Monday, July 17, 2017

Helping resettled refugees with careers: the importance of interviews

By: Shelley Zhao '18, Computer Science
Team: Refugee Careers

The days have flown by! It’s week three of Tiger Challenge, and Team Refugee Careers is making good headway on our project. We’ve spent the first few weeks scoping out our question: how can we help refugees find stable and fulfilling careers? This past week was spent refining our design brief, and conducting interviews with mentors and community members. From our research, two obstacles keep appearing as major barriers refugees face for every volunteer organization we’ve talked to – the first is finding a job, and the second is learning English. From this information, we’ve started refining our design brief and will ideally a few fleshed out potential solutions in the next couple of weeks. We’ve seen several kinds of solutions already - many revolve around food. For example, we visited Global Grace Cafe, an initiative of Interfaith Rise, which hires chefs who are refugees to cook foods from their homelands several times a week. During our visit, we had grilled chicken and bulgur wheat pilaf prepared by a refugee from Syria. Everything was delicious!

The interviews we’ve conducted have been incredible experiences. We’ve learned an amazing amount from our mentors about both the big picture questions of refugee resettlement and the smaller but equally important stories of the individual people who have faced violence and persecution, the total upheaval of their lives, and the difficulty of cultural adjustment and yet flourish here. Although privacy issues prevent us from discussion specific cases, their stories are really inspirational and push us to keep working hard.

Next week, we plan to finally meet with a refugee family. Empathy and cultural awareness are key for this process and we hope to conduct the interview with sensitivity and care.

Our team visiting the Global Grace Cafe and our mentor Carrie at Interfaith Rise.

Lead poisoning: our first home visit

By: Stephanie Cook, '18 CBE
Team: UnLEADed

We did our first home visit this week, shadowing a nurse case manager as she inspected a home to try to identify sources of lead harming the little boy who lived there. It turns out that the longest challenge in lead remediation is actually finding out how a child is exposed! Sometimes it will be obvious - like the peeling paint on the floorboard or windowsills - but it often isn't. While the nurse was explaining to us the sorts of things they inspect, I got a bit nervous. Apparently microwaving bowls that aren't microwave-safe can cause lead to leach into food, so perhaps my middle school snack-making habits weren't the world's greatest idea. I was shocked to hear how significant something so small could be; at least one child in Trenton had moderate lead poisoning and associated cognitive losses stemming solely from a bowl he microwaved his oatmeal in every morning.

The visit was a speedy lesson in how difficult identifying sources of lead can be. The little boy who lived in the house we visited had fairly severe lead poisoning, and the lead levels in the house weren't high enough to explain how that much lead got into his blood. The mother volunteered the information that he spent a lot of time at a babysitter's house, but claimed she didn't know the address. Inspectors are careful to let parents know that they don't record immigration status in any way, but there are still myriad reasons why someone might not want city inspectors in their home. Some lead abatement could be done in the primary residence - there was significant lead in the paint chipping off the stair banister - but it is likely that the most important sources of lead exposure for the little boy won't be handled until the babysitter's house can be inspected and renovated. Of course, the babysitter's house still isn't a guarantee, but it's the #1 suspect.

The nurse was optimistic that she would eventually be able to find the boy's primary source of lead exposure and refer the building over for city-funded renovation, so it was heartening for us to hear that the situation wasn't hopeless. The most affecting part of the home visit however was hearing what the mother had to say about the changes she'd been observing in her son. He used to speak about as well as his two-year-old peers do, but over the last six months his vocabulary dwindled and he only used the words "yes", "no", and "help". So much of the research around lead poisoning that my team has been reading focuses on later outcomes because lead poisoning is a long term issue, and I'm well accustomed to hearing about high school graduation rates, test scores, carceral rates, and so forth in connection with blood lead levels in childhood. I honestly didn't know that the cognitive effects associated with lead poisoning could strike so quickly, and it was heartbreaking to see a toddler losing the words he once knew.

Lead poisoning affects a person for life, so prevention is absolutely key. The good news is that the problem can absolutely be solved. The crisis in Flint, Michigan brought new publicity to longstanding lead crises in other cities and new grants have rolled into Trenton to address the problem. The Tiger Challenge team focusing on lead poisoning is currently conducting interviews to develop a deep knowledge of the issue before investing in any of the twenty solution ideas we have written on sticky notes hanging in our workspace, and we are all so honored to get to play a role in tackling this vitally important issue!

Princeton Tiger Challenge Adventures

By: Theodor Marcu, '20 COS
Team: PulseOx

Princeton Tiger Challenge Adventures

The moment I realized that it was up to our team to start working and that there would not be much hand holding involved, I felt an internal shudder. I was terrified that our summer was going to be a string of disorganized pushes and frustrated pulls to actually create something relevant. I took the whiteboard marker and, frightened because I didn’t have clarity about what we should do, I said: “Let’s organize our to-do list today!”

Now, every day begins and ends with a crafted to-do list where we outline our next steps in order to achieve as much as possible in the limited time we have to achieve our mission: redesigning the process with which pulse-oximetry is used to identify medical events in infants.

I am extremely proud to be part of the pulse-ox team. Everybody is driven, and I feel that I am part of a supportive group that pushes me to do my best work. This drive felt a bit frustrating in the beginning, especially when we held hour-long debates on the wording of a specific phrase! Nevertheless, those debates have now transformed into a quiet confidence in each other’s ability to carry this project forward.

Our first week and a half were dedicated to better understanding the scope of our project: we knew that our challenge involved tackling the problem of infant pulse oximetry reliability, but we didn’t know where to start, or what was inside our project’s scope and what was outside our scope. This scoping phase started arduously: one of the first things that we needed to do was to prepare for our first mentorship meeting. We put effort into every detail, in order to make sure that we took advantage of all our mentors could offer. Our goal was to create a project description and guide that would direct our research in the inspiration phase. Things went well, and we managed to impress our mentors, but the biggest reason this phase was important was because it laid the groundwork for our team’s dynamic and workflow. In a way, the scoping phase was a way for us to become accustomed to each other so that we could better work together while being mindful of each other’s needs and habits.

With this groundwork laid, we moved into the inspiration phase of our project. The inspiration phase is dedicated to a divergent approach to understanding the stakeholders and issues surrounding pulse-oximeters. This allows us to develop a holistic perspective on the whole issue and draws us away from preconceived notions or prejudice regarding our solution to the problem. This is important to our project, especially because the first idea that came to us when reading about what we were going to do over this summer was linked to creating a new pulse-oximeter.

Inspiration started with us sending numerous emails to our mentors and various other people so we could get help with setting up interviews with nurses, doctors, and parents, as well as other stakeholders relevant to our project such as medical device manufacturers and the FDA. Another important thing that we started doing was trying to get access into hospitals, because it is crucial to our research that we better understand how pulse oximeters are really used on infants in a hospital setting.
 Another thing we started doing was reading about the science behind pulse-oximetry, so we would get at least a high level understanding of the device we were working around. To do this, we drew on the experience of Ray Watrous, one of our mentors, who works for 3M, a company that manufactures pulse-oximeters. He sent us a technical book, white papers, and journal articles about pulse-oximetry. He also held a 2-hour meeting on pulse oximeters and their history that was detailed and offered us a lot of background information about our project.

Setting up interviews with doctors, nurses, and other stakeholders was not as hard. It was relatively easy to get in touch with alums who worked in these fields in order to get a better understanding of how pulse oximeters are used in hospital settings--It’s incredible how generous alums and others have been with their time and experience. These interviews are extremely important to us, especially because they provide us with a detailed account of the intricacies regarding pulse oximeters.

Getting access into hospitals was by far the hardest task. We did not realize the amount of bureaucratic hurdles we had to go through in order to set up hospital visits, which felt daunting at first. Nevertheless, with a lot of effort we have managed to get access into 4 hospitals, including a 2-day visit at CNMC in Washington.

Looking at the Pulse-Oximetry challenge in the beginning, I realize I had a superficial perspective on the way we would go about it! I did not realize that the design thinking process was going to be such a holistic experience. So far, Tiger Challenge has proven itself to be a unique, once-in-a-lifetime opportunity that both pushes me to put in more effort in what I am doing while also being extremely rewarding. I am definitely interested in working with design-thinking after this program ends!

We Are ... PulseOx

By: Amber Altaf, '19 WWS
Team: PulseOx

“We Are” Poem (An adaptation of an “I am” poem)

We are team pulse-ox.
We wonder how machine learning can be implemented in healthcare.
We hear the silent alarms.
We see the discomfort in the parents’ eyes.
We want to improve the pulse-ox’s diagnostic ability.
We are team pulse-ox.

We pretend to be medical school students.
We feel lost at times in the legal hurdles of healthcare.
We touch the hand of simulation baby.
We cry for the children in pain.
We are team pulse-ox.

We understand the market of hospital grade pulse-oximeters.
We say “good enough” is never enough.
We dream of innovation.
We strive for diligence, excellence, and unity.
We are team pulse-ox.

Wednesday, July 12, 2017

Meta-Design Thinking: Some first (or second??) impressions

By: Suzhen Jiang
Team: Tiger Challenge!


This is Suzhen Jiang. (That's pronounced SUSAN, believe it or not). I'm a Woody Woo major from the Class of 2019, and I'm a program associate for Tiger Challenge this summer. There are two of us--Liz Yu, SOC '19, is the other associate, and you'll hear from her in a few weeks as well.

Last summer I was in Tiger Challenge as a member of a project team, Affordable Housing (eventually known as OneRoof) team. Although I had a wonderful summer, our team struggled during the subsequent school year, as we attempted to balance academic and extracurricular responsibilities with Tiger Challenge work. So, one of my goals for TC this summer is to help teams prepare for another academic year while also making progress on their projects.

This past week (Week 2), while fighting a nasty episode of strep throat and trying to get as much sleep as possible, I've been able to observe the developing team dynamics and the different personalities of individual team members. Everyone is still getting used to having most days free of programming, and having to actually decide what to do with them. This uncertainty is a real throwback to last summer. Although we didn't have a TC meme channel to take up all our time back then, the basic issue remains: "what do we do now?" is a recurring question. And though I experienced the same dilemma last summer, I don't know how exactly to help the new teams work through it. Each team has a different approach—for example, the Climate team likes to perform quick three-minute brainstorms, which are also small-scale exercises of divergent and convergent thinking, to decide their next steps.

On the plus side, I love that TCers are developing strong bonds of friendship and respect. Whether it's over copious amounts of breakfast food or poking fun at one another's napping habits, the connections between us are solidifying from day to day. I can't stress enough how important this is. Design Thinking is about empathy, we say frequently: empathy with clients and end-users. But it is also about empathy between teammates.

Team bonds help us fight uncertainty. When we can trust our teammates to come up with ideas, to help us when we're stuck, and when they can expect the same from us, we are able to take risks, shoot for more ambitious targets, and yes, learn from failure as well.

We are currently in the research phase, in which we practice divergent thinking; this can be, as many have put it, "scary." The deeper you go into an issue like refugee resettlement or lead poisoning, the more complicated it gets. It may strike us as arrogant sometimes to say that we can and will find solutions to these problems. But luckily, we have the time to explore, knowing that nothing we do is done alone. So, TC 2017, keep diverging, and keep developing your identities as team players. We're doing great so far.


Alarm fatigue with Pulse-Oximeters: A crying wolf

By: Joe Redmond '18 CBE
Team: PulseOx

80% of alarms for low blood-oxygen in a given hospital are false. This can lead to a risky boy-who-cried-wolf scenario in hospitals, since nurses learn not to trust pulse oximeters. The result: an average response time to such alarms of 7 minutes. This could mean the difference between life and death for some patients with low oxygen.

The Princeton PulseOx Team celebrates our first round of interviews in our Design Studio in the Keller Center’s eHub. Top row left-to-right: Theodor Marcu ’20, Divyanshu Pachisia ’20, Rasheeda Saka ’20, Joe Redmond ’18 (me!). Bottom row: Amber Altaf ’19, Ariella Cohen ’19.

The Princeton PulseOx Team seeks to redefine this standard of care for some of the most vulnerable patients: infants. A parent told us that her infant daughter was not quickly diagnosed when she had an object lodged in her airway, since the hospital staff did not trust the readings from their instruments. “Because the nurses wrote off dips in her O2 levels as the machine’s fault, she could have lost her life,” she said.

The team approaches the problem holistically: how can the technology be improved, how can trust be built between nurse and device, how can we get a better system implemented, etc. The team began our discovery process three weeks ago through ethnography: what are people saying about the device, and how are they actually using it.

Through the course of roughly 20 interviews and counting, we’ve gathered rich insights into the way doctors, parents, and nurses view and use the device. For example, doctor/nurse satisfaction with the device tends to be quite high, since the pulse oximeter is “better than nothing” and provides “at least a guess.” This tells us that there is hidden potential in improving these products. The work we have done so far has been and continues to be very instructive.

With nine days of field research across five hospitals ahead of us, the team is excited to gather insight into how nurses and doctors use the device and how infants and parents interact with it. We are also interested in how this behaviour contrasts with perceptions of the device.

In a few weeks, we will move into the ideation and prototyping phases of the process. I am very excited to see what kinds of viable ideas we can come up with, and I am thrilled to start building prototypes. Our work has been part of the process of building potential, and I expect applying our insights into solutions will feel like cashing in. I love designing and building and creating impact for people, and I am thrilled to see where we go from here.