the epidemic, it does play a significant role in awareness, transmission, and patient agency. How can we increase patients' awareness of their condition and reduce attrition in a field of complex biological, medical, and regulatory constraints?

Julian Siegelmann, Kenneth So, Janet Sung, and Kiran Wattamwar

MDE VOLUME 1

ABSTRACT 37 million people in the world have HIV, and number grows at the rate of millions per year. Attrition remains a problem where patients enter the diagnostic pipeline, only to drop out of their testing schedule before reaching a final diagnosis. The team aims to reduce attrition rates by reducing detection time for HIV infections.

Due to a complex and strenuous diagnostic pipeline, many patients who are initially interested in a formal diagnosis lack timely feedback to inform steps toward treatment. Even though testing is not to blame for the epidemic, it does play a significant role in awareness, transmission, and agency. Current HIV testing may lack sensitivity to cost, is slow, and requires training, relegating it to expensive procedures often performed in labs. The need for sensitive testing is furthered by the "U=U" movement (undetectable = untransmittable), which was recently backed by the CDC. Given our market, regulatory challenges, and technical requirements, a good solution is (1) simple and intuitive, (2) fast, (3) deployable and easy to use in the field, and (4) affordable.

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The team created a flow cytometry-based assay that implements microfluidic processes to safely, accurately, and quickly count viral load measurements in 1 mL of blood. The microfluidic device is implemented in concert with a companion app and phone accessory, which is designed to fit all standard phone types used in Africa and America. This allows both in-clinic and at-home usage. To circumvent the regulatory need for lab-based testing, the device is designed with simplicity and disposability in mind. The research and solution is presented here on four different scales: (1) the viral scale (technical interactions), (2) the device scale (components), (3) human scale (clinical and user experience), and (4) the systems scale (national rollout).

For HIV patients, there are multiple roadblocks to getting the care they need. Clinics in rural Africa are few and far between, leading to long travel times. Once at the clinic, congestion creates long wait times and patient anxiety, resulting in some parties leaving prior to receiving their test results. Currently, a patient who is interested in taking a test follows a rigid testing pipeline to confirm a positive diagnosis.

HEALTH SYSTEMS

A PRIMER ON HIV

First, the patient must find a clinic. This alone can present a large barrier to those who live in rural regions or those who lack adequate access to healthcare funding to cover testing costs.

Depending on available resources, clinics may lack the resources to service their patients. Additionally, the need for labs requires batch testing and formally trained clinical practitioners, leading to longer turnaround times.

Healthcare practitioners experience the same problems, but from a different perspective: centralized clinics may alienate patients farthest away from health centers, while also increasing patient load beyond capacity for a single point of access, leading to reduced patient/clinician time and elevated exposure to waiting room diseases. Additionally, costly lab equipment and batch processing mean tests cannot be carried into rural areas.

Furthermore, clinical testing is a densely regulated process that, under the regulatory framework of the Clinical Laboratory Improvement Amendments (CLIA) in the U.S., requires the clinics to hand over collected human biological samples to labs for sensitive medical testing. Clinics may not analyze samples themselves, and the submission of samples to labs introduces a significant amount of latency in communicating results back to patients.

These clinical barriers to HIV diagnostics have contributed to high rates of attrition in HIV screening. In order to speed up the diagnostic process, there needs to be a solution that can be safely performed at the point of care. To this end, an intervention that bypasses CLIA requirements is an essential design requirement.

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Methodology Background The clinical screening process for HIV is staged and requires an array of sequential tests. Patients without known exposure to HIV will usually take the ELISA (enzyme-linked immunosorbent assay) rapid test first.

The ELISA test checks to see if antibodies are present in samples collected from cheek swabs. The ELISA is cost-effective, non-invasive, and fast, but lacks enough sensitivity to determine a positive diagnosis. Patients with negative results drop out of the screening loop at this stage, and others continue with the more sensitive Western Blot test, followed by a Nucleic Acid Test (NAT). These tests are progressively more expensive and require incrementally more technical laboratory processes. NATs are the most precise test, with the authority to confirm a positive diagnosis, but they are also the most expensive in the screening process.

↓ MICROFLUIDIC DEVICE

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Below is an example of the AFIA microfluidic device, a new, proposed HIV test. Here, you can visibly see the effects of the mixer (the wavy portion of the design) that combines the chemicals from the wells, before forming small droplets. In reality, the diameter of these channels is 50um, smaller than a human hair.

Advanced imaging tools and complicated lab procedures provide feasibility challenges that serve as bottlenecks in rural regions and under-supported clinics. Complicated devices with complex preparation processes, like NATs, which traditionally use gel electrophoresis, are difficult to deploy in remote clinics, where pocket-sized devices may be the most successful. Furthermore, devices must be resilient

These bottlenecks contribute to a grueling diagnostic process that requires patients endure the psychological burden of waiting, scheduling, and repeated planning.

For clinics, regulations require the transfer of samples to labs for testing, creating a time crunch that compounds with a lack of adequate workers to address growing patient populations.

HEALTH SYSTEMS

against dust and somewhat mobile to optimize for their usage in the field for clinics that travel (especially those that service rural regions).

An optimal test given these challenges would be (1) affordable, (2) fast, (3) intuitive, and (4) accurate – AFIA. Affordable tests make individual testing rather than batch testing possible, which can incentivize point-ofcare testing. Fast tests reduce the psychological burden on patients who must sit alone, anxiously waiting for results. Intuitive tests make on-site testing possible, instead of requiring labs to intervene. And finally, accurate tests can eliminate the battery of testing and offer a diagnosis from a single test.

In Arabic, “afia” means “good health.” This project, AFIA, embodies the above design principles as a framework for both evaluating the current HIV screening system and as a proposed clinical solution that could reduce attrition in patient diagnostics for HIV.

A New Testing Paradigm While there are several intervention points in the system that could improve patient awareness of their HIV status, this project specifically focuses on HIV diagnostics. The diagnostics process itself is also broad, spanning improvements in patient experience to reductions in stigma, which can increase the volume of people who get tested. The team decided to address the shortfalls in the device utilized in testing for HIV. While improving the patient experience directly could ease the psychological burden of the process, we saw that addressing the problem at its root – a thorny series of tests – might offer a much larger scale solution for deployment in an array of clinics worldwide.

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↑ AFIA, AT MICROSCALE This plate serves as a template for testing the microfluidic design of AFIA's channels, bumpy mixers, and droplet former. The darker sections on the plate above have widths of 50um (smaller than a human hair). By pouring PDMS (a gel-like substance) above these raised sections, letting it set, and removing it, we form small channels and wells in the surface that are used as the base of our device. In that regard, this mask is a "negative" of the Afia device.

The team was also motivated by CDC's research with U=U (Undetectable = Untransmittable), demonstrating that HIV+ people with viral loads below 200 copies / mL cannot transmit HIV to someone else during exposure.

While considering how to empower those managing HIV on a daily basis to understand their condition and transmissibility, the team also wanted to explore solutions that could measure viral load in the home.

AFIA imagines a future where viral load testing can be performed the same way a diabetic might manage their sugar consumption by using a glucometer, which eliminated venous blood draws as a means of collecting blood samples.

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Solution Most existing HIV screening procedures do not meet the standards of affordable, fast, intuitive, and accurate. The team decided to take on the task of counting individual viruses, using a technique from droplet microfluidics. This technique can isolate single viruses and count them through fluorescent markers that attach onto the virus itself. The full solution is mapped in the schematic on the right, along with the corresponding components of the microfluidic device.

HEALTH SYSTEMS

← STEP 1: COLLECT A SAMPLE First, samples are collected using fingersticks, which plug into the microfluidic device. Plasma is extracted to reduce noise and prevent markers from binding to other parts of the blood sample. Along with this filtering, a pair of FRET markers that attach to HIV is introduced. FRET pairs fluoresce when they are close to each other. The team uses Alexa555 and Alexa647 antibody dyes conjugated to two nearby antibodies on HIV's surface to illuminate HIV (and only HIV).

The wavy pattern in the schematic is a mixer used to marry the chemicals in each well (circles) together.

← STEP 2: ISOLATE THE VIRUS To count the virus' load, the viruses are separated into a single file line so that they can be imaged. This is done by flowing the mixture into a droplet generator geometry, a very small opening where a water-based and oil-based emulsion meet. By varying the flow rates of each, the team is able to generate bubbles of the water-based sample at a desired droplet size of 50um. The fluorinated oil functions as a spacer to keep the bubbles, or vesicles, separated. This droplet size is statistically likely to either have 0 or 1 copies of the HIV virus in it.

← STEP 3: DETECT + QUANTIFY Using the excitation wavelengths and emission filters of the FRET pair, it is possible to excite each vesicle that passes a specially selected light. If the vesicle fluoresces, it contains a FRET pair and thus, contains a virus. The total count of fluorescent vesicles is a proxy for the viral load. To make this low cost and easy to deploy in the field, the design is an assembly that attaches to a cell phone, which then captures video of the droplets for processing.

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↑ LIGHTS, CAMERA, ACTION This assembly represents the optical array.

A light specifically makes FRET pairs visible, lenses focus on the viral scale, and filters specifically isolate fluorscent signals. The full assembly can allow a phone or microscope to see vesicles that contain viruses, and in turn, count the viral load of a sample.

One of the biggest challenges in biology is the reproducibility of experiments. Given the variability in microfluidic implementations, the team thought through many of the nitty-gritty details to make the proposed solution both practical and feasible.

HEALTH SYSTEMS

Process

Using fluorescent markers, AFIA aims to capture fluorescence as a signal to mark that a virus is present. Organizing the signal emitted from markers is just as important as the ability to quantify it. An optical system with filter and lens is attached to the phone camera to remove environmental noise and amplify the correct fluorescent signal. By guaranteeing that vesicles have maximally one virus, an algorithm can count the binary signal and obtain the virus load of each sample.

Travelling clinics in the field require additional features: adequate lighting, protection from dust and theft, and portability.

Because this work will likely not be done in a lab, the device must be be easy to use, and adjusted to phones used in the regions in which AFIA is deployed.

The team explored several methods of prototyping and fabrication. Microfluidic devices are traditionally prepared by introducing engraved channels into some kind of base material. Many different ways to fabricate the device were considered, from laser cutting, to PDMS, to modular components that enable plug and play applications. Because the channels were around 50um, the team settled on PDMS.

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Implementation AFIA will be implemented in three stages: 1) in the clinical environment, to reduce the time needed to obtain results and reduce the number of uncollected results; 2) in the field, to allow mobile clinics and inthe-field healthcare workers to increase the number of HIV diagnoses; and 3) at home, to increase awareness regarding HIV viral load levels and empower patients to monitor their own health and transmission levels.

↓ FULL DEVICE AFIA is not only a microfluidic device, but also a full setup, that can be clipped onto a cell phone camera and covered to protect the imaging from dust when used on the field.

AFIA helps both patients and health practitioners by creating an affordable, fast, intuitive and accurate test that is portable and easily deployable in areas without clinical infrastructure. AFIA improves existing testing on two scales: 1), the physical scale, allowing the test to be deployable anywhere due to its lightweight and disposable nature; 2), in terms of interoperability, as this test can be used by anyone, eradicating the need for clinics and clinicians. This is extremely important, as increased access to HIV testing in rural areas decreases the amount of patients visiting centralized clinics for diagnostic and routine appointments, reduces the spread of diseases in waiting rooms, and reduces the number of patients leaving early due to uncomfortable and long waiting times. We can also roll this out to primary health entities in rural towns, providing accurate testing to even the most remote areas.

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By making HIV tests more accessible and increasing the amount of patients that can be seen by doctors, we increase the number of HIV tests taken, reduce the number of uncollected results, and hope to create more transparency and understanding of viral load levels and treatment efficacy. This benefits both the clinic and the patient, both in Africa and the U.S..

We therefore aim to implement our solution within Africa and America first, creating a two-market strategy to monetize one market while subsidizing the other. In order to get our device onto the market, we have to (1) kick-off the medical certification process, (2) test implementation in rural markets, and (3) refine our market strategy to scale appropriately in both the U.S. and Africa.

HEALTH SYSTEMS

CONCLUSION In implementing AFIA, we need to understand if we want to pursue public or private partnerships in the African market. Sadly, the NGO landscape can be dispersed and ineffective. A better option might be to work directly with governments. However, how can we ensure that our product does not get hampered by red tape and bureaucratic processes? Additionally, how can we incentivize health entities to implement AFIA? After speaking to experts, we understood that creating private sector profit established an appealing solution to implementation. Most importantly, how can we make testing a rewarding experience for the patient?

HIV testing leaves both physical and psychological harm - pricking yourself isn’t fun, and being reminded that you have HIV isn’t either. There is still substantial work to be done to make HIV consumer testing a viable and desirable experience, but it is clear that advancing this technology development can advance the health and agency of a significant population in spades.

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Interviews

References

Peter Stark, Harvard SEAS

1. Promso S, Srichunrusami C, Utid K, Lulitanond V, Pairoj W, Chantratita W. Quantitative detection of human immunodeficiency virus type 1 (HIV-1) viral load by real-time RT-PCR assay using self-quenched fluorogenic primers. Southeast Asian J Trop Med Public Health.

2006 May;37(3):477-87. https://www.ncbi.nlm.nih.gov/pubmed/17120967

Dr. Bruce Walker, Professor of Medicine at Harvard Medical School, Professor of Practice at MIT, and a Howard Hughes Medical Institute (HHMI) Investigator Dr. David Knipe, Knipe Laboratory, Harvard Medical School Dr. Hadi Shafiee, Principal Investigator, Assistant Professor in Medicine, Brigham and Women's Hospital, Harvard Medical School Dr. Daniel Kuritzkes, Professor of Medicine at Harvard Medical School and Chief of the Division of Infectious Diseases at Brigham and Women's Hospital Dr. Gio Traverso, MD, PhD. Instructor in Medicine, Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School. Research Affiliate, Koch Institute & Dept. of Chemical Engineering, Massachusetts Institute of Technology Galina Smith, Outreach Coordinator, The Boston Alliance for LGBT Youth (BAGLY) Jordina Shanks, Chief Operating Officer, Planned Parenthood Massachusetts

4. Zeng et al., 2014 U. Zeng, X. Zhang, K. Nie, et al. Rapid quantitative detection of Human immunodeficiency virus type 1 by a reverse transcription-loop-mediated isothermal amplification assay Gene, 54 (12) (2014), pp. 123-128. https://www.sciencedirect.com/ science/article/pii/S0014480014000896#bbb0010 5. Barnor JS, Yamamoto N, Brandful JAM, Ampofo W, Bonney JHK, et al. (2014) Establishment of In-House Quantitative Real-Time RT-PCR Assay for HIV-1 Viral Load Measurement: Application to Evaluate Efficacy of ART in Ghanaian Patients in an Urban Setting. J AIDS Clin Res 5:305. doi:10.4172/2155-6113.1000305

Dr. David Weitz, Director of the Materials Research Science and Engineering Center Melissa Hancock, Biological/Environmental Lab Engineer (INT), Harvard Medical School

7. Borghino, D. 3D-printed attachment turns smartphones into sub-wavelength microscopes, October 2013. https://newatlas.com/3d-printed-smartphone-microscope/29340/

Anas Chalah, Asst. Dean for Teaching and Learning, Director of SEAS's Teaching Labs

8. LaFratta CN, Huh SP, Mallillin AC, Riviello PJ, Walt DR. Visualizing Fluorescence: Using a Homemade Fluorescence “Microscope” to View Latent Fingerprints on Paper. Journal of chemical education. 2010;87(10):1105-1107. doi:10.1021/ed100290w.

Jason Robinson, IDEO Dirk Ahlgrim, IDEO Christopher Wright, IDEO Jeffrey Blander, CIO US Department of State Darius Shahida, CFO, Butterfly Networks, John Didier, Weitz Lab, Harvard University Raoul Rosenthal, Lexiang Zhang, Postdoctoral Fellows Walther Mothes, Professor of Microbial Pathogenesis, Yale School of Medicine Alice Ly, Associate Director for Health and Sciences (H&S) at the Harvard Innovation Labs Dr. Caleb Dresser, Clinical Fellow in Emergency Medicine, Beth Israel Deaconess Medical Center

PATIENT

3. Janet M. Barletta, PhD, Daniel C. Edelman, MS, and Niel T. Constantine. Lowering the Detection Limits of HIV-1 Viral Load Using Real-Time Immuno-PCR for HIV-1 p24.

Antigen American Society for Clinical Pathology. Microbiology and Infectious Disease / IMMUNO-PCR FOR HIV-1 P24 ANTIGEN 20 Am J Clin Pathol 2004;122:20-27 20 DOI: 10.1309/529T2WDNEB6X8VUN

6. A. Orth, E. R. Wilson, J. G. Thompson & B. C. Gibson. A dual-mode mobile phone microscope using the onboard camera flash and ambient light. Nature. Scientific Reportsvolume 8, Article number: 3298(2018). 06 February 2018. https://www.nature. com/articles/s41598-018-21543-2

Christopher Hinojosa, Director of Discovery, Emulate, Inc.

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2. Cappy P, De Oliveira F, Gueudin M, Alessandri-Gradt E, Plantier J-C. 2016. A multiplex PCR approach for detecting dual infections and recombinants involving major HIV variants. J Clin Microbiol 54:1282–1288. doi:10.1128/JCM.03222-15.

9. Tarver CL, Pusey M. A low-cost method for visible fluorescence imaging. Acta Crystallographica Section F, Structural Biology Communications. 2017;73(Pt 12):657-663. doi:10.1107/S2053230X17015941.

10. Wei Q, Qi H, Luo W, et al. Fluorescent Imaging of Single Nanoparticles and Viruses on a Smart Phone. ACS nano. 2013;7(10):9147-9155. doi:10.1021/nn4037706.https://www. ncbi.nlm.nih.gov/pmc/articles/PMC3951925/ 11. Micahud, S. An Open Source Smartphone Microscope. The Optical Society of America. O6 December 2017. https://www.osa-opn.org/home/newsroom/2017/december/an_opensource_smartphone_microscope/ 12. Ngangue P, Bedard E, Zomahoun HTV, et al. Returning for HIV Test Results: A Systematic Review of Barriers and Facilitators. International Scholarly Research Notices.

2016;2016:6304820. doi:10.1155/2016/6304820.

We were happy to dive deeply into a topic so technical and foreign to us. Our fresh eyes helped us approach and frame the problem with a unique perspective that doesn't often infiltrate this highly specialized space.

We are so grateful to the incredible advisors who guided us through our process and the numerous clinicians, nurses, professors, researchers, and labs that offered us a glimpse into the many challenges and important lessons of HIV research.

Getting our hands dirty and really working on fabricating the device and learning additional lab techniques was immensely rewarding.

The resources we were given and support to actually fabricate the microfluidic device made our project tangible and real. Early on, we chose to focus our efforts on tackling

the technical sides of our project, but realize that this came at the expense of the user experience journey. Nonetheless, we were able to use the insights gained from secondary sources to intuit pain points that our test could solve, and the next step would be to validate that with real users.

HEALTH SYSTEMS

Team Reflections

We deeply appreciated the opportunity to transcend barriers of academic disciplines and make full use of the resources given to us.

By working very closely with studio professors and researchers who made the jump from academia to the private sector, we gained deep insight into how to transition from the lab to the real world. Every interview inspired clarity, learning, and technical expertise that we will carry forward with us as design engineers.

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P2

CODA A therapeutic, palliative care sanctuary for hospice patients Coda is a palliative care sanctuary designed to help terminal patients and their families feel psychologically and physically more relaxed through sensory therapies. Against an alternative of taxing hospitals or bland hospice care facilities, Coda’s goal is to support wonder and reflection. The space is designed to target specific sensory channels that promote calmness by utilizing warm color temperatures, soothing visuals, and ambient, consonant sounds. The experience is responsive to user activity and biometric data captured in the space.

Jeronimo Beccar, Jenny Fan, Vish Srivastava, and Janet Sung

↑ CHANNELS OF CALM Coda uses channels of light, color temperature, ambient sound, musical consonance, and natural visuals to create a calm and soothing environment for palliative care patients.

CODA

Several studies suggest stressed individuals feel significantly better after exposure to nature scenes, exhibiting significantly reduced fear arousal (Ulrich). Coda’s images are inspired by “komo rebi”, the Japanese word for sunlight filtering through leaves, as a way to evoke images of nature.

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Problem

↑ COST OF CARE

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Dementia and cardiovascular disease are the leading conditions driving hospice care spending in the United States (National Hospice and Palliative Care Organization).

As the world grays, approximately 80% of Americans would prefer to die at home, if possible, but despite this, 60% die in acute care hospitals, 20% in nursing homes, and only 20% at home (Stanford). For hospice patients who have spent years battling terminal illness in a series of sterile, intimidating hospital environments, the clinical and dull hospice facilities are far from the kind of spaces that promote tranquil reflection or wonder.

In 2015, there were over 1.4 million Medicare patients enrolled in hospice care, with 37% of patients receiving hospice care for more than 30 days (National Hospice and Palliative Care Organization, Harris Williams & Co). A number of end-of-life patients are conscious but suffer from diseases that limit end-of-life mobility, such as cancer and heart disease. These patients often find themselves emotionally and physically confined in hospice care facilities, without access to environments that make them feel relaxed, peaceful, and reflective.

Coda offers a dedicated sanctuary space for people in the final stage of their illnesses to cope, reflect, and find peace. The system develops an immersive, interactive, therapeutic experience using visuals, sound, and light to soothe patients and their families. It can be installed in a dedicated room in hospices and hospitals, and accommodates patients in a rolling bed or wheelchair, as well as friends, families, and caretakers.

↓ RENDERING OF LIGHTS The color temperature is choreographed with LEDs and fiber-optics to calm physiological activity in concert with a biometric pulse sensor.

HEALTH SYSTEMS

Solution

Using inputs from a Leap Motion sensor that tracks hand motions and a deployable audiovisual system of speakers and projectors, Coda generates interactive, consonant sounds, alternates through color temperatures, and generates nature-inspired visuals in response to a user’s biometric inputs. The experience naturally loops to allow patients to stay and reflect as long as they would like.

← OPERATIONAL DIAGRAM

CODA

This technical blueprint describes how user inputs control sensory outputs. The Leap Motion controller captures small, subtle hand motions to trigger corresponding actions in output channels, such as playing sounds or changing the pattern of lights.

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↓ USER-CONTROLLED INPUT

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The visuals react to hand gestures captured by a Leap Motion controller, which detects hand motions, gestures, and movements above it. A projector system displays a custom-developed Unity app that generates nature-like images when triggered by Leap Motion.

The go-to-market strategy targets hospice care facilities to offer Coda as a value-added service for their patients, differentiating them from competitors in a field with limited innovation. As a semi-portable and deployable service, Coda can be installed and operated with a one-time installation fee and ongoing service contract for hospices. Beyond this initial prototype, future iterations could be smaller for consumer use in homes and expand upon the experience, adding in outdoor scenes or even personalized preferences for visuals and sensory channels.

HEALTH SYSTEMS

↑ COLOR TEMPERATURE Coda uses low illuminance and warmer color temperatures to lower central nervous system activity and induce calmness. Research suggests that color temperatures below 3000K can create a “smooth lowering of central nervous system activity... to facilitate lowered physiological activity” (Noguchi).

→ CONSONANT SOUNDS Using hand gestures detected by a Leap Motion controller, Coda generates consonant sounds to accompany a looping background chord progression. Coda cycles through a harmonious background chord progression, while interactive motions trigger the melodies. Musical consonance can trigger pleasant responses from the limbic system, which is responsible for much of human emotion and memory formation (Roederer).

References 1. Stanford School of Medicine (Palliative Care). “Where do Americans die?” https://palliative. stanford.edu/home-hospice-home-care-of-the-dying-patient/where-do-americans-die/ 2. Hospices & Palliative Care Centers in the US. IBIS World. March 2017.

3. Harris Williams & Co. “Hospice Industry Overview.” 2013. https://www.harriswilliams.com/ system/files/industry_update/hospice_industry_overview_v3.pdf 4. National Hospice and Palliative Care Organization. “Facts and Figures: Hospice Care in America.” October 2017. https://www.nhpco.org/sites/default/files/public/Statistics_ Research/2017_Facts_Figures.pdf 5. Noguchi, Hiroki and Toshihiko Sakaguchi. “Effect of Illuminance and Color Temperature on Lowering of Physiological Activity.” Journal of Physiological Anthropology and Applied Human Science, 1999, Vol.18(4), pp.117-123 [Peer Reviewed Journal] 6. Roederer, Juan G. “The Physics and Psychophysics of Music: An Introduction.” 4th Ed. Section 5.6 “Cognitive and Affective Brain Processes in Music Perception: Why Do We Respond Emotionally to Music?” Pg. 196.

CODA

7. Ulrich, Rogers. “Visual landscapes and psychological well-being.” Landscape Research, 1 March 1979, Vol 4(1), p. 17-23. Taylor & Francis Group. [Peer Reviewed Journal]

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P3

OLIVE Moisture-detecting smartbelt for ostomy care Many patients with IBD, Crohn’s, colitis, and cancer are living with stomas, a surgical opening created to assist with evacuation in lieu of a functioning colon. Stoma care comes at a tremendous mental and physical cost that requires persistent management.

Ostomates must change a skin barrier and pouch every 3-4 days, and empty their ostomy bags regularly to avoid a leak, which is especially common at night. Leaks can undermine self-esteem and confidence, as well as irritate the sensitive peristomal skin.

Olive is a moisture-detecting smartbelt designed to unobtrusively assist in day-to-day ostomy care. By detecting for stoma leakages via a Bluetooth moisture sensor, especially when the user is sleeping, Olive alerts wearers with a subtle audible alarm and vibration motor. By catching leaks early, Olive can help improve the agency and mobility of ostomates.

Jenny Fan and Kenneth So

↑ PROVIDING EASE OF MIND Olive is a wearable device for ostomy patients to help detect accidental leaks in their ostomy pouches. An accompanying mobile app helps notify wearers when leaks may be occuring and provides ancillary health information, such as hydration levels, to help ostomates more easily manage their condition.

OLIVE

Early iterations focused on improving ease of emptying the pouch or enhancing the skin-barrier flange with a flexible PCB (printed circuit board), but deeper research into ostomy care companies and ostomy patients revealed the many regulatory and ergonomic challenges with designing directly for skin-adhering appliances. The lack of devices addressing the emotional needs of ostomy care patients inspired an up-market solution.

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↕ TYPES OF OSTOMIES A stoma is an opening outside of the body, used to assist in evacuation in lieu of a colon.

Surgeries remove part or all of the intestinal tract, affecting the requirements of what a pouch must collect.

Problem There are approximately 120,000 ostomy surgeries in the U.S. per year, with an estimated 3% annual growth rate as more people age and encounter colon-related illnesses. Ostomy surgeries involve removing part or all of a diseased large intestine (colostomy), small intestine (ileostomy), or urinary tract (urostomy), producing an external opening in the abdomen (a stoma) to assist with evacuation.

While ostomy surgeries are often necessary for colon disease management, stoma management comes with a host of physical and mental burdens, such as chronic dehydration, leaks, skin irritation, and self-esteem issues. Ostomates must frequently empty their ostomy bags and change the attachment flange that holds the bag in place, a challenge for many patients who are also often limited in mobility. Despite the growing market for ostomy care (expected to reach $3.41 billion by 2021), there are few assistive tools beyond spandex belts meant to keep the pouch in place.

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Solution To assist with not only the physical but also emotional demands of ostomy care, the team designed Olive to be a sleek, attractive smartbelt that detects leaks, tracks vital data, and alerts the wearer promptly but subtly if moisture levels pass a certain threshold. This improves wearers’ self-confidence and freedom of mobility, but especially peace of mind when sleeping.

As a wearable, early prototypes experimented heavily with form, construction, and basic electronic functionality to detect for moisture.

Later refinements included the more sensitive BME280 moisture sensor that could transmit the exact humidity percentage data to a mobile app via Bluetooth (the Feather 32u4 Bluefruit LE board). The Bluefruit board came with a strong developer community for the mobile app, which was refined as an interface in Sketch and Principle.

HEALTH SYSTEMS

↓ PROTOTYPING OLIVE

Olive is designed to be functional, versatile, and reliable, but most importantly, sexy. To be as widely applicable as possible, this belt can be used with most existing ostomy pouches and flanges in the market. The prototype is made from athletic fabrics with sweat-wicking and specific moisture properties to minimize the impact of leaks. Though minimal, the electrical circuitry is easily removable for washing. As an assistive tool rather than medical device, it is branded to stand out from the swathes of bland, geriatric appliances as a tech-forward lifestyle device (like a Fitbit or Apple watch). As such, Olive comes with a companion mobile app to not only alert users when there are leaks, but also detect pouch capacity, set reminders for flange replacement, and potentially track health and nutritional information in the future.

To best approach the design challenge, the team explored how any proposed solution would interface with the body, adapt to existing solutions for the broadest market, add value beyond existing offerings, and design for durability and reusability.

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↓ LEAKAGE ALERT APP

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As part of the accompanying mobile app, Olive has features to easily monitor moisture levels, potential leaks, body temperature, and pouch capacity to create added value for ostomates.

HEALTH SYSTEMS

↑ MOISTURE DETECTION MECHANISM The circuit is designed with two copper circuits on separate clothes, separated by filter paper that gets wet in the presence of excess moisture and runs a current. The connected circuit powers a number of moisture detection features, such as the buzzer alarm and vibrating motor.

← USER JOURNEY RESEARCH As a condition that the team knew little about, the research process first began with hours spent watching ostomy care video blogs and reading ostomy forums to build empathy about the challenges facing this community. A subsequent in-depth video interview with Collin Jarvis, a young ileostomy patient who was actively advocating for increased mobility as a marathon runner, solidified many of the design principles and features that propelled Olive’s design forward.

The team could not have developed Olive without the help and guidance of Mike Litchfield from Harvard’s Electronic Instrument Design Lab, Evan Smith from the Active Learning Labs, Mark Feldmeier from MIT’s Responsive Environment group, and ostomy bag samples from Sensura Mio and Spalding Hospital.

References

2. “Stoma Care/Ostomy Care and Accessories Market - Global Forecast to 2021.” Research and Markets. July 2016.

OLIVE

1. Pittman J, Rawl SM, Schmidt CM, Grant M, Ko CY, Wendel C, Krouse RS. Demographic and clinical factors related to ostomy complications and quality of life in veterans with an ostomy. J WOCN. 2008;35(5):493– 503

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PAIR The perfect pair of air shoes Foot pain has a major negative influence on foot function and impinges on human mobility. Research shows that for people suffering from foot pain, some parts of the foot experience excessive pressure in areas that are not biologically adapted to support it. In response to this asymmetric distribution of pressure between feet, people adjust their body posture and dramatically change their gait cycle, worsening the problem.

Pair proposes a solution to counterbalance excessive pressure placed on the wrong points of the feet. Once abnormal pressure is detected in target areas, the sole inflates in that area to counter it, and indicates the pressure difference to the wearer. With automatic detection, localization of pressure, and high personalization in the shoe's fit, Pair is designed with the user in mind, at a low production cost.

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→ A PNEUMATIC PAIRING

Carla Saad and Janet Sung

Air pumps into both the sole and upper shoe to better support the foot and normalize plantar pressure. By automatically triggering inflation at abnormal pressure sites and balancing it with inflation in the soles, users can preserve their own sense of balance while learning to adjust their gait.

� DESIGNING THE GARMENT

The contours of the garment are designed around lines of non extension, allowing the wires remain clear of joints as well as closures preventing both breakage and user frustration.

The sports-inspired spandex base design offers a flexible and comfortable fit to the user.

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Problem One in five Americans suffer from foot pain and foot fatigue (American Podiatric Medical Association). Over 50% of Americans say foot-related pain limits their activity. Among the top foot ailments affecting the U.S. population, foot pain (ranked sixth) and foot fatigue (ranked third) dramatically impact mobility. Foot pain causes strain that leads those affected to walk with a gait that places excessive pressure on parts of the foot that are not meant to support weight. While adjusting gait may temporarily relieve foot pain or foot fatigue, this modified pressure profile can exacerbate foot pain and lead to additional concerns like poor posture, back pain, and joint pain.

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Walking is an essential part of most individuals' daily lives, but is difficult to modify. Correcting this modified gait requires awareness and precise, instantaneous adjustments to natural behaviors. Medical shoes offer effective custom solutions, often at a prohibitive cost.

Foam insoles only solve half the problem by providing relief, but conform to feet over time without informing wearers of ways to correct poor gait, leaving the problem to grow more harmful. Fluid insoles are flexible, but are prone to leakage with extended use.

HEALTH SYSTEMS

Solution

← MAPPING PRESSURE The foot experiences different abnormal pressures and pathologies. Plantar fasciitis is an inflammation of the ligament located underneath the sole of the foot and is usually caused by muscle strain due to high heels. Metatarsalgia is an inflammation of the ball of the foot and is classified as an overuse injury. It is usually common among athletes or people who do a lot of sports activities. These two cases of abnormal distributions of pressure on the foot offered us reference points which were used to register our insole and frame our design.

Pair is a mobility solution that not only provides support and comfort, but also corrects poor walking form to further train improved gait and posture. Pair’s intervention is in the form of shoes comprised of four core elements. On its exterior, the Pair shoe features a customized grip that conforms to feet and offers stretch to allow for unhindered movement. Beneath the shoe’s exterior is an automated inflation layer. Using pneumatic technology, air is delivered to specific regions of the insole where excessive pressure is detected. An effective insole minimizes slipping of the foot within a shoe, helps heel spurs, closes gaps in slightly larger shoes, improves arch support, and reduces joint pain.

Finally, Pair is completed by a base layer made of a flexible and durable material. Together, Pair’s effective insoles complement the pressure map to provide active gait correction with mobility comfort.

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↑ EMBEDDED SENSORS A sensor embedded within the custom insole detects areas of over-pressurization caused by unhealthy weight distribution and triggers inflation to assist in modifying the user’s gait.

The insole was developed with a custom mold and cast in silicone with an inflatable layer inside. One sensor node is shown here, where the wearer's heel would be in the insole. By considering the design of both the upper and lower part of the shoe in parallel, Pair offers a firm grip around the foot while embedding nudges that can train users to walk with a better gait over time.

HEALTH SYSTEMS

Process

Localized inflation of the insole is coupled with inflation in the upper part of the shoe to keep a firm grip around the affected foot, which offers support to improve balance while walking.

In this prototype of Pair, the materiality of different components is visible. The rigid outer materials, prototyped using 3D printing, offer a firm grip while the silicone-casted sole fits to the wearer and can be custom made.

References 1. American Podiatric Medical Association, New York Times Health, Institute for Preventive Foot Health

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P5

PHARMA 2100 Global pharmaceutical funding “The system doesn’t want you to get well and it doesn’t want you to die – it just wants you to keep coming back.” – Escape Fire Is the global healthcare system focused more on maintaining patients’ problems or on preventing them in the first place?

Unless governments devote a larger proportion of their healthcare expenditures to preventative measures rather than palliative medicines, “no country will be able to fund the healthcare needs of its inhabitants by 2020” (PwC). This project, Pharma 2100, evaluates funding allocations within global pharmaceutical companies through two lenses: the funding spectrum (1) as compared between countries (population, health score, GDP) and (2) as a whole, regardless of country, in order to better understand preventative versus reactive funding allocations within the industry. As of 2017, funding within the global pharmaceutical field is focused on preventative care research. This representation of the findings is intended to provide a live feed from the Orbis database, allowing users to explore the research data and find new patterns as new information is added to the study.

References 1. PwC. “Pharma 2020: The Vision”. Available from https://www.pwc.com/gx/en/pharma-lifesciences/pdf/pharma2020final.pdf

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2. Matthew, Heineman et al.. 2013. Escape Fire: The Fight to Rescue American Healthcare. Santa Monica, Calif.: Lionsgate.

Anesta Iwan

PHARMA 2100

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provide compare exercise

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scale research range

time

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arthritis

visualization

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response

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individual

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USER

incorporate

U USER continent

How do I actively utilize resources?

At the center of products, platforms, and interfaces are users. As users, we are empowered to control the way we experience the world around us. With human-centered design and studies on the impact of design decisions, these projects begin to understand the role of users in informing health outcomes along specific issues in healthcare.

U₁

MALCOLM TEN

An enhanced data collection platform for patient-reported outcomes

U₂

MOMENT

Focus training through a multi-sensory chair experience

U₃

SYNCSENSE

Motion-sickness mitigation for air travelers

U₄

MOBILIZE

A comfortable, concealable, affordable exosuit for assisting arthritis patients

U5

FLEXFIT

A fitness ecosystem supporting seniors and their families with physical activities

U6

ANOPHELINE VECTORS

Visualizing environmental change with longitudinal disease vectors

ABL ACC ACT AIM ALW ART BNF BSE CLN CMM CMP CPH CRE CRR CRT CTC CTY CTY DAT DCN DRC DSN DSS DTH DTL DTR DVC EXP EXR FCS FML GEN GTH GVN HLC HLT HMN HPP HSP ICP IMP IMR INC IND INF LCT LEV LNG LVE LYR MLL OTC PHY PLL PLT PPL PPU PRC PRJ PRS PRT PRV PSR PTN RSR RTE SCL SLP SMP SNS SPN SPP STT SYS TME TRK TRM TRT UND USR UTL VIS VSN WRL YER

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decision • tool • human-cenetered • location • platform • device • agent • interface • control • product • interaction

U1

MALCOLM TEN Enhanced data collection for patient-reported outcomes Healthcare delivery today relies primarily on clinically-collected discrete data to inform doctors’ decision-making and patient tracking. However, over the past several years, new collection methods and devices have emerged for patients to gather data such as mood, activity, heart rate, blood pressure, temperature, weight, sleep, and even glucose levels.

These measurements, combined with patient-reported outcomes (PROs), can play an important role in clinical outcomes and patient experience. There is a significant opportunity to combine patient-generated and clinically-generated data to improve patient outcomes and engagement.

Named after IBM Watson’s misreading of “Malcolm X” as “Malcolm Ten”, the Malcolm Ten platform proposes a way to reconnect patients and doctors in the healthcare delivery process, moving beyond the current black box of medical technologies.

Arjun Menon and Vish Srivastava

MDE VOLUME 1

ABSTRACT Today, Patient-Reported Outcomes (PROs) for both clinical outcomes and patient experience are valued by clinicians and hospital administrators. However, the system to obtain PROs is broken. Expensive survey providers mail letters to patients, and even the most successful hospitals only get a 30% response rate (Vasudevan). For the majority of the 990 million visits to clinical facilities in a year (CDC), clinical staff are largely unaware of how their patients fare after returning home. Subsequent follow-up appointments or physical therapy visits are black boxes to the clinical team, providing a challenge to measuring outcomebased performance.

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To create a solution to mend the broken feedback loop between clinical staff and patients, the team designed Malcolm Ten, a simple platform that gathers PRO data after procedures and utilizes intelligent conversation flow design to maximize patient response rates. The platform can interact with patients through a variety of interfaces, including a mobile application, Short Message Service (SMS), or even Amazon Alexa. This data is made available to clinical staff and hospital administrators for use in managing their patients, and is based on existing clinical standards (e.g., VR-12) to support a range of different disease states and procedures.

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PROBLEM Under the Obama administration, U.S. health providers were pushed to move towards electronic health records (EHRs) and incentivized towards value-based care.

EHR adoption increased from only 17% in 2008 to 97% by 2017 (ONC). Though this speed of adoption is remarkable, the increased role of technology in medicine hasn’t had the promised results, and has come at the cost of patient-doctor interaction. A Johns Hopkins survey in 2013 found that medical residents spend only 12% of their time talking to patients. As Dr. Abraham Varghese from Stanford Medical School has said, “Technology is cleaving the sacred bond between patient and doctor.”

Healthcare delivery today relies primarily on clinically-collected discrete data for decision-making and patient tracking.

However, over the past several years, a range of new methods have emerged for patients to collect their own data. These include familiar and common consumer devices such as smartphones, Fitbit, and internet-connected weight scales, as well as innovative clinical devices, such as Verily’s internet-connected contact lens and continuous, semi-invasive glucose monitors. These changes in the consumer health technology market provide an opportunity to improve patient outcomes by combining patient-generated and clinically-generated data in order to close the ineffective feedback loop between doctors and patients.

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The increased push for value-based care has also put more emphasis on patient outcomes. Medicare and Medicaid have programs in place to incentivize healthcare outcomes, including hospital penalties for patients readmitted within 30 days of certain procedures. In addition, 2% of total hospital reimbursement is tied to quality

and resource-use metrics. Consequently, spending tied to value and outcomes-based incentives is expected to increase from $2 trillion in 2016 to $5 trillion by 2020.

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SOLUTION Malcolm Ten envisions a healthcare system in which data generated by patients outside of clinical facilities can effectively be shared with clinical teams.

This proposal assumes that the systems, processes, and communication channels in place between clinical teams, insurance companies, and regulatory bodies remain static. By creating a new feedback loop, Malcolm Ten adds useful information into these existing systems.

↑SYSTEM DIAGRAM

↑INPUTS AND APPLICATIONS

Malcolm Ten is a flexible and modular platform. It hosts a set of shared services and capabilities that can be deployed across a range of user interfaces and specific clinical applications.

The platform is designed to support multiple data inputs in order to improve patient access by being available on any platform that the patient prefers. Additionally, because the core functionality for gathering and reporting PROs is similar between different clinical applications, Malcolm can start with orthopedics and expand from there to other applications.

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↑PATIENT APP UI Prototype of the patient's phone application.

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Caleb Dresser, MD

Suresh Mohan, MD

Sue Cullinane, MD

Rick Weinhaus, MD

Resident ER Physician, Beth Israel Deaconess

Resident Otolaryngology Surgery, Mass Eye & Ear

Internist, Massachusetts General Hospital

Opthamologist, Schepens Eye Research Institute

Larry Nathanson M.D.

Sean Tackett, MD/MPH

Julia Moore

Sunil Vasudevan

ER Physician, Director of Emergency Medicine Informatics, Beth Israel Deaconess

Assistant Professor, Johns Hopkins

Psychotherapist and Executive Coach

Senior Director of Finance, Suburban Hospital Johns Hopkins

Research ↑EXPERT PANEL

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The team interviewed a number of experts to glean several important insights.

For many of the doctors the team spoke to, the clinical workflow starts with, and is largely centered around, the Electronic Health Record (EHR) software. Some doctors make the intentional choice not to carry around tablets to their appointments, with the objective of maximizing face time with patients (Dresser).

There is, however, a large variance in doctors’ feedback based on their respective EHR systems (e.g., Epic, Cerner). Even advanced hospitals still utilize antiquated data-sharing systems. Some residents use something called “the list” (Mohan), which is an Excel Workbook for inter- and intra-departmental information exchange. On the other hand, in one particular emergency department, doctors loved their EHR software because it was built in-house and was constantly updated to meet their specific clinical and workflow needs. Patient data sharing between healthcare providers is evolving with the establishment of health information exchanges (HIE). For example, CRISP (Chesapeake Regional Information System for our Patients) is a regional HIE serving Maryland and the District of Columbia (Vasudevan). CRISP has been formally designated as Maryland's statewide health information exchange by the Maryland Health Care Commission.

Designer, IDEO

Arthur Kleinman Professor of Medical Anthropology and Psychiatry, Harvard University

HEALTH SYSTEMS

Prat Ganapathy

Every hospital is required by the Center for Medicare & Medicaid (CMS) to measure performance on patient-satisfaction surveys as part of a system called Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) (Centers for Medicare and Medicaid Services). The results of these surveys are not generally held in high regard by clinical staff, and even the most successful hospitals are only able to get a 30% response rate (Vasudevan).

The majority of hospitals use a company called Press Ganey to administer and analyze surveys, which are physically mailed to patients.

Demographics play a very large role in the measurement of patient outcomes. Socioeconomic status is strongly tied to issues of care plan adherence, health literacy, access to technology, and more. These are important factors when designing a system that has to work in all patient and provider contexts.

Across nearly all the interviews, doctors and administrators saw a missed opportunity to more accurately gather, measure, and report patient-reported outcomes. This was combined with a healthy dose of caution about creating yet another tool that takes up the precious time of clinical staff.

Based on the interviews and further research, the team focused on Malcolm Ten for the following reasons: •

Data-based diagnosis isn’t a burning need. The interviews revealed that diagnosis is complex and subjective, and current software/artificial intelligence (e.g., IBM Watson) are far away from being actually helpful to clinical staff.

•

Patient-reported outcomes are important to providers. Interviewees repeatedly emphasized that doctors and nurses don’t really know how their patients are doing after they go home, and that this data is important to improve quality of care.

•

Patient survey response rates are abysmal. All hospitals survey their patients, but not only do a limited percent of patients respond, the making.

•

Patient demographics vary dramatically. Solutions should be accessible to everyone, including older and/or less digitally literate patients.

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resulting data is not very useful for decision-

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Process message to the phone number on record).

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For the purposes of demonstrating and testing the various Malcolm Ten interfaces, the team prototyped the solution using various tools such as Invision (application interfaces), Twilio Studio (SMS chatbot), and Storyline (Alexa skill). These prototypes evolved through the iterative design process described above and incorporated a wide range of stakeholder input and design feedback.

From a technical perspective, the Malcolm Ten platform will comprise of a shared back-end service as well as several front-end interfaces. These will be compliant with standards such as Health Insurance Portability and Accountability Act of 1996 (HIPAA) in order to safely handle patient data. The back-end will be built on Amazon Web Services and other commonly-available, scalable services. This system will support deep integrations with Electronic Medical Record (EMR) systems so that data can be shared appropriately. For example, patient profile information would be read from the EMR in order to display it in Malcolm Ten and take actions (e.g., send a text

Malcolm Ten offers a range of front-end interfaces for users to interact with. Clinical teams rely heavily on desktop computers, so the Malcolm Ten platform for them will primarily be web-based with support for tablets. Additionally, the goal for Malcolm Ten is to be ubiquitous in the patient’s life. This means supporting both iOS and Android mobile platforms, but also offering SMS-based conversational input as a fallback if patients don’t (or can’t) set up the mobile app, and utilizing Amazon Alexa and Google Home voice chatbots to make Malcolm Ten a comfortable and natural part of patients’ homes. Future expansion of the platform includes integrations with connected devices, such as continuous glucose monitors and smart home sensors.

Implementation

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Results

Malcolm Ten’s business model will include charging hospitals per active patient per month, which is a standard model in healthcare, inspired by disease management services such as Livongo (Japsen). This platform will be offered as a cloud-based softwareas-a-service product that integrates with existing EMRs, requiring minimal ongoing operational support.

Patients use the product for free and are encouraged to do so by their clinical team. ↑DESIGN PROCESS Over the course of the semester, the team followed a process that involved extensive primary and secondary research, and ultimately, product prototypes.

There are other business models that were considered, including shared value models (e.g., charging a percentage of hospitals’ savings) or charging insurance companies, who could then require providers to deploy the system. These may merit further exploration but would likely be even more complex to implement.

There are no competitors in the market that offer the type of solution the team has designed. However, nearly every hospital has a hacked-together version of patient-outcome reporting (typically including nurses that call patients on the phone). To encourage adoption, the team would need to justify investment and change management costs for replacing current systems with Malcolm Ten.

Impact

For the Malcolm Ten platform to be successful, it needs to engage a range of stakeholders. In the context of orthopedic surgery, these stakeholders include:

MALCOLM TEN

The team selected orthopedics, specifically knee replacement and hip replacement surgeries, for early prototypes since the procedures are common, with almost a million procedures performed in the U.S. annually (Berry). There are also well researched and documented clinical pathways for tracking and measuring subjective and objective outcomes. The platform can easily be applied to other procedures and disease states, such as tracking outcomes after a heart attack or after a facial reanimation surgery.

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•

PATIENTS: Patients are at the center of the solution.

Without their engagement, the system has no data.

•

CARETAKERS: Loved ones such as friends and family are important in helping the patient feel supported and encouraged in following a care plan.

•

SURGEONS: Surgeons are invested in patient outcomes, and should be included appropriately to make clinical decisions.

•

NURSES: A range of other clinical staff interact with patients, provide basic care, and manage the process.

•

PHYSICAL THERAPISTS: Patients form deep relationships with their physical therapists, often seeing them for months after a procedure. These individuals also gather data about the patient’s outcomes and may escalate matters to the clinical team as needed.

•

Hospital administrators. Hospitals care about their bottom line, and patient-reported outcomes affect costs and revenues in a variety of important ways, including legal exposure and growing patient volume.

Ultimately, Malcolm Ten offers a significant opportunity to combine patient-generated and clinically-generated data to improve patient outcomes and engagement. Based on a semester of research, interviews, prototyping, and iteration, the team has landed on a solution that could feasibly address this opportunity and provide value to a range of stakeholders. Malcolm Ten imagines a world in which clinical teams actually know how their patients are doing and use this data to provide improved, more preventative care.

References 1. Charles, Dustin et al, “Adoption of electronic health record systems among U.S. non-federal acute care hospitals: 2008-2014,” Office of the National Coordinator for Health Information Technology, April 2015, https://www.healthit.gov/sites/default/files/data-brief/2014HospitalAdoptionDataBrief.pdf 2. Vasudevan, Sunil, telephonic interview, Senior Director of Finance Suburban Hospital Johns Hopkins, February 22, 2018.

3. Centers for Disease Control and Prevention, “National Ambulatory Medical Care Survey: 2015 State and National Summary Tables, tables 1, 11, 16”, https://www.cdc.gov/nchs/fastats/physician-visits.htm 4. Dresser, Caleb, telephonic interview, Resident ER Physician, Beth Israel Deaconess, March 10, 2018.

5. Mohan, Suresh, telephonic interview, Resident Otolaryngology Surgery, Mass Eye and Ear, March 18, 2018.

6. Centers for Medicare and Medicaid Services, “HCAHPS Fact Sheet’, https://www.cms.gov/Medicare/QualityInitiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalHCAHPS.html 7. Berry, Daniel J., MD, The American Joint Replacement Registry (AJRR), “AJRR-2017-Annual-Report---Final’, http://www.ajrr.net/images/annual_reports/AJRR-2017-Annual-Report---Final.pdf

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8. Centers for Medicare & Medicaid, “Hospital_VBPurchasing_Fact_Sheet_ICN907664.pdf, https://www.cms.gov/ Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/Value-Based-Programs. html 9. Japsen, Bruce. “Livongo Raises $105M As Mobile Diabetes Monitoring Takes Off,” Forbes, April 11th, 2017, https://www.forbes.com/sites/brucejapsen/2018/04/11/livongo-raises-105m-as-mobile-diabetes-monitoringtakes-off/#69527b9f6c13

This project was fun to work on and was a great learning experience on multiple levels The topic itself is complex and an unmet need in today’s healthcare system. It was intellectually stimulating to discover this need and dig further into understanding its dynamics and nuances. These issues spanned a range of topics, including medicine, policy, business, behavioral science, and technology. The interplay between these different topics kept us on our toes. In understanding how hospitals track patient satisfaction, it became clear over several months that the status quo is driven by a range of interdependent forces, such as the business needs of hospitals, the policies in place from CMS, and the organizational structure of hospital administrations.

We derived quite a bit of value from conducting expert interviews, including frank assessments of surgeons’ motivations, as well as encouragement that we were generally on the

right path. Along the way, we met incredibly interesting and insightful individuals, such as an emergency room doctor that moonlights as a programmer and a Harvard professor that thinks about the quality of care from clinical, ethical, and anthropological perspectives.

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Team Reflections

Within our team, we encountered a smooth co-working process. We discovered that because we were only a team of two, we were able to make decisions quickly and efficiently, and execute more collaboratively than perhaps if our team was larger.

In-person brainstorming and collaborative working time was essential for our team. It felt like the most productive times were when we were both together and working on solving specific product challenges and putting together presentation materials. Some amount of work was done individually, but we always came together to form a cohesive whole during our multi-hour meetings.

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U2

MOMENT Focus training through a multi-sensory chair experience Moment is a multi-sensory chair aimed to help individuals with Attention-Deficit/ Hyperactivity Disorder (ADHD) develop their ability to focus. Inspired by research showing that individuals with ADHD have a lower ratio of beta-to-theta brainwave activity when compared to the general population, the Moment chair targets this disparity and creates both a physical space and a digital interface to improve an individual’s ability to focus. When a user engages with Moment, an array of sensory stimuli are activated, allowing for beta-to-theta brain activity to be affected. With meditative breath-rate visualization, scent, light, and sound, the Moment chair offers an oasis from distraction and a ritual to train your mind.

Nicki Adler, Saad Rajan, and Kiran Wattamwar

↓AN OASIS FOR FOCUS Moment is a multi-sensory chair designed for a holistic therapy experience for anyone along the attention spectrum. The system is thoughtfully designed to consider ergonomics, cognitive states, multiple sensory inputs, and lifestyles to create a ritual of focus.

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Problem Moment is a multi-sensory chair aimed at helping individuals improve focus, as based on neural activity models of populations with Attention-Deficit/Hyperactivity Disorder (ADHD). Research indicates that individuals with ADHD have a lower beta-to-theta brainwave activity ratio compared to the general population during periods of intense focus. Based on this cluster of studies, the Moment chair hypothesizes that inducing brain activity to match the general population’s will improve an individual's ability to focus.

In a world of incessant notifications, infinite access to information, and addictive media baked into daily life, society's collective ability to concentrate is eroding. These phenomena, combined with pressure to boost cognitive performance, have led to record use of addictive stimulant drugs like Adderall and Ritalin. Moment counteracts the distraction and distress of modern times as a drug-free method of boosting performance and concentration.

It ultimately seeks to help society control its reactions to everincreasing stimuli. The design concept aims to help users focus on the moments, projects, and relationships that are most important.

Solution Environmental factors measurably impact one's well-being. By reversing the paradigm and calibrating the environment, there are ways to reclaim control over one's well-being. Inspired by global meditation practices and mindfulness rituals, and informed by measured focus patterns in the brain, the Moment chair provides an oasis from a busy day.

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It is also possible to modulate brain activity (specifically, the beta-to-theta ratio) by presenting sensory signals to the user at specific target frequencies. Combining these key insights, the Moment chair utilizes an array of sensory stimuli to induce brain activity and includes neural sensors to measure that activity.

With a series of aurally prompted breathing exercises, alongside a meditative breath-rate visualization, scent, and light, the Moment chair is a rich sensory experience and a training ground for improving focus. By shaping the chair with smooth curves, minimally intrusive technology, and the feel of a protective shell, Moment is both a sanctuary and a productive environment to affect one’s state of mind.

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12:00pm

8’ individual scale (isolation)

3:00pm

WEST 9:00am

40 components

zone use by natural light paths

EAST

SUNPATH STUDY 6:00 7:00 8:00 9:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00 20:00 21:00 22:00 ADD/ADHD Meditation Concentration Sun peak focus, concentration lull

focus transition

focus transition

peak focus habitual

↑SCHEDULE (BELOW)

As a device that can easily fit in one's office or home, the use of natural light can directly affect concentration or meditation levels. This study analyzes the impact of light throughout the day.

The beta and theta waves of people with ADHD vary throughout the day at a different rate than normal rates. Theta waves are associated with daydreaming, and beta waves are associated with focus. Moment facilitates intervention points to promote momentum and enervation in daytime focus activities, or "calm-ment" at night to help wind down the day.

MOMENT

↑SUNPATH STUDY (ABOVE)

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↓BIOMETRIC CALIBRATION

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The user’s breathing rate and brain activity together determine the breath-rate activity, where targets are adjusted and the visualization updates in real time. To accompany changing brain activity and breath-rate targets, sensory elements like sound, scents, and light are activated at certain frequencies. The technical diagram below shows the integrated feedback mechanism for biometric calibration.

Moment collects user data during the programmed exercises to measure how the programming is affecting brain activity in real time, and adjusts the activity (for example, target breath rate) accordingly. The feedback loop allows for each session to be individually tailored for each Moment experience. Despite its technical foundation, the Moment chair abstracts the technology, allowing for an organic user experience.

From the anatomical curves to the raw wood, Moment is designed to immerse, relax, and captivate. The sensory elements of the chair (light, aromatherapy, sound, and visual cues) are informed by research on their impacts on state of mind, but also by time-tested cultural traditions. Most importantly, Moment is centered on a user’s individuality, adjusting its programming for unique brain activity profiles, routines, and functions, all available as a daily ritual.

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↑CNC-MILLED CHAIR The physical body of the Moment chair is the composite of several 2-dimensional cuts of wood made by a CNC mill. Assembled together, the Moment chair’s contours represent a wave with smooth lines that mimic the sensory elements and breathing task integrated inside it. Aside from the physical body, the chair also features an embedded projector and a smooth surface covering the interior of the hood, which is where the breath-rate activity is projected within the chair. Inside the head cushion rests the body of a brain activity monitor, and additional components that users can attach to their temples to get a reading of their brain activity, while a detached FLIR camera captures their breath rate by monitoring temperature changes near the users’ nose or mouth.

References 1. Journal of Attention Disorders, “A Decade of EEG Theta/Beta Ratio Research in ADHD”; American Psychiatric Association.

2. Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD 2017) 3. Pereira, Carina Barbosa et al. “Remote monitoring of breathing dynamics using infrared thermography” Biomedical optics express vol. 6,11 4378-94. 16 Oct. 2015, doi:10.1364/ BOE.6.004378 4. Procházka, Aleš et al. “Microsoft Kinect Visual and Depth Sensors for Breathing and Heart Rate Analysis” Sensors (Basel, Switzerland) vol. 16,7 996. 28 Jun. 2016, doi:10.3390/ s16070996 5. Mott, M. S., Robinson, et al. (2012). Illuminating the Effects of Dynamic Lighting on Student Learning.

6. Nature, Dellacherie, D., et al. (2017). “Children and adults with Attention-Deficit/ Hyperactivity Disorder cannot move to the beat.”

7. Sowndhararajan, K., et al. (2016). “Influence of Fragrances on Human Psychophysiological Activity: With Special Reference to Human Electroencephalographic Response.” Scientia Pharmaceutica 8. NCBI, Moore, A., Gruber, et al. (2012). “Regular, brief mindfulness meditation practice improves electrophysiological markers of attentional control”; 9. Desai, R., et al. (2015). “Effects of yoga on brain waves and structural activation: A review.

Complementary Therapies in Clinical Practice” 10. Australian Journal of Educational & Developmental Psychology “Biofeedback and Children with ADHD”; 11. New York Academy of Science, “Alternative treatments for adults with attention-deficit hyperactivity disorder”

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U3

SYNCSENSE Motion-sickness mitigation for air travelers From ships rolling in the high seas to rocket-boosted sleds running at 632 mph, humans have been experiencing extreme dynamic motion for eons.

Under these conditions, people are susceptible to motion sickness due to sensory conflict between what they are seeing (controlled by the ocular system) and the forces they are experiencing (controlled by the proprioceptive and vestibular systems). Syncsense is a motion sickness mitigation system designed to be implemented on commercial airplanes. The intervention is a multi-step process that rescues the user from nausea by disrupting the brain's emetic response and then provides relief by uniting the ocular and vestibular senses. Syncense is based on mapping the coordinates of the passenger and projecting a corresponding horizon line, which can be displayed on a deployable screen or through virtual reality glasses offered to passengers.

Erin McLean, Arjun Menon, and Carla Saad

SYNCSENSE

↑SYNCSENSE PROTOTYPE Unity was used to develop a VR virtual horizon line application that orients based on a personal smartphone gyroscope, with the horizon line constantly mapping to personal motion.

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Problem Scientists have long identified that people experience motion sickness when one’s visual input contradicts inner ear input, or in other words, when what we see is in conflict with what we feel. The sensory conflict theory hypothesizes that motion sickness is experienced from an asynchrony in what the vestibular (inner ear) and ocular (vision) systems experience. In more technical terms, sensed rotation from inner-ear semi-circular canals and sensed acceleration from the otolith organs are combined with visual input from the proprioception/ somatosensory system to develop a sense of spatial orientation and self-motion perception (Oman). When unbalanced, acute motion sickness can cause nausea symptoms ranging from skin flushing, cold sweating, drowsiness, dizziness, and vomiting.

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With the advent of future high-speed mobility modes such as the Hyperloop, many have raised questions such as whether human bodies can even handle the force of that speed of travel without excessive

nausea (Akpan, Patel). As such, adapting for motion sickness is an increasingly important challenge for the future of mobility.

It’s estimated that approximately 28% of plane travelers, 20% of bus and train travelers, and 39% of car travelers are affected by motion sickness (Lentz et al). Between these modes of U.S. transportation, over 178 million trips in the United States are impacted by motion sickness. As increased workforce and connectivity trends create a class of frequent flyers, commercial air travel can be especially taxing. The average trip length in the United States is 1,470 miles (e.g. a 3.5 hour flight from Dallas to New York), and planes cannot stop for motion sick passengers, unlike rides in private cars or buses. Current interventions are limited, ranging from the consumer drug Dramamine to the extremely capital-intensive g-force simulator used by NASA to train astronauts. For the majority of commercial travelers, relief only comes from time and increased exposure.

Syncsense harnesses a personal smartphone gyroscope sensor to map personal motion to a virtual horizon line.

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→ VIRTUAL HORIZON LINE

↓ DEPLOYABLE SCREEN A smart, foldable design for the screen allows for space-efficient storage when not in use.

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Solution

↑ RESCUE FROM NAUSEA Putting pressure on the P6 acupressure point (median line of the underside of the wrist) is shown to reduce the feeling of nausea in up to 60% of patients.

↑ RELIEF OF SYMPTOMS Having visual input that confirms the motion one is feeling will help prevent motion sickness from onsetting again.

↑ RELAX IN FLIGHT

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Continue reading or watching a movie on the immersive contoured screens while the horizon passes in the background.

To rescue travelers from nausea and provide relief from its symptoms, Syncsense creates an intervention that mitigates the effects of motion sickness for travelers by disrupting and distracting the emetic response and uniting the senses within the same dynamic system. The solution prototypes both a higher fidelity intervention for first class/business travelers, which includes a deployable immersive wellness environment, as well as a lower-cost, on-demand intervention kit for economy travelers.

Rescue: Acupressure, specifically on the P6 pressure point (located between two wrist tendons, three finger widths from crease), has been found to reduce the symptoms of nausea (Stern et al). Syncsense uses an embedded sensor in the acupressure applicator to measure skin temperature, heart rate, and blood pressure. Detected abnormalities can provoke the acupressure applicator to apply pressure at the P6 pressure point, decreasing motion sickness symptoms and the gastric activity that typically accompanies it.

Relief: Sensory conflict resolution and motion sickness reduction is aided by a visual information system that is in agreement with information from the vestibular and other sensory receptors (Schmäl). Syncsense develops an immersive wellness system focused on forward-looking gaze (to avoid uncorrelated visual information from sideways or backwards glances). At the higher fidelity tier, Syncsense offers a deployable screen that displays a virtual horizon line as designed for business class flights on commercial planes. The horizon-line app uses a personal smartphone gyroscope sensor to constantly map the display to personal motion, aiding in visual and vestibular synchrony.

At the lower fidelity tier, this same virtual horizon line display can be made available cheaply via VR goggles (such as Google’s Cardboard) and given to passengers feeling motion sick as part of an airsickness recovery kit onboard commercial flights.

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↑ BUSINESS CLASS The higher fidelity offering includes a deployable screen designed for business class flights. A virtual horizon app is projected on the curved surface to aid in motion sickness abatement as well as entertainment options.

→ COMMERCIAL CLASS A lower fidelity version of this same virtual horizon app can be offered to commercial passengers in the form of a virtual reality app as part of an onboard airsickness recovery kit.

References 1. Akpan, Nsikan. Can our bodies handle the hyperloop? How to make G-forces from a 1,000-kph tube ride “Vomit free.” Scientific American.

May 13, 2016. https://www.scientificamerican.com/article/can-ourbodies-handle-the-hyperloop/

3. Oman, Charles M. “Brainstem processing of vestibular sensory exafference: implications for motion sickness etiology.” Exp Brain Res (2014) 232:2483-2492. DOI 10.1007/s00221-014-3973-2.

5. Lentz, Michael and William E. Collins. “Three studies of motion sickness susceptibility.” Department of Transportation, Federal Aviation Administration, Office of Aviation Medicine, 1976. Available at https://www.faa.gov/data_research/research/med_humanfacs/ oamtechreports/1970s/media/am76-14.pdf 6. Stern, R. M. and M. D. Jokerst, E. R. Muth, C. Hollis. Acupressure relieves the symptoms of motion sickness and reduces abnormal gastric activity. Altern Ther Health Med. 2001 Jul-Aug; 7(4): 91–94.

SYNCSENSE

2. Patel, Neel V. “The problem with Elon Musk’s Hyperloop Plans no one wants to talk about: Vomit.” Inverse. April 26, 2016. https://www. inverse.com/article/14643-the-problem-with-elon-musk-s-hyperloopplans-no-one-wants-to-talk-about-vomit

4. Schmäl, F., and W. Stoll. “Neuronal Mechanisms and Treatment of Motion Sickness.” Antiemetic Therapy, 2003, pp. 98–112., doi:10.1159/000071412.

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U4

MOBILIZE A concealable exosuit for improving walking efficiency Mobilize is a comfortable, concealable, and affordable exosuit for increasing muscle efficiency and decreasing joint pain while walking. While walking is already an extremely efficient process handled by the human body, muscle movements can still be used to activate external systems like passive exoskeletons to make walking even more efficient.

Using auxetic springs that work to complement muscle movement, the Mobilize exosuit uses a tensile structure to support walking. In parallel, the suit uses rigid structural elements to support joints, providing structure and compression. Together, these elements assist with muscle movement and joint pain, two major pain points for arthritis patients. An affordable, discrete, wearable device can improve mobility for a wide range of people who do not want their mobility constraints to be visible to others through the use of canes or walkers.

Mobilize lets users take dignity and strength in their strides.

Jeronimo Beccar, Arjun Menon, and Kiran Wattamwar

↲ STRIDE SUPPORT Since energy use is not distributed evenly during the walk cycle, Mobilize assists its users by harnessing excess energy that is lost in certain parts of a stride and redirecting it towards more strained parts.

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More than 50 million adults have already been diagnosed with some form of arthritis within the U.S. (Arthritis Foundation). Walking is an essential part of mobility for members of aging America, but even the simplest of actions become painful and difficult for those with arthritis.

↲ EXPLORATION PROCESS The core of this project rests on its materiality – from comfort to effectiveness, the success of a wearable exosuit meant for the masses depends entirely on its attention to detail in choosing the right materials.

Relying on materials like tensile polymers, the team designed its own auxetic stretchy materials, shaped by the contours of the human leg and calf muscles, to function as a spring in the tensile mechanism. This was cast in silicon with a custom mold, as a first pass.

Because this section of the garment was meant to support and mimic human musculature and increase muscle efficiency, this auxetic spring was tested for tensile properties like shore hardness, and compared to what was recorded by other academic research focused on muscle efficiency with passive systems.

HEALTH SYSTEMS

Problem

Many exosuits designed to reduce the load (and therefore strain) on a wearer have been in development, but they are made with rigid materials that are meant to be worn on the exterior of a person's clothes.

These are not easy to integrate into daily lifestyles with dignity, and are not seamless.

Exosuits currently on the market are primarily targeted towards defense and factory applications, with little focus on most of the population battling the consequences of arthritis. Other products currently address the needs of arthritis patients separately, without integrating them into a single system. Partial solutions like compression garments (usually designed for athletes), spring shoes, canes, pain medicines, and therapies for muscle development are difficult to weave into a single consumer product that performs well.

Usually, these needs are not combined into all-purpose systems that are truly integrated and effective in increasing muscle efficiency. Without a viable market solution to appeal to the mass market, sufferers of arthritis look to temporary relief solutions or drastic changes like surgeries and medication rather than seeking external aids that can continue to keep people mobile and active.

↲ MATERIAL CONSIDERATIONS The team investigated a collection of other materials, like stretchy fabrics, that could feasibly provide compression and comfort while withstanding daily wear, to construct the actual body of the suit.

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Ultimately, Spandex was the best and most familiar option to users, which could make the garment integrate better into a daily wear cycle. Stiffer and supportive foams like Dela Foam and polyurethane foams were sewn into supports for a connected knee-brace, ankle brace, and shoe sole, to offer more compression and structural support in these areas where joint pain is the most prominent.

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↑ FUTURE ITERATIONS

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After performing a topology optimization on where the rigid supports would best be placed, the team considered the construction of rigid structural elements made of carbon fiber, which would offer a lightweight and thin shell to the areas of the exosuit that need a fixed structure. Other methods, like printing tensile materials directly onto fabrics to incorporate gradients of rigidity in a more streamlined way, might offer this exosuit more fertile ground in consumer applications in the future.

Though the final suit was not realized in its intended form, the blueprints of the suit and its individual components offer promise that a wearable exosuit for arthritis patients is on the horizon.

The combination of a rigid support system and a tensile passive system can increase muscle efficiency, reduce joint pain, and promote better gait for patients with developing arthritis and decreased mobility. Mobilize aims to synthesize the benefits of orthotics, passive exosuits, and compression by focusing on soft, wearable materials. By using such materials, the Mobilize exosuit addresses its core design competency: the opportunity for concealment and daily use. Based on surveys with people with arthritis, it was evident that many people who could benefit from exo-suits do not consider them as options when choosing solutions to mitigate the effects of arthritis.

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Solution

Canes and walkers fall within the same category, because they are not concealed and reduce the user's dignity. With a strong focus on material, the Mobilize exosuit is stretchy in areas of expansion and rigid where the body does not compress or expand. This combination accommodates movement but provides compression along joints to reduce pain. Guided by research in academia, the tensile structure and clutch redistribute energy along the walk cycle to increase muscle efficiency. Finally, the Mobilize exosuit incorporates a multi-material injection molding of stiff and flexible polymers that is applied directly onto the garment’s base layer to increase comfort for users.

References 1. US Figure for 2017, by the Arthritis Foundation, 2017 Annual Report https://www.arthritis. org/Documents/Sections/About-Arthritis/arthritis-facts-stats-figures.pdf

3. https://doi.org/10.1016/j.paerosci.2013.07.001 4. Smardzewski, Jerzy & Kłos, Robert & Fabisiak, Beata. (2013). Design of small auxetic springs for furniture. Materials and Design. 51. 723–728. 10.1016/j.matdes.2013.04.075.

MOBILIZE

2. Kuder, Izabela & Arrieta, Andres & Raither, Wolfram & Ermanni, Paolo. (2013). Variable stiffness material and structural concepts for morphing applications. Progress in Aerospace Sciences. 63. 33–55. 10.1016/j.paerosci.2013.07.001.

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decision • tool • human-cenetered • location • platform • device • agent • interface • control • product • interaction

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FLEXFIT Socially connected physical activity for seniors Exercise is critical to health and well-being. However, many seniors struggle with finding motivation and managing the physical techniques for regular exercise. Limited communication between family members and healthcare professionals exacerbates this difficulty. The scale of this challenge is staggering; there are 46 million people in the U.S. over 65 years old, and 55-65% of adults over 75 years old are not physically active (Milanovic).

The proposed solution, Flexfit, is a digital platform that uses social support to assist the elderly with common health concerns, including physical activity, arthritis, and balance disorders. It is comprised of a patient device and a series of apps for elderly users, their families, and their therapists. The digital platform is paired with a physical device designed for the needs of seniors, incorporating an easily adaptable band and colored indicators to communicate warnings and show progress. The apps encourage progress, rewards, and sharing. Flexfit hosts an ecosystem of health devices, including the band's inductive charging box, additional sensors, resistance bands, and integrations with other health devices and apps.

Vivek HV, Saad Rajan, and Vish Srivastava

The product's final design focused on factors like ease of use, limited setup, simplicity, and learnability. With an inductive charger embedded in the wearable band's case, charging the product is almost an innate action. The band’s flexible screen display uses large and recognizable icons to communicate reminders (like hydrating, balance or strain warnings, and progress indicators) without requiring an additional interface. An additional senior-facing app includes a simple interface that makes navigating the app a streamlined process.

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↑ DESIGNING FOR SENIORS

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Problem With 55-65% of adults over 75 struggling to stay physically active, there are significant hurdles to improving the well-being of America’s older population. While exercise is a critical part of establishing good health and well-being, many seniors struggle with both finding the motivation to exercise and with practicing proper technique to avoid injury and strain. Motivational support within families could help alleviate this issue, but a lack of clear communication channels between family members and healthcare professionals hinders this.

Several issues affect America’s older population, ranging from broken bones to joint replacements, balance disorders, and memory disorders. Given the market size and potential for these conditions, Flexfit is particularly designed for seniors suffering from arthritis, those seeking general physical activity, and those with balance disorders as its initial target population.

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Solution Flexfit offers a holistic solution to bridge the gap in communication between physicians, seniors, and their families. The intervention provides an ecosystem of apps, connecting all of these groups in a single place.

The apps are accompanied by a wearable patient device that can be used to indicate progress and sense strain or potentially dangerous form to prevent injury. On the patient-facing app, physical activity progress is gamified and can be shared with others.

By building a community to share in critical health information, Flexfit constructs a supportive climate for families to engage on exercise and health habits. This solution targets the problem in two ways: preventative care and reactive care. Through preventative care, targeted exercises build seniors’ strength and find early indications of pain in joints, especially focusing on wrists, elbows, knees, and ankles. Through reactive care, targeted exercises improve seniors’ strength, endurance, and flexibility to reduce arthritis progression in affected joints. By leveraging health information directly from physicians, Flexfit is able to directly engage with elderly patients’ needs and incentivize a persistent support network that fosters motivation.

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↑DESIGN FOR MULTIPLE SCALES At the human scale with the wearable band, the embedded exercise tracker can track personal data to measure progress for both the user and their physicians. At the family scale, the system engages family relationships to establish an enduring network to sustain motivation. Finally, at the community scale, Flexfit integrates with key stakeholders like physicians and other health and fitness related apps to extend the use of this data to its maximum value for the user.

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Flexfit’s business model incorporates multiple channels, including single-time retail purchases as well as an ongoing service reimbursable by insurance via clinic channels. The retail strategy for Flexfit might include selling directly to consumers (targeting senior customers or their families) or alternatively, selling

to hospitals as a clinical tool to moderate arthritis and balance disorders. Given the rich product ecosystem of senior health data that can be integrated into Flexfit, the product has room to expand and support a variety of additional senior health applications.

HEALTH SYSTEMS

References

FLEXFIT

1. Milanović, Z., Pantelić, S., Trajković, N., Sporiš, G., Kostić, R., & James, N. "Age-related decrease in physical activity and functional fitness among elderly men and women." Clinical interventions in aging (2013): 549-56. https://www.ncbi.nlm.nih. gov/pmc/articles/PMC3665513/

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ANOPHELINE VECTORS decision • tool • human-cenetered human-muscle-motion, • location • platform mind-physical-social-identity-emotion-sensory-personal-own-intimate • device • agent • interface • control • product • interaction

U6

Visualizing environmental change with longitudinal disease vectors As common vectors (transmitters) of malaria and other diseases, anopheles mosquitoes are susceptible to temperature and other climatic changes in their local habitats. Research on anopheles vectors (movements of these disease carriers) has produced many conflicting claims regarding the correlation between vectorborne epidemiology and environmental changes.

This project visualizes the movements of anopheline mosquitoes as they travel throughout Sub-Saharan Africa. A century of geographic data was aggregated and binned into hexagons overlaid with ovoid markers conveying the direction and magnitude of anopheline migration. The tool overlays geospatial anopheline vector data with epidemiological statistics and changes in the natural and built environment, allowing researchers to identify correlations.

CENTROID INDEX

VECTOR

CENTERPOINT

CELL

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HEX BIN

Saif Haobsh

← HEX-BINNING This visualization uses a technique known as hex-binning, which aggregates dense information into hexagons. This allows for complex, multidimensional information to be visualized through simple geometry.

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comprehensive

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life

CITIZEN How do I participate in governance?

As citizens, we are woven into the fabric of our communities. These communities might be geographic zones, neighborhoods, or even political jurisdictions. As individual units in these large human systems, we are subject to forces that we, as individuals, cannot control. Instead, we must act with a will that is fortified by a community. These projects unravel and explore the various actors that affect our collective governance and the role of the individual within them.

C₁

NODE

Reimagining emergency response for resilient cities

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CHÚ

Breathe fresh air everywhere

HEALTHCARE: SPENDING VS. OUTCOMES C₃

Evaluating the effectiveness of Medicare and Medicaid spending on health outcomes

ABL ACC ACT AIM ALW ART BNF BSE CLN CMM CMP CPH CRE CRR CRT CTC CTY CTY DAT DCN DRC DSN DSS DTH DTL DTR DVC EXP EXR FCS FML GEN GTH GVN HLC HLT HMN HPP HSP ICP IMP IMR INC IND INF LCT LEV LNG LVE LYR MLL OTC PHY PLL PLT PPL PPU PRC PRJ PRS PRT PRV PSR PTN RSR RTE SCL SLP SMP SNS SPN SPP STT SYS TME TRK TRM TRT UND USR UTL VIS VSN WRL YER

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world • fund • tackle • active • government • country • developing • agency • social structure • community • regional • contribution

C1

NODE Reimagining emergency response for resilient cities Natural disasters and other large-scale emergencies are impacting city-dwellers more than ever. From Hurricane Harvey to Irma to Maria, cities are not equipped to deal with the scale of disaster response required by recent 21st century storms. When official services like local police and FEMA (the U.S. Federal Emergency Management Agency) are overwhelmed, civilians rely on neighbors and spontaneously organized groups like the “Cajun Navy,” which consists entirely of volunteer dispatchers and boat rescuers (Graham, Markowitz, Wallace-Wells).

When these situations arise, official 911 emergency operation centers (EOCs) play a critical role in communicating and coordinating relief efforts and medical assistance. Despite this, EOCs rely on aging infrastructure built in the 1960s, a world with landlines, printed manuals, and radio frequency communication, but without mobile phones, cloud databases, or Internet Protocol-based communication.

Humberto Ceballos, Jenny Fan, and Carla Saad

MDE VOLUME 1

ABSTRACT Reliable emergency response is an important part of community health. With inspiration from well-documented phenomena of emergent cooperation during disasters, Node is a smart, comprehensive, emergency response system built on resilient wireless routers and community engagement to reimagine the future of urban disaster preparedness. A distress call app transmits relevant data about a caller's location, medical history, and urgency. An AI agent triages for first responders or nearby volunteers, depending on system load. In cases of extreme infrastructure damage, users can also connect to the LoRaWAN-based, wireless, mesh network nodes for backup connectivity.

Node is a dual-mode emergency communications system that can help cities become more resilient, supporting the day-to-day stresses of urban life as well as handling extreme disaster situations gracefully.

PROBLEM

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As the world becomes increasingly urbanized, cities are increasingly vulnerable to natural and man-made disasters on an unprecedented scale. In 2017 alone, the U.S. suffered $306 billion in economic losses from natural disasters (SwissRe). Damages from disasters are amplified by failure to deliver time-sensitive aid due to antiquated emergency response systems. During Hurricane Harvey, 911 call centers experienced a 900% surge in the peak daily call volume, going from 8,000 calls to 80,000 calls within a 24-hour period (Kelly, Silverman).

While 911 currently handles 240 million calls a year, much of its technological foundation still relies on technologies from the 1960s, the heyday of the Bell telephony system, and is subsequently poorly equipped to handle modern disaster relief efforts (NENA). Given resource constraints, it would only take a few callers to overwhelm a region’s emergency operation centers (EOCs), even in normal times (Kelly). Public safety announcements have been successful in training people to use 911 services, but many people now falsely believe that dispatchers can always locate the caller, even during silent or distressed calls. In fact, the system is only designed to locate calls placed over landlines, even though

HEALTH SYSTEMS

80% of calls now come from mobile devices (Public Safety and Homeland Security). Consequently, most calls have inaccurate location data, sometimes with deadly impacts. The FCC estimates that approximately 10,000 lives could be saved from improved location identification.

The U.S. already spends approximately $17 billion a year maintaining outdated 911 infrastructure, and states have routinely siphoned budgets for other projects (Migdail-Smith). In addition, while the federal government has funded some infrastructural updates through Next Generation 911 (NG911), the amount has been just $3MM per state spread over 15 years. These funding constraints, combined with technological issues and increased demand, leave the candle burning at both ends for public safety departments: local governments are left to absorb the rising costs of 911 obsolescence while the number of vulnerable citizens they must cover increases (Fontes).

↑OUTDATED 911 TECH

NODE

Existing 911 infrastructure is outdated. Over 240 million 911 calls are made each year (NENA), all reliant on a voice connection with less data than was originally transmitted through the first trans-Atlantic cable in 1858.

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↑ SYSTEMIC SOLUTION The Node system includes not only the mesh network hotspots (using LoRaWAN), but also the emergency response platform that users and first responders can connect to in times of normalcy as well as during disasters with damaged infrastructure.

SOLUTION Node reimagines an emergency response application that enables cities to adapt and respond more effectively to disasters by harnessing the power of technology and community.

Designing for Community Engagement A healthy emergency response system requires careful communication and coordination between the civilians in distress, dispatchers coordinating rescue response, and the emergency responders themselves.

In extreme cases where bottlenecks begin to form amidst the dispatchers or responders, opportunities emerge for volunteers to step in and fill the gaps (Carafano, Graham, Hartman, Whittaker).

Designing with Resilient Technologies

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Mesh networks use routers linked to other nodes on the network rather than linking to a single source like a cellular tower (star network). Even if one node goes down, packets can be rerouted through other users in the network. Communication can continue, even if outside internet connection is severed (Manoj).

LoRaWAN (Long-Range Wide Area Network) is a type of low-bandwidth radiofrequency protocol that can send emergency data like GPS coordinates, unique user IDs, and time stamps. As long as the text-based data is passed between the end user and the emergency operation center, responders can pinpoint calls for help with a database of user information (New America, Osborne, Chandra-Sekaran, LoRa Alliance).

It takes state and national responders over 72 hours to respond, even during the most devastating disasters.

During this time, the community must step in to fill the gap. Node recruits and onboards volunteers who agree to help neighbors if local emergency services are overwhelmed. This would be an “opt out” system, where all registrants are automatically added, but with the option to remove themselves. For users with medical training, they can add their credentials to be marked as a Medical Volunteer.

HEALTH SYSTEMS

Community Responders

Data Safety Node’s mobile application allows users to opt-in to granting EOCs temporary access to their personal information, such as location (mobile GPS coordinates), medical history, emergency contacts, etc. This information is already requested by first responders but can be delayed or miscommunicated during crises.

↓ DUAL-MODE USE Node’s app responds to the underlying connectivity available. When local telecommunication towers are down, Node connects to the back-up wireless LoRaWAN network and gracefully degrades to a low-bandwidth version of the app.

Research shows that users in emergencies are willing to share personal information like addresses, even in public forums like Twitter, as long as they are helped.

Despite this, Node aims to proactively protect user privacy by allowing users to customize the default access level of information they are willing to share to EMTs and volunteers.

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Methodology Literature Review Key Insights 1. During natural disasters, vulnerable populations are disproportionately affected and must rely on local resources, city, and community, for support (Graham, Carafano).

2. Emergent disaster response forces are often at the local level, and face coordination and resource management challenges (Carafano, Markowitz, Wallace-Wells, Hartman, Salmon).

3. Technology-oriented solutions can improve clarity for disaster response but must be accompanied by a reliable network connection (Simon, Panagiotopoulos).

↳ HOTSPOT PROTOTYPE The design of the mesh network hotspots was inspired by the Disaster.Radio project, which used Low-Power Wide Area Networks (LPWAN) to create a back-up wireless infrastructure for extreme situations.

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The prototypes below use the Arduino ESP8266 board and a LoRaWAN transceiver.

They are placed in sturdy, weather-proof casing built from custom, CNC-milled steel. The board supports the low-bandwidth version of the app. With a multi-year battery life, the modules are economical and scalable, but future versions could incorporate solar panels to be more completely stand-alone.

4. Most of the nation’s 911 infrastructure is outdated and vulnerable. It can’t support extending location services to mobile or internet phones, can’t accommodate rich media (text, video, social networking, webbased calling), and is easy to knock offline due to its circuit-based routing system. When these centers are knocked offline, there is no automatic way to reroute calls to nearby centers (Kelly, Fontes).

5. International examples of 911 data privacy offer precedents for caller privacy protection in emergency situations (Barnes).

The team's study of rescue requests made during Hurricane Harvey helped detail the information flow of an emergency call through the 911 ecosystem. Given the severe flooding and high volume of calls, civilians who were unable to reach official channels also requested help through informal overflow channels including social media (Twitter, Facebook) and ad-hoc volunteerrescue organizations such as Team Rubicon, the Cajun Navy, and church groups.

↑ IN NORMAL TIMES The current emergency response system is designed around calling 911 and being passed through a dispatcher to an official responder (police, fire, or ambulatory services). When all local responders are busy, calls are redirected to neighboring centers or put on hold.

HEALTH SYSTEMS

Information Flow of a 911 Call

During natural disasters or unusually high call loads, all responders may be busy or calls may be unable to go through altogether. Victims may reach out to whatever avenues they can find – family and friends, neighbors, and increasingly, social media. While there is typically a cadre of willing volunteers available to assist, the process of matching and finding verified, legitimate, and active requests is very haphazard.

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Implementation Node App

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The high-fidelity version of the application prioritizes user experience, surfacing relevant emergency response action items in context. Upon opening the app, a user can 1) immediately make an urgent call (red button) to connect to a human operator, 2) make a non-urgent request (blue button) to an AI responder, or 3) search for emergency services via text or voice input.

↓ NODE APP (HI-FI)

Node Lite App

Features for the high-fidelity Node app include options to: – Pre-register personal medical data for rapid emergency assistance from responders.

– Share rich media to provide the most context and receive immediate advice.

– Opt-in to serve as a volunteer or medical specialist in extreme emergencies when official responders are overwhelmed.

The low-fidelity version of the app is designed for graceful degradation on slower-bandwidth internet connections, transmitting primarily text-based content (unique user ID, name, request, GPS coordinates, etc.) to emergency responders.

HEALTH SYSTEMS

↑ RESPONDER PLATFORM Platform features support 911 call centers by: – Integrating with existing workflows and computer-aided dispatch programs.

– Contextualizing user’s call with personal medical data.

– Supporting dispatchers with caller triage using an AI voice interface to filter out low-urgency calls.

↲ NODE LITE APP Features for the lo-fi version include: – Lite version of app for low-bandwidth connectivity situations – Access to verified volunteer responders when 911 is overloaded – A low-bandwidth platform to communicate with 911 dispatchers and nearby volunteers – Accurate user location linked to a user's mobile location

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User Persona 1. MEET ROBERT

2. ONBOARDING

3. URGENT DISASTER ON ITS WAY

4. DISASTER TURNS CATASTROPHIC

A hurricane is coming, but as an elderly man living alone without a car, Robert chooses not to evacuate and instead ride out the storm at home.

After days of heavy rain, the cell towers are knocked out just as the waters begin to enter Robert’s house.

Without signal to call 911, he connects to a Node wifi hotspot on his phone.

5. REQUESTING HELP

6. RESPONDER ASSISTANCE

Robert is an elderly man living alone in Nahant, a flood zone in Massachusetts. He manages chronic diabetes, but otherwise lives independently. He gave up driving 2 years ago.

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He requests help on the Node app, and his GPS coordinates are added to the map and seen by a dispatcher.

Robert downloaded Node on the insistence of his granddaughter, who heard about it from school. He signs up, adds his personal information, and tests the AI assistant feature with a non-urgent 311 question

He chats with a dispatcher, who explains that all official responders are busy but a volunteer near him can help get him out of his house.

As a platform business, Node has a two-sided customer base: at-risk civilians requesting help, and officials responding and offering help. To build this platform, the software (mobile app) would be distributed for free to civilians, prioritizing at-risk populations, such as the elderly, chronically ill, and handicapped individuals.

In addition, civilians living alone could benefit from having peace of mind during an oncoming storm. On the responder side, Node would offer EOCs an ongoing contract to use its response software and wireless hotspot network. To establish relationships for these contracts, the audience would not only be the EOCs themselves, but also a broader base of municipal public safety departments in at-risk cities, such as mayors, police chiefs, and Chief Resilience Officers uniquely appointed to find and fund projects such as Node.

↓ NODE COVERAGE Utilizing the city of Cambridge as a test bed, 18 Nodes create full coverage for first responders.

HEALTH SYSTEMS

Results

For the Node ecosystem to be well-utilized, communities must accept and buy into the system. To support future operation, Node can engage communities to build and maintain hotspots as part of a STEM education program. By inviting educators to participate and teach students how to produce the relatively easy-to-assemble wireless nodes and subsequently support their maintenance as digital stewards, Node can support an invaluable educational experience while increasing the importance of a distributed emergency response system to the community.

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References 1. SwissRe, “At USD 144 billion, global insured losses from disaster events in 2017 were the highest ever, sigma study says,” accessed March 12, 2018, http://swissre.com/media/news_releases/nr20180410_sigma_ global_insured_loses_highest_ever.html.

2. Kelly, Heather. “Harvey highlights issues of aging 911 tech”, CNN online, last modified September 1, 2017, http://money.cnn.com/2017/09/01/ technology/future/911-tech-harvey/index.html.

3. Silverman, Lauren. “Facebook, Twitter Replace 911 Calls For Stranded In Houston,” NPR, last modified August 28, 2017, https://www.npr.org/ sections/alltechconsidered/2017/08/28/546831780/texas-policeand-residents-turn-to-social-media-to-communicate-amid-harvey.

4. National Emergency Number Association (NENA), “911 Statistics National Emergency Number Association”, Nena.org, accessed March 12, 2018, https://www.nena.org/page/911Statistics.

5. Public Safety and Homeland Security, “Wireless E911 Location Accuracy Requirements,” FCC, last modified February 21, 2014, https:// www.fcc.gov/document/proposes-new-indoor-requirements-andrevisions-existing-e911-rules 6. Carafano, James and Jill Rhodes, “State and Regional Responses to Disasters: Solving the 72-Hour Problem,” The Heritage Foundation, last modified August 21, 2006, https://www.heritage.org/homelandsecurity/report/state-and-regional-responses-disasters-solving-the72-hour-problem 7. “Disaster Radio,” Github, accessed March 12, 2018, https://github.com/ sudomesh/disaster-radio 8. Migdail-Smith, Liam. “The rising cost of 9-1-1 emergency service,” Reading Eagle, March 29, 2015, http://www.readingeagle.com/news/ article/the-rising-cost-of-911-emergency-service 9. Fontes, Brian. “America’s 9-1-1 infrastructure is showing cracks, too,” The Hill, February 23, 2017, http://thehill.com/blogs/congress-blog/ technology/320743-americas-9-1-1-infrastructure-is-showing-crackstoo 10. Graham, David A. “Why Ordinary Citizens Are Acting as First Responders in Houston,” The Atlantic, August 28, 2017, https://www. theatlantic.com/politics/archive/2017/08/ordinary-citizens-are-firstresponders/538233/ 11. Markowitz, Miriam. “We’ll Deal with the Consequences Later: The Cajun Navy and the Vigilante Future of Disaster Relief,” GQ.com, December 7 2017, https://www.gq.com/story/cajun-navy-and-the-future-ofvigilante-disaster-relief 12. Wallace-Wells, Benjamin. “Why does America need the Cajun Navy?”, The New Yorker, August 31, 2017, https://www.newyorker.com/news/ news-desk/why-does-america-need-the-cajun-navy

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13. Hartman, Holly. “I downloaded an app. And suddenly, was part of the Cajun Navy”, Houston Chronicle, last modified December 22, 2017, https://www.chron.com/local/gray-matters/article/I-downloaded-anapp-And-suddenly-I-was-talking-12172506.php 14. “Regional Disaster Response Coordination to Support Health Outcomes: Summary of a Workshop Series,” Forum on Medical and Public Health Preparedness for Catastrophic Events; Board on Health Sciences Policy; Institute of Medicine, Washington (DC): National Academies Press (US); 4, Coordination of a Community Response, August 11, 2015, available from https://www.ncbi.nlm.nih.gov/books/ NBK311260/

15. Salmon, Paul and Neville Stanton, Dan Jenkins, Guy Walker, “Coordination during multi-agency emergency response: issues and solutions”, Disaster Prevention and Management: An International Journal, Vol. 20 Issue: 2 (2011), pp.140-158, https://doi. org/10.1108/0965356111112608 16. Whittaker, Josh and Blythe McLennan, John Handmer, “A review of informal volunteerism in emergencies and disasters: Definition, opportunities and challenges”, International Journal of Disaster Risk Reduction, Vol. 13 (Sept. 2015): pp. 358-368, https://www. sciencedirect.com/science/article/pii/S2212420915300388 17. Simon, Tomer and Avishay Goldberg, Bruria Adini, “Socializing in emergencies - a review of the use of social media in emergency situations,” International Journal of Information Management, Vol. 35 Issue 5 (Oct 2015), pp. 609-619, https://doi.org/10.1016/j. ijinfomgt.2015.07.001 18. Panagiotopoulos, Panos and Julie Barnett, Alinaghi Ziaee Bigdeli, Steven Sams, “Social media in emergency management: Twitter as a tool for communicating risks to the public,” Technological Forecasting and Social Change, Vol. 111 (Oct 2016), pp. 86-96, https://doi. org/10.1016/j.techfore.2016.06.010 19. Manoj, B.S. and Alexandra Hubenko Baker, “Challenges in using distributed wireless mesh networks in emergency response,” Communications of the ACM, Vol. 50 No. 3 (March 2007), https://www. researchgate.net/publication/228966616_Challenges_in_using_ distributed_wireless_mesh_networks_in_emergency_response 20. Jones, V.M. and G. Karagiannis, and S.M. Heemstra de Groot, “Support for Resilient Communications in Future Disaster Management,” Computer and Information Sciences II, pp.

355-359, September 29, 2011, https://link.springer.com/ chapter/10.1007/978-1-4471-2155-8_45 21. “Rise: NYC,” New America, accessed March 18, 2018, https://www. newamerica.org/resilient-communities/flexible-future-ready-networks/ rise-nyc/ 22. Osborne, Jeffrey and Joseph Giordano, and Gautam Khanna, “Smart Cities: The Path to a More Intelligent and Connected Future,” Cowen Equity Research, August 14, 2017, https://cowen.bluematrix.com/docs/ pdf/6d83c7b0-d9d1-4af4-bc86-4981470355dc.pdf 23. Joshi, Ashu. “A letter to OpenSensors on LoRaWAN vs. Zigbee,” Medium.com, July 24, 2016, https://medium.com/@ashujoshi/a-letterto-opensensors-on-lorawan-vs-zigbee-9ad65da677e6 24. Chandra-Sekaran, A.K. and A. Nwokafor, P. Johansson, K. D. MuellerGlaser and I. Krueger, “ZigBee Sensor Network for Patient Localization and Air Temperature Monitoring During Emergency Response to Crisis,” 2008 Second International Conference on Sensor Technologies and Applications (sensorcomm 2008), Cap Esterel, 2008, pp. 233-238, https://doi.org/10.1109/SENSORCOMM.2008.67 25. “LoRaWAN: What is it? A technical overview of LoRA® and LoRaWAN,” LoRa Alliance, November 2015, https://docs.wixstatic.com/ugd/eccc1a_ ed71ea1cd969417493c74e4a13c55685.pdf 26. Barnes, Richard and Brian Rosen, “How to Design 911 for the 21st century”, IEEE Spectrum, March 27, 2014, https://spectrum.ieee.org/ telecom/standards/how-to-design-911-for-the-21st-century

Working in the disaster management and crisis informatics space is at once humbling and overwhelming. Our team came together from our mutual interest and exposure to large-scale natural and man-made disasters, many occurring during our first year in MDE: Hurricane Harvey in Jenny’s hometown of Houston, the earthquake in Berto’s hometown of Mexico City, and the Syrian refugee crisis impacting Carla’s hometown in Lebanon. The sheer scale and complexity of managing and coping with these catastrophes represented the type of intractable, wicked problem that first attracted us to the Design Engineering program at Harvard.

Thus, with the spring studio's Health Systems topic, it was natural for us to focus on the space of emergency management.

The challenge of designing for extreme states is that it often requires extreme user behaviors: transparency beyond the comfort of daily privacy, altruism beyond the expectations of a stranger, and high-stakes efficiency beyond any ordinary decision-making we might do with the luxury of time. As we dove deeper into the subject area, we closely examined the fragility of current

rescue systems, not only technically and infrastructurally, but also culturally. Against a backdrop of huge, lumbering systems, we wondered: was there a way to leverage the well-demonstrated power of community response in disaster relief?

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Team Reflections

Our personal histories pushed us and made this project urgent, but it was the many encounters and touching interviews we had with survivors, volunteers, and researchers that made this project meaningful. They inspired us to frame the problem and propose a solution that included both the human touch and the power of community, along with cutting-edge, LoRaWAN, mesh network technology. As a result, Node is neither a black-box, neo-cybernetic urban-control system like other interventions in this space, nor an entirely lawless self-organizing system. It lies somewhere in-between, optimizing the resources of local governments, but anchored in the power of the community.

We hope that through this humble intervention, lives will be saved – because a healthy city is a helping city!

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C2

CHÚ Breathe fresh air everywhere Air pollution causes 16% of all deaths worldwide, or 9 million deaths annually, about half of which is attributed to indoor air pollution and half of which is attributed to outdoor air pollution (Landrigan et al. 2017). The most prolific product solution in large metropolitan areas is the common blue surgical mask, but these masks are unsealed and incapable of filtering out the majority of harmful particulates.

CHÚ is a simple and stylish solution to the global air pollution epidemic. The CHÚ device is designed to filter particulates from the air down to 0.3 μm, an order of magnitude finer than surgical masks seen in cities like Beijing and Delhi. CHÚ is comprised of two main parts — a pair of tusks and a filter. The air intake, located at the back of CHÚ, allows atmospheric air to enter into a series of tortuous-path filters and continue through the tusks directly into the nostrils. The filter contains a replaceable cartridge which can be “tuned” to various geographic locations based on local pollutant types and levels of particulates in the air. A silicone gel ring seals the perimeter space between each nostril and CHÚ, preventing unfiltered air from entering the nose during each breathing cycle.

Exhaled air is purged through one-way gill valves located near the tips of the tusks, just under the nostrils. The design of CHÚ maximizes the filtration of harmful air contaminants, but also takes fashion and ergonomics into consideration. When idle, CHÚ is draped around the neck as an accessory or adornment.

Anesta Iwan and Kate Spies

CHÚ

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Problem Air pollution can be broken down into two main categories: indoor air pollution, which includes cooking fires and indoor heating, and outdoor air pollution, which is the result of vehicles, industrial plants, construction, and more. Pollution disproportionately affects poor- and middle-income countries where regulations are loose and solutions are limited, as well as minorities and women who do the majority of cooking and construction. Diseases caused by air pollution include stroke, chronic obstructive pulmonary disease, asthma, pneumonia, and lung cancer, and are caused

→ ITERATIVE DESIGN PROCESS The CHÚ design process was iterative, with artifacts created at each step for critical critiques in both design and engineering.

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The tusks and filter evolved through four main phases: (1) form related to the structure of the human head, (2) material exploration to optimize flexibility while maintaining overall rigidity, (3) simplification of form and material application, and (4) filter development. Sizing and flexibility are key for CHÚ to fit properly on the head/face.

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by high levels of fine particulate matter and carbon monoxide released by the burning of solid fuels such as wood, coal, animal waste, crop debris, and charcoal in inefficient stoves, space heaters, or lamps (World Health Organization 2014). With the production of particulate pollutants growing, system-level strategies to address the problem are necessary at the population level. Addressing the issue of pollution risk at the individual scale, where interventions remain severely limited, provides an opportunity to reduce the risk of damaging particulates inhaled, improving daily quality of life as well as long-term health outcomes.

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↑ HOW CHÚ WORKS The air intake, located at the back of CHÚ, allows atmospheric air to enter into a series of torturous-path filters and continue through the tusks directly into the nostrils. Silicone gel rings seal the perimeter space between the nostril and CHÚ, preventing unfiltered air from entering the nose directly.

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Exhaled air exits the CHÚ nostril opening and purges through the one-way gill valves. The filter can be "tuned" to various geographic locations based on local pollutant types and levels.

Solution Looking at images out of Shanghai and Mumbai, the landscape is filled with blue surgical masks, which are ineffective and lack individual style. The team set out to design a pollution filtration device that a) protects the user from inhaling damaging particulates, and b) provides a fashionable accessory to the user, similar to the notion of sunglasses. CHÚ, as a pollution solution, was designed, fit, tested, and produced with a desire to impact a variety of users, from city-dwellers to motor-bike riders, the fashion-conscious, and anyone affected by air pollution. The business of CHÚ is based on a filter subscription model. The CHÚ device can be registered upon purchase, which allows the makers of CHÚ to curate the right filter for each unique experience. The user platform recommends when new filters should be ordered and provides travel packages geared toward specific destinations.

CHÚ then evolved from an original attempt at having filters reside within the nasal cavity to a modularized

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tusk/filter solution, where the filter serves as the connector between the two tusks.

The tusks and filter evolved through four main phases: (1) form related to the structure of the human head, (2) material exploration to optimize flexibility while maintaining overall rigidity, (3) simplification of form and material application, and (4) filter development.

Sizing and flexibility are key for CHÚ to fit properly on the head/face. The air intake, located at the back of the CHÚ, allows atmospheric air to enter into a series of tortuous-path filters and continue through the tusks directly into the nostrils. A small flexible band on the filter provides the needed flexibility for wear and for donning and doffing the device.

COMSOL multiphysics software for advanced airflow simulations allowed the team to adjust the circumference of the device, as well as the tip design, to optimize the breathing cycle for user comfort while maintaining robust particulate filtration.

The seal between the nostril tip and nostril was critical for ensuring a closed system, and a series of custom tips were developed to fit a variety of users. The tusks are made of an FDA-approved hard plastic and were thoughtfully designed to be dishwasher safe. The filter is replaced when saturated with particulates, which depends on local pollutant types and levels. ↑ PROCESS The CHÚ design process was iterative, with artifacts created at each step for critical critiques in both design and engineering. The most important first step was to understand an individual user’s breathing cycle, including lung capacity and the pressure differential created when inhaling and exhaling. Next, we looked at creating unique new filter types, but through research, found that the tortuous-path style of filter provides the best capture rate across multiple scales of particulates.

References 1. Department of State. 2017. Mission China - Beijing. Accessed October 22, 2017. http://www.stateair.net/web/historical/1/1.html.

2. Environmental Protection Agency. 2016. AirNow Air Quality Index (AQI) Basics. August 31. Accessed October 22, 2017. https://airnow.gov/ index.cfm?action=aqibasics.aqi.

3. Landrigan, Philip J et. al. 2017. "The Lancet Commission on pollution and health." The Lancet Commissions 1.

CHÚ

4. World Health Organization. 2014. WHO sets benchmarks to reduce health damage from indoor air pollution. November 14. Accessed October 15, 2017. https://www.who.int/mediacentre/news/ releases/2014/indoor-air-pollution/en/.

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world • fund • tackle • active • government human-muscle-motion, • country • developing mind-physical-social-identity-emotion-sensory-personal-own-intimate • agency • social structure • community • regional • contribution

C3

HEALTHCARE Spending vs. Outcomes

Healthcare spending should lead to improved healthcare outcomes. While the goal of Medicare and Medicaid spending in the United States is clear, a number of partisan biases, conflicting stories, and disparate data sources make program impact difficult to measure.

This interactive D3.js visualization aggregates health data across geographic and temporal scales in order to track long-term changes and correlations with spending. Data from 1998 to 2007 are displayed visually to show trends in allocated spending, hospital quality, patient returns, and mortality. It also allows for the comparison of metrics between states and on the national stage, where policies and spending may vary.

Kiran Wattamwar

↓ DATA PROCESSING

↓ DATA DISSECTION

1. Data.gov. https://www.data.gov/ 2. Centers for Medicaid and Medicare Services. https://www.cms.gov/ 3. US Census Bureau. https://www.census.gov/

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References

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spending

research

pattern

human tracking

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D DIGITAL SELF Is it possible to differentiate between the physical self and the digital self?

For centuries, humankind has distinguished itself from other forms of life by its consistent and creative use of technology. Today, software and hardware are deeply embedded into our lives, making it difficult to determine how we are uniquely identified. Technology is personal, and often a feature we highlight in describing who we are in a given exchange. Many of our decisions, feelings, and processes are mediated by digital appendages. These projects critically assess and produce solutions that truly unite the digital self with the physical self.

D₁

OMNI INDI

Improving health outcomes with a multi-layered, data-driven, digital health service

D₂

ATELIER

A creative agency, from your brain, for your brain

D₃

REMESYS

Reanimated emotional system

D₄

INSOMNIGRAPH

A framework for visualizing and quantifying sleep patterns across time scales

ABL ACC ACT AIM ALW ART BNF BSE CLN CMM CMP CPH CRE CRR CRT CTC CTY CTY DAT DCN DRC DSN DSS DTH DTL DTR DVC EXP EXR FCS FML GEN GTH GVN HLC HLT HMN HPP HSP ICP IMP IMR INC IND INF LCT LEV LNG LVE LYR MLL OTC PHY PLL PLT PPL PPU PRC PRJ PRS PRT PRV PSR PTN RSR RTE SCL SLP SMP SNS SPN SPP STT SYS TME TRK TRM TRT UND USR UTL VIS VSN WRL YER

DIGITAL SELF

data • technology • metric • quantity • profile • embedded • human 2.0 • integrated • feedback • actuation • cyborg

D1

OMNI INDI Improving health outcomes with a multi-layered, datadriven, digital health service The U.S. healthcare system is complicated, frustrating to navigate, and expensive for everyone involved. There are insurance companies, hospitals, specialists, researchers, employers, health IT, pharmaceutical companies, policy makers, clinical labs, lobbyists, lawyers, data miners, and the list goes on. Within this system, individual healthcare data are dispersed and difficult to leverage into comprehensive treatment and care for the individual user. The average user/patient is unaware of how and where their individual health data are being shared. Meanwhile, data miners profit from the bulk sale of our personal data on the open market.

Saif Haobsh, Vivek HV, Anesta Iwan, and Kate Spies

↑ DIGITAL INTERFACE The OMNI INDI digital interface allows users to seamlessly engage with their health data.

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ABSTRACT Individual healthcare data are dispersed and difficult for users to leverage into improved health outcomes. While medical research and insurance thrive in the new age of digitized health, the benefits have not trickled down to the user. Inherently siloed and difficult to track due to industry economic models, health data systems have introduced inefficiencies leading to increased medical costs as well as increased clinical/diagnostic errors. The process of collecting, documenting, and retrieving health data is inconsistent across regions, healthcare systems, and providers, leading to higher administrative healthcare costs.

OMNI INDI provides the infrastructure and platform to help users manage, secure, and utilize personal health data for improved health outcomes. The digital portal is supported by a robust data architecture and security layer, creating a space where users can (1) travel between insurance systems, geographic boundaries, and all types of care providers without losing data fidelity, (2) view their health data at any time to ensure they are following the doctor’s orders, (3) combine additional layers of information to include environmental data and family history, (4) have quick access to comprehensive and accurate data in times of emergencies, and (5) control the outflow of data to either healthcare providers, researchers, insurers, or public health entities.

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OMNI INDI focuses on leveraging multi-layered health data sets for improved individual health outcomes, and at the heart of OMNI INDI is the functionality to allow users to own their health data. On a platform where individual users own their data, OMNI INDI creates an exchange where health data can be sold or donated to researchers, pharmaceutical companies, hospitals, and more. Individual users of OMNI INDI decide what data they want to sell for personal profit and what data they want to keep private. When a researcher visits the exchange, they can query for specific metrics, see the current price of that data query, directly purchase data, and create incentives to attract additional or new users. The OMNI INDI exchange allows for robust, longitudinal health data to be leveraged for improved research and health outcomes for all.

HEALTH SYSTEMS

Problem Individual healthcare data are dispersed and difficult for users to leverage. Users, such as those with chronic illnesses, have wasted significant time, money, and energy and still are not receiving comprehensive care.

When looking at the system as a whole, there are a myriad of players, including insurance companies, hospitals, specialists, researchers, employers, health IT, pharmaceutical companies, policy makers, clinical labs, lobbyists, lawyers, etc. It is estimated that 30 cents of every dollar spent on medical care in the United States is wasted, amounting to $750 billion annually. Components of waste include "inefficient delivery of care, excessive administrative costs, unnecessary services, inflated prices, prevention failures, and fraud" (NCBI). While medical research and insurance thrive in the new age of digitized health, the benefits have not trickled down to the user. Inherently siloed and difficult to track, health data systems have introduced inefficiencies in healthcare, leading to increased medical costs and clinical/ diagnostic errors. The process of collecting, documenting, and retrieving health data is inconsistent and inefficient, leading to higher healthcare costs attributed to administrative rather than health-based issues. ↓ DATA MAP Within this system, one stakeholder group that is less commonly known is the Discharge Data Holders, which is a group of hospital consortiums or entities authorized by the state to receive patient health data from providers (e.g., hospitals and physicians) and distrib-

Currently, health data flows through multiple stakeholders within the healthcare system (left), and the user has little oversight or knowledge of this exchange. With OMNI INDI, data sharing with stakeholders flows from the user (right).

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ute that information to researchers, analytic companies, prescription analytic companies, public health departments, the CDC, health payers, other government entities, health information technology companies, the FTC, online websites, employee unions and providers. In other words, they are data miners who profit from health data.

Because data and financial relationships are deeply entrenched in the U.S. healthcare system, OMNI INDI focuses on data as the entry point to generate a paradigm shift.

Solution OMNI INDI provides the infrastructure and platform to manage, secure, and utilize personal health data for improved health outcomes. OMNI INDI’s infrastructure reads, parses, processes, organizes, stores, and protects data inputs from clinical, personal, and environmental sources merging all inputs into a unique “data profile.” OMNI INDI then relays the data profile to users through a digital platform.

↓ THREE FUNCTIONS

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OMNI INDI provides three key functions: endto-end management of health data, blockchain-based health data security, and layered data analytics.

The three functions of OMNI INDI’s infrastructure are to: •

Manage data end-to-end to benefit all stakeholders in the system,

•

Secure data with a Blockchain Light model, a different type of blockchain specifically relevant to OMNI INDI, and

•

Utilize layered data to improve individual health outcomes so that users can access more comprehensive and holistic healthcare.

OMNI INDI’s key platform features include the ability to: •

Access and visualize multi-layered datasets leveraged for personalized care,

•

Control (external) access to personal health data,

•

Manage family health data (dependents/ spouse),

•

Gather environmental data through physical location reference as well as smart home devices, and

•

Receive data directly from clinicians, laboratories, pharmacies, and other personal sensors.

By owning their individual health data, users/patients can a) have more transparency over their own personal health status, b) more easily switch between insurance systems, c) move beyond geographic boundaries, and d) work with all types of care providers without losing data fidelity. In

OMNI INDI aims to diversify itself from existing personal-health and health-data solutions (e.g., Apple Health) by allowing the user to own and utilize their data for alternative purposes (e.g., donating it directly to research facilities). Furthermore, unlike Apple Health, where the user does not own their health data but primarily scans in copies of health records, and unlike proprietary health record systems like Epic, where users cannot move data between specialists, primary providers, and urgent care, OMNI INDI coalesces all health data directly from each source into one location with sole patient ownership and access.

fiable health information is information, including demographic data, that relates to an individual's past, present, or future physical or mental health condition, provision of care to that individual, and provision of healthcare that provides a reasonable basis to identify that individual.

How is healthcare data protected? The primary government policy related to healthcare data is the Health Insurance Portability and Accountability Act, or HIPAA. HIPAA was signed into law in 1996 and has been consistently modified to provide further protection to individuals as the healthcare landscape evolves. Two primary areas of focus are privacy and security.

HIPAA is comprised of five parts, or Titles: •

According to the U.S. Department of Health and Human Services, individually identi-

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform

•

Title III: Tax-related Health Provisions Governing Medical Savings Accounts

•

Title IV: Application and Enforcement of Group Health Insurance Requirements

•

Title V: Revenue Offset Governing Tax Deductions for Employers

The Privacy Rule and Security Rule fall under Title II. In January 2016, HIPAA was updated to increase patient access to health information. The changes were designed to clarify how patients may access their health information, and to include electronic health records. Specifically, in section 45 CFR 164.524(c)(2)(i), an individual request for protected health information must be fulfilled within 30 days for no more than a cost-based fee. But more importantly, the provision requires health entities to provide an electronic copy, if requested.

This policy change increased both access and care transparency for patients.

Where HIPAA does not intervene is the

OMNI INDI

To start, what is health data? Health data spans any information related to an individual's health status or health risk. Examples include medical protocols and conclusions, reproductive outcomes, labs results, sleep patterns, scans, x-rays, and more.

Title I: Health Care Access, Portability, and Renewability

•

Research for OMNI INDI began with a series of simple questions: (1) How might we use health data to benefit the patient? (2) How might we ensure security as well as access to personal health data? (3) How might we improve the ecosystem behind healthcare administration? Early interviews with key stakeholders in the healthcare data space, healthcare mergers and acquisitions, healthcare law, healthcare policy, patient advocacy groups, medical professionals, insurance company representatives, healthcare state system representatives, and most importantly, individual patients and users, allowed a multi-channel understanding of the system.

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addition, OMNI INDI’s platform approach accounts for all stakeholders, allowing users to directly interact with their healthcare providers, which helps ensure they are following the doctor's orders.

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→ MAPPING OMNI INDI The system design incorporates multiple data sources into a Data Profile. The user interfaces with the OMNI INDI portal and can then share, donate, or sell their health data on a data exchange.

buying and selling of health data without user consent. LaTonya Sweeney’s theDataMap was a key resource in understanding how data and money flow throughout the healthcare system, specifically how discharge data are sold on an open market due to both state and federal loopholes, as well as stakeholder interdependence. Each state is different, but personally identifiable healthcare data can be purchased for pennies on the dollar and is sold in bulk to researchers, pharmaceutical companies, startups, and more.

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A large player in the healthcare data system is the Healthcare Cost and Utilization Project, or HCUP. HCUP includes the largest collection of all-payer, encounter-level hospital care data in the United States. HCUP is a family of health care databases, software tools, supplemental files, reports, and other related products developed through a Federal-State-Industry partnership and sponsored by the Agency for Healthcare Research and Quality (AHRQ). The project builds on the data collection efforts of state data organizations, hospital associations, and private data organizations (known as “HCUP Partners”). Without HCUP Partners’ voluntary data contributions, this national resource supporting health services, research, and policy would not be possible. HCUP’s partners are not patients, and HCUP does not have patient consent.

Another key factor within the healthcare system is standardization, a requirement for moving data throughout the system and a current limitation in eliminating silos of health data. Health data operates among unique software systems, database struc-

tures, political environments, and financial relationships. Every hospital, lab, specialist, treatment center, and clinic has a unique way in which to collect, store, access, and utilize data. Standardization allows healthcare entities to interact with both data, and patients. Health Level-7 (HL7) is one such set of international messaging standards for clinical applications to exchange data across the various applications used by healthcare providers. The HL7 standards were adopted by the American National Standards Institute and the International Organization for Standardization.

Continuous research allowed for the discovery of three key facts: (1) Patient data are collected only as often as patients visit

HEALTH SYSTEMS

the doctor, which may not be effective in tracking their health. (2) Processes of data creation, conversion, and storage are not streamlined for optimizing patient health.

(3) The current system does not allow for a smooth transition between institutions, medical professionals, and insurance companies.

Design Process

Entering the shifting landscape of a highly entrenched system, the team began to navigate branching clusters of highly localized knowledge abreast of data ownership.

This involved reaching out to experts from multiple schools within the Harvard community as well as experts from the greater Boston ecosystem. Some of the domains included innovation policy, competitive strategy, quality of care, as well as privacy and security. What first appeared to be a clear extension of an initial direction would later prove to have greater ties to unanticipated realms of thinking.

OMNI INDI

OMNI INDI's design process was a highly circuitous, emergent, and contingent journey of interwoven phases. However involved, the process maintained a collective dedication to the urgency of data ownership in the healthcare system. Inspired by a Copernican Health Revolution, the team

took on the challenge of envisioning a user-centered health information system.

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↓ SIMULATION (PRESENT) Data and financial exchange simulation overview within the U.S. Healthcare system, as currently existing.

↓ SIMULATION (PROPOSED) Data and financial exchange simulation overview within a U.S. Healthcare system in which OMNI INDI exists.

With a deep knowledge base sourced from academic pursuits, the next step returned to the user, the stakeholder at the center of our envisioned system. Through a series of user interviews that captured both the relatively extreme and mild system use scenarios, the team became equipped with vignettes of system pressure points at the human scale. A series of crafted surveys with conditional questioning and logical chains quantified these narratives among four user groups: patients, nurses, health administrators, and doctors.

The next step was to prototype user touchpoints categorized as either system integration tools or data collection devices. The array of ideas addressed the flow of data across stakeholders, the representation of data on interfaces, passive and active collection methods, and at-home or in-lab processing of samples. By mapping out nearly twenty prototypes, the team started to extrapolate an ecosystem for a larger solution: a formulaic system of inputs and outputs. Data, money, access, and control converged into a form of delineated elegance. This temporary semblance of clarity informed one of the most pivotal moments of the design and decision-making process. The team realized the need for a larger solution that could incorporate all the considerations of the many touchpoints. This realization was twofold: any solution needed to reinvigorate individual health data, as well as streamline controlled exchange between stakeholders. OMNI INDI emerged as a paradigm shift – a data dialectic between the collective (OMNI) and the individual (INDI).

OMNI INDI utilizes individual, verified, multi-layered health data to improve individual health outcomes by coalescing medical, laboratory, personally collected, historical family, and environmental data into one place.

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Process outline: •

Defining the problem: scoping the project

•

Initial impetus: data ownership and Copernican Health Revolution (envisioning a user-centered health information system)

•

Expert interviews: divergence, expanding knowledge base in multiple domains and schools of thought

data market) •

User group interviews and surveys: patients, doctors, nurses, health administrators

•

User touch points: system integration vs. data collection/sampling

•

Analogous models: Harvard Art Museum's archiving

•

Analogous implementation strategy: Google's product ecosystems

•

Pivotal decision: Designing around a basis (one of future or one of present), thinking of the transition between present and future was critical

•

Solution at a systemic scale (4 aspects of a larger picture)

•

User interaction: UX design + implementation

•

Product design: early prototypes

•

Business design: economic simulation/modeling

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Data security (blockchain concept)

•

Capturing the research in one cohesive story

Implementation The inability to share health information across medical systems is slowing down the consumers’ ability to access high-quality health care. To this extent, OMNI INDI considered implementation challenges across multiple stakeholder groups.

Patients might ask… How much work will this involve?

Like a bank account, patients can access their health information when they want. Users can log-in everyday, multiple times or just when they need to reference a specific provider visit or vaccination date.

OMNI INDI KEY TERMS USER-CENTERED OMNI INDI is a patient-centered data system in which users own their personal health data.

PORTAL TO HEALTHCARE OMNI INDI provides the platform to have healthcare data in the palm of one's hand.

HEALTH SYSTEMS

(healthcare policy, data privacy, public health,

QUANTIFIED SELF OMNI INDI creates a holistic record by coalescing all of one's health data in one place in order to generate the most comprehensive insights into user health.

EFFICIENT OMNI INDI is interoperable across systems, doctors, and insurer to ensure that the data travels with the patient.

TRANSPARENT OMNI INDI is a transparent system with a focus on data awareness and trust.

RESEARCH FOCUS Researchers gain access to multi-faceted, longitudinal, cross-sectional, and verified data sets. All data includes patient consent.

SECURITY AND PRIVACY Health data are stored using a Blockchain Light model with biometric user access. Users have complete control over their data, and every transaction is transparent and easily trackable to the user.

HEALTH INSIGHTS Holistic health data are employed to generate deeper insights into personal health and wellness.

INTEROPERABILITY OMNI INDI utilizes the HL7 international standard to ensure medical data are formatted and able to move between systems.

Healthcare Providers might ask… How does this change my access to patient data?

OMNI INDI

When providers record blood pressure or notes from a visit, that information is uploaded into the patient’s health data file. The healthcare facility at which they work will also record a copy, so if they generated the data, they can always see that individual record. For additional patient health data, the individual patient can provide consent for providers to view their complete medical record. This access is granted prior to an appointment, or upon arrival.

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Hospitals/Clinics/Urgent Cares/Emergency Rooms might ask… Will we have to input data into both the current Electronic Health Record (or other system) and OMNI INDI? No, OMNI INDI replaces the current structure of Electronic Health Records, which are proprietary and lack interoperability. With OMNI INDI, health data generated and recorded during a patient visit will be stored in accordance with the current Health Level 7 Fast Healthcare Interoperability Resources standard. Data generated by the facility will be saved by the facility for record keeping and will be directly uploaded to the patient’s standardized health record. Additionally, with Urgent Care visits, attending providers will now have the ability to access healthcare data (with patient consent) in order to more holistically treat patients. And in an emergency situation, a standardized subset of information will be available, via bio verification, for the emergency room team to better provide immediate care to patients.

Insurance Companies might ask… How do we obtain state and federally mandated patient information?

↓ UX ARCHITECTURE

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OMNI INDI digital application architecture.

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Health data will be transmitted directly to insurance companies based on state and federal mandates, following patient consent. A lack of consent could constitute termination of the insurance policy. Additionally, because a more complete data set is available for patients and providers, redundant tests will be eliminated, administrative costs will decrease, and patient health will improve, all resulting in lower costs to insurance providers.

Employers might ask… I thought we already had an electronic health record system; what’s the point of this?

Health data are siloed in individual systems, so when employees have to visit a specialist, visit a provider while on travel, or change primary care providers, their health records are not seamlessly transferred, and in turn, care protocols are often lost, repeated, or simply ignored by subsequent healthcare professionals.

These errors result in increased prices and decreased health care for employees.

Researchers might ask… My institution currently buys patient data from hospital consortiums (via discharge data); what will my access to data look like in the OMNI INDI system?

Robust, longitudinal, health data sets are hard to come by, especially when you need specific demographics or health conditions. With OMNI INDI, health data includes not just discharge data, but environmental data, family data, and personal device data. This layered collection of quantified data and social data is far richer than the data currently available to researchers from hospital consortiums and can be purchased on the OMNI INDI marketplace. Individual users of OMNI INDI decide what data they want to sell for personal profit and what data they want to keep private. When a researcher visits the exchange, they can query for specific metrics, set the current price of that data query, and directly purchase data, or, they can create incentives to attract additional, or new, users.

The OMNI INDI digital interface includes a personalized introduction page with file search (top), data analytics (middle), and environmental data tracking (bottom).

OMNI INDI

→ UX STILLS

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Researchers might also ask… Does the data come with patient consent?

Yes, always!

Impact

↓ DATA MANAGEMENT

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Individuals' protected health information is uploaded, sorted, stored, and encrypted on OMNI INDI servers. The ledger references each piece of data (based on a data-naming convention) to an individual’s identification (user ID) and the ledger is secured on the blockchain. (cryptographic encryption). The blockchain ledger is accessed by the user via a biometric identification security system that utilizes fingerprint or facial recognition, with password entry as a backup option.

The U.S. healthcare system faces a reality where private, competing companies have sold proprietary, non-interoperable health record systems and medical software to hospitals. Many of these companies have prioritized billing and regulatory reporting over other aspects of care. Meanwhile, many hospitals are still wedded to “fee for service” models, which reward doctors for pricey procedures and tests, rather than patient outcomes. OMNI INDI turns this system on its head by creating the infrastructure and platform to help patients manage, secure, and utilize their personal health data for improved health outcomes.

Team "Lego My Data" began the project focused on health data within the American healthcare system, initially addressing secretive pricing models. We had visions of leveling the playing field for patients and creating a system in which the best care could be found at the best price.

Pricing data soon moved to the back burner as the team dove into who owned health data, who had access to that data, and how financial models were modified based on that data. We spoke to experts in healthcare law, healthcare mergers and acquisitions, healthcare policy, healthcare providers, healthcare management, healthcare researchers, and others in related fields. As we began to piece together the data shared between the countless stakeholders within the American healthcare system, we began to see how data was power.

We dove into alternative data profit models to better understand the flow of money and data within the healthcare system. The forthcoming implementation of the European Data Protection Directive, paired with the Facebook / Cambridge Analytica data breach and the sub-

sequent Zuckerberg Congressional Hearing, highlighted the necessity of understanding the value of data. Data is a currency, and health data is a personal currency. How might a model of personally owned data be leveraged within the American healthcare system to advance both personal and societal healthcare? The synthesis of data and “–omics” has spawned seminal initiatives such as Veritas, The Genome Company, and doc.ai – examples of how critical personal data ownership is in future economic models.

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Team Reflections

With the aim of improving health outcomes for both individuals and society, OMNI INDI was born. OMNI INDI was imagined as a system in which healthcare data are owned and managed by the individual. The idea of "better health outcomes" is not just for the individual, but for society as a whole. As OMNI INDI evolved, critics challenged the tension between data access and ownership, such as concerns around heightened responsibility for users. But the heart of OMNI INDI is the paradigm shift. OMNI INDI provides the platform and infrastructure, but only you (the users) own the data.

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data • technology • metric • quantity • profile • embedded • human 2.0 • integrated • feedback • actuation • cyborg

D2

ATÉLIER A creative agency, from your brain, for your brain Atelier is an experience that combines the best in VR technology and brain research to deliver a personalized therapy that unlocks your creativity. Creativity is defined as the brain's ability to associate abstract concepts and ideas for producing original thought.

Such neurological, associative states are defined by alpha wave activity in the left dorsolateral prefrontal cortex. The team built a neuroscience-based mechanism through a virtual-reality setup complete with EEG brain-wave tracking and EOG eye-motion tracking, to trigger alpha waves and increase the amount of alpha wave saturation within the brain over a limited timeframe. The headset provides a measurable, affordable creativity trigger that allows people to train their brain to become more creative. When used in corporate environments with employees, this therapy could facilitate a faster, more effective innovation process.

Vivek HV, Anesta Iwan, Julian Siegelmann, and Kenneth So

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↑ TECHNOLOGIES Electroencephalography (EEG) is an electrophysical monitoring method to record electrical activity of the brain. Electrodes are placed alongside the scalp to measure the voltage fluctuations resulting from ionic current within the neurons of the brain over a period of time.

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Electrooculography (EOG) is a technique for measuring eye position by looking at the electrical charge between the front and back of the eyes. The human eye is dipolar: the retina has a positive charge, the cornea a negative charge.

Based on the charges in the eyes, an EOG sensor can measure the voltage differences and x and y coordinates to identify visual targets.

Problem To remain competitive in the future of creative work, companies are investing heavily in supporting innovative workforces through a variety of internal and external channels, including dedicated teams, centers of excellence, intrapreneur programs, external accelerators, acquisitions, open innovation programs, and more (Macri). Most companies have focused on spatial interventions (e.g., Google’s workplace redesigns, Wework’s co-working spaces) with minimal exploration of more experimental, expensive cognitive tools, such as transcranial stimulation (Harris). The capital-intensive real estate battles for the most creative office spaces are increasingly unsustainable, particularly for startups and other SMEs. Atelier offers a personalized creativity stimulation tool.

Using consumer-grade EEG sensors and VR headsets, it leverages biofeedback to stimulate a user's creativity while maintaining a price point and portability that make it scalable across workforces.

Atelier is designed to provoke creative states (the ability to associate concepts and abstract thoughts to generate new and unique ideas) through alpha wave activity. Existing neuroscience research has found that human brain waves relate to different states of mind: delta waves (1-3hz, deep sleep), theta waves (3-8hz, drowsiness and light sleep), alpha waves (8-12hz, creativity and relaxation), beta waves (12-38hz, alertness and problem-solving), and gamma waves (38-42hz, higher mental activity) (Grabner, Lustenberger, Sawyer). Researchers have found that increased alpha wave activity is associated with deactivation of the left dorsolateral prefrontal cortex (DLPFC), and one way researchers have been able to elicit creativity is by deactivating the DLPFC through transcranial brain stimulation at the alpha frequency (Pidgeon et al., Tei).

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Solution

Atelier’s VR headset is designed to emphasize mobility and the seamless integration of VR, EEG, and EOG technologies. It uses a three-step process to noninvasively elicit and prolong alpha waves using electroencephalography (EEG) and electrooculography (EOG) technology to zero in on visual alpha wave triggers (Hersh).

Various VR visual stimuli (e.g., randomly generated images) are displayed to users while EEG and EOG signals track which stimuli are most associated with induced alpha wave spikes. The experience can be personalized for returning users to increase the peak alpha latency and improve alpha saturation over time.

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Process Phase 1. Diagnostic (1 minute)

↑DIAGNOSTIC Visual stimuli designed to trigger a user's alpha waves.

For new users, a diagnostic phase presents various visual stimuli in the form of randomly generated images while EOG and EEG signals continuously monitor which stimuli most trigger a user’s alpha waves.

Phase 2. Optimal alpha state (3 minutes) Repeat users can directly leap into a dynamically generated VR environment with visual stimuli optimized for key alpha waves. EEG and EOG sensors continually monitor alpha waves and feed information to the algorithm that controls visuals. The user's experience is then adjusted to keep alpha wave activity high.

↑ OPTIMAL ALPHA SPACE Dynamically generated VR environment based on key alpha-wave visual stimuli.

Each visual stimulus is recorded and scored by a combination of time spent (EOG) and indexed alpha spikes (EEG). Based on the highest ranking visual stimuli, one optimal alpha wave environment and 5-10 alpha wave-inducing objects are selected to procedurally generate objects and environments for the experience.

Phase 3. Transition to reality (30 seconds)

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↑ CONVERGE TO REALITY Transition user to reality and store data for their use.

The final phase gradually transitions the user to reality and stores data for future use.

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References 1. Grabner RH, Krenn J, Fink A, Arendasy M, Benedek M. Effects of alpha and gamma transcranial alternating current stimulation (tACS) on verbal creativity and intelligence test performance. Neuropsychologia. 2017 Oct 31. pii: S0028-3932(17)30411-6. doi: 10.1016/j.neuropsychologia.2017.10.035. [Epub ahead of print] PubMed PMID: 29100950.

2. Harris, Karen, Andrew Schwedel, and Austin Kimson. "Spatial Economics: The Declining Cost of Distance."

Management Tools - Mission and Vision Statements - Bain & Company. February 10, 2016. Accessed November 27, 2017. http://www.bain.com/publications/articles/spatial-economics-the-declining-cost-of- distance.aspx.

3. Hersh, Julie. "TMS or ECT? A Mental Health Consumer Weighs the Options." Psychology Today. June 27, 2013.

Accessed November 27, 2017. https://www.psychologytoday.com/us/blog/struck- living/201306/tms-or-ectmental-health-consumer-weighs-the-options.

4. Lustenberger C, Boyle MR, Foulser AA, Mellin JM, Frรถhlich F. Functional role of frontal alpha oscillations in creativity.

Cortex. 2015 Jun;67:74-82. doi: 10.1016/j.cortex.2015.03.012. Epub 2015 Apr 1. PubMed PMID: 25913062; PubMed Central PMCID: PMC4451406.

5. Macri, Reno. "Before You Renovate Office Space, Consider Fit-Out Costs." YFS Magazine. October 13, 2016. Accessed November 27, 2017. http://yfsmagazine.com/2016/10/13/before-you-renovate-office-space- consider-fit-outcosts/.

6. Pidgeon LM, Grealy M, Duffy AH, Hay L, McTeague C, Vuletic T, Coyle D, Gilbert SJ. Functional neuroimaging of visual creativity: a systematic review and meta-analysis. Brain Behav. 2016 Aug 11;6(10):e00540. eCollection 2016 Oct. PubMed PMID: 27781148; PubMed Central PMCID: PMC5064346.

7. Rominger C, Papousek I, Perchtold CM, Weber B, Weiss EM, Fink A. The creative brain in the figural domain: Distinct patterns of EEG alpha power during idea generation and idea elaboration. Neuropsychologia. 2018 Feb 13. pii: S0028-3932(18)30070-8. doi: 10.1016/j.neuropsychologia.2018.02.013. [Epub ahead of print] PubMed PMID: 29452125.

8. Sawyer, Keith. "The Cognitive Neuroscience of Creativity: A Critical Review." Journal Creativity Research 23, no. 2 (May 09, 2011): 137-54. doi:10.1080/10400419.2011.571191.

ATร LIER

9. Tei S, Fujino J, Kawada R, Jankowski KF, Kauppi JP, van den Bos W, Abe N, Sugihara G, Miyata J, Murai T, Takahashi H. Collaborative roles of Temporoparietal Junction and Dorsolateral Prefrontal Cortex in Different Types of Behavioural Flexibility. Sci Rep. 2017 Jul 25;7(1):6415. doi: 10.1038/s41598-017-06662-6. PubMed PMID: 28743978; PubMed Central PMCID: PMC5526981.

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REMESYS Reanimated emotional system Human emotion is predominantly conveyed through facial expression, giving expressions a critical role in the formation of social bonds. As such, expression impairments like facial paralysis and other nerve conditions can cause emotional and social distress. The causes for these conditions range from the temporary, such as Bell’s Palsy, to the permanent, such as nerve damage or burns.

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Traditionally, prosthetics are understood through the interface of a product on skin. Remesys instead explores a novel way of understanding implantable, subdermal kinematics. The project developed "kinenatomy" to create a wearable hybrid device that could reanimate the paralyzed side of the face based on muscle data from the nominal side. This conceptual device could be used to prevent muscle degradation, improve emotional communication, and aid physical therapy treatment.

Saif Haobsh and Erin McLean

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Problem Emotion is communicated via body language and facial expression. However, various situational, temporary, and permanent impairments of facial anatomy can prevent emotional communication, hindering the creation or maintenence of social bonds. Affected user groups may vary from those with situational limitations in facial expression, such as actors or Botox patients, to temporary impairments from minor burns and diseases like Bell’s Palsy, all the way to permanent impediments caused by major burns, autism, or strokes.

↓ EMOTIONAL CATALOG

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Research on the rigging of facial musculature, allowed the wearable design to target a wider range of emotions while simulating a smaller number of muscles.

As the functional use case of this project, the team looked specifically at Bell's Palsy, a unilateral facial paralysis condition that has a recovery rate within 6-9 months. For most people, Bell’s Palsy is temporary, and the symptoms usually start to improve within a few weeks, resulting in a complete recovery within about six months (Mayo Clinic). During this time, there are limited recuperation or assistive technologies that facilitate emotional communication in the way a prosthetic may help with ambulatory mobility.

HEALTH SYSTEMS

Solution Remesys is a conceptual prosthetic device that reanimates the face to bridge gaps in emotional communication. Though speculative, the project builds on existing social and technological precedents of wearable devices that stimulate nerve endings with small electric pulses to generate expression. The process of “kinenatomy” analyzes the anatomic composition of the face as layers of nerves, muscles, and subdermal tissue, and translates that analysis into implied lines of motion. Through a rigorous visualization process, the team developed a catalog of expressions capturing neutrality, happiness, anger, sadness, and shock.

In order to stimulate muscle response, Remesys uses electromyography (EMG) receivers to generate a signal for muscle-position detectors, which are distributed across the face in a mesh network. The network nodes are situated at the key points of motion, providing broad coverage. The generated signal in turn feeds into a stimulation-pattern generator that sends pulses to the electrodes. Designed to be worn subdermally, this prosthetic could help bridge the gap between facial immobility and desired human expression.

↕ KINENATOMY

“Kinenatomy” analyzes the anatomic composition of the face as layers of nerves, muscles, and subdermal tissue as translated into implied lines of motion.

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1. Helme RD, Gibson SJ. The epidemiology of pain in elderly people.

Clin Geriatr Med. 2001. Aug;17(3):417-31, v. Review. PubMed PMID: 11459713.

2. Pisters MF, Veenhof C, van Meeteren NL, Ostelo RW et al. Long-term effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a systematic review. Arthritis Rheum 2007; 57(7): 12451253. [PubMed]

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References

3. Bremner LA, Sloan KE, Day RE, Scull ER, Ackland T. A clinical exercise system for paraplegics using functional electrical stimulation.

Paraplegia. 1992 Sep;30(9):647-55. PubMed PMID: 1408342.

4. IBERALL AS. THE USE OF LINES OF NONEXTENSION TO IMPROVE MOBILITY IN FULL-PRESSURE SUITS. AMRL-TR-64-118. AMRL TR. 1964 Nov:1-35. PubMed PMID: 14262984.

⬑ PHYSICAL PROTOYPES The prototyping process included 3D printing facial and musculature systems, working with sensor technologies, and sewing shouldershrug housings for components.

← EXPLODED VIEW REMESYS

The design consists of electrodes, EMG receivers, the wearable made of PDMS silicone, a shrug, and componentry housing.

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human-muscle-motion, mind-physical-social-identity-emotion-sensory-personal-own-intimate

D4

INSOMNIGRAPH A framework for visualizing and quantifying sleep patterns across time scales More than a third of Americans don't get enough sleep (CDC). Sleep is essential for learning and memory formation, and insufficient sleep affects health, longevity, and public safety. Differences in sleep type (e.g., deep sleep vs. light sleep) can also affect overall quality of rest. This project aggregates the author’s personal biometric and contextual information to provide a framework for visualizing and quantifying sleep patterns across days, months, and years. By comparing and filtering user-collected sleep data across time scales, this visualization describes how different inputs affect one's sleep quality, encouraging self-experimentation and sleep "hacking."

→ SLEEP, VISUALIZED

Kenneth So

Tracking hours slept, sleep quality, time taken to fall asleep (sleep latency), deep sleep, restlessness, and whether pharmaceutical sleep aids were taken allows the user to leverage data analytics in identifying patterns.

INSOMNIGRAPH

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Martin Bechthold Kumagai Professor of Technology, Harvard GSD

Architectural

Martin’s research, academic and industry publications, and teaching curriculum focus on innovative material systems, structural design, and robotic fabrication, with recent projects centered on structural applications of architectural ceramics. Martin's work broadly looks at material and fabrication technology as a catalyst of innovation for design practice.

In 2010, he founded the GSD’s Design Robotics Group and recently merged it into the Material Processes and Systems (MaP+S) Group, a collaboration of faculty, research associates, and students pursuing sponsored research projects.

Woodward Yang Gordon McKay Professor of Electrical Engineering and Computer Science,SEAS,and HBS University Fellow

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Dr. Yang has an extensive technical background in microelectronic systems and semiconductor manufacturing, and wider intellectual interests in technology transfer, intellectual property, entrepreneurship, innovation, and engineering design. His innovative and pioneering research results were recognized through the prestigious National Science Foundation Young Investigator and Army Young Investigator awards and as IEEE Distinguished Lecturer. Dr. Yang was also the founder and CEO of a DRAM design company, based in Korea and Taiwan, and focused on designing and manufacturing special purpose memory products.

HEALTH SYSTEMS

From the Directors

The 2018 MDE studio book marks the completion of the second MDE Collaborative Design Engineering Studio, which focused on health systems. During this academic year of growth, we enjoyed, for the first time, the interactions between two cohorts of students and a growing range of student-led initiatives and activities.

Knowledge about MDE-relevant courses as well as a multitude of campus resources were passed down from second- to first-year students. The MDE internship program began to take shape, and the expansion of the GSD’s career fair provided opportunities for MDE students to connect to employers beyond design firms. At the time of writing, two startups led by MDE alumni are forming, and other entrepreneurial ideas are already in the pipeline.

This year, the studio instructors Chuck Hoberman, Peter Stark, and Jock Herron were joined by Andrew Witt and Fawwaz Habbal. The team refined their pedagogy while maintaining the focus on teaching methods to understand and solve complex societal problems. The theme of Health Systems took on a challenging, multi-dimensional domain with obvious connections to the previous studio theme of Food Systems, while also connecting to other areas of interest such as mobility. As a microcosm, health and aging allowed deep dives into specific problems and prototyping approaches, giving ample opportunity to develop techniques and methods geared to tackle one of the most vexing challenges of our time.

We would like to take this opportunity to thank all of our students for their remarkable effort and their creativity, rigor, and curiosity.

Our stellar instructors and the administrative experts at SEAS and GSD we thank for their collaborative spirit and dedication beyond the call of duty. It has been an honor and pleasure to guide the program through its second year!

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Student Bios

Nicole Adler

Jeronimo Beccar

Nicki joined the MDE program to work creatively and collaboratively on socially relevant projects and build original solutions in areas of health & aging, community access & engagement, and waste & sustainability. Before the program, Nicki studied Public Policy and Behavioral Economics, worked as a corporate strategist for Microsoft where she evaluated the potential for new technologies across product groups and the implications of competitive developments, and lived in dozens of countries around the world. More recently, she worked in user research and design strategy for an R&D group at Amazon. Nicki brings a focus on scalable, culturally viable solutions, as well as an ability to spot patterns in the world and convene people and ideas from disparate spaces. She is happiest when outdoors, surrounded by friends and family, brainstorming crazy ideas, or pursuing a new adventure.

Jeronimo went from working in the Hollywood film industry to starting his own company that designed and manufactured LED roadway lighting fixtures for private and public contracts. After seven years of operating the company, he moved to Boston, where he joined the Master in Design Engineering program to further understand how technologies such as automation, Industrial IoT, and advanced robotics are disrupting the workforce, generating what is now called "the skills gap". During the summer, he worked at Tulip, a company that designs manufacturing software for assembly-line processes optimization, where he explored ways of addressing the skills gap. Through his studies at various Harvard schools (SEAS, the GSD, and HBS) and his IDEP (Independent Design Engineering Project), he is seeking to address issues of chronic, unmanaged stress by bringing human-centered design to non-invasive technologies and devices that reduce stress.

Humberto Ceballos

Jenny Fan

Berto is a systems thinker and strategist with a background in economics and five years of entrepreneurial experience from founding and leading Bemena, a video production company based in Mexico City. He has created and led diverse projects in areas combining design with technology and the arts, including duCode, a non-profit where children from under-served neighborhoods experimented with electronics and programming for the first time. During the summer of 2018, Humberto developed a product for the Corporate Strategy team at Autodesk, leveraging machine intelligence to create a mutual growth relationship between users and machine. His current work falls at the intersection of social cognition, lifelong learning, and human-machine collaboration. Humberto is an amateur runner, a gourmand, and enjoys art in all its forms.

Jenny is a product designer and creative technologist with a background in business from the University of Pennsylvania's Wharton School. Before MDE, she worked on digital strategies for Fortune 50 companies at Accenture Interactive's Customer Experience group and helped early stage start-ups refine their product vision and UI/ UX at a boutique design consultancy. She built the Product Design team at a Series A retail start-up in NYC and worked most recently as an Interaction Designer with IDEO CoLab and IDEO on autonomous vehicles in partnership with Ford's Greenfield Labs. She is inspired by pushing the boundaries of interdisciplinarity in human-machine interaction, particularly in the areas of urban resilience, sustainability, digital rights and ethics, and complex adaptive systems.

Saif Haobsh

Vivek HV

Saif’s professional experience has been in the NY Metro Area and the Middle East, most recently at AECOM-Abu Dhabi as an architect specializing in computational design and algorithmic modeling, with additional exposure to project management. At AECOM, his work spanned high-rise towers, healthcare, hospitality, transportation, and masterplan developments. He is dedicated to addressing problems at the interface between human behavior and the built environment, with a focus in crisis mitigation, urban displacement, and resiliency. He enjoys music and film production, and has created music videos.

Vivek is an engineer with a background in product, entrepreneurship, and computer science. After his undergraduate studies in Aerospace Engineering, he joined Honeywell, where he worked on rapid prototyping and development of products for private jets. More recently, Vivek has worked with founding teams at multiple startups - including Utopia.do, My Online Health Hub, and Predible Health - on strategy, product, software, and user experience. Across his professional and academic work, Vivek believes in creating and influencing through design, engineering, and innovation. He is particularly interested in issues concerning innovation and change in large complex systems. Beyond this, Vivek enjoys art, cats, soccer, waffles, programming, and trekking.

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Erin McLean

Prior to joining the MDE program, Anesta worked at several design firms in San Francisco on projects ranging from private residences, a place of worship, an airport, and more. Although trained and professionally employed in the field of architecture, Anesta has spent the last year delving into new topics in product design, data science and visualization, digital design, film, and most recently, the field of science related to the human microbiome. She has received awards for several design competitions in both architecture and product design, and has exhibited works in the Museum of Canadian Contemporary Art, Museum of Craft and Design, and the A+D Gallery. She is constantly curious, forever innovating, and enjoys both playing the piano and figure skating.

Erin is a practitioner of human-centered design and is passionate about creating equitable experiences for users of diverse abilities as well as designing for extreme environments. Most recently, Erin worked as an Interaction Designer for Disney Parks & Resorts. Additionally, she has led research projects investigating affordable access to space systems, as supported by a Washington NASA Space Grant. From this research, she conducted several novel launches, including the launch of a 3D-printed, high-powered rocket, and a rocket + balloon system. She is interested in exploring the intersection of astronaut activities on Mars and human-centered design. Hailing from the Pacific Northwest, Erin can often be found hiking, backpacking, or sailing.

Arjun Menon

Saad Rajan

Arjun has been an automotive enthusiast for as long as he can remember, and turned this passion into his work as an automotive concept designer for Tata Motors in India after graduating. Having previously interned at General Motors and Ashok Leyland, he has gained a significant understanding of the principles of design, engineering, and manufacturing in the automotive industry, and now focuses on mobility and transportation systems through a more holistic lens.

He is specifically interested in developing innovative, human-centric solutions to transportation problems, and is also an avid collector of jazz records.

Saad has over five years of experience in strategy, design, and project management across various sectors, including oil and gas, solar energy, hazard mitigation, consumer goods, and real estate. He has managed teams from the conceptual design phase to final implementation and worked on projects in five different continents.

In Tanzania, Saad co-founded and helped grow various social enterprises. In Tajikistan, he worked with the Aga Khan Development network on earthquake engineering and housing improvement. His love for design and the built environment drove him to his most recent experience as a project manager in real estate development. Saad led large-scale development projects in Canada through the entire process of land acquisition, design, construction, and marketing. Saad loves exploring cities, nature, and learning about new cultures.

Carla Saad

Julian Siegelmann

Carla has explored her passion for spatial experience in the kinetic and static realms of design through theater and architecture.

With the MDE program, her fascination with spatiality expanded to encompass both virtual and tangible perspectives, and their connection to technologies. Prior to Harvard, Carla’s professional journey included high-end design and low cost architecture work in the Middle East, Spain, and the United States. While at Soma Architects and Hashim Sarkis Studios, she worked on residential and mixed-use projects. At UNRWA, she implemented design solutions within the shelters’ rehabilitation program at the Palestinian Refugee Camps. Carla is interested in the spatial interrelation of borders and technologies as well as their repercussions on design, social patterns, and economics.

For fun, she enjoys photography, diving, CrossFit, and recently, sailing.

Julian worked at McKinsey & Company’s Berlin office, where he consulted with European clients in Germany, Switzerland, Thailand, and China. At McKinsey, he also helped launch a start-up consulting group, which introduced him to the e-commerce start-up Amorelie, where he eventually led a team. As part of the MDE program, he wants to develop ideas that have a social impact, pursue his passions, and launch a venture in the art world. In his free time, he loves running, rowing, or playing basketball.

STUDENT BIOS

Anesta Iwan

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Student Bios

Kenneth So

Kate Spies

Kenneth is a creative and technologist with a background in neuroscience and anthropology from Brown University. He has worked with companies such as IDEO, Kaiser Permanente, and venture-backed startups designing new products and services. His work has spanned several areas– autonomous vehicles, blockchain, fashion, and healthcare. Bridging his experience in product strategy, visual design, and consumer psychology, he is passionate about building mission-driven brands that solve technically deep and multi-scale societal challenges.

Following undergraduate engineering studies, Kate was commissioned into the United States Marine Corps, where her training focused on leadership and flying acumen. Kate’s early career as a pilot included experience flying over 3000 hours, leading more than 100 combat missions, and ultimately, a selection to attend the United States Naval Test Pilot School. As an experimental test pilot, Kate integrated aeronautical engineering, high-risk test and evaluation, and program management to guide Department of Defense acquisition decision-making. She bridged the gap from conception to employment of revolutionary new technologies. Kate’s research at Harvard is centered on smart materials, innovative design, and autonomous systems, with a specialized focus on the electric-VTOL space. Outside of academia, Kate loves spending time on adventures, running, practicing yoga, reading quietly, and crafting savory vegan dishes.

Vish Srivastava

Janet Sung

Vish worked with and led teams to develop and launch pioneering product and business model innovations across a range of industries. As a Senior Product Manager at BCG Digital Ventures, he helped launch the home services startup All Set, and designed a digital banking app for unbanked populations. As a Senior Strategy Analyst at Accenture, he focused on digital health. He is passionate about building cutting-edge products that extend the benefits of technological and societal progress to underserved populations, and is also an Indian classical musician with 7 years of training.

Janet’s undergraduate and professional experience has largely focused on machine learning applications, including computer vision and machine comprehension. She has worked in research at Yahoo and National Taiwan University, and helped set up MediaTek’s data-centric infrastructure and process. While enrolled in the MDE program, Janet is extending her data science knowledge toward addressing social problems, including networked systems like public transportation and social media. In her free time, she is an avid traveler and enjoys photographing food around the world.

Kiran Wattamwar

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Kiran joined the MDE program directly out of her undergraduate studies at MIT in Computer Science and Architecture. Through inherently interdisciplinary exploration in academia, Kiran explored the intersection of technology, design, and law with research at the MIT Media Lab. In industry, Kiran explored internships at Microsoft, Square, and Palantir's Privacy and Civil Liberties Team. Through interdisciplinary activities like directing MIT's Global Startup Workshop, she aims to apply her learnings directly in practice. Kiran's thesis work focuses on her primary interests in privacy law, data governance, and the social impact of technology-driven systems.

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STUDIO Faculty

Guest Critics

Heather Boesch (IDEO) Fawwaz Habbal (SEAS) Jock Herron (GSD) Chuck Hoberman (GSD) Peter Stark (SEAS) Andrew Witt (GSD)

Welcome Bender (HMS) Suzanne Cullinane Jeppson, MD Bob Culver (Mass Development) Jenny French (GSD) Nabil Harfoush (SEAS) Sawako Kaijima (GSD) Lauren Kim (IDEO) Julia Lee (SEAS) Bri Patterwan (IDEO) Robert Pietrusko (GSD) Hannah Rosenfeld (IDEO) Allen Sayegh (GSD) Marco Steinberg (GSD) Mary Tolikas (SEAS) Lindsey Turner (IDEO) Rick Weinhaus, MD

Teaching Assistants

177

Brian Ho (MDE '18) Michael Raspuzzi (MDE '18)

HEALTH SYSTEMS

MDE PROGRAM

PUBLICATION

Co-Directors

Editors

Martin Bechthold (GSD) Woodward Yang (SEAS)

Jenny Fan Saif Haobsh Janessa Mulepati Kate Spies Kiran Wattamwar

Program Administrators Janessa Mulepati (GSD)

External Advisory Board Sean Chiao Dana Cho Andrew B. Cogan Fiona Cousins Karen Harris Jonathan Hursh Ana Pinto da Silva David Radcliffe Wolfgang Rieder Randy Swearer Harry West

Photography Jenny Fan Erin McLean Michael Raspuzzi Carla Saad Kate Spies

Proofreaders Brian Ho Vivek HV

Printer Puritan Capital 178

179

HEALTH SYSTEMS

Acknowledgements This publication would not have been possible without the patient help and guidance of the MDE community and its supporters.

Harvard University Graduate School of Design 48 Quincy Street Cambridge, MA 02138 gsd.harvard.edu Harvard John A. Paulson School of Engineering and Applied Sciences 29 Oxford Street Cambridge, MA 02138 seas.harvard.edu

Š 2018 by the President and Fellows of Harvard College. All rights reserved.

The editors have attempted to acknowledge all sources and images used and apologize for any errors or omissions.

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