WELCOME TO INNOVATIVE APPROACHES
TO IMPROVE MATERNAL HEALTH
HYBRID WORKSHOP DAY 1. THANKS
FOR JOINING VIRTUALLY AND IN
PERSON.
I'M WITH THE HEART, LUNG, AND
BLOOD INSTITUTE IN THE DIVISION
OF BLD DISEASES AND RESOURCES
AND WE ARE ALL GATHERED HERE
TODAY TO DISCUSS HOW TO IMPROVE
MAT TERNAL HEALTH FOR ALL
COMMUNITIES IN THE UNITED
STATES. THIS WORKSHOP BRINGS
TOGETHER DIVERSE CULTURES AND
GEOGRAPHIC REGIONS AND MANY
EXPERTISE AND ARE EXCITED TO
HEAR DIFFERENT PERSPECTIVES IN
OUR DISCUSSION TODAY.
FIRST AND FOREMOST, I WOULD LIKE
TO THANK THE ENTIRE WORKSHOP
PLANNING TEAM. IT HAS BEEN
TRULY A TEAM EFFORT TO GET TO
THIS DAY AND HAS BEEN A TRANS
NIH EFFORT. THIS IS WORKSHOP IS
SPONSORED BY NIHLBI AND NIH'S
MATERNAL HEALTH AND PREGNANCY
OWE OUTCOMES VISION FOR EVERYONE
OR IMPROVE INITIATIVE AND
SEVERAL NIH INSTITUTES AND
CENTERS THAT INCLUDE THE
NATIONAL INSTITUTE ON MINORITY
HEALTH AND HEALTH DISPARITIES
NIMHD AND NATIONAL INSTITUTE OF
NEUROLOGICAL DISORDERS AND
STROKE, NINDS AND NATIONAL
CENTER FOR COMPLEMENTARY AND
INTEGRATIVE HEALTH NICCH AND
INSTITUTE FOR TRIAL HEALTH
DEVELOPMENT, NICHD AND NATIONAL
INSTITUTE OF ENGINEERING AND
BIOMEDICAL ENGINEERING AND WE
HAVE SEVERAL INTERACTIVE PANELS
INCLUDING THE CLINICAL AND
TECHNOLOGY PANELS AND COMMUNITY
AND ENGAGEMENT PANEL AND
IMPLEMENTATION SCIENCE PANEL AND
AT END OF THE DAY WE WILL HAVE
TWO CONCURRENT DISCUSSION
SESSIONS THAT ARE MODERATED
SESSIONS.
THEY ARE DESIGNED TO DISCUSS ON
FOCUS OF MATERNAL HEALTH E1 AND
E2 IDENTIFYING AND OVERCOMING
INNOVATION BARRIERS FOR MATERNAL
LUNG HEART HEALTH AND BLOOD AND
SLEEP HEALTH AND DEVELOPMENT OF
INNOVATIVE TECHNOLOGIES TO
IMPROVE MATERNAL HEALTH
FACILITATING SUBSTANCE USE
DISORDER TREATMENT AND IF
INTERESTED IN ATTENDING SESSIONS
IN PERSON, PLEASE SIGN UP ON
SHEETS AT THE REGISTRATION TABLE
AND DUE TO SPACE LIMITATION OF
THE BREAKOUT ROOMS WE HAVE TO
LIMIT IN-PERSON ATTENDANCE AND
HAVE A SEPARATE ZOOM ROOM FOR
BREAKOUTS AND WILL ALLOW VIRTUAL
ATTENDEES TO PARTICIPATE FULLY.
FINALLY, I WANT TO MAKE SURE
THAT I SHARE DISCLOSURE
STATEMENT. NATIONAL INSTITUTES
OF HEALTH DOESN'T SPONSOR OR
ENDORSE INFORMATION SHARED OR
PRESENTED IN THE WORKSHOP SLU
INCLUDING PRODUCTS OR SERVICES
AND MATERIALS SHOULDN'T BE
REPRESENTED VIEWPOINT OF HEALTH
AND HUMAN SERVICES OR NATIONAL
INSTITUTES OF HEALTH.
WE ARE HONORED TO HAVE TWO
SENIOR LEADERS FROM NIH HERE TO
GIVE OPENING REMARKS DR. PANNA
PIN TO -- BEFORE JOINING NHLBI
IN 2021 SHE WAS A TENURED
PROFESSOR OF PEDIATRICS AND
HEMATOLOGY AND DIRECTOR OF
CENTER FOR CLINICAL
EFFECTIVENESS RESEARCH AT
MEDICAL COLLEGE OF WISCONSIN AND
CHIRNS WISCONSIN AND CLINICIAN
RESEARCHER WITH BACKGROUND IN
PUBLIC HEALTH SHE FOCUSED HER
ACADEMIC CAREER UNDERSTANDING A-
HEALTH OUTCOMES OF PATIENTS WITH
CHRONIC DISEASES AND DR. THOMAS
IS -- WHICH OVERSEES THE IMPROVE
INITIATIVE AND SPECIAL DIRECTOR
TO ORWH AND BEGAN RESEARCH
CAREER TO INTRAMURAL RESEARCH
PROGRAM AT NATIONAL INSTITUTE ON
-- AND ON IMPACT OF OPIOIDS ON
PAIN AND JOINED NATIONAL
INSTITUTE ON DRUG ABUSE, NIDA
AND MANAGED NIDA'S PAIN AND
OPIOID RESEARCH.
HE IS A FOUNDING MEMBER OF NIH'S
PAIN CONSORTIUM THAT DOES PAIN
RESEARCH ACROSS THE UNITED
STATES AND THANK YOU FOR BEING
HERE TODAY AND TURNING THE MIC
TO DR. PANE APIN TO.
>> GOOD MORNING. WELCOME. IT
IS A PLEASURE TO SEE ALL OF YOU
HERE TODAY AND OPEN THE
INNOVATIVE APPROACHES TO IMPROVE
MATERNAL HEALTH WORKSHOP AND
THANKS TO ORGANIZERS OF WORKSHOP
ALONG WITH TRANS NIH WORKING
GROUP PUTTING IN SIGNIFICANT
AMOUNT OF WORK TO LAY OUT A VERY
EXCITING AGENDA. MANY OF YOU
KNOW IN THE UNITED STATES THAT
PREGNANCY-RELATED DEATHS AND
COMPLICATIONS ARE AMONG HIGHEST
IN DEVELOPED WORLD.
BLACKS AND AMERICAN INDIANS AND
ALASKA NATIVES THEY ARE
ESPECIALLY HIGH REGARDLESS OF
INCOME OR EDUCATION LEVELS AND
PANDEMIC ONLY MADE THE SITUATION
WORSE. COLLABORATION AMONG
RESEARCHERS SMALL BUSINESSES AND
THE COMMUNITY COULD LEAD TO NEW
WAYS TO IMPROVE MATERNAL HEALTH
REDUCING US MATERNAL MORBIDITY
AND MORTALITY RATES.
CARDIOVASCULAR HEALTH AND SLEEP
DISORDERS AMONGST OTHERS
SIGNIFICANTLY CONTRIBUTE TO
MATERNAL MORBIDITY AND MORTALITY
MAKING MATERNAL HEALTH PRIORITY
AREA FOR NHLBI AND ADDRESS THREE
KEY QUESTIONS DURING THE
WORKSHOP. NO. 1, WHAT ARE MAJOR
SCIENTIFIC ADVANCES OF MATERNAL
HEALTH RESEARCH AND RELATED
DISEASES AND NO. 2 CHALLENGES
DEVELOPING AND TRANSLATING
SOLUTIONS TO REDUCE MATERNAL
MORBIDITY AND MORTALITY AND 3
HOW THEY COULD BE LEVERAGE THE
AND UNDERSERVED COMMUNITIES AND
THRILL TODAY SEE ALL WHO HAVE
JOINED US TODAY AND YOUR
INSIGHTS AND EXPERTISE ARE
ESSENTIAL TO HELP US ANSWER
QUESTIONS AND IMPROVE MATERNAL
HEALTH ACROSS THE COUNTRY.
THANKS FOR JOINING THE WORKSHOP.
I WILL NOW TURN IT TO DR. TH
THOMAS.
>> GOOD MORNING. THANK YOU DR.
PANEPINTO FOR INTRODUCTION OF
ME. THIS IS SURREAL AND MY
FIRST TIME SINCE THE PANDEMIC
AND NICE TO SEE FACES AND
VIRTUAL PEOPLE, I HAVEN'T
FORGOTTEN ABOUT YOU EITHER.
PLEASURE TO WELCOME YOU TO
INNOVATIVE APPROACHES TO IMPROVE
MATERNAL HEALTH WORKSHOP.
MATERNAL HEALTH IS HUGE PRIORITY
AT NIH AND EVIDENCE OF IMPROVED
PROGRAM AND OTHER FUNDING IN
THIS AREA AND THINK THAT A KEY
THING ABOUT IMPROVE IS THE
WORKSTREAMS ARE ALL
INTERCONNECTED THAT IS HOW WE
HAVE TO APPROACH MATERNAL HEALTH
CRISIS ON EVERY FRONT AND ONLY
UNITE IN A UNITED WAY AND
IMPROVE INCLUDES VARIOUS
INITIATIVES AT THIS POINT AND
INCLUDES A CONNECT ATHON.
IT IS A -- IT IS ENGAGING
STAKEHOLDER COMMUNITIES TO
DEVELOP ELECTRONIC HEALTH RECORD
STANDARDS AND ESTABLISH
LONGITUDINAL MATERNAL HEALTH
RECORDS AND ENABLE RECORDS TO
AUTOMATICALLY CONNECT THE CHILD
TO THE MOTHER AND LOOK AT
ELECTRONIC HEALTH RECORDS IN
TANDEM AND HAVE TWO CHALLENGES
AND THERE IS A MECHANISM WE HAVE
THAT IS BEYOND GRANTS AND
CONTRACTS WHERE WE CAN MAKE
AWARDS TO PEOPLE THAT COME UP
WITH INNOVATIVE IDEAS AND ONE IS
[INDISCERNIBLE], WHICH IS TO AIM
TO ACCELERATE DEVELOPMENT OF
MATERNAL HEALTH DIAGNOSTICS AND
REMOTE SENSING DEVICES IT HAS
VERY ALIGN THE WITH WHAT WE WILL
TALK ABOUT OVER THE NEXT TWO
DAYS AND THERE IS CONNECTING
COMMUNITIES AND MATERNAL HEALTH
CHALLENGE ALSO. IT IS BUILDING
RESEARCH INFRASTRUCTURE AND
CAPACITY FOR NON-PROFIT
ORGANIZATIONS THAT ARE SEEKING
TO ADVANCE MATERNAL HEALTH
RESEARCH.
SO, BEYOND THAT, WE HAVE THE
MATERNAL HEALTH COMMUNITY
IMPLEMENTATION PROGRAM TO
DEVELOP AND TEST PROMISING
COMMUNITY-BASED INTERVENTIONS
AND STRATEGIES TO INCREASE
ADOPTION UPTAKE AND EXPANSION OF
EVIDENCE-BASED INTERVENTIONS AND
OF MATERNAL HEALTH AND
CORNERSTONE OF EFFORTS AND
MATERNAL HEALTH RESEARCH CENTERS
OF EXCELLENCE TO DEVELOP AND
EVALUATE INNOVATIVE APPROACHES
FOR REDUCING PREGNANCY RELATED
COMPLICATIONS PROMOTING MATERNAL
HEALTH EQUITY AND WE SEE THESE
THINGS REALLY COMING TOGETHER
JUST AT THE BEGINNING TO HOPE
THAT IMPROVE HAS A BIG IMPACT
AND WE HOPE IT GROWS AND BECOMES
MORE AND MORE OF AN ENTITY AT
THE NIH WHERE WE WORK TOGETHER
TO FIGHT THE MATERNAL HEALTH
CRISIS.
WITH THAT, I WILL TURN IT BACK
TO MY ESTEEMED COLLEAGUE DR.
GOLDBERG WHO WILL INTRODUCE OUR
PLENARY SPEAKER.
>> THANK YOU SO MUCH DR.
PANEPINTO AND DR. THOMAS FOR
YOUR REMARKS. BEFORE I
INTRODUCE OUR PLENARY SPEAKER, I
WANT TO REMIND EVERYONE HERE
TODAY THAT AT NIH WE PROMOTE A
CULTURE OF ACCEPTANCE AND YOU
ARE ABOUT TO HEAR MATERNAL
ADVOCATE TELL HER PERSONAL STORY
AND SOME THINGS YOU MAY HEAR
MIGHT NOT BE MEDICALLY ACCURATE
AND MIGHT NO THE BE PRACTICE AT
YOUR MEDICAL FACILITY. WHAT YOU
WILL HEAR IS ACCOUNTING OF
MEDICAL EVENTS AS UNDERSTOOD BY
A PATIENT DURING SOME OF HER
WORST LIFE EVENTS AND IS NOT TO
DISCREDIT HER ACCOUNT BUT TO
UNDERSTAND AND IDENTIFY
COMMUNICATION GAPS THAT CAN
OCCUR WHEN SPEAKING TO A PATIENT
IN DEEP DISTRESS AND HEARING AND
LISTENING TO HER STORY CAN HELP
US ALL TO UNDERSTAND WHAT IS
HAPPENING WHEN WE HAVE DIFFICULT
CONVERSATIONS WITH PATIENTS AND
HOW HARD IT COULD BE TO
UNDERSTAND WHERE SOMEBODY ELSE
MIGHT BE LISTENING FROM. ALL OF
US IN THE ROOM HAVE A POWER TO
MAKE A DIFFERENCE IN THESE
PATIENT'S STORY.
NOW, I'M PROUD TO INTRODUCE
CANDICE.
SHE IS AN AFRICAN AMERICAN
MATERNAL HEALTH ADVOCATE
DEDICATED CAREER TO IMPROVING
LIVES AND OUTCOMES OF BLACK
MOTHERS AND HIGHLY RESPECTED IN
FIELD OF MATERNAL HEALTH AND
POLICY AND INITIATIVES TO
PROMOTE MATERNAL HEALTH OUTCOMES
FOR BLACK WOMEN AND RECOGNIZED
FROM SEVERAL ORGANIZATIONS FOR
RESULTS AND DEEP UNDERSTANDING
OF COMPLEX CHALLENGES FACING
BLACK MOTHERS AND FAMILIES AND
IN ADDITION TO ADVOCACY WORK
PASSIONATE ADVOCATOR AND MEN
TORE AND THANK YOU CANDICE FOR
BEING HERE WITH US TODAY AND FOR
SHARING YOUR STORY WITH US.
>> MORNING. HOW MANY HAVE BEEN
EFFECTED BY MATERNAL HEALTH IN
THE US? LOTS OF HANDS RAISED.
I'M CANDICE AND HERE TO SHARE MY
STORY WITH YOU. MY STRUGGLE
HAPPENED LONG BEFORE PREG IN A
NCY AND HAVING A BABY. -- WHEN
HAVING THAT SURGERY DONE, I
WASN'T AWARE THAT HAVING THAT
TYPE OF MANIPULATION DONE TO MY
UTERUS WOULD EFFECT ME DOWN THE
ROAD WHEN HAVING CHILDREN AND I
WAS TOLD TO WAIT A YEAR AND TRY
TO GET PREGNANT AND YOU EITHER
DO OR DON'T AND WE WILL HAVE A
DIFFERENT DISCUSSION.
ALMOST FIVE YEARS LATER I GOT
PREGNANT WITH MY SON AIDE AN AND
JULY 2019 JULY 9TH MY SON WAS
FOUND TO NOT HAVE A HEARTBEAT
AND STARTED PREGNANCY OFF WITH
EXPECTATION I'M PREGNANT AND
NEED TO GET THROUGH INTOIN
MONTHS AND HAVE A BABY. THAT
WASN'T THE CASE FOR ME.
PROBABLY AT 10 WEEKS I WAS AT A
REGULAR OB APPOINTMENT. SHE
TOLD ME SHE COULD NO LONGER TAKE
CARE OF ME MY CASE WAS TOO
COMPLEX AND TRANSFERRED TO FETAL
MEDICAL DOCTOR WHO SAID WE WILL
DO EVERYTHING TO GET YOU THROUGH
THIS PREGNANCY IN NEXT 6 MONTHS
I HAD GESTATIONAL DIABETES EARLY
ON NOT KNOWING THAT IT COULD BE
VERY DEBT TREMENTAL TO ME AND MY
BABY. AT 23 WEEKS I WENT IN FOR
A STANDARD APPOINTMENT.
STANDARD ULTRASOUND AND TWO
WEEKS PRIOR I HAD BEEN FOUND TO
HAVE A SHORT CERVIX AND KNEW
WHAT NONE OF THAT MEANT PRIOR TO
GOING INTO PREGNANCY AND DIDN'T
KNOW WHAT SHORT CERVIX WAS --
THEY WERE DOING THESE EXTRA
ULTRA SOUNDS TO MAKE SURE THAT I
WAS KIND OF GAINING SOME C
CERVICAL LENGTH BACK AND WAS BUT
DIDN'T EXPECT TO GO IN AND HEAR
MY SON DIDN'T HAVE A HEARTBEAT.
THAT ALL QUICKLY KIND OF CHANGED
IN THE MOMENTS WHEN I BEGAN --
WHEN I HEARD MY SON DIDN'T HAVE
A HEARTBEAT IT WENT FROM YOU ARE
PREGNANT TO NO LONGER BEING
PREGNANT TO LET'S FIGURE OUT HOW
TO GET THE BABY OUT OF YOU AND
YOU OUT OF THIS HOSPITAL. YOU
DON'T UNDERSTAND WHEN PERSON IS
HAVING WORST TIME OF THEIR LIFE
HOW MUCH EMPATHY PLAYS A BIG
ROLE IN.
I WAS TOLD BY A RESIDENT CAN
CAME INTO THE ROOM AND SAID WE
CAN NAME YOUR SON AND FIGURE OUT
WHAT YOU WILL DO WITH HIS
REMAINS AT THAT POINT. AT THAT
POINT I WASN'T IN SPACE TO HAVE
THAT CONVERSATION AND HAVING IT
WITH SOMEONE I HAD NEVER MET OR
HAD A CONVERSATION WITH AND WERE
DECIDING WHAT WOULD HAPPEN TO MY
SON. I DECIDED TO HAVE A D & E
DONE AND DURING MY D & E, I
HEMORRHAGED WHICH RESULTED IN ME
HAVING A UAE, A UTERIN AT RATE
EMBOLISM. IF YOU CAN GO TO NEXT
SLIDE. NEXT ONE AFTER THAT,
PLEASE THIS IS A LIST OF ALL
ISSUES I HAD. I HAD UTERINE
ARTERY EM BBEMBOLIZATION I HAD Y
DOCTOR KNEW I WANTED HAVE
CHILDREN AND I WAS CLOSE TO
HAVING A HYSTERECTOMY AND THEY
WORKED DILIGENTLY AND HARD TO
PRESERVE MY FERTILITY BUT DON'T
KNOW ALL WOMEN HAVE THAT
RELATIONSHIP WITH THEIR DOCTORS
AND DON'T KNOW IF I DIDN'T HAVE
THE RELATIONSHIP I HAD WITH THE
PROVIDER IF THAT WOULD HAVE BEEN
THE CASE FOR ME UPON MY SON'S
PASSING AND VISIT YOU HAVE AFTER
YOU HAVE A BABY YOU HAVE TO GO
TO [INDISCERNIBLE]. DOESN'T
STOP BECAUSE YOUR BABY DIDN'T
LIVE YOU HAVE POSTPARTUM VISITS
AND POSTPARTUM CARE AND I HAD A
VERY SHORT VISIT WITH MATERNAL
FETAL MEDICINE DOCTOR AND WENT
OVER SON'S AUTOPSY RESULT AND NO
REASON ACTUALLY AFTER HIS DEATH
A COUPLE THINGS TRANSPIRED AND
THOUGHT MAY BE THE REASON. BUT
I TOOK IT UPON MYSELF TO READ
THE AUTOPSY LINE BY LINE AND WAS
ME AND GOOGLE AND THIS AUTOPSY
REPORT AND I'M GOING THERE YOU
IT LINE BY LINE AND IN THE
AUTOPSY REPORT IT WAS FOUND MY
SON HAD BETA SALISEMIA AND
DIDN'T KNOW WHAT IT MEANT UNTIL
I DID FURTHER RESEARCH AND IT
DIDN'T EFFECT ME DIRECTLY BUT MY
SON DID HAVE IT. IT WAS
SOMETHING THAT INFORMATION
WASN'T PROVIDED TO ME YOU CAN GO
TOLE NEXT SLIDE, PLEASE.
LIST OF THINGS I HAVE AND THERE
ARE DEFINITIONS OF THEM AS WELL.
I WENT ON TO HAVE ANOTHER BABY
AND MY SON GRAYSON WILL BE 2 IN
JUNE THANK YOU. GRAYSON IS THE
LIGHT OF MY LIFE AND AIDE AN IS
IMPORTANT AS WELL. I DO THIS
BECAUSE I DON'T WANT TO FORGET
AND DON'T WANT HIS DEATH TO BE
SOMETHING THAT HAPPENED IN VEIN
AND DECIDED AFTER THIS I NEEDED
A SPECIFIC TYPE OF PROVIDER THAT
WOULD LISTEN TO ME AND HOLD MY
HAND AND WHEN THINGS GOT SCARY
FOR ME THEY WOULD LISTEN.
I WENT THROUGH THREE INTERVIEWS
AND FINALLY PICKED A PROVIDER
AND HAVE A WONDERFUL
RELATIONSHIP WITH HER. I WISH
ALL BIRTHING MOMS COULD HAVE THE
TYPE OF RELATIONSHIP I HAVE.
I'M REMOVED FROM MATERNAL
MEDICINE WORLD BECAUSE I HAVE A
BABY AND LEAN ON TO HER TO ASK
QUESTIONS AND QUESTIONS ABOUT MY
CASE NO LONGER NOT ON FRONT KAIS
LOAD SHE IS WILLING TO ANSWER
AND TALK ME THROUGH ANYTHING.
WHEN PREPARING FOR THIS I SAID I
HAVE QUESTIONS ABOUT WHAT KIND
OF HAPPENED TO ME IN THE OR.
SHE WAS LIKE ABSOLUTELY LET'S
SIT DOWN AND TALK ABOUT IT CH.
LOT OF TIMES PROVIDERS ARE
FOCUSED ON GETTING THE MOM
THROUGH WHATEVER IS GOING ON
WITH HER AND MY SECOND PREGNANCY
I HAVE PRECLAMPS YA AND
GESTATIONAL DIABETES FROM THE
VERY, VERY BEGINNING.
WHAT I LOVED ABOUT MY PROVIDER,
SHE WAS VERY TRANSPARENT WITH ME
FROM THE VERY BEGINNING DO I
THINK WE CAN GET YOU THROUGH THE
PREGNANCY ABSOLUTELY TO TERM?
PROBABLY NOT.
I WAS ABLE TO FOCUS IN ON THAT
AND BE PREPARED FOR IT. I
CARRIED A BAG IN MY CAR FOR
WEEKS PRIOR TO BEING ADMITTED TO
THE HOSPITAL I KNEW I PROBABLY
WOULDN'T MAKE IT TO 37 WEEKS AND
WOULDN'T GET TO THAT POINT BUT I
WAS PREPARED FOR IT AND THERE
WAS NO REAL SURPRISES AT THAT
POINT. WHEN I WENT IN TO HAVE
MY STANDARD APPOINTMENT WITH HER
AND SHE LOOKED AT ME I THINK YOU
ARE STAYING I'M READY FOR THIS
BAG IN CAR CALL MY FAMILY I'M
PREPARED. I WANT TO ALSO NOTE
THAT WHEN I WAS PREGNANT WITH MY
SECOND SON I WENT INTO LABOR AND
DELIVERY 12 DIFFERENT TIMES AND
THAT IS NOT COMMON BECAUSE YOU
ONLY KNOW WHAT YOU KNOW WHEN YOU
ARE PREGNANT. I WENT IN BECAUSE
I HAD THIS HORRIBLE OUTCOME
FIRST TIME I HAD MY FIRST SON
AND EVERY TIME SOMETHING WASN'T
RIGHT I WAS CALLING AND JUST
LIKE HEY SOMETHING DOESN'T FEEL
RIGHT I NEED TO COME IN.
ONE THING I'M SO THANKFUL TO MY
PROVIDER UNDERSTANDING IS 24
WEEKS SHORTLY AFTER WHERE I LOST
MY FIRST SON MY DEPRESSION SET
IN AND SET IN, IN A WAY I WASN'T
ABLE TO GET UP IN THE MORNING
AND WASN'T ABLE TO FUNCTION OR
WORK AND REMEMBER GOING IN FOR A
VISIT WITH HER AND SAYING TO
HER, I CAN'T DO THIS. SHE SAID,
YOU DON'T HAVE TO. YOU KNOW, IF
YOU CAN'T GET UP AND CAN'T
FUNCTION WE WILL DO THIS WEEK BY
WEEK AND SEE WHERE YOU LAND IN
TH
THIS.
I NEVER ENDED UP GOING BACK TO
WORK AND SHE GAVE ME A SMALL
LIST OF THINGS TO DO DAILY GET
UP IN MORNING WALK FOR 10
MINUTES EAT BREAKFAST AND I HAD
TO JOURNAL WERE THREE THINGS
THAT WERE MOST IMPORTANT TO HER.
SHE WAS LIKE IF YOU CAN DO THOE
THREE THINGS YOU HAVE DONE THREE
THINGS I'M ASKING YOU TO DO IN
THIS PREGNANCY AND CHANGED
TRAJECTORY OF ME GETTING THROUGH
PREGNANCY AFTER ALL I DO WANT TO
FOCUS IN ON WHAT IT WAS LIKE
AFTER LOSING MY FIRST ONE. THEY
SEND YOU HOME. YOU ARE SUPPOSED
TO JUST FIGURE EVERYTHING OUT.
YOU ARE NOT REALLY A PATIENT TO
THEM ANYMORE. YOU NO LONGER
HAVE A BABY. THAT SHOULDN'T BE
THE CASE FOR ANYONE THAT HAS
LOST THE CHILD YOU STILL HAVE TO
GO THROUGH POSTPARTUM PERIOD AND
DEAL WITH ALL OF THE THINGS A
PERSON BRINGING A BABY HOME HAD
TO DEAL WITH AND I WASN'T
PREPARED FOR THAT AND BREAST
MILK COMING IN AND PHYSICAL
CHANGES HAPPENING SO QUICKLY
BECAUSE MY SON WAS NO LONGER
THERE AND WAS GIVEN A LIST OF
PROVIDERS AND TOLD TO CALL THEM
AND GET MYSELF A MENTAL HEALTH
PROVIDER. I HAD A CONVERSATION
AND LEFT A VOICEMAIL FOR A WOMAN
BY NAME OF ANDY.
WHEN SHE CALLED ME BACK SHE SAID
TO ME AND SAID YOU CAN'T MAKE
THESE PHONE CALLS ON YOUR OWN
PROVIDER'S OFFICE SHOULD. I
COULDN'T UNDERSTAND WHAT YOU
WERE SAYING LET ALONE I CAN'T
HELP YOU IN THIS WAY. SHE IS
LIKE YOUR PROVIDERS NEED TO CALL
AND TELL US EXACTLY WHAT
HAPPENED.
SO, I'M FOREVER INDEBTED TO ANDY
WHO CALLED TO MY PROVIDER'S
OFFICE AND GOT ME A PROVIDER TO
ASSIST WITH MY POSTPARTUM
DEPRESSION. I HAD NO CLUE WHAT
THAT WAS. NO ONE PREPARES YOU
FOR THAT. YOU KNOW, I HAVE BEEN
IN THERAPY EVER SINCE. SON
WOULD HAVE BEEN 4 IN JULY. I GO
TO THERAPY EVERY WEEK LIKE CLOCK
WORK.
I ALSO WANT TO TOUCH ON MENTAL
HEALTH ASPECTS FOR FATHERS AS
WELL. I'M IN THE MIDDLE OF A
SEPARATION. I DO THINK THAT
THERE IS A BIG STATISTIC THAT
80% OF COUPLES THAT LOSE
CHILDREN DON'T MAKE IT THROUGH
THEIR MARRIAGE. I'M STANDING
HERE TO TELL YOU THAT IS TRUE
AND THINK THAT PLAYED A LARGE
PART IN OUR SEPARATION AND ALSO
DO THINK IF THERE WAS FOCUS ON
ME AND ON DAD THINGS MIGHT HAVE
BEEN DIFFERENT. MY HUSBAND
DIDN'T HAVE A REAL UNDERSTANDING
WHAT I WAS GOING THROUGH EXACTLY
AND I DIDN'T HAVE AN
UNDERSTANDING WHAT I WAS GOING
THROUGH AND NO WAY FOR HIM TO
HAVE AN UNDERSTANDING AS WELL.
AND HE WASN'T REALLY WELL VERSED
ON WHAT COMPLICATIONS FOR MY
PREGNANCY JUST THAT WE WERE
PREGNANT AND GOING TO THE
DOCTORS EVERY WEEK.
I WISH THERE WAS MORE FOR MOMS
IN POSTPARTUM PERIOD AND LESS
BABY BLUES AND IT IS OKAY TO NOT
BE OKAY. WHEN I HAD SECOND SON
PROBABLY WHEN HE WAS 6 WEEKS OLD
CALLED DOCTOR SOMETHING IS NOT
RIGHT I'M NOT CONNECTING WITH
HIM. THIS IS SUPPOSED TO BE
VERY DIFFERENT AND SUPPOSED TO
FEEL VERY DIFFERENTLY ABOUT HIM.
I LOVE HIM BUT DON'T LIKE HIM
VERY MUCH RIGHT NOW.
I HAD CONVERSATIONS WITH HER
OVER AND OVER AND SHE WAS
FINALLY LIKE WE WILL GET YOU
INTO A DAY PROGRAM AND SEE IF IT
HELPS A LITTLE BIT. IT CHANGED
THINGS COMPLETELY. I WAS ABLE
TO SEE OTHER WOMEN GOING THROUGH
SAME THINGS I WAS GOING THROUGH
AND DIDN'T FEEL AS CRAZY AS I
WAS FEELING AND IN THIS MOMENT
OF BEING LIKE OH, MY GOODNESS.
I'M ONLY PERSON GOING THROUGH
THIS. PEOPLE DON'T TALK ABOUT
WHAT POSTPARTUM DEPRESSION
REALLY LOOKS LIKE. IT IS HARD.
I WANT TO ALSO TOUCH ON
IMPORTANCE OF GIVING PATIENTS
CLEAR DIAGNOSIS AND EXPLAINING
TO THEM.
SO, I KNEW I HAD A SHORT CERVIX
IN FIRST PREGNANCY AND DIDN'T
KNOW WHAT IT MEANT EXACTLY.
WHATEVER DOCTOR NOELD I NEED
TODAY DO I WAS GOING TO. DO I
NEED TODAY GET THROUGH MY
PREGNANCY.
SECOND PREGNANCY, I WAS VERY
INTENTIONAL ABOUT THE
CONVERSATION I WAS HAVING WITH
MY PROVIDER AND WANTED TO SAY I
WANT [INDISCERNIBLE] RIGHT AT 13
WEEKS WHEN IT IS SAFE TO HAVE A
PLACE AND I WANT TO YOU KNOW
HAVE THAT AS ONE LESS THING ON
LIST OF THINGS TO HAVE TO WORRY
ABOUT. IF YOU BELIEVE IN YOUR
[INDISCERNIBLE] IT WILL HOLD AND
YOU WILL GET THROUGH A
PREGNANCY. YOU CAN GO THROUGH
THE NEXT SLIDE.
NEXT SLIDE AS WELL.
ONE THING THAT I LIKE TO TOUCH
ON IS LACK OF EMPATHY OF
PROVIDERS IN THE MATERNAL HEALTH
WORLD. THERE IS A LOT OF TIMES
PROVIDERS WILL HAVE
CONVERSATIONS WITH YOU IN THE
ROOMS AND IN THESE SPACES AND
WANT YOU TO JUST ACCEPT WHATEVER
THEY ARE SAYING AND
UNFORTUNATELY IF YOU ARE LIKE
HOW I WAS IN FIRST PREGNANCY
WHATEVER DOCTOR TOLD ME TO DO I
WAS GOING TO DO AND THAT WAS
WITHOUT RESEARCH AND WITHOUT --
YOU ARE THE PROVIDER AND
ASSUMING THIS IS YOUR JOB AND
YOU WILL DO WHATEVER IS GOING TO
BE BEST FOR ME.
IT IS SUPER IMPORTANT TO DISCUSS
WHAT ALL THOSE THINGS ARE GOING
TO LOOK LIKE.
I HAD PREECLAMPSIA WITH MY
SECOND SON AND DOCTOR CAME IN.
SHE WAS GOING ON VACATION AND WE
PLANNED OUT THIS WHOLE BIG
DELIVERY AND WHEN THINGS CHANGED
THEY CHANGED DRAMATICALLY.
DROPPING KIDS OFF AT CAMP I NEED
YOU TO SIT HERE. SIT HERE AND
JUST WAIT. WAIT AND SHE WAS
LIKE WE WILL WAIT AND SEE WHAT
KIND OF HAPPENS. WHILE SHE WAS
AWAY DROPPING HER KIDS OFF, SHE
-- MY BLOOD PRESSURE KEPT
GETTING HIGHER AND HIGH. ER.
THEY WEREN'T ABLE TO CONTROL
THEM AND SATURDAY BEFORE MY SON
WAS BORN TOOK ME TO LABOR AND
DELIVERY AND STARTED MAGNESIUM
FOR ME. I REMEMBER CALLING HER
BEING LIKE I'M NOT PREPARED FOR
THIS OR READY FOR THIS. WE
PLANNED ON ME HAVING THIS BABY
WITH YOU I DON'T KNOW ANY OF
THESE OTHER PROVIDERS. I'M VERY
UNCOMFORTABLE WITH THIS AND
REMEMBER HER SAYING YOU ARE IN
THE BEST PLACE YOU NEED TO BE
AND YOU WILL GET THE BEST CARE.
UNFORTUNATELY BEING AN AFRICAN
AMERICAN WOMAN, THOSE WORDS
DON'T MEAN MUCH TO ME. WHEN YOU
HAVE A PROVIDER YOU TRUST AND
SOMEONE THAT YOU ARELE TO PUT
YOUR LIFE IN THEIR HANDS THAT IS
KIND OF THE ONLY PERSON YOU WANT
TO BE ABLE TO DO EVERYTHING FOR
YOU.
I DON'T KNOW WHO SHE CALLED OR
WHAT CONVERSATION SHE HAD THEY
KEPT ME ON LABOR AND DELIVERY
FOR 48 HOURS INLE SHE WAS BACK
THAT MONDAY AND SHE DELIVERED MY
SON AND I HEM RANLED AGAIN IN
THE OR. I HAD A VERY LARGE C
SECTION AND WHEN I WAS DIAGNOSED
WITH SOME OF MY OTHER ISSUES
ENDO MITES THEY FOUND AND HAD TO
HAVE DNC AND HAD TO RECEIVE
BLOOD PRODUCTS WHEN IN THE OR
AND HAD TO RECEIVE BLOOD
PRODUCTS AFTER MY SON WAS BORN.
YOU ARE NOT EXPECTING THAT WHEN
YOU ARE HAVING A BABY.
I WAS ON A HIGH FOR THE FIRST 24
HOURS AND HIGH STARTED TO COME
DOWN ONCE THINGS WEREN'T ALL
RAINBOW AND ROSES AS I THOUGHT
THEY WERE GOING TO BE I HAD SUCH
A DIFFERENT OUTCOME SECOND TIME
I HAD A BABY. I FELT THAT
PEOPLE LISTENED TO ME AND
PROVIDER -- SHE SPENT EXTRA TIME
AND FIVE MINUTES SUFFERING OR
GOING OVER THINGS WITH ME AGAIN
AND REASSURING ME WE WOULD GET
TO THE OTHER SIDE. THERE WERE
PLENTY TIMES I DIDN'T BELIEVE
THAT WOULD HAPPEN AND THERE WERE
PLENTY OF TIMES WHERE I HAD
ANTIER YOOR PLACENTA AS WELL AND
COULDN'T FEEL MY SON MOVE AND
WAS A REASON I ALWAYS WAS GOING
INTO LABOR AND DELIVERY. I
COULDN'T FEEL THINGS.
I REMEMBER WHEN I FIRST MET HER
I SAID TO HER, OH, I HAVE A
[INDISCERNIBLE] AT HOME. SHE
WAS LIKE YOU WILL GET RID OF
THAT. THAT IS NOT SOMETHING YOU
WILL USE. IF YOU FEEL LIKE
SOMETHING IS NOT RIGHT YOU WILL
COME INTO THE HOSPITAL. I DON'T
WANT YOU MONTH NTORRING YOURSELF
AT HOME.
THAT CHANGED EVERYTHING FOR ME
AND MADE IT SO I WAS ABLE TO BE
LESS WORRIED ABOUT WHAT MY
PROVIDER WOULD THINK AND MORE
CONCERNED ABOUT MY ACTUAL HEALTH
AND WELLBEING.
AND I WANT TO TOUCH ON THAT
MEDICAL CARE SHOULD BE A
PARTNERSHIP NOT DICTATORSHIP.
YOU SHOULDN'T HAVE TO FEEL YOU
CAN'T TALK TO YOUR PROVIDER
WHOMEVER THE PROVIDER IS WHETHER
A NURSE OR DOCTOR. YOU SHOULD
BE ABLE TO HAVE WHATEVER
CONVERSATION YOU ARE HAVING AND
DOESN'T MEAN I'M ASKING
QUESTIONS THAT DON'T TRUST YOU
JUST THAT I NEED MORE
INFORMATION.
ONE OTHER THING -- ONE THING I
WANT TO SUMMARIZE ON MAIN POINTS
I WANT YOU GUYS TO REMEMBER IS
GIVING YOUR PATIENTS MENTAL
HEALTH THAT THEY NEED DURING AND
AFTER THEIR PREGNANCIES.
ALSO, GIVING THEM QUALITY CARE,
WHATEVER IT LOOKS LIKE TO YOU.
REALLY SPEAKING TO WOMEN YOU ARE
SEEING AND SPEAKING TO DADS YOU
ARE SEEING IN CLINICS AS WELL
AND ASKING THEM WHAT WOULD MAKE
THIS EASIER FOR YOU AMD MAKE
THIS SOMETHING THAT YOU WOULD
FEEL COMFORTABLE WITH?
I ENCOURAGE YOU TO GET INVOLVED
IN MATERNAL HEALTH ADVOCACY AND
SUPPORT POLICIES INITIATIVE THAT
PROMOTES MATERNAL HEALTH
OUTCOMES IN WHATEVER WAY IT LOOK
LIKES SO MANY NON-PROFIT
PROGRAMS OUT THERE OFFER
TRAININGS AND ALL SORTS OF
THINGS FOR PATIENT AND PROVIDERS
AND IMPLORE ALL OF YOU TO AT
LEAST ATTEMPT TO TRY SOME OF
THEM AND TALKING TO PATIENTS IS
MOST IMPORTANT THING AS WELL.
YOU CAN GO TO THE NEXT SLIDE.
THERE IS A PICTURE OF MY SON.
THAT IS GRAYSON.
>> IF THERE ARE ANY QUESTIONS,
CANDICE IS WILLING TO TAKE
QUESTIONS. WE HAVE MICS. YOU
CAN GO UP TO THE MICS.
>> HI. THANK YOU SO MUCH FOR
SHARING YOUR STORY. MY QUESTION
WAS WHEN YOU WENT FOR THE OPEN
MYOECTOMY, WAS IT FOR FERTILITY
ISSUES OR SYMPTOMS YOU WERE
GETTING TREATED?
>> IT WAS FOR SYMPTOMS.
ACTUALLY, PRIOR TO HAVING --
PRIOR TO LIKE EVEN MEETING MY
HUSBAND, I DIDN'T WANT CHILDREN.
SO, IT WAS FOR SYMPTOMS I WAS
HAVING.
THEN WHEN I WENT IN AND MET WITH
MY SURGEON, SHE WAS LIKE THIS
WILL CLEAR UP ANY FERTILITY
ISSUES YOU MIGHT HAVE. DIDN'T
NECESSARILY CLEAR IT UP FOR ME
BUT I HAD A VERY LARGE OPEN
MYOECTOMY AND I ALSO HEMORRHAGED
THEN. I'M JUST A BLEEDER,
APPARENTLY. YEAH. IT WAS FOR
SYMPTOMS I WAS HAVING.
>> THANK YOU.
>> UH-HUH.
>> THANK YOU SO MUCH FOR SHARE
YURG STORY.
>> ABSOLUTELY.
>> I'M A MATERNAL FETAL
MEDICINE DOC AND EVERY TIME I
HEAR A PATIENT'S NARRATIVE, IT
CHANGES ME AGAIN. I SAY THAT
NOW AFTER 10 YEARS DOING THIS.
MY QUESTION FOR YOU IS WHAT
ADVICE WOULD YOU OFFER A BRAND
NEW PERSON? I THINK ABOUT THIS
A LOT WITH MEDICAL EDUCATION AND
BRINGING IN INTERNS WHO HAVEN'T
HAD A BABY AND NEVER GAVE BIRTH
AND CHOSE A FIELD TO SUPPORT AND
THEY GO THROUGH THE STEPS AND
SOMETHING IS LOST AND SPARK GOES
OUT FOR THE WOMAN OR PERSON WHO
IS BIRTHING AND WONDER IF YOU
HAVE THOUGHTS OR IDEAS HOW TO
FRAME TRAINING GOOD HIGH-QUALITY
MEDICINE FOR THE PERSON THAT
MIGHT BE BRAND NEW TO THE TRUE
HUMAN INTERACTION OF IT.
>> ABSOLUTELY.
I THOUGHT ABOUT THAT QUESTION A
LOT AND EMPATHY.
IF EMPATHY IS TRAJECTORY FOR
EVERYTHING, YOU WILL GO A LONG
WAY.
AND I LIKE TO TELL PEOPLE TO
THINK ABOUT YOUR MOTHER AND
SISTER AND FRIEND AND WIFE AND
PARTNER THAT WILL GO THROUGH
THESE THINGS.
I THINK THAT UNFORTUNATELY
PEOPLE BECOME SENSITIZED WHEN
THEY HAVE BEEN DOING THINGS FOR
A WHILE. BABIES DIE; RIGHT?
I'M NOT THE FIRST PERSON AND
WON'T BE THE LAST PERSON.
BUT, THAT WAS MY BABY THAT DIED.
>> UH-HUH.
>> IT IS NOT JUST A BABY THAT
DIED.
IF YOU ARE ABLE TO GIVE THAT
EXTRA FIVE MINUTES AND GIVE THAT
PERSON THE ATTENTION THAT THEY
NEED, A HUG, EXTRA TISSUE,
WATER, ANYTHING, IT GOES A LONG
WAY. EMPATHY IS THE BIGGEST
THING.
>> THANK YOU.
>> YOU'RE WELCOME.
>> CANDICE?
>> BEFORE WE TAKE THE NEXT
FLOOR MIC QUESTION, I HAVE TO
ASK IF WE HAVE ANY VIRTUAL
QUESTIONS.
>>.
>> JUST A LOT OF PEOPLE ARE
EMPATHIZING WITH THE STORY YOU
ARE SHARING AND VERY THANKFUL
YOU ARE SHARING AND ASKING IF
YOU HAVE ANY IDEA WHERE YOU CAN
IMPROVE IT.
>> BIGGEST THING FOR PEOPLE TO
IMPROVE MATERNAL HEALTH OUTCOME
DON'T CARE IF STANDARD OR
COMPLEX PREGNANCY. LISTENING TO
YOUR PATIENT WHO IS LIVING IN
THEIR BODY.
THEY KNOW WHAT IS GOING ON AND
WHAT IS OR IS NOT NORMAL AND
UNFORTUNATELY WHEN PEOPLE HAVE
THEIR FIRST PREGNANCY WITH MY
SON, I THOUGHT THESE THINGS WERE
NORMAL AND REMEMBER CALLING AND
IN LABOR AND DELIVERY ONE NIGHT
SOMEONE SAYING TO ME THOSE ARE
NORMAL PAINS OF BEING PREGNANT
AND DON'T KNOW HOW DIFFICULT IT
IS TO BRING SOMEONE IN THE HO PT
TO GIVE REASSURANCE AND
INSURANCE PLAYS A PART IN THAT
AND IF YOU TALK TO SOMEONE FOR
NEXT TO FIVE MINUTES NOT
DISMISSING YOU SEE LOTS OF
PEOPLE AND IT MIGHT BE STANDARD
FOR YOU AND IS IMPORTANT TO
LISTEN TO THAT PERSON CALLING OR
HAVING THAT CONVERSATION AND IS
VERY SCARY AND NOT -- IT IS NOT
A WALK IN THE PARK. YOU SEE
PREGNANT PEOPLE ALL THE TIME.
LOTS OF TIMES THESE ARE PEOPLE
FIRST AND SOMETIMES ONLY
PREGNANCY.
SO, AGAIN, I TOUCH ON BEING
EMPATHETIC AND TRYING TO PUT
YOURSELF IN THEIR SHOES.
>> CANDICE I WILL SPEAK AGAIN
TO MEMBERS IN THE AUDIENCE AND
WANT TO THANK YOU FOR GIVING US
THAT TALK. ALSO, YOUR BRAVERY
IN BEING ABLE TO DO THAT. I
KNOW IT IS NOT EASY.
ONE THING WHEN I WAS LISTENING
TO YOU TALK ABOUT HOW CORROSIVE
A LOSS OF A CHILD OR TWO OR FIVE
SOMETIMES.
HOW IT CAN BE TO A RELATIONSHIP,
I TEND TO FIND IN THESE SETTINGS
THAT THEY ARE PROBABLY THE MOST
CORROSIVE SORT OF EMOTION THAT
IS GUILT.
AND I TRIED TO TAKE IT HEAD ON
WITH THE PATIENTS SAYING, YOU
KNOW, THIS WASN'T YOUR FAULT.
YOU DIDN'T -- BUT IT IS LIKE A
POISONED ARROW THAT IS INSIDE.
AND I WAS WONDERING IF YOU COULD
TALK A LITTLE ABOUT THAT AND HOW
THOSE OF US WHO TAKE CARE OF
PATIENTS CAN DEAL WITH THAT.
>> ABSOLUTELY.
SO, ONE OF THE THINGS THAT I
TOUCH ON A LOT IS THAT IT IS
EASY TO SAY THAT IT IS NOT YOUR
FAULT. MY BABY DIED IN MY BODY,
A PLACE THEY WERE SUPPOSED TO BE
SAFE.
AND AS DIFFICULT AS THAT IS TO
ACCEPT AND AS DIFFICULT AS IT
HAS BEEN TO -- I SPEND A LOT OF
TIME -- I HAVE A LOT OF FRIENDS
WHO ARE IN THE LOSS WORLD WITH
ME AND HAVE VERY GOOD
CONNECTIONS WITH WOMEN WHO HAVE
GONE THROUGH THE SAME THING I
HAVE GONE THROUGH.
AND WHILE THAT IS TRUE THAT YOU
-- IT IS NOT YOUR FAULT THAT IT
HAPPENED, IT IS HARD TO REFRAME
YOUR BRAIN IN THAT.
SO, I DO IMPLORE DOCTORS TO PUSH
FOR THEIR PATIENTS TO GO GET
MENTAL HEALTH THEY NEED PRACH I
IMPLORE DOCTORS TO DO WORK THEY
NEEDED. I WAS IN A PLACE I
WASN'T GETTING OUT OF BED OR UP
TO SHOWER AND GET OUT EVERY DAY
GOT UP AND SHOWERED AND DAD MADE
SURE I WAS EATING.
AND YOU -- THERE IS NOT A SPACE
FOR PEOPLE WHEN THEY LOSE KIDS.
THEY WANT YOU TO GO BACK TO WORK
AND LIVE A NORMAL LIFE AND ACT
AS IF YOU DIDN'T IF YOU HAVE A
BABY AND YOU GO THROUGH ALL
THINGS YOU GO THROUGH HAVING A
BABY AND GO THROUGH POSTPARTUM
PERIOD AND YOU JUST DON'T HAVE
THE CHILD.
AND WHAT I WOULD LOVE TO SEE IS
THERE BE ADVOCATES THAT ARE ABLE
TO COME INTO HOSPITALS AND SPEAK
TO MOMS AND IS EASIER TO HAVE A
CONVERSATION WITH SOMEONE THAT
HAS GONE THROUGH IT AND KNOWS
WHAT YOU WILL GO THROUGH FOR THE
NEXT SIX MONTHS OR A YEAR OR TWO
YEARS.
BECAUSE THERE WAS A TIME I
DIDN'T THINK I WOULD EVER DO
THIS AND TIME I DIDN'T THINK I
WOULD EVER SMILE AGAIN OR LAUGH
AGAIN AND DIDN'T THINK I WOULD
HAVE THIS.
HERE I AM FOUR YEARS LATER AND
I'M ABLE TO SHARE MY STORY AND
ABLE TO HOPEFULLY CHANGE THINGS
FOR PEOPLE.
I WOULD LOVE TO SEE DOCTORS AND
NURSES AND PEOPLE IN THESE
SPACES TO TAKE MENTAL HEALTH
PORTION MORE SERIOUSLY.
IT IS SO DETRIMENTAL THAT IF YOU
DON'T GET HELP THAT YOU CAN TURN
INWARDS AND BLAME YOURSELF AND
BE THIS PERSON THAT IS SUPER
ANGRY AT THE WORLD. I WAS THERE
AND SUPER ANGRY AND HATED
EVERYONE FOR SIX MONTHS AND I
WAS OUT OF WORK FOR FOUR MONTHS
AND SPENT DAY WHERE'S I COULDN'T
GET BEHIND A WHEEL OF A CAR AND
FELT I HAD A SCARLET LETTER ON
ME. I DIDN'T START TO REFRAME
THAT UNTIL I WAS IN THERAPY.
SO, I REALLY PUSHED MAKING SURE
THAT YOUR PATIENTS GOING THROUGH
LOSS GET THERAPY HELP THEY NEED
EVEN IF THEY DON'T WANT IT.
>> DO WE STILL HAVE TIME FOR A
FEW MORE QUESTIONS.
>> LET'S TAKE ONE MORE QUESTION
FROM VIRTUAL AUDIENCE.
>> SO, S AGAIN, EVERYONE IN THE
VIRTUAL AUDIENCE IS THANKING YOU
FOR SHARING YOUR STORY VERY MUCH
IT THEY APPRECIATE IT. THEY ARE
ASKING WHAT YOUR BEST ADVICE
WOULD BE FOR -- THERE ARE
SEVERAL QUESTIONS BUT FOR
EXPECTANT MOTHERS AND IF IN HIGH
RISK COMMUNITY LIKE THE BLACK
COMMUNITY, WHAT WOULD BE YOUR
BEST WAY TO ADVISE THEM TO GET
THROUGH THE SYSTEM?
>> LEARNING TO ADVOCATE FOR
YOURSELF AND IT TOOK A LONG TIME
FOR ME TO DECIPHER THAT LIKE I
SAID EARLIER, THIS IS NOT A
DICTATORSHIP. THIS IS A
PARTNERSHIP. WE ARE IN THIS
TOGETHER. YOU ARE BIRTHING BABY
AND I'M CARRYING BABY AND
HOLDING HANDS TO GET THROUGH
THIS AND LOOKING FOR A DOULA AND
PUSHING TO HAVE DOULAS WHEN
CAN'T TALK TO MEDICAL
PROFESSIONAL THEY HAVE SOMEONE
ELSE TO GO TO AND MAKING SURE
THEY ARE IN SPACE WHERE OPEN
DOOR POLICY THEY WILL ASK
QUESTIONS AND ANSWER QUESTIONS
AND WON'T MAKE THEM FEEL STUPID
FOR ASKING SAID QUESTIONS AND,
AGAIN, BEING EMPATHETIC TO THE
PERSON. YOU HAVE NO CLUE WHAT
IT HAS TAKEN FOR SOMEONE TO GET
THERE AND YOU HAVE NO CLUE WHAT
IT HAS TAKEN TO HAVE SOMEONE
TRUST YOU.
UNFORTUNATELY, IN THE BLACK
COMMUNITY, THERE IS A LOT OF
DISTRUST WITH PROVIDERS.
THAT CULTURE HAS BEEN P MADE.
SO, YOU KNOW, BEING AS TRUTHFUL
AS YOU POSSIBLY CAN AND WHATEVER
THE OUTCOME WILL BE.
I MEAN, YOU KNOW, LIKE I SAID
EARLIER, BABIES DO DIE. I WAS
NEVER PREPARED FOR THAT OR TO
HAVE THE CONVERSATION NOW YOU
HAVE TO FIGURE OUT WHAT TO DO
FOR YOUR CHILD. I WASN'T
PREPARED FOR. THAT AS SCARY AS
IT MIGHT BE SOME PEOPLE WANT ALL
OF THE FACTS I WOULD HAVE WANTED
ALL OF THE FACTS UP FRONT.
>> THANK YOU SO MUCH, CANDICE.
>>.
>> WE WILL START WITH THE NEXT
CLINICAL OUTCOMES PANEL.
>>.
>> GOOD MORNING, EVERYONE.
I'M WITH THE NATIONAL HEART,
LUNG AND BLOOD INSTITUTE AND ON
BEHALF OF ORGANIZING COMMUNITY I
WOULD LIKE TO WELCOME YOU TO THE
CLINICAL OUTCOME PANELS AND SO
MAJOR OBJECTIVE OF THE SESSION
IS TO FIRST SUMMARIZE CURRENT
STATE OF RESEARCH AND IN CASE OF
DISCOVERIES OF PREVENTION AND
DIAGNOSIS AND TREATMENT AND
MANAGEMENT CONDITIONS WHICH ARE
CONTRIBUTING TO RISING RATES OF
MORTALITY AND MORBIDITY AND
SECONDLY TO IDENTIFY AREAS READY
FOR TRANSLATION TO GET WHAT
MIGHT BE POTENTIALLY ADDRESSED
THROUGH TECHNOLOGY INNOVATION.
IT IS MY GREAT PLEASURE TO
INTRODUCE TWO MODERATORS DR.
AARON PAWLYK WHO IS IN THE
NATIONAL INSTITUTE OF CHILD
HEALTH AND HUMAN DEVELOPMENT AND
DR. GEORGE SAADE WHO IS IN
WOMEN'S HEALTH AT EASTERN
VIRGINIA MEDICAL SCHOOL AND
WELCOME AGAIN AND HOPE YOU ENJOY
THE DISCUSSION AND PRESENTATION.
TURNING IT TO YOU.
>> ALL RIGHT. HOW DO WE
ADVANCE THIS SLIDE? NICE TO SEE
EVERYBODY BACK AROUND EVERYONE
SHOWING UP IN PERSON AND GREAT
VIRTUAL ATTENDANCE AND BEFORE I
DIVE IN, THANK YOU CANDICE FOR
TALKING TODAY TO HIGHLIGHT WHAT
IS IMPORTANT AND DOING A BETTER
JOB OF FIGURING OUT MATERNAL
HEALTH.
IT IS IMPORTANT THAT AS WE TALK
THROUGH SCIENCE WE FOCUS TODAY
ON WHAT TO GET OUT THERE IN THE
CLINIC.
NEXT SLIDE.
NO REVEL LENT INTERESTS.
NEXT SLIDE.
GOING THROUGH A SERIES OF
SLIDES. EACH COULD BE AN
HOUR-LONG TALK AND WANT TO
INTRODUCE REGULATORY CONCEPTS
THAT MIGHT COME UP TODAY AND
SLIDES WILL BE AVAILABLE AND
REFERENCES THERE AND FIRST WHAT
IS A BIOMARKER THAT IS A TERM
THAT WE TOSS AROUND AND
TECHNICAL AND REGULATORY
DEFINITIONS.
HANDBOOK THAT IS BEST RESOURCE
PUT TOGETHER BY FDA AND
BIOMARKER WORKING GROUP AND FDA
USED AND HIGHLY RECOMMEND THIS
IS A RESOURCE AND ESSENCE OF
BIOMARKER DEFINED
CHARACTERISTICS MEASURING
INDICATOR OF NORMAL PATHOLOGICAL
BIOLOGICAL PROCESS AND IMPORTANT
AS WE GO THROUGH TODAY TO THINK
ABOUT WHAT BIOMARKERS ARE NOT
ASSESSMENTS HOW AN INDIVIDUAL
FEELS, FUNCTIONS OR SURVIVES AND
IS NOT A CLINICAL ENDPOINT.
NEXT SLIDE.
BRIEFLY, WHAT IS A CLINICAL
OUTCOME?
AGAIN, GOING HERE TO THE FDA AND
REGULATORY DEFINITION AND
CLINICAL OUTCOME AASSESSMENT IS
DESCRIBING HOW PATIENT FEELS AND
FUNCTIONS AND SURVIVES AND
VARIETY OF DIFFERENT TYPES THAT
IS NOT EXCLUSIVE AND HITS ON
MAJOR ONES.
NEXT SLIDE.
SO, NEXT TWO SLIDESLY TALK ABOUT
ARE DEFINITIONS THAT ARE
PARTICULARLY RELEVANT TO
AUDIENCES AND TODAY WE TALK
ABOUT INNOVATIONS AND
TECHNOLOGIES AND FIRST WHAT IS A
DIGITAL BIOMARKER?
THIS IS NOT AN FDA FWIEDANCE
FROM A PUBLICATION PUBLISHED
FROM FDA PUBLIC AUTHORS A SET OF
CHARACTERISTICS COLLECTED FROM
DIGITAL HEALTH TECHNOLOGIES
BIOMARKER IT IS THAT, THAT IS
KEY HERE FOR DIGITAL BIOMARKER.
NEXT SLIDE.
WHAT ARE MULTICOMPONENT
BIOMARKERS?
THEY INCLUDE FEATURES BASED ON
TWO ORE MORE MEASUREMENTS
CLINICAL CHARACTERISTICS AND
DEMOGRAPHICS, ET CETERA, THAT
COULD BE USED INDEPENDENTLY OR
COMBINED BY SOME TYPE OF
ALGORITHM AND IS A GREAT
WORKSHOP ON THIS TO SEE WHAT THE
FDA HAD.
THIS IS IMPORTANT AND THINKING
ABOUT ALGORITHM OF DIGITAL
BIOMARKER IS A MULTICOMPONENT
AND THESE LEAD TOGETHER AND
BLEND AND DEFINITIONS BECOME
VERY IMPORTANT THINKING ABOUT
ADVANCING SOMETHING DOWN A
REGULATORY PATHWAY.
NEXT SLIDE.
I WANT TO TOUCH BRIEFLY ON
BIOMARKER PROCESS THAT FDA
UNDERGOES. LETTER INTENT GOING
TO FDA IS REALLY IMPORTANT AND
INITIATES QUALIFICATION PROCESS
AND WANT TO STATE QUALIFICATION
OF BIOMARKER IS REGULATORY TERM
OF ART AND APPROVED BIOMARKER IS
QUALIFIED BY FDA NOT APPROVED
BUT QUALIFIED AND PROPOSED
CONTEXT OF USE TALKING ABOUT
THIS MORE AND CONTEXT OF USE OF
BIOMARKER. YOU HAVE ONE AND
WHAT YOU ARE PLAN GS TO USE IT
FOR AND HAMMERING OUT LETTER OF
INTENT AND SUBMITTING TO FDA
WHAT WILL YOU GET IN TERMS OF
DATA TO SUPTHOORT AND FULL
QUALIFICATION PACKAGE INCLUDING
DATA AND DETERMINATION TO
QUALIFY BIOMARKER OR NOT.
NEXT SLIDE.
LEFT HERE IS BIOMARKER
CATEGORIES FROM THE BEST
HANDBOOK AND VARIETY OF
DIFFERENT TYPES WON'T READ THEM
IN THE INTEREST OF TIME AND THEY
ARE BROKEN OUT AND DEFINITIONS
CAN BE TRICKY TO GET THROUGH AND
WHY HAVING THAT LETTER OF INTENT
WORKING ON IT WITH FDA EARLY ON
OR REGULATORY EXPERTS IS VERY
IMPORTANT AND RIGHT HERE IS
CONTEXT OF USES AND WE WILL LOOK
HERE AT A SECOND FOR PROGNOSTIC
BIOMARKERS AND TWO CONTENTS OF
LISTED AND STRATIFICATION OF
PATIENTS OR CLINICAL TRIAL OR
ENRICHMENT INCLUSION AND
EXCLUSION DATA TWO DIFFERENT
USES AND BIOMARKERS TWO LETTER
OF INTENTS AND CUTOFF MIGHT BE
DIFFERENT USING SAME BIOMARKER.
MAY NEED DIFFERENT LETTERS OF
INTENT AND ALL SHOULD BE THOUGHT
THROUGH THINKING OF BIOMARKERS
AND ASSESSMENT AND VALIDATION
AND NEXT SLIDE.
I WANT TO TALK ABOUT A PROJECT
THAT HAS BEEN IN DEVELOPMENT FOR
OVER TWO YEARS THROUGH THE
FOUNDATION FOR NIH THAT FOR
THOSE THAT DON'T KNOW NON-PROFIT
CREATED BY CONGRESS TO SUPPORT
PUBLIC AND PRIVATE PARTNERSHIPS
INVOLVING NATIONAL INSTITUTES OF
HEALTH AND CERTAIN LIMITATIONS
FEDERAL AGENCY AND BIOMARKER
PROJECT RISK STRATIFICATION AND
EARLY ONSET OF PREECOLLAPSIA AND
DOING IT SOON AS POSSIBLE TO
AVOID THINGS THAT CANDICE WENT
THROUGH. I WON'T HAVE
ACKNOWLEDGEMENTS FOR THIS AND
WANT TO RECOGNIZE A TREMENDOUS
AMOUNT OF WORK GOING INTO
PROJECTS ONCE IT IS LAUNCH THE
IT WILL BE CLEAR AND WE ARE NOT
IDENTIFYING THAT AND HEARING
MORE ABOUT SIGNIFICANCE OF
PRECOLLAPSIA AND PERSONAL STORY
OF MATERNAL HEALTH ISSUE EARLIER
TODAY AND I WANT TO HIGHLIGHT
FROM THE SLIDE REEMPHASIZING ONE
THIS IS A TWO PATIENT ISSUE FOR
MOTHER AND CHILD AND BOTH SHORT
AND ACUTE EFFECTS AND LONG-TERM
CARDIOVASCULAR RISK ASSOCIATED
WITH PRECOLLAPSIA FOR MOTHER AND
CHILD NOT JUST IMMEDIATE BUT
LONG-TERM EFFECTS TO ADDRESS
EARLIER AND THIS IS FROM AMNESTY
USA AND UNITED STATES IS 50 YENL
IN THE WORLD AND THIS IS A
COUPLE YEARS LATE AND WE ARE NOT
MUCH BETTER AND DOG A GOOD JOB
HER TALKING ABOUT TODAY THIS
PANEL THAT IS DRIVEN BY
DISPARITY AND DRIVEN ON A LOT OF
LEVELS FOR THAT AND THIS IS
COMING UP BIOMARKER CONSORTIUM
HUGE EXPERTISE FDA AND PUBLIC
AND PRIVATE PARTNERSHIPS AND
BIOMARKERS FOR PREECOLLAPSIA FOR
DIAGNOSIS AND RISK PREDICTION
AND WE ARE PROPOSING TO DO IN
RACIALLY DIVERSE COHORT OF NORTH
AMERICAN INDIVIDUALS USING
EXISTING BIOSAMPLES ASSOCIATED
AND NEED TO GET DATA IN NORTH
AMERICAN COHORT THAT IS
DIFFERENT FROM MANY COHORTS FOR
WHICH GENETIC BIOMARKERS ARE
[INDISCERNIBLE] AND SECOND
SPECIFIC AIM IS DEVELOPING IN
ALGORITHM AND WHERE WE GET TO
MULTICOMPONENT BIOMARKERS THAT
WILL INCORPORATE PATIENT
DEMOGRAPHICS AND WILL TALK ABOUT
THIS MORE IN A SECOND.
SOME FOLKS ARE GOING WE KNOW
ABOUT BIOMARKERS AND WHY AREN'T
WE FOCUSING ON THEM?
WE HAVE EXPLORATORY AIM TO DELVE
INTO NEW THINGS.
NEXT SLIDE.
I WANT TO HIGHLIGHT GROUPS AND
WE WILL USE COMMERCIALLY
AVAILABLE KITS AND THEY ARE USED
IN THE UNITED STATES IN LOTS OF
PLACES.
WE NEED TO GET WHAT IS AVAILABLE
IN THE UNITED STATES TO IMPROVE
INSURANCE AND LABS ACROSS
COUNTRY CAN DO THIS AND GETTING
CARE ACROSS COUNTRY LAND INVOLVE
ACADEMIC COLLABORATORS TO DO
ANALYSIS AND GENERATE DATA FOR
REGULATORY FILINGS AND BE USED
TO SUPPORT DRUG DEVELOPMENTS AND
TREATMENTS FOR PREECOLLAPSIA AND
HIGH RISK PATIENTS NOT GETTING
CARE TO PEOPLE ESPECIALLY
AFRICAN AMERICANS.
NEXT SLIDE.
DRIVING THIS HOME AGAIN THIS IS
A CALCULATOR AVAILABLE FROM
FETAL MEDICINE FOUNDATION AND
THIS IS OUTSIDE OF THE UNITED
STATES AND DON'T KNOW CUTOFF FOR
AMERICAN COHORT AND ETHNIC
VARIABILITY IN IT AND ANGIOGENIC
BIOMARKERS ARE NOT AVAILABLE AND
MEDICAL CENTERS COULD GET LABS
DONE AND AFRICAN AMERICAN WOMAN
ENROLLED IN MISSISSIPPI, YOU
CAN'T GET LABS DONE AND WE WANT
TO GET IT UPDATED TO BE USED.
NEXT SLIDE. A FEW QUESTIONS
HERE AND CONSIDERATIONS AND
BIOMARKERS RELY ON DEVICES AND
TECHNOLOGIES HEAVILY AND
CLINICAL OUTCOME MEASURES AND
ARE THERE ADDITIONAL
TECHNOLOGIES TO USE AT HOME
MEASURES MORE FREQUENT
MEASUREMENTS FOR THESE TYPES OF
BIOMARKERS.
MACHINE LEARNING ENABLE MORE
DYNAMIC AND FLEXI COMPONENT
BIOMARKERS TO ADAPT AS WE LEARN
AND WHAT TECHNOLOGIES COULD
ENHANCE IMPLEMENTATION GETTING
THIS OUT TO COMMUNITY IN VARIOUS
LEVELS AND WHAT COULD COM
COMINOVATION AND CREATIVITY IS
IN THE AUDIENCE THAN I HAVE.
I'M REALLY LOOKING FORWARD TO
DISCUSSIONS TODAY.
WE WILL TAKE QUESTIONS AT THE
QUESTION PERIOD AND WE WILL GET
THROUGH ALL SPEAKERS WAND THAT I
WOULD LIKE TO TURN IT TO LORI
HARPER AT UNIVERSITY OF TEXAS,
AUSTIN.
>> >> THANK YOU. I'M SPEAKING
ABOUT HYPERTENSIVE DISORDERS AND
PREGNANCY ON BEHALF OF
CONSORTIUM AND [INDISCERNIBLE]
WHO WAS NOT ABLE TO MAKE IT
TODAY. NEXT SLIDE, PLEASE.
HYPERTENSIVE DISORDERS AND
PREGNANCY ARE LEADING CAUSE OF
MATERNAL MORTALITY WORLDWIDE IN
THE U SCS HYPERTENSIVE DISORDER
COULD BE DIVIDED INTO CHRONIC
HYPERTENSION AND -- HIGH BLOOD
PRESSURE 20 WEEKS WITHOUT
PREGNANCY AND -- PREECOLLAPSIA
COULD LEAD TO ECOLLAPSIA AND
THROW IN DISORDER ELEVATED LIVER
ENZYMES AND LOW PLATEMENTS IN
THIS SPECTRUM DOESN'T REQUIRE TO
HAVE HIGH BLOOD PRESSURES AND
NEXT SLIDE. FOCUSING IN ON
CHRONIC HYPERTENSION AND THE
STORY IS EXCELLENT EXAMPLE
TAKING WHAT WE DO OUTSIDE OF
PREGNANCY SAYING WHY DON'T WE DO
THAT WHILE PEOPLE ARE PREGNANT
TOO?
OUTSIDE OF PREGNANCY IS LONG
ESTABLISHED THAT WE TREAT BLOOD
PRESSURES GREATER OR EQUAL TO
190 AND LIFESTYLE
RECOMMENDATIONS RECOMMENDATIONS
FROM EVERYONE AND LISTED
AMERICAN COLLEGE OF CARD YOL AND
AMERICAN HEART ASSOCIATION AND
DIE PETIES AND EVERY SOCIETY
RECOMMENDS THESE; RIGHT?
NEXT SLIDE. DURING PREGNANCY
PRIOR TO APRIL OF 2022
RECOMMENDATION WAS TO ONLY TREAT
BLOOD PRESSURES IF GREATER OR
EQUAL TO 160 OVER 110.
THIS IS OUT OF CONCERN FOR FETAL
GROWTH RESTRICTION THAT HAD
BLOOD PRESSURE CONTROL AND MILD
HYPERTENSION AND OVER A 9 MONTH
PERIOD ESSENTIALLY WAS UNLIKELY
TO IMPACT MATERNAL OUTCOMES AND
IMPROVING PREGNANCY OUTCOMES AND
NEXT SLIDE.
ALLAN APPLIED FOR FUNDING
THROUGH NHLBI AND RECEIVED IT
FOR THIS STUDY TREATMENT OF
CHRONIC MILD HYPERTENSION DURING
PREGNANCY. NEXT SLIDE.
THIS WAS AN OPEN LABEL RCT
GREATER IT THAN OVER 70US
CENTERS COORDINATING SIGHT AND
IT WAS OPEN LABEL RANDOMIZED
CONTROLLED TRIAL COMPARING
TREATING WOMEN WITH BLOOD
PRESSURES. NEXT SLIDE, PLEASE
ACHIEVING BLOOD PRESSURE LESS
THAN 140 OR 90 CONTRIBUTING TO
GREATER OVER 160 OVER 110.
PRIMARY EVALUATING BENEFITS --
WE RANDOMIZED WOMEN WITH SINGLE
TERM PREGNANCY PRIOR TO 23 WEEKS
AAND THEY HAD TO HAVE BLOOD
PRESSURE OF 140 OVER 159 TO 90
OVER 104 NEXT SLIDE TO GET INTO
THE STUDY IF NOT TAKING
MEDICATIONS AND TRIAL OF WOMEN
WITH CHRONIC HYPERTENSION OR
THEY HAD TO BE ON MEDICATIONS.
NEXT SLIDE.
I'M SORRY NEXT SLIDE.
SO, ACTIVE ARM GOT TARGET BLOOD
PRESSURE OF LESS THAN 140 OVER
90 AND PROVIDED STUDY AND PEOPLE
COULD USE OTHER MEDICATIONS THEY
DESIRED AND MEDS TIGHT TREATED
IF THEY WERE ADHERIENT TO BLOOD
PRESSURES GREATER THAN 140 OVER
90 AND STANDARD TREATMENT
WITHHELD OR DISCONTINUED AND
BLOOD PRESSURE GREATER THAN 160
OR 105 AND BLOOD PRESSURE TIGHT
TREATED AND PRIMARY OUTCOME WAS
PREECOLLAPSE YA WITH SEVERE
FEATURES AND LESS THAN 35 WEEKS
ADRUPGS OR FETAL NEONATAL DEATH
AND DIAGNOSED WITH PREECOLLAPSE
YA AND YOU HAD TO HAVE
PROCONTINUE URIA OR LABORATORY
ABNORMALITY OR SOME SYMPTOMS AND
NEXT SLIDE AND LOT OF TIME
ADJUDICATING OUTCOMES.
LESS THAN 10TH PERCENTILE AND
LESS THAN A FIFTH PERCENTILE.
NEXT SLIDE.
WE RANDOMIZED 2400 WOMEN AND
1200 TO EACH GROUP WITH OUTCOMES
ON ALMOST EVERYONE 1170 AND THIS
WAS A PRIMARY STUDY AND 30% FROM
ACTIVE TREATMENT GROUP COMPARED
TO 37% IN STANDARD TREATMENT
GROUP AND NEXT SLIDE AND NUMBER
TREATED FOR 14.7.
NEXT SLIDE.
SAFETY OUTCOME WAS REASSURING
AND WAS NO DIFFERENCE FOR FETAL
GROWTH RESTRICTION AT LESS THAN
10TH PERCENTILE OR LESS THAN A
FIFTH PERCENTILE.
NEXT SLIDE.
IN SUMMARY TREATING PERSONS WITH
CHRONIC HYPERIT INGRESS TO
TARGET BLOOD PRESSURE OF 140 OR
190 AND ADRUPGS AND PERINATAL
DEATH OUTINCREASING SMALL
GESTATIONAL AGE AND 14.7 AND
NEXT SLIDE.
WHERE DO WE GO FROM HERE?
FIRST OF ALL WE HAVE TO GET
WORDS OUT ABOUT THE STUDY AND
ACOG AND [INDISCERNIBLE] WERE
STATEMENTS ABOUT THIS
RECOMMENDING CHANGING
RECOMMENDATIONS OF WITHHOLDING
TREATMENT AND RECOMMENDING
TREATING TO LESS THAN 140 OVER
90 AND A YEAR LATER NOT EVERYONE
HAS GOTTEN MEMO AND STILL NOT
BEING IMPLEMENTED COMPLETELY AND
IS A LOT OF NEXT SLIDE. THERE
IS A LOT OF QUESTIONS THAT ARE
ABOUT ACTUALLY A RE -- ARE WE
GETTING TO RIGHT BLOOD PRESSURE
NOW? AMERICAN COLLEGE OF
CARDIOLOGY CHANGED DEFINITION OF
STAGE 1 OF HYPERTENSION AND SOME
IN AUDIENCE THINK THAT HAPPENED
A WHILE AGO IT TOOK A LONG TIME
AND WAS HAPPENING AS WE STARTED
NOW.
QUESTION BECAME IS THERE BENEFIT
TO LESS THAN 130 OVER 80 IN
PREGNANCY?
NEXT SLIDE.
HOW DO WE MEASURE BLOOD
PRESSURES WE USE CLINICAL
PRESSURES SOME DID MANUAL BLOOD
PRESSURES AND SOME AUTOMATED
BLOOD PRESSURES YOU MAY NOT
REALIZE ONLY ONE AUTOMATED BLOOD
PRESSURE CUFF THAT I KNOW OF IS
VALIDATED DURING PREGNANCY AND
POSTPARTUM AND I FREQUENTLY GET
QUESTIONS ABOUT PATIENT HAS
WHOLE BLOOD PRESSURE CUFF AND
THEY ARE ELEVATED AT HOME AND
HIGH HERE AND NORMAL AT HOME AND
WHAT DO WE DO WITH THAT AND
CONTINUOUS BLOOD PRESSURE
MONITORING AND WEARABLE CUFFLESS
DEVICES AND NEXT SLIDE.
THE BIG QUESTION THAT I GET
ABOUT CHAP IS ARE WE MASKING
PREECOLLAPSIA AND ADJUSTING
MEDICINES AND GOING HOME AND HOW
DO WE DISTINGUISH PREECOLLAPSE
YA FROM HYPERTENSION AND
DESPERATE NEED OF TESTING IN
CLINIC AND SHOULD WE TREAT BLOOD
PRESSURES GREATER THAN 140 OVER
90 IN PREECOLLAPSIA? WHAT DO WE
DO FOR PATIENTS AND WOULD THEY
BENEFIT IN SOME WAY?
IF TREATING BLOOD PRESSURES HOW
DO WE DIAGNOSE PREECOLLAPSE YA
WITH SEVERE FEATURES. NEXT
SLIDE. AGAIN, DESPERATELY
NEEDING TREATMENT FOR
PREECOLLAPSIA THAN FORDELIVERY
AND DON'T HAVE WAY TO TEMPERIZE
PREECOLLAPSIA WITHOUT MATERNAL
MORTALITY AND PATIENTS COME IN
WITH SEVERE FEATURE AS NTD DON'T
HAVE ANYTHING FOR THEM EXCEPT
FOR TIME AND BLOOD PRESSURE
MANAGEMENT AND DOING TO TREAT
PREECOLLAPSIA POSTPARTUM AND
RECOMMENDATION TO MAINTAIN BLOOD
PRESSURE GREATER THAN 150 OVER
100 AND WHY IS THIS GREATER
POSTPARTUM THAN OUTSIDE OF
PREGNANCY.
NEXT SLIDE.
AGAIN, DIAGNOSIS PREECOLLAPSIA
POSTPARTUM CANDICE SAID A LOT
AFTER THE DELIVERY SHE WAS SORT
OF ON HER OWN AND WHERE LOTS OF
THE MORBIDITY AND MORTALITY IS
HAPPENING IS IN POSTPARTUM AND 2
TO 3 WEEKS AFTER DELIVERY AND
HOW WE CAPTURE PATIENTS WE STOP
SEEING THEM AND SEND THEM HOME
WITH THE BABY AND SAY GOOD LUCK
AND THOUGHT ABOUT MANAGEMENT ORE
MEDICATIONS FOR TREATING
PREECOLLAPSIA AND BIG DEBATE AT
HOSPITAL MAGNESIUM OR
PREECOLLAPSIA WHEN DIAGNOSED
WITH POSTPARTUM. NEXT SLIDE.
THANK YOU.
>> ALL RIGHT. NEXT UP IS DR.
ELIZA MILLER FROM COLUMBIA
UNIVER
UNIVERSITY.
>> HI. THANK YOU. HONOR TO BE
HERE ELIZA MILLER VASCULAR
NEUROLOGIST AND CLINICAL
RESEARCHER AT COLUMBIA
UNIVERSITY STUDYING MATERNAL
STROKE AND RAISING QUESTIONS
ABOUT PREDICTION AND PREVENTION
OF THIS CATASTROPHIC EVENT NEXT
SLIDE. THIS IS FUNDING DON'T
HAVE IRRELEVANT DISCLOSURES THIS
IS MATERNAL STROKE AND FOR THOSE
THAT DON'T LOOK AT CAT SCANS
VERY OFTEN THEY ARE VERY
TERRIBLE AND WHAT I WOULD POINT
OUT IS THAT MANY OF THESE
STROKES ARE HEM ORRAGIC. IN
GENERAL POPULATION ABOUT 15% OF
STROKES ARE DUE TO HEMORRHAGE IN
THE BRAIN AND REST ARE DUE TO ES
KEEMIC OR CLOTTING EVENTS IN THE
BRAIN AND MATERNAL POPULATION,
50% ARE HEMOAGIC AND THIS STROKE
CARIES VERY HIGH MORTALITY AND
MORBIDITY. NEXT SLIDE.
STROKE IS ALWAYS ON THE LIST OF
CAUSES OF MATERNAL MORTALITY AND
POINT THAT IT MIGHT BE
UNDERESTIMATED AND MANY TIMES
ACTUAL DIRECT CAUSE OF DEATH IN
SOMEONE WITH PREECOLLAPSIA IS IN
CEREBRAL HEM RANL AND NO THE
SURE IF IN EACH BOX AND DOESN'T
PARTICULARLY MATTER AND WHAT IS
NOT CAPTURED HERE ALSO IS MOST
STROKES DON'T KILL YOU AND
CEREBRAL HEM RANLS MOST ARE NOT
FATAL BUT DISABLING AND
DISABLING EVENT LIKE THIS EARLY
IN LIFE IS JUST CATASTROPHIC FOR
THE PERSON THAT EXPERIENCES IT
AND FOR THE FAMILY.
NEXT SLIDE.
THERE IS A LOT OF DIFFERENT
REASONS PEOPLE CAN HAVE A STROKE
AND I WON'T GET INTO THE PANELO
PHYSIOLOGY OF IT. IT CAN BE
VERY COMPLEX AND THERE IS
DIFFERENT TYPES OF STROKES AND I
WILL FOCUS ON INTRACEREBRAL
HEMORRHAGE IT IS MOST
CATASTROPHIC AND MOST
PREVENTIBLE, I THINK. NEXT
SLIDE. QUESTION I WOULD LIKE TO
POSE:
IS IT POSSIBLE TO PREDICT A RARE
AND CATASTROPHIC EVENT? DOESN'T
HAPPEN THAT OFTEN BUT WHEN IT
DOES IT IS A DISASTER AND COULD
WE USE TECHNOLOGY TO PREDICT
THIS BEFORE IT HAPPENS?
LOOKING BACK AT CASES I
PERSONALLY REVIEWED MANY, MANY
CASES AND FOUND THAT LARGE
PROPORTION OF CASES THERE ARE
MISSED OPPORTUNITIES OR
DIAGNOSTIC DELAYS THAT OCCUR
BEFORE THE STROKE IS FINALLY
DIAGNOSED AND IN CASE OF
HEMORRHAGIC -- NATIONAL STROKE
CONFERENCE THIS YEAR 50% HAD
DELAYS IN DIAGNOSIS.
NEXT SLIDE.
HERE IS A EXAMPLE OF A CASE LIKE
THAT THIS PERSON PRESENTED ON
POSTPARTUM DAY 4 WHAT WAS FAIRLY
HEALTHY PREGNANCY GENERALIZED
SEIZURES DIAGNOSED WITH
PRECOLLAPSIA AND FOUR DAYS
LEADING UP TO THAT SEVERE
HEADACHES AND BLOOD PRESSURE
SOUGHT MEDICAL ATTENTION AND
COUPLE MED ENCOUNTERS DIAGNOSED
WITH MIGRAINE OR TOLD IT WAS AND
BLOOD PRESSURE WAS ATRIB UTD
TODAY PAIN AND SHE WAS SENT
HOME.
SHE CAME IN WITH A SEIZURE WHAT
WAS MORE CONCERNING IS SHE
DIDN'T GET A SCAN IMMEDIATELY IT
WAS OH,ING MY GOSH SHE HAS
ECOLLAPSIA RECEIVING TREATMENT
FOR IT AND MAGNESIUM DRIP AND
LOST CONSCIOUSNESS AND
EVENTUALLY FOUND TO HAVE THIS
AND SCANNING SOMEONE'S BRAIN AND
THIS IS NOT PART OF TYPICAL
PREECLAPGSIA PROTOCOL.
SEEMS A STRAIGHTFORWARD
DIAGNOSIS AND DIDN'T HAVE A
TERRIBLE OUTCOME. NEXT SLIDE.
WHEN -- HOW COULD WE PREDICT IT?
LOOKING BACK ANOTHER CASE SERIES
YOU CAN SEE A CLUSTER OF
HEMORRHAGES AND HEMORRHAGIC
STROKE IN FIRST COUPLE WEEKS
POSTPARTUM AND SEEMS MAYBE FIRST
FEW DAYS POSTPARTUM ARE KEY TIME
AND IF WE FIND A PREDICTOR OR
IDENTIFYING CHARACTERISTICS THAT
IS WHERE WE SHOULD LOOK. NEXT
SLIDE.
THIS IS ANOTHER STUDY WE DID
THAT LOOKED AT NATIONWIDE DATA
AND FOUND MEDIAN TIME TO
READMISSION FOR STROKE AFTER
POSTPARTUM STROKES IS 8 DAYS AND
THAT FIRST COUPLE WEEKS SEEMS TO
BE HIGH YIELD PERIOD AND FOUND
IN PEOPLE WITH HYPERTENSIVE
DISORDERS AND PREGNANCY WE HEARD
ABOUT THAT IS HIGHEST RISK
THROUGH.
NEXT SLIDE.
ONE QUESTION COULD WE USE BETTER
IMPLEMENTATION AND EDUCATION TO
SO PEOPLE WOULD RECOGNIZE SIGNS
OF STROKE?
UNFORTUNATELY MOST PEOPLE DON'T
HAVE NEUROLOGY TRAINING THAT IS
NOT EVEN REQUIRED IN MEDICAL
SCHOOL FOR MANY MEDICAL SCHOOLS
AND PEOPLE GOING TO OGBYN NO
REASON THERE IS NOT ELECTIVE
NEUROLOGY AND DON'T RECEIVE ANY
DURING PREGNANCY AND IS NOT
THEIR FAULT THEY DON'T RECOGNIZE
RED FLAG FEATURES FOR EXAMPLE.
I HAVE DONE WORK WITH A NEAT
GROUP OBLS FUNDED BY HRQ THAT IS
DEVELOPING A CURRICULUM FOR ACLS
LIKE MATERNAL CARDIAC ARREST
SYNDROME ADDING STROKE FOR THAT
AND DEVELOPING TOOLS TO HELP
PEOPLE THAT DON'T HAVE NEUROLOGY
TRAINING TO RECOGNIZE FEATURES.
NEXT SLIDE. THIS IS A TOOL WE
DEVELOPED PNEUMONIC TO POINT OUT
RED FLAG FEATURES TO EXIST IF
SOMEONE IS PRESENTING WITH
HEADACHE IN POSTPARTUM FEATURES
DOESN'T MEAN THAT NECESSARILY
EVERYONE NEEDS A SCAN BUT STEP
BACK AND THERE MIGHT BE
SOMETHING ELSE GOING ON.
NEXT SLIDE.
SECOND QUESTION I WOULD POSE IS
SAY WE WERE ABLE TO IDENTIFY A
PERSON AT RISK. RIGHT?
DO WE DO ANYTHING TO PREVENT THE
STROKE?
AND I WOULD SORT OF BUILD ON THE
LAST SPEAKER TO SAY THAT OUR
BLOOD PRESSURE MANAGEMENT IN
SETTING IN PERFECT EGG NANCY AND
POSTPARTUM IS ONE-SIZED FITS ALL
YOU CAN IMAGINE SOMEONE WITH
BLOOD PRESSURE IS TYPICAL FOR
YOUNG WOMEN LOTS OF THE TIME AND
GETTING TO 160 OVER 110 IS A BIG
CHANGE FOR THAT PERSON.
NEXT SLIDE.
THENALLY GET INTO THE WEEDS.
I WON'T SPEND TOO MUCH TIME AND
THERE IS A CONCEPT CALLED
CEREBRAL AUTO REGULATION AND
IDEA BEHIND THIS, EVERYBODY'S
BRAIN LIKE A CONSTANT FLOW OF
BLOOD THAT DOESN'T LIKE TOO MUCH
OR TOO LITTLE AND BLOOD PRESSURE
FLUCTUATES NORMALLY AND BRAIN
HAS TO ADJUST FOR THAT CEREBRAL
ARTERY REGULATION AND
MAINTAINING CONSTANT FLOW.
THERE IS A PLATEAU PERIOD IF
BLOOD PRESSURE STAYS IN MIDDLE
RANGE WHERE IT IS FLAT BRAIN CAN
HANDLE THAT, THOSE CHANGES AND
IF YOU GET BELOW THAT IT CAN'T
HANDLE THAT AND YOU DON'T GET
ENOUGH BLOOD FLOW AND BELOW THAT
YOU COULD GET CEREBRAL EDEMA AND
HEMORRHAGE.
SETTING OF CERTAIN CONDITIONS
CEREBRAL AUTO REGULATION IS NOT
WORKING LIKE THAT AND EXAMPLE ON
LEFT YOU SEE PLATEAU IS SMALL
AND MIGHT BE YOU NEED TIGHTER
RANGE OF BLOOD PRESSURE CONTROL
TO AVOID CATASTROPHIC
COMPLICATIONS AND RIGHT YOU SEE
REGULATIONS COMPLETELY LOST AND
IF BLOOD PRESSURE IS HIGHER
BLOOD FLOW IS HIGHER AND SETTING
OF PREECOLLAPSIA COULD BE VERY
CATASTROPHIC. WHY TALKING ABOUT
THIS?
NEXT SLIDE. RESEARCH IDENTIFIED
IN FIRST WEEK POSTPARTUM THAT
KREER EBB RAL AUTO REGULATION IS
NOORMAL IN POSTPARTUM
INDIVIDUALS REGARDLESS WHAT
BLOOD PRESSURE IS AND THIS IS
UNDER REVIEW NOW AND WE PUT OUT
PRELIMINARY RESULTS AND BRAIN
BASICALLY DIDN'T SEEM TO BE
CAPABLE OF DAMPENING SIGNAL IN
WAY IT NORMALLY WOULD AND ANYONE
WHO IS POSTPARTUM WITHIN FIRST 7
DAYS AND YOU CAN IMAGINE IF YOU
ADD ON A SPIKE IN BLOOD PRESSURE
IT HAS RESULTS.
IS THERE ANYTHING WE COULD DO
ABOUT THIS? TO MANAGE BLOOD
PRESSURE DIFFERENTLY?
THIS IS A TRIAL I'M RUNNING
FUNDED BY NHCID I'M EXCITED
ABOUT AND EXCITE TODAY REPORT WE
ENROLLED FIRST PATIENT LAST
THURSDAY AND REALLY EXCITING.
PHASE 2 SMALL PILOT STUDY USING
TECHNOLOGY THAT IS STICKERS ON
HEAD THAT TELL SOMETHING ABOUT
BLOOD FLOW AND CONTINUOUS BLOOD
PRESSURE MONITORING NOT INVASIVE
WITH BLOOD PRESSURE CUFF YOU
IDENTIFY TARGET BLOOD PRESSURE
RANGE FOR THAT INDIVIDUAL PERSON
AT THAT MOMENT THAT IS WITHIN
CEREBRAL AUTO REGULATORY
[INDISCERNIBLE] AND IS THE GOAL
WHAT WE WILL DO AND FIRST THAT
IT IS SAFE TO DO THIS AND MANAGE
BLOOD PRESSURE THIS WAY AND
SECOND TO SEE IF DIFFERENCE IN
OUTCOMES AND TYPE OF WAYS THAT
NEWER TECHNOLOGIES CAN HELP
PREVENT STROKE AND NEXT SLIDE
TAKING AWAY THIS IS A RARE AND
CATASTROPHIC EVENT AND MOST BAD
ONES OCCUR AT POSTPARTUM PERIOD
AND HYPERTENSION ARE HIGHEST
RISK WE COULD IDENTIFY PEOPLE
PROBABLY AND PREVENT THESE IF WE
RECOGNIZE EARLY SIGNS AND THAT
WE COULD PROBABLY MANAGE
PEOPLE'S BLOOD PRESSURE IN
DIFFERENT WAY RESULTING IN LESS
NEUROLOGICAL AND WITH THAT I
WILL STOP.
NEXT SLIDE.
>> HAPPY BIRTH DAY. GREAT.
NEXT UP APOLOGIES GHADA FROM
BROWN UNIVERSITY AND MIRIAM
HOSPITAL.
>> I WILL TALK ABOUT SLEEP
DISORDERED BREATHING AND
FOCUSING ON IMPROVING SCREENING
DIAGNOSIS AND MANAGEMENT.
NEXT SLIDE.
THESE ARE DISCLOSURES.
NEXT SLIDE.
LEFT SIDE, YOU CAN SEE A NORMAL
AIRWAY THAT IS A QUICK OVERVIEW
WHAT OBJECTIVE EVENTS WOULD LOOK
LIKE AND RIGHT SIDE YOU SEE
OBSTRUCTION IN AIRWAY THAT COULD
HAPPEN AT ANY POINT IN HERE.
NEXT SLIDE.
WHAT THIS WILL RESULT IN IS
THESE FLOW LIMITATION EVENTS
ASSOCIATED WITH DROPS IN OXYGEN
ASSOCIATION AND AROUSALS THAT WE
SEE ON THIS.
NEXT SLIDE.
OBJECTIVELY DEFINED SLEEP
DISORDER BREATHING IS QUITE
COMMON AND YOU SEE IT VARIES
AMONG POPULATIONS AND LOW RISK
POPULATIONS LIKE HERE AND EARLY
PREGNANCY PREVALENCE OF SLEEP
DISORDER BREATHING IS 5% OR SO
AND LATER IN MID PREGNANCY IS
ABOUT 9% WHEN WE START TO TALK
ABOUT WOMEN WITH OBESITY OR
WOMEN WITH GESTATIONAL DIABETES
OR WOMEN WITH SMALL GESTATIONAL
AGED BABIES YOU SEE PREVALENCE
IS ELEVATED. NEXT SLIDE.
IT IS ASSOCIATED WITH ADVERSE
[INDISCERNIBLE] AND SLEEP
DISORDER BREATHING IN EARLY AND
MID PREGNANCY IS ASSOCIATED WITH
TWO INCREASE AND NEXT SLIDE
SIGNIFICANT ASSOCIATION WITH
GESTATIONAL DIABETES AND DOSE
RESPONSE RELATIONSHIP.
NEXT SLIDE.
POPULATION-BASED STUDIES AND
NATIONAL STUDIES HAVE
DEMONSTRATED SLEEP DISORDER
BREATHING IS ASSOCIATED WITH
CAUSES OF SEVERE MATERNAL
MORBIDITY AND.
HOPEFULLY WE CAN IMPACT THE
EVENTS OF SEVERE MATERNAL
MORBIDITY AND MORTALITY. NEXT
SLIDE. GENERAL POPULATION 35%
OF WOMEN SNORE AND TAKING
SIMILAR POPULATIONS 90% OF WOMEN
END UP BEING DIAGNOSED WITH
OBJECTIVELY DEFINED SLEEP
DISORDER BREATHING AND
PREDICTIVE TOOLS DEVELOPED
OUTSIDE OF PREGNANCY PERFORMED
INCONSISTENTLY IN PREGNANCY AND
THOSE DEVELOPED IN PREGNANCY DO
NOT SEEM TO PERFORM WELL IN HIGH
RISK PATIENTS AND STUDY LOOKING
AT 8 DIFFERENT SCREENING TOOLS
AND SEE SENSITIVITY AND
SPECIFICITY IN EARLY AND LATE
PREGNANCY IS NOT SO GREAT. NEXT
SLIDE.
REASON WHY THIS HAPPENS IS
SCREENING QUESTIONNAIRE ISSUES
AND POPULATION ISSUES AND
DIAGNOSTIC TEST ISSUES LAND TALK
ABOUT DIAGNOSIS IN A BIT. WE
NEED BETTER OPPORTUNITIES AND
TOOLS AND SLEEP MONITORING AND
TRACKING MARKET IS 1.8 BILLION
DOLLAR MARKET TO DOUBLE IN NEXT
FEW YEARS AND ISSUE WE HAVE IS
WEARABLES AND TECHNOLOGIES
AVAILABLE ARE NOT CLOSELY MONTH
N TORS ARE NOT REGULATED BY FDA
AND PRESENT A GOOD OPPORTUNITY
AND 35% OF WOMEN SNORE IN
PREGNANCY AND NO ACCESS TO THEM
WE CAN TRACK THEM USING SOME OF
THESE AND NEED BETTER VALIDATION
AND MANY STUDIES ARE NOT
VALIDATED OUTSIDE OF THE
ORIGINAL COHORT WHEN THEY WERE
DEVELOPED AND WE NEED TO WORK ON
THAT. NEXT SLIDE.
FROM A DIAGNOSTIC STANDPOINT,
THAT IS THE APNEA AND HYPOXIA.
NEXT. WHETHER THAT APNEA HYPE
OPNIA IS 5 EVENTS PER HOUR AND
DEFINITION OF WHERE MILD SLEEP
APNEA STARTS OR 15 EVENTS PER
HOUR AND MEDICARE ALLOWS US TO
STREET IF SOMEONE DOESN'T HAVE
SYMPTOMS, NEXT. OR WHETHER TO
INCLUDE UPPER AIRWAY RESISTANCE
OR SNORING IS LEFT TO BE
DETERMINED AND WE DON'T KNOW
WHERE TO DRAW THAT LINE TALKING
ABOUT APNEA HYPE OP KNEE INDEX.
NEXT SLIDE. IT HAS BEEN
CRITICIZED IN THE SECTION AND WE
COLLECT A TON OF DATA DURING A
SLEEP STUDY AND WE CONDENSE ALL
THESE DATA INTO ONE METRIC THAT
IS APNEA AND HYPE OPNIA INDEX
AND COUNT THEM AND DIVIDE BY
TOTAL HOURS OF SLEEP AND LOOK AT
ANOTHER MARKER POST TRANSIT
INDEX SURROGATE MARKER FOR
PERIODIC ARTERIAL STIFF FENNING
AND DROP HAPPENS AND ARTERIALS
ARE STIFFENING AND WE TRY TO
MEASURE THAT AND SAW THAT IN
SNORERS HAVE APNEA HYPE OP KNEE
INDEX -- HIGHER THAN IN CONTROLS
AND SAME HAPPENED IN SNORERS
WITH APNEA HYPE OPNIA INDEX OVER
5 AND INTERESTING PIECE WAS THAT
WHEN WE LOOKED AT CATEGORIES OF
POST TRANSIT TIME INDEX WE WERE
ABLE TO SEE HIGHEST CATEGORY
DEFINING 30 EVENTS PER HOUR AND
VAST MAJORITY OF PAISHIENTS YOU
SEE IN DARK BLUE DIDN'T MEET
CRITERIA OR OBSTRUCTIVE APNEA
AND HYPE OPNIA INDEX AND THERE
IS PATHO BIOLOGY HAPPENING IN
WOMEN AT RISK OR SNORING NOT
CAPTURING THESE CRITERIA. NEXT
SLIDE. PICTURE WHAT POLYSOM
KNOW GRAM LOOKS LIKE YOU SEE
TENS OF THOUSANDS OF DATA POINTS
WE COLLECT WITHIN 30 SECONDS OF
MEASUREMENTS AND CONTINUE THEM
IN ABOUT 6 TO 8 HOURS AND DURING
ENTIRE SLEEP AND RELYING ON
HUMAN EYE TO DETECT PATTERNS AND
DEFINE ALL OF THE THINGS BY THAT
APNEA AND HYPE OP KNEE INDEX IS
MISSING A HUGE OPPORTUNITY AND
HAS TO BE BETTER WAYS BE IT
MACHINE LEARNING AND DEEP NEURAL
NETWORKS LOOKING AT DATA POINTS
DETECTING PATTERNS WE CAN'T
DETECT AND PHENOTYPE WOMEN AND
LINKING LOTS OF OUTCOMES TO
OUTCOMES THAT MATTER TO US AND
SEE WHETHER WE CAN PREDICT
OUTCOMES LAND WE CAN TREAT THEM
AND THAT IS SOMETHING THAT WE
NEED TO STILL DO.
NEXT SLIDE.
TREATMENT IS ALSO COMPLICATED
AND SO PREGNANT WOMEN ARE AMONG
THE CATEGORY OF REPRODUCTIVE AGE
WOMEN THAT HAVE LOWEST ADHERENCE
TO CPAP THAT IS BEING GOLD
STANDARD TREATMENT FOR SLEEP
APNEA. WHEN WE LOOKED AT SOME
VERY FEW STUDIES LOOKING AT
SLEEP APNEA ADHERENCE IS 50% OR
SOME STUDIES IS SIGNIFICANTLY
LOWER THAN THAT AND WE NEED TO
DO BETTER THAN THAT AND GOT
FUNDING FROM IMPROVE INITIATIVE
TO LOOK AT QUALITATIVE DATA FROM
PREGNANT WOMEN INITIATED ON CPAP
DURING PREGNANCY AND SEE IN
GREEN YOU SEE FACILITATORS AND
LOTS OF THE WOMEN THAT WERE
INTERESTED IN IMPROVING THEIR
HEALTH AND HEALTH OF THEIR BABY
THAT IS A DRIVING MOTIVATION FOR
CPAP AND YOU SEE THERE ARE LOTS
OF BARRIERS THAT IS ANOTHER
THING FOR WOMEN TO DO IF THEY
HAVE GESTATIONAL DIABETES AND
CHECKING BLOOD SUGAR TAKING
INSULIN, ET CETERA. ONE MORE
THING TO DO BEFORE THEY GO TO
BED. SOME WOMEN SAID IT IS
DISGUSTING AND POWER OF
NARRATIVE WE TALKED ABOUT
EARLIER AND WOMEN WERE CONCERNED
ABOUT INTIMACY DIDN'T WANT
HUSBANDS OR PARTNERS TO SEE THEM
USING CPAP AND MANY WERE
CONCERNED ABOUT BILLS AND COST
OF THIS ESPECIALLY IF THE
TREATMENT WAS ONLY COVERED
DURING PREGNANCY AND NOT
[INDISCERNIBLE].
NEXT SLIDE.
SO, HOW CAN WE DO BETTER?
WE NEED TO INCORPORATE EDUCATION
ABOUT SLEEP INTO PRENATAL CARE.
IT IS A LOT TO EXPECT OF THE
OBSTETRIC PROVIDERS AND HAS TO
BE STANDARDIZED WAY TO TALK
ABOUT SLEEP AND MAKE SURE WOMEN
ARE HEARING MESSAGE AND WHETHER
THAT HAPPENS DURING PRENATAL
VISITS BECAUSE THOSE HAPPEN
OFTEN OR WHETHER IT HAPPENS AS
PART OF THE PRENATAL APPS THAT
WOMEN MOSTLY NEW MOMS LOOK AT TO
SEE WHAT IS GOING ON WITH
PREGNANCY THAT NEEDS TO BE
DETERMINED OR WHETHER WE NEED TO
LOOK AT SOME ALTERNATIVE
MEASURES AS WELL THAT LOOK AT
AND IMPROVE SLEEP AND WE NEED TO
EXAMINE THAT AS WELL. NEXT
SLIDE.
WE NEED TO HARNESS TECHNOLOGY TO
DO A BETTER JOB IN TERMS OF
SCREENING TREATMENT AND
DIAGNOSIS OF SLEEP APNEA AND
REGULATE THOSE THINGS ON MARKET
AND EDUCATION AND DIAGNOSIS AND
SCREENING AND NEED TO MAKE SURE
THAT INFORMATION IS VALIDATED IN
STUDIES PERFORMED BY SCIENTIFIC
COMMUNITY AND HAVE TO BE
PREPARED FOR HUGE INFLUX OF DATA
WE MIGHT HAVE WHEN WE START TO
USE TECHNOLOGY AND SEE THAT IN
ELECTRONIC HEALTH RECORDS SYSTEM
THAT COULD BE QUADRUPLED IN
ISSUE AND SEEING THAT
RECOMMENDATIONS ARE CULTURALLY
APPROPRIATE BECAUSE THERE IS
LOTS OF CULTURAL DIFFERENCES
AROUND MOERJHOOD AND PREGNANCY
AND MAKING SURE WE KEEP THEM IN
MIND AND PATIENT EDUCATION IN
MATERIALS OF THAT WE NEED
EDUCATION ABOUT USING AND
ADVISING ABOUT SLEEP AND SLEEP
APNEA AND SLEEP DISORDER -- AND
I DO THIS A LOT AND LOTS OF
TIMES IT IS TOO MUCH INFORMATION
THAT I COULD NEVER COVER IN ONE
VISIT AND IN TERMS OF
PHARMACEUTICAL TRIALS WE DON'T
REGULARLY TREAT SLEEP DISORDERED
BREATHING WITH TRIALS THAT THERE
ARE A FEW DRUGS BEING DEVELOPED
AND HAVE TO ADVOCATE AGAINST
SYSTEMATIC EXCLUSION OF
[INDISCERNIBLE].
THANK YOU.
>> THANK YOU. FINAL SPEAKER
FOR SESSION IS LYDIA PECKER FROM
JOHNS HOPKINS MEDICINE.
>> GOOD MORNING AND PLEASURE TO
BE HERE WITH ALL OF YOU. MY
PLEASURE TO TALK ABOUT SICKLE
CELL DISEASE WITH FIVE PANELISTS
WHO MIGHT BE NEW BEST FRIENDS TO
SICKLE CELL DISEASE AND THANKS
FOR YOUR TALKS AND NEXT SLIDE
THESE ARE MY DISCLOSURES AND
NEXT SLIDE.
I WILL GIVE A QUICK WALK THROUGH
SICKLE CELL DISEASE THAT IS
AUTOSOMAL RECESSSIVE BLOOD
DISORDERER AND GLOBALLY 3
HUNDRED THOUSAND INUM NUMB
BABIES BORN WITH SCD EACH YEAR
AND IN THIS COUNTRY WE THINK
ABOUT 1 HUNDRED THOUSAND INUM
NUMB LIVE WITH SICKLE CELL
DISEASE AND SURVIVAL INTO
ADULTHOOD IS NEAR UNIVERSAL IN
UNITED STATES AND -- ONE OF THE
REASONS I'M HERE TODAY.
THERE IS PERSISTENT HIGH
MATERNAL MORBIDITY AND MORTALITY
FOR PEOPLE WITH SICKLE CELL
DISEASE AND WANT TO MAKE
SOMETHING CLEAR ABOUT WHO GETS
SICKLE CELL DISEASE. THIS IS A
MAP OF DISTORTED PROJECTION
WHERE PEOPLE WITH SICKLE CELL
DISEASE ARE BORN IN THE WORLD
AND HOPE YOU KNOW MOST BABIES
WITH SICKLE CELL DISEASE ARE
BORN IN SUB-SAHARAN AFRICA AND
IN THE MIDDLE EAST AND INDIA AND
IT IS A HEALTH DISPARITY AND
MOST THAT CAME HERE THEIR
ANCESTORS CAME HERE WITH
TRANSATLANTIC SLAVE TRADE OR
FAMILIES MOVED HERE WITH NEW
IMMIGRANT DIE ASS SPORAS AND
PANEL OF PHYSIOLOGY OF SICKLE
CELL DISEASE IS COMPLEX.
IT INTERACTS WITH SICKLE CELL
STRUCTURAL RACISM.
YOU CAN I HOPE WALK THROUGH
PATHOPHYSIOLOGY OF SICKLE CELL
DISEASE YOU NEED TO KNOW ABOUT
TO LEARN ABOUT HOW TO TREAT
DISEASE IN -- THEY POLYMERIZE
AND STICK TOGETHER AND GET
STITCH AND LONG AND CAUSE
VASCULAR -- IT LEADS TO
DOWNSTREAM END ORGAN INJURY AND
LOTS OF WHAT COLLEAGUES HAVE
TALKED ABOUT IS REVELLENT FOR
SICKLE CELL DISEASE AND TO
HIGHLIGHT A FEW PLACES THAT ARE
PARTICULARLY RELEVANT IN
PREGNANCY AND BRAIN AND HEART
AND LUNGS AND KIDNEYS AND
OVARIES AND PLACENTA AND FETUS
ARE -- PATHOPHYSIOLOGIES OF
SICKLE CELL DISEASE IN PREG
NANNY AND ANEMIA BECOMES
MATERNAL ANEMIA AND THOSE IN
AUDIENCE ARE FAMILIAR WITH
SIGNIFICANCE OF THAT DIAGNOSIS
AND BASAL ACOLLUSION IN PLACENTA
LEADS TO PLACENTAL INJURY AND
EFFECT SICKLE CELL PREGNANCIES
EXPANDING BLOOD VOLUMES PUTS
ADDITIONAL STRESS ON ALREADY
STRESSED SYSTEM AND PRONLEST
TROEN LEADS TO PULMONARY
VASCULAR RESISTANCE RISK FOR
HYPERTENSION AND LEADING TO
FURTHER ELEVATED RISK OF BLOOD
CLOT THAT IS HIGH FOR PEOPLE
WITH SICKLE CELL DISEASE AND
EXPANDING UTERUS EVERYBODY THAT
IS PREGNANT -- I JUST PUT THIS
AND ALMOST UNBEARABLE MECHANISMS
IN SICKLE CELL DISEASE FOR YOU
TO LOOK AT STUDIES FOR IT IS
LEADING TO HOPE FOR US AND THREE
NEW DRUGS FDA APPROVED FOR THE
DISEASE IN LAST FOUR YEARS AND
HOPE MORE ARE ON THE WAY. NEXT
SLIDE.
THERE IS AT PRESENT ONE
TREATMENT FOR SICKLE CELL
DISEASE AND PREGNANCY AND THAT
IS BLOOD.
GRIM SITUATION AND UNITED STATES
PRACTICE AT JOHNS HOPKINS --
THAT SHOWED TRANSFUSIONS WAS
ASSOCIATED WITH REDUCED STAFF
PAIN PULMONARY COMPLICATIONS
PRETERM BIRTH AND DOWNSTREAM
IMPLICATIONS OF TREATMENT HAVE
NOT BEEN EXPLORED AND REDUCTION
IN PAIN CRISIS WOULD BE
ASSOCIATED WITH DECREASED RISK
AND OPIOID EXPOSURE TO MOTHER
AND FETUS AND WHEN WE CONSTITUTE
REDUCED RISK OF VOC FOR
TRANSFUSIONS WITH PREGNANT
PEOPLE WITH SICKLE CELL DISEASE
WE DON'T TALK ABOUT THAT.
ANY CASE JOHNS HOPKINS WE TAKE
POSITION THAT IT IS A HIGH RISK
STATE AND TRANSFUSE EVERYBODY
WITH SS AND [INDISCERNIBLE] THAT
ARE MOST SEVERE FORMS OF SICKLE
CELL DISEASE AND HOPEFULLY
STATISTICS WILL HELP TELL YOU
WHY. NEXT SLIDE. SOON TO BE
DOCTOR NEXT WEEK. PUT TOGETHER
DATA FROM NATIONAL IN PATIENT
SAMPLE RECENT FORMULAITION OF
DATA 2012 TO 2018 LIST OF CDC
SEVERE MATERNAL MORBIDITY AND
INDEX AND ORIENTING YOU TO SLIDE
YOU SEE LABELS FOR SM QUALITIES
AND MEASURES AND ONE ON THIS IS
A NONBLACK PATIENT POPULATION IN
THE UNITED STATES PURPLE IS
RISKS FOR BLACK IN THIS COUNTRY
AND ORANGE AND RED ARE RISKS IN
SICKLE CELL DISEASE AND HOPE YOU
SEE WITHOUT MUCH EFFORT
CATASTROPHIC RISK OF SEVERE
MORBIDITY AND OUTCOMES IF IN
SICKLE CELL DISEASE AND STROKE
AND PREECOLLAPSIA AND
COLLAPSINGIA AND THESE RISKS
EFFECT FETUS AND IUGR INCREASED
WITH WOMEN WITH SICKLE CELL
DISEASE AND EFFECTS ON FETUS
WHEN BECOMING CHILDREN AND GROW
UP IS ONE STUDY LOOKING AT
DEVELOPMENTAL OUTCOMES AND
CHILDREN BORN TO WOMEN WITH
SICKLE CELL DISEASE AND THINK
THAT POPULATION EXPOSED TO
MULTIPLE DRULGS AND ALSO WITH
NEAR UNIVERSAL MATERNAL ANEMIA
AND IUGR COMPLETELY CONSIDERED
RISKS FOR ADVERSE DEVELOPMENTAL
OUTCOMES FOR THOSE WOMEN. NEXT
SLIDE, PLEASE.
LAST 12 MONTHS TWO PAPERS ONE
FROM LARGE CALIFORNIA DATABASE
AND IN-PATIENT SAMPLE DRAWING
SAME CONCLUSION AND PREGNANT
PEOPLE WITH SICKLE CELL DISEASE
IS STAGNANT FOR OVER THREE
DECADES IN THE UNITED STATES.
NEXT SLIDE, PLEASE.
AS A CONSEQUENCE, THERE IS A
NEED TO SYSTEMATICALLY INCLUDE
PEOPLE WITH SICKLE CELL DISEASE
WHEN DEVELOPING POLICY SOLUTIONS
AND CLINICAL INTERVENTIONS AND
RESEARCH INNOVATIONS TO IMPROVE
MAT TERN AM FETAL HEALTH.
I HAVE A FEW THOUGHTS I WOULD
LIKE TO SHARE WITH YOU IN THIS
NEARLY WIDE OPENED FIELD FOR
WHAT INNOVATIONS MIGHT REACH OUR
PATIENTS INTERESTING STUDY DONE
BY COLLEAGUES IN BRAZIL LOOKING
AT METHYLATION PATTERNS IN
PLACENTAS.
VEXING QUESTION IS WHY PEOPLE
WITH SS AND [INDISCERNIBLE] ARE
SEVERE FORMS OF SICKLE CELL AND
S BETA PLUS THAT ARE CONSIDERED
MILDER FORMS OF SICKLE CELL AND
WHY TWO DISEASES LOOK SIMILAR IN
PREGNANCY AND I WAS INTRIGUED TO
NOTE AND HOPE YOU CAN SEE IT TOO
THAT SS AND SC PATIENTS
METHYLATION PATTERNS LOOK
SIMILAR AND ARE MARKERS OF
HYPOXIA AND INFLAMMATION IN
PLACENTA OF PATIENTS OPPORTUNITY
TO DEFINE DISEASE PATHOLOGY AND
DEFINE SIMILARITIES ACROSS
GENOTYPES. NEXT SLIDE, PLEASE.
NEW DIAGNOSTIC TEST CLEO
CERTIFIED DON'T KNOW HOW MANY
ARE USING IT GREAT TO ME
INVASIVE PRENATAL TEST FOR
SICKLE CELL DISEASE -- THIS IS
THE KIND OF DIAGNOSTIC TOOL THAT
WOULD BE USEFUL NOT JUST FOR
PEOPLE WITH SICKLE CELL DISEASE
BUT THOSE AT RISK HAVING A CHILD
[INDISCERNIBLE] DISEASE AND HOPE
BY NEXT TIME THIS MEETING
RECONVENES THAT COUNSELING IS
REACHING FAMILIES TO ELECT AND
HAVE TEST ON NEXT SLIDE, PLEASE.
DESPERATELYINOVATIONS AND SICKLE
CELL DISEASE TREATMENT NO
TREATMENTS FOR SICKLE CELL
DISEASE THAT HAVE BEEN STUDIED
IN TRIALS AND EVER BEING STUDIED
FOR PREGNANT PEOPLE WITH SICKLE
CELL DISEASE AND NEED
PARTNERSHIP FROM TOXICOLOGY
FOLKS NHLBI AND OTHERS TO
ADVANCE THIS AND THIS IS GOING
TO TAKE INNOVATIVE DESIGN AND
RESEARCH COLLEAGUES AND HIV HAVE
LED WAY PARTNERING WITH PEOPLE
TO DEFINE WHAT RISKS PREGNANT
PEOPLE ARE WILLING TO ASSUME TO
BE TREATED THAT IS NOT JUST
RESEARCH IN PHARMACOLOGICAL
RESEARCH NEEDED BUT NOVEL
FORMULATION HOW WE PARTNER WITH
PATIENTS MOVING CARE FORWARD.
NEXT SLIDE, PLEASE.
WEINOVATIONS AND DATA
COLLECTIONS AND SOME THINGS ARE
HAPPENING AND CDC COLLECTS DATA
IN SEVERAL STATES IN COUNTRY
SICKLE CELL DISEASE OUTCOMES WE
NEED TO EXPAND SURVEILLANCE TO
UNDERSTAND SICKLE CELL MORE
BROADLY AND DON'T COLLECT DATA
ON IN VITRO FERT WILLIZIZATION
FOR SICKLE CELL DISEASE IN THE
COUNTRY UNCLEAR WHETHER PEOPLE
USE THIS PREVENTIVE APPROACH
HAVING CHILD WITH SICKLE CELL
DISEASE AND START OF CDC HAVE
OPPORTUNITIES TO COLLECT DATA
AND HOPE THAT TOOLS THAT ARE IN
PHOENIX TOOLKIT YOU CAN CHECK
OUT BEING DEVELOPED NOW TO
MEASURE OUTCOMES PREGNANT PEOPLE
WITH SICKLE CELL DISEASE CAN BE
USED TO DEVELOP THINGS LIKE RISK
PREVENTION TOOLS AND WAY -- HIGH
RISK PREGNANCY SITUATION. NEXT
SLIDE, PLEASE.
WE NEED INNOVATIONS AND CLINICAL
AND AT HOME MONITORING DISEASE
CHARACTERIZED BY [INDISCERNIBLE]
HALLMARK SYMPTOM AND DISEASE
THAT IS DEFINED BY LOTS OF
THROMBOSIS IN A PARTICULARLY IN
PREGNANCY AND ALL KINDS OF AT
HOME MONITORING AND SURVEILLANCE
PORE PATIENTS WOULD BE WELCOME
MAKING TRIPS TO HOSPITAL AND ANY
COULD BE AVOIDED WITH AT HOME
MONITORING THAT COULD BE GREAT.
NEXT SLIDE, PLEASE.
WEINOVATIONS AND CARE DELIVERY
AND FAVORITE MAPS OF CARE
DISTRIBUTION IN THE UNITED
STATES AND OUTCOMES DIFFERENT
FAVORITE AND STAIR AT THEM A
MINUTE OVERLAYING YOUR FAVORITE
MAP AND DISTRIBUTION A IS SICKLE
CELL IN THIS DISEASE AND
DISTRIBUTION OF SICKLE CELL CARE
AND OTHER SIDE OF THE MAP IS
DISTRIBUTION OF MATERNITY CARE
AND HOPE YOU SEE OVERLAP BETWEEN
MATERNITY CARE DESERTS WHERE
PEOPLE WITH SICKLE CELL DISEASE
LIVE AND YOU CAN'T SEE ON MAP
HOW MANY PEOPLE EXIST TO TAKE
CARE OF PEOPLE WITH SICKLE CELL
DISEASE HAS TO BE UNDERSTOOD AS
PART OF DISPARITY TRANSFORMING
OUTCOMES FOR PEOPLE WITH SICKLE
CELL DISEASE AND WROTE DOWN. I
WANT TO GET IT RIGHT.
THERE ARE 140 CENTERS TO CARE
FOR 330,000 PEOPLE WITH
HEMOFEELIA IN THE COUNTRY. THEY
ARE FEDERALLY REGISTERED AND 280
CENTERS TO CARE FOR PEOPLE WITH
CYSTIC FIBROSIS IN THE COUNTRY
AND -- SO, KU NOT SEE THAT IN
THIS LAYOUT OF MAPS AND OF
COURSE THIS NEEDS TO CHANGE IF
WE CHANGE OUTCOMES FOR PATIENT
POPULATION.
NEXT SLIDE, PLEASE.
FINALLY, WE NEED INNOVATION AND
PROBLEM FORMULATION AND LAST
DECEMBER MATERNAL FETAL MEDICINE
DOCTOR LOOKING AT FAMOUS STAMP
CELEBRATE AGO RIFLE OF SICKLE
CELL DISEASE AND MOST PEOPLE
LOOK AT THIS AND SEE THAT BABE
IS UNIVERSALLY SCREENED FOR
SICKLE CELL DISEASE DIDN'T OCCUR
TO ME BABY WAS [INDISCERNIBLE]
FOR SICKLE CELL DISEASE AND NEED
THESE MULTI-DISCIPLINARY FORUMS
TO MOVE FORWARD FOR PEOPLE WITH
SICKLE CELL DISEASE AND OVENGSS
WE MAKE IN MULTI-DISCIPLINARY
COLLABORATIONS -- JOHNS HOPKINS
LOOKING AT DATA MULTIDISCIPLINE
COLLABORATIVE CARING FOR
PREGNANT WOMEN WITH SICKLE CELL
DISEASE -- IN OVER 20 YEARS AND
SO IT SEEMS IT IS TIME TO ALSO
CHANGE OUR PROBLEM FORMULATION
ABOUT WHETHER THIS SHOULD BE A
DISEASE THAT IS ASSOCIATED WITH
INCREASED MATERNAL MORTALITY AT
ALL OR PROBLEM OF CARE STRUCTURE
AND AABILITY TO DELIVER
COMPREHENSIVE CARE FOR SICKLE
CELL DISEASE. NEXT SLIDE,
PLEASE.
IN CONCLUSION THERE IS URGENT
NEED FOR EXISTING TECHNOLOGIES
TO BE BROUGHT TO WOMEN WITH
SICKLE CELL DISEASE AND ALL
PEOPLE WITH SICKLE CELL DISEASE
AND THINGS EXISTING FOR MY
COMMUNITY ARE NOT REACHING
PEOPLE WITH THIS DISEASE AND FOR
EXAMPLE ULTRASOUND TECHNOLOGY
IDENTIFYING CHILDREN WITH
INCREASED RISK OF STROKE WE
HAVEN'T BEEN ABLE TO DELIVER ON
THAT FOR EVERY CHILD LIVING WITH
SICKLE CELL DISEASE IN THE
UNITED STATES AND THINKING OF
KINDS OF INTERVENTIONS TO REACH
PREGNANT PEOPLE WITH SICKLE CELL
DISEASE AND NEW TECHNOLOGIES ARE
NOT DEVELOPED BUT CAN REACH
PEOPLE WHO NEED THEM MOST.
NEXT SLIDE, PLEASE.
THIS IS JUST 10 MINUTES.
WE HAVE A WHOLE DAY DEDICATED TO
SICKLE CELL DISEASE PREGNANCY
THIS FRIDAY ON THIS STAGE I
BELIEVE. WE ARE HAVING A
CONFERENCE THURSDAY AND FRIDAY
THAT IS A HYBRID MEETING SHOULD
BE TERRIFIC AND YOU ARE INVITED
TO JOIN US.
THANK YOU SO MUCH FOR YOUR
TIME.
>> I WANT TO THANK SPEAKERS FOR
INFORMATIVE LECTURES AND FOR
SETTING THE STAGE FOR THE
DISCUSSION REALLY WE HAVE JUST
SCRATCHED THE SURFACE WITH A FEW
COGNITIONS THAT INCREASE
MATERNAL HEALTH MORBIDITY AND
ARE LOOKING FORWARD TO
DISCUSSION.
WHILE PEOPLE ARE COMING TO THE
MICROPHONES OR WE ARE GATHERING
THE QUESTIONS FROM ONLINE, I
WANT TO WISH DR. MILLER HAPPY
BIRTH DAY AND ASK HER THE FIRST
QUESTION.
ARE THERE ANY TECHNOLOGIES OR
ANY APPROACHES NOT EVEN WITHOUT
TECHNOLOGY TO DETERMINE AUTO
REGULATION IN EACH PATIENT?
IS IT DONE IN NONPREGNANT
INDIVIDUALS?
HOW?
>> THANK YOU FOR THE QUESTION
AND BIRTH DAY WISHES. I
APPRECIATE IT. LOTS OF DIFB
WAYS TO MEASURE CEREBRAL AUTO
REGULATION SOME ARE INVASIVE AND
I'M INTERESTED IN NON-INVASIVE
WAYS ONE WAY IS TRANSCRANIAL
DOPPLER THAW ARE ELUDING TO I
BELIEVE AND SAME TYPE OF ULTRA
SOUND WE USE IT ALL TIME IN
SICKLE CELL KIDS THAT IS VERY
EASY BEDSIDE ULTRASOUND
PROCEDURE IF YOU MEASURE
TRANSCRANIAL DOPPLAR BASED
CEREBRAL BLOOD FLOW VELOCITY
ALONG WITH CONTINUOUS BLOOD
PRESSURE MONITORING WITH FINGER
[INDISCERNIBLE] AND DON'T NEED
ARTERIAL LINING WITH
NON-INVASIVE YOU CAN CALCULATE
REGULATION ON SIMULTANEOUS
SIGNAL STREAMS AND NEAR INFRARED
SPECTROSCOPY I'M USING FOR THAT
TRIAL THAT IS A LITTLE BIT --
THEY BOTH HAVE PROS AND CONS AND
NEAREST DATA IS NOISIER AND YOU
NEED MORE DATA TO GET MORE
ACCURATE RESULTS AND
TRANSCRANIAL DOPPLAR YOU NEED
GOOD ULTRA SOUND TECH AND NOT
MANY PEOPLE KNOW HOW TO DO IT.
MACHINES ARE, YOU KNOW,
EXPENSIVE AND YOU NEED COMPANIES
TO KIND OF GET ON BOARD TO HELP
DEVELOP TOOLS AND AS ONE EXAMPLE
IN POSTPARTUM POPULATION WE ARE
DOG LITTLE TRIAL WE HAVE
MODIFICATION AND WHOLE THING IS
UNCOMFORTABLE AND IF ON
MAGNESIUM PEOPLE ARE STICKY AND
TAKING INTO ACCOUNT THIS WILL BE
KEY.
>> THANK YOU. YES.
>> HI. GOOD MORNING CHELSEA
FROM GET WELL AND WOULD LIKE TO
SAY PRESENTATION FROM HOPKINS
THANK YOU FOR YOUR ATTENTION TO
YOUR SPECIFIC POPULATION THAT IS
IMPACTED BY SICKLE CELL AND TO
THE REST OF THE PANELISTS I
WOULD ASK WE ARE HERE TO TALK
ABOUT INNOVATIONS TO ADDRESS
MATERNAL HEALTH CARE AND KNOW
DEFICIENCIES IN MATERNAL HEALTH
CARE ARE IMPACTING BLACK AND
BROWN BIRTHING PERSONS AND TO
THE REST I WOULD SAY FABULOUS
PRESENTATIONS WHAT IS WORK TO BE
DONE TO ENGAGE BLACK AND BROWN
BIRTHING PERSONS IN AREAS
SPECIFICALLY TO HYPERTENSION
CONVERSATION AND PREECOLLAPSIA
AND SLEEP APNEA AND
UNDERSTANDING HOW TO GO ABOUT IN
RESEARCH WORKING WITH
POPULATIONS THAT ARE MOSTLY
UNDERSERVED IN PARTICULAR AREAS.
THANK YOU.
>> THANK YOU SO MUCH.
DO YOU HAVE A QUESTION?
>> >> YES. SIMILARLY, I
WANTED TO THANK YOU ALL.
THIS --
>> GO AHEAD.
>> THIS IS A REALLY GOOD POINT.
WITH 10 MINUTES, IT IS HARD TO
COVER ALL WE NEED TO DO.
BLACK WOMEN HAVE WORSE SLEEP
SYMPTOMS THAN WOMEN THAT ARE NOT
BLACK AND DATA THAT HAS LOOKED
AT THEM THERE IS A LOT OF
DISCREPANCIES AND BLACK PEOPLE
IN GENERAL MIGHT HAVE LOWER
ADHERENCE AND ACCESS TO CARE
MIGHT BE HARDER ISSUE WE HAVE TO
GO EXAMINE OVENGSS AND
[INDISCERNIBLE] MIGHT BE HIGHER
IN BLACK INDIVIDUALS THAT ARE
PRESENT AND DON'T HAVE DATA ON
THAT AND NEED TO BETTER
UNDERSTAND THAT.
THERE IS NEED TO ADDRESS THAT IN
BLACK AND BROWN POPULATIONS ON
SO MANY DIFFERENT LEVELS AND
THIS IS ONE FOCUS FOR
QUALITATIVE DATA AND COMPARING
DATA FROM BLACK INDIVIDUALS TO
NONBLACK INDIVIDUALS TO SEE IF
THESE THINGS ARE DIFFERENT.
WE DON'T HAVE FUNDING YET AND MY
NEXT PROJECT IS GOING TO FOCUS
ON THAT POPULATION AS WELL.
YOUR POINT IS WELL TAKEN AND
THERE IS A NEED FOR THAT.
>> SYSTEMATIC CLINICAL
INVESTIGATIONS STANDPOINT HAS TO
BE WORK TO INCLUDE POPULATIONS
THAT ARE REPRESENTATIVE OF THE
DISEASE AND ALL OF THE STUDIES
AND WE HAVE TO BE INCLUDING
BLACK WOMEN IN STUDIES AND
[INDISCERNIBLE] HAD AND I DIDN'T
LOOK AT NUMBER THIS MORNING BUT
WAS 30 TO 40% BLACK POPULATION
INCLUDED IN THE STUDY THAT IS A
HUGE ACCOMPLISHMENT FOR US AND
ONE THING WE PUT A FOCUS ON
MAKING SURE THAT WE WERE
ENROLLING IN DIVERSE POPULATIONS
AND THINK THAT IS A SYSTEMATIC
EFFORT IN ALL CLINICAL TRIALS.
>> I WILL JUST ADD ON
PREECOLLAPSIA BIOMARKER MOVING
FORWARD WITH IS SOMETHING WE
DISCUSSED INCLUSION OF AFRICAN
AMERICAN WOMEN IN THE COHORTS
AND ONE -- THERE ARE DATA AROUND
THE BIOMARKERS IN EUROPE AND
ASIA; RIGHT?
A REASON TO QUALIFY THESE IN THE
UNITED STATES IS TO GET RACIALLY
DIVERSE POPULATIONS THAT IS
SOMETHING THAT WE LOOKED AT
PULLING TOGETHER COHORTS AND WE
WOULD BE ABLE TO STUDY TO MAKE
SURE THEY ARE HIGH ENRICHED FOR
AFRICAN AMERICAN PREGNANCIES AND
OTHER GROUPS AS WELL. I THINK
WITH NIH HAT ON THIS IS ANOTHER
REASON TO PUSH FOR INCLUSION IN
ALL CLINICAL TRIALS AND STUDIES
WE CONDUCT AT NIH THAT IS
DEFINITELY VERY CLEAR THAT
AFRICAN AMERICANS AND OTHER
ETHNIC MINORITIES ARE NOT
REPRESENTED WELL IN ENTIRE
CLINICAL RESEARCH ENDEAVOR AND
CONSIDERING GLOBAL RELIANCE ON
US-PRODUCED DATA THAT IS MORE
GLARING WE NEED TO DO THIS NOT
JUST FOR THE UNITED STATES BUT
FOR GLOBAL HEALTH AS WELL.
>> >> THANK YOU. I'M
CHRISTINE FROM THE UNIVERSITY OF
NORNL CAROLINA CHAPEL HILL AND
QUESTION WAS TO APPLAUD YOU FOR
EXCITING INNOVATION AND
DISCOVERY AND DIAGNOSIS IN
TREATMENT.
I WONDERED IF YOU WOULD SHARE
YOUR THOUGHTS ON STRUCTURAL
REFORMS NEEDS TO ACCOMMODATE.
DR. PECKER I ALSO -- YOU SAID
PROBLEM IS INABILITY TO CARE FOR
PEOPLE.
SIMILARLY NOT ONLY INCLUSION BUT
SYSTEM COULD BE ACCOMMODATING.
THANK YOU.
>> THANK YOU FOR QUESTION.
NICE YOU COME FROM UNC AND
COMPREHENSIVE SICKLE CELL CENTER
AT UNIVERSITY OF NORNL CAROLINA
ONE WAY TO -- THERE IS ONE KIND
OF INNOVATION FOR YOU AND
LETTING PANELISTS TAKE A SHOT.
>> I THINK FROM A PRACTICE
PERSPECTIVE THOSE THAT HAVE NEUR
LOGIC COMPLICATIONS AND
NEUROVASCULAR COMPLICATIONS THAT
IS IMBEDDED IN CENTER MOTHER
CENTER IN COLUMBIA THAT IS A
MEDICAL HOME FOR HIGH-RISK
PREGNANCY AND THINK THAT IS
REALLY HELPFUL.
MY OFFICE IS THERE RIGHT NEXT TO
THE OFFICE OF MFMS AND PEOPLE
CAN SEE US BOTH.
IT MAKES IT EASIER TO PROVIDE
COORDINATED COMPREHENSIVE CARE
FOR HIGH-RISK PATIENTS.
>> FROM A SYSTEMATIC STANDPOINT
PROBLEM IS HUGE. IT STARTS WITH
WE ARE TALKING ABOUT PREGNANCY
COMPLICATIONS AND ACTUALLY
STARTS PRIOR TO PREGNANCY AND IS
HELPFUL TO ME AS MATERNAL FETAL
MEDICINE AND -- BLOOD PRESSURE
OF 180 OVER 110 AND HAVING CARE
AND ACCESS TO CARE AND UNIVERSAL
ACCESS TO CARE OUTSIDE OF
PREGNANCY THROUGHOUT PREGNANCY
CENTERS OF EXCELLENCE ARE
WONDERFUL RESOURCES AND I'M
HAPPY TO BE PART OF THEM AND
MATERNAL MORTALITY IS HAPPENING
WHERE CENTERS ARE NOT AND
DESERTS AND MATERNITY CARE
DESERTS AND HOW DO WE GET THIS
LEVEL OF EXCELLENT CARE OUT TO
THESE OTHER COMMUNITIES?
>> I WILL ADD TO BUILD TO THE
COMMENT THAT IS ONE THING THAT I
THINK HOPEFULLY WE CAN TALK
ABOUT TODAY IN TERMS OF DEVISES
AND TECHNOLOGIES AND HOW WE GET
CARE TO DELIVER IN ACADEMIC
MEDICAL CENTERS OUT TO HEALTH
CARE DESERTS AND INDIVIDUALS IN
SOCIOECONOMIC STATUS THAT THEY
CAN'T AFORWARD TO TAKE 2 OR
THREE DAYS OWE OF TO GO FOR
CLINICAL TRIAL AND STUDY AND
THOSE PRESSURES AND GETTING
TECHNOLOGY AND MEASURES OUT TO
TH
THEM.
>> WE HAVE TO CHANGE STRUCTURES
TO PANEL AND UNDERRESTED IN
MEDICINE AND YOUNG PEOPLE IN
PIPELINES SO PATIENTS ARE SEEING
PEOPLE WHO LOOK LIKE THEM AND
CARE FOR THEM AT EVERY LEVEL OF
THE SYSTEM.
>> >> WE HAVE QUESTIONS
ONLINE.
>> YEAH. I SEE A LOT OF
QUESTIONS ON THE FLOOR AND THERE
IS A LOT ABOUT TECHNOLOGY THAT
SPECIFICALLY IS REFERRING TO
BLOOD PRESSURE MEASUREMENT AND
DEVICE IF YOU KNOW THAT THEY ARE
SAYING THOSE DEVICE ARE NOT
CALIBRATED FOR PREGNANT WOMEN
AND ANYONE THAT HAS ANY ANSWER
ABOUT HOW WE REALLY SEE THOSE
BLOOD PRESSURE MEASUREMENTS
BEING ACCURATE.
>> YEAH. THIS GOES BACK TO
INCLUDING PREGNANT WOMEN AT --
IN ALL THESE STUDIES OF THESE
NEW MEDICATIONS AND SPEAKER HERE
THERE IS FOUR NEW MEDICATIONS
AND -- NONE WILL BE USED IN
PREGNANCY ANY TIME SOON AND
DEVICES HAVE TO BE STUDIED
DURING PREGNANCY AND HARD TO
ENROLL 20 OR 30 WOMEN AND
POSTPARTUM.
>> SHOULD WE KEEP GOING?
>> YES. DR. AMRAN FROM CITY OF
NEW YORK SCHOOL OF MED KRINL AND
THANK YOU FOR PRESENTATIONS AND
QUESTION IS FOR THOSE WHO ARE
PRACTICING IN LARGELY IN
NONPREGNANT POPULATIONS IS THIS.
A VERY SIGNIFICANT NUMBER OF
PREGNANCIES OCCUR IF INTENDED
AND WANTED AND UNWANTED TLAPD IS
NO TIME FOR PRECONCEPTION CARE
AND PRESENTATIONS THAT HAVE MADE
CLEAR, THERE IS A HUGE AMOUNT OF
WORK THAT NEEDS TO BE DONE ON
PROVIDING APPROPRIATE CARE AND
COUNSELING FOR RISK OF PREGNANCY
TO WOMEN OF HIGH RISK EVEN
BEFORE THEY BECOME PREGNANT AND
WHAT PRACTICES DO YOU THINK WE
SHOULD ADOPT TO ENSURE THAT
EVERY PREGNANCY THAT OCCURS
OCCURS IN THE SETTING WHERE A
WOMAN HAS APPROPRIATE KNOWLEDGE
OF HER RISKS AND HER POTENTIAL
CHILD'S RISKS BEFORE SHE GOES
INTO PREGNANCY TO MAKE AN
INFORMED AND ACTIVE DECISION
THAT SHE CAN ACTUALLY IMPLEMENT
WITH EXISTING SERVICES TO ENSURE
ANY PREGNANCY OCCURRING OCCURS
IN THE SETTING SHE IS BEST
SUITED TO CARRY IT TO A HEALTHY
OUTCOME AND WE ARE PREVENTING
THESE UNINTENDED PREGNANCIES AND
MANY LEAD TO HIGH RATES OF
MATERNAL MORTALITY AND MORBIDITY
THAT WE ARE SEEING.
>> THIS IS A GOOD POINT. LOTS
OF THINGS WE -- AT LEAST FROM
THINGS I PRACTICE IN PULL MONDAY
OLS AND SLEEP RESEARCHER AND
LOTS HAPPENS BEFORE PREGNANCY
AND MANY CONDITIONS CATCHING
FIRST TIME BEFORE PREGNANCY
BEFORE YOU INITIATE TREATMENT
YOU HAVE ALREADY MISSED BOAT AND
IF I THINK I WANT TO PREVENT
PREECOLLAPSIA IN SLEEP
DISORDERED -- AND GET THEMMAC
CLIMATED TO CPAP PLACENTA HAS
PERFORMED BIOLOGY THAT PREDICTS
PREECOLLAPSIA HAS HAPPENED AND
IS LOTS OF WORK THAT NEEDS TO
HAPPEN IN PRECONCEPTION PERIOD
AND MAKE IT A POINT IN MY
PRACTICE AND POINT WHERE I END
WITH FELLOWS WHEN PRECEPT THEIR
CLINIC AND EVERY WOMAN OF
CHILDBEARING AGE I ASK WHAT IS
SHE USING FOR CONTRACEPTION AND
IS SHE PLANNING PREGNANCIES?
IT IS NOT SOMETHING THAT PEOPLE
THINK ABOUT ON A REGULAR BASIS A
LOT BUT SHOULD. IT WOULD BE SO
MUCH BETTER IF WE LOOK AT THIS.
WE EVEN IDENTIFY THAT WOMEN WITH
SLEEP APNEA HAVE HIGHER INSULIN
RESISTANCE IN FIRST TRIMESTER
ALREADY. BY TIME THEY GET TO
THAT IT MIGHT BE TOO LATE AND
PRECONCEPTION COUNSELING IS
IMPORTANT TO DO AND WE HAVE TO
INCORPORATE THAT IN CARE OF
ANYBODY AND ANY MEDICAL
SPECIALTY NOT JUST FOR PRIMARY
CARE FOR INSTANCE AND
RESPONSIBILITIES OF PRIMARY CARE
PHYSICIANS SEEM TO BE INCREASING
EVERY DAY.
>> I WANT TO ADD TO THAT I
THINK POSTPARTUM PERIOD IS GREAT
TO ADDRESS THIS. MANY PEOPLE
HAVE MORE THAN ONE PREGNANCY.
THAT MIGHT BE KIND OF AN
OPPORTUNITY WHERE IF WE ARE ABLE
TO PROVIDE BETTER POSTPARTUM
CARE YOU CAN THINK ABOUT
INTERPREGNANCY INTERVAL AS AN
OPPORTUNITY FOR PRECONCEPTION
COUNSELING.
>> YES?
>> >> THANK YOU FOR YOUR
EXCELLENT PRESENTATION. I WANT
TO CALL OUT [INDISCERNIBLE] FOR
THAT PHENOMENAL ACHIEVEMENT OF
INCLUSION OF 30% OF PREGNANT
WOMEN AND MY QUESTION IS
DIRECTED TO [INDISCERNIBLE] AND
YOU HAVE IMPORTANT RESULTS YOU
ARE SEEING HERE AND WHAT ARE
CHALLENGES AND WHAT YOU ARE DOG
TO ENSURE OUTCAN REACH TO THE
COMMUNITY THAT IS A RESOURCE
THAT IS UNDERSTOOD FOR DESIRED
OUTCOME GOING FOR?
>> WE HAVE SEEN THESE RESULTS,
REALLY INTERESTING RESULTS.
WHAT IS EFFORT YOU ARE MAKING
FOR [INDISCERNIBLE] TO COMMUNITY
WHERE IMPACT IS [INDISCERNIBLE]
SO THAT YOU CANNOT SHIFT DESIRED
OUTCOME LONG TERM AND WANTING
RESULTS AND TO HAVE AVERAGES AND
EDUCATION AND CHANGING BEHAVIOR
AND WHO HAVE DESIRED IMPACTS AND
WHAT IS EFFORT AND WHAT ARE
CHALLENGES?
HOW CAN WE ADDRESS THAT?
>> I THIS I THAT IMPLEMENTATION
IS ALWAYS A CHALLENGE AND
BARRIER AND HAS ALWAYS SORT OF
BEEN CONSIDERED A SEPARATE THING
FROM THE INITIAL TRIAL; RIGHT?
NHLBI WAS VERY GENEROUS IN
FUNDING AND SPENT A LOT OF MONEY
TO GET STUDIES ON 2400 WOMEN.
THAT WAS OUR FOCUS AND THERE ARE
ONGOING STUDIES NOW TO DO FOLLOW
UP OF MOMS WHAT THEIR LONG-TERM
OUTCOMES AND WHAT ARE LONG-TERM
NEONATAL CHILDHOOD OUTCOMES
ASSOCIATED WITH TREATMENT AND
IMPLEMENTATION IS NEXT STEP. I
DON'T HAVE A GREAT ANSWER FOR
YOU AND THINK THAT SUPPORT FROM
SFM AND ACOG IS KEY AND LOTS ARE
CHANGING THEIR PRACTICE. THERE
IS STILL LOTS OF WORK TO DO
AROUND THAT.
>> THANK YOU.
>> NEXT QUESTION ON THE LEFT.
CAN YOU PLEASE SPEAK LOUDER?
>> YES.
>> SPEAKERS ARE DIRECTED TO THE
AUDIENCE. WE ARE HAVING A HARD
TIME HERE.
>> CAN YOU HEAR ME.
>> WHY HE.
>> I'M A FAIRLY NEWLY MINTED
MFM FROM HOW WARD UNIVERSITY AND
WANT TO SAY THANK YOU FOR
PUTTING THIS WHOLE THING
TOGETHER. IT IS INSPIRATIONAL
FOR A NEW PHYSICIAN THAT IS
TAKING CARE OF SUCH A POPULATION
THAT IS IN NEED.
I -- MY QUESTION IS MORE FOR
PROFESSIONALS TAKING CARE OF
PATIENTS OUT IN THE COMMUNITY
AND WHAT IS BEING DONE TO REALLY
ADDRESS I THINK THE NATIONAL
ISSUE OF RESOURCES TO TAKE CARE
OF WOMEN IN NEED?
BECAUSE I HAVE FOUND AND WE ALL
KNOW THAT MOST OF THE
PATHOLOGICAL BURDEN IS IN
INSTITUTIONS OR AREAS THAT DON'T
HAVE A LOT OF RESOURCES.
SO, EXAMPLE TODAY, I -- I MEAN,
I'M STILL ON SERVICE AND HAVE TO
GO AROUND ON MY PATIENT. I HAVE
A SICKLE CELL PATIENT WITH A
PULMONARY EMBOLUS LAST YEAR AND
SHORT PREGNANCY AND PATIENT WITH
TIA AND SHE IS PREGNANT AGAIN
AND SHE HAD TIA IN 2022. I
ACTUALLY HAVE A PATIENT NOW WHO
IS 42 AND HAD TWO MIIS.
SHE IS ABOUT TO DELIVER SOON.
THESE ARE THE PANELOLOGIES THAT
I DEAL WITH EVERY DAY.
I DON'T HAVE THE RESOURCES, ONE,
TO DO THE RESEARCH. I AM VERY
INTERESTED IN.
OR TWO, EVEN STAFFING TO HAVE
SOMEBODY TO WRITE GRANTS FOR ME
BECAUSE I'M TOO BUSY TAKING CARE
OF THOSE PATIENTS DAY IN AND DAY
OUT. I'M LITERALLY IN THE
TRENCHES.
WHAT IS BEING DONE FROM A
SYSTEMATIC PERSPECTIVE TO HELP
SUPPORT INSTITUTIONS LIKE MY OWN
RIGHT HERE IN THE NATION'S
CAPITAL AND NO THE TO MENTION
I'M FROM RURAL TENNESSEE WE
DIDN'T HAVE RURAL MATERNITY
WARDS AND I HAVE HEART FOR
RURALS AND WE CAN CALL THEM
MATERNITY DESERTS OR
INSTITUTIONS THAT DON'T HAVE
FUNDING TO DO RESEARCH IN THE
POPULATIONS THAT WE SERVE.
>> BEFORE THE BREAK, I WANT TO
JUST SAY THAT WE CAME HERE TO
DISCUSS TECHNOLOGY.
IT IS OBVIOUS FROM THE QUESTIONS
THERE IS A LOT OF OTHER ISSUES
TO DISCUSS. THANK YOU FOR
BRINGING UP THESE QUESTIONS AND
HOPEFULLY WE CAN ANSWER SOME OF
THEM.
>> YEAH. IF I CAN ADD ONE
THING GEORGE GOT INTO AND I
DEFINITELY VERY MUCH HEAR YOU.
WE ARE IN -- YOU TALKED ABOUT
REALLY POINTS TO FACT WE ARE
RESOURCE LIMITED IN WHAT WE CAN
ACCOMPLISH OVERALL AND WE CAN
TALK ABOUT VARIETY OF GRANT
OPPORTUNITIES FOR PHYSICIAN
SCIENTISTS THAT COULD PROTECT
TIME AND THINGS LIKE THAT.
WE CAN TALK ABOUT THAT.
THERE IS HUGE SYSTEMIC ISSUES
THAT NEED TO BE ADDRESSED AND
TODAY TWO THINGS WE CAN THINK
ABOUT IN TERMS OF INNOVATION AND
DEVICE, ONE, THINKING ABOUT
INNOVATION AND DEVICES FROM DAY
1 THINK ABOUT HOW THEY CAN BE
ACCESSIBLE EVERYWHERE AND HOW
THEY CAN HELP PEOPLE AND MAKING
DEVICES USED BY PEOPLE GETTING
TOP CARE; RIGHT?
SECOND OF THAT IS CAN WE
GENERATE DEVICES AND INNOVATION
APPROACHES MAKING LIFE EASIER
FOR PHYSICIANS TO ELIMINATE
CERTAIN THINGS FOR USE OF
DOPPLAR ULTRA SOUND AND AI
APPROACHES THAT COULD MAKE THIS
EASIER TO USE SO WE SDROEPT TO
HAVE TRAINED TECHNICIANS TO MAKE
THIS MORE ACCESSIBLE AND
BRINGING BACK SYSTEMIC ISSUES
AND THINKING ABOUT HOW TO SOLVE
THEM TODAY.
THEY ARE VERY BIG PROBLEMS WABD
THAT I KNOW WE WILL TAKE A BREAK
AND THANK YOU, EVERYBODY.
>> ALL RIGHT. I'M A PROGRAM
DIRECTOR AT NATIONAL INSTITUTE
BIOENGINEERING AND AWESOME TO BE
HERE WITH THE AWESOME TECHNOLOGY
PANEL AND -- THIS PANEL WILL
FOCUS ON TECHNOLOGICAL GAP FOR
THOSE TECHNOLOGY AND TOOLS
DEVELOPMENT ALGORITHM AND SO ON.
WE HAVE ONE HOUR FOR THE PANEL
DISCUSSION AND WILL HAVE A SHORT
TALK AND INTRODUCTION FROM
PANELISTS FOLLOWED BY Q & A AT
THE END AND WANT TO BE AWARE OF
GREAT PANELS INCLUDING
INMREMENTATION [INDISCERNIBLE]
MODERATOR TODAY IS DR. LAM FROM
GEORGIA INSTITUTE OF TECHNOLOGY
AND EMORY UNIVERSITY AND WITH
THAT I WELCOME HIM ON BOARD.
THANK YOU.
>> THANK YOU. WE WILL DO
DIFFERENTLY WITH OUR PANEL HERE
LIGHTNING ROUNDS AND EACH
PANELIST WILL TALK ABOUT
TECHNOLOGY THEY ARE WORKING ON
AND GO INTO PANEL DISCUSSIONS
AND THIS IS THE TECHNOLOGY PA
PANEL.
WE WILL GEEK OUT AND NERD OUT.
PANELS WILL COME BACK AND
TECHNOLOGY DEVELOPMENT CAN'T BE
DONE IN ISOLATION OF THE ASPECTS
AND WE WILL SEE THAT.
WITH THAT, WHAT WE WILL DO IS
LIGHTNING ROUNDS AND SLIDES
MAYBE SOMEONE CAN ADVANCE THE
FIRST SLIDE.
IT WILL BE A SURPRISE TO ALL TO
POP UP FIRST.
LOTS OF RESPONSES HERE. OKAY.
ARE THERE ANY SLIDES?
OKAY.
SO, WE HAVE TO WING IT THIS
THEN.
WHILE WE ARE FIGURING OUT, YOU
KNOW, WHICH TECHNOLOGIES WILL BE
PRESENTED FIRST, THERE IS SOME
GENERIC QUESTIONS THAT WE CAN
EVEN START FROM THE GET-GO.
WHAT WE HAVE ARE MAYBE WHAT WE
WILL DO IS JUST A QUICK 30
SECOND INTRO FOR EACH PANEL.
SETTING THAT UP. OKAY. TA-DA.
OKAY. I WILL BE YOUR MODERATOR.
THESE ARE PANELISTS.
LET'S JUMP AHEAD TO THE NEXT
SLIDE IF YOU SEEM TO HAVE ONE
POPPED UP. IF NOT, I WILL LET
EACH PANELIST DO A LITTLE BIT OF
AN INTRODUCTION AND WILL START
MAYBE WITH DR. CHRISTIAN AND WE
WILL GO DOWN 30 SECONDS.
>> HI. I'M AN ASSISTANT
PROFESSOR OF MEDICINE AND AT
UNIVERSITY OF PITTSBURGH AND
CO-FOUNDER OF [INDISCERNIBLE]
AND WILL TALK MORE ABOUT IT WHEN
SLIDES COME UP FOR COMPANIES
FLAGSHIP PRODUCT DIGITAL
PLATFORM TO --
>> BETH AN ANY?
>> -- I WILL TALK A BIT TODAY
ABOUT SOME WORK IN RURAL RUE
WANT DAH TO SUPPORT WOMEN WITH
SIS SEERIAN DELIVERY.
>> ASSISTANT PROFESSOR OF
BIOMEDICAL ENGINEERING AND
GRADUATE PROGRAM DIRECTOR FOR
JOHNS HOPKINS CENTER FOR DESIGN
AND PROGRAM WITH
MULTI-DISCIPLINARY TEAMS WITH
STUDENTS AND CLINICIANS AND
PUBLIC HEALTH PROFESSIONALS
FOCUSING ON PROCESS OF MEDICAL
INNOVATION AND SEVERAL EXAMPLES
SHARING TODAY BRIEFLY IN
MATERNAL HEALTH SPACE THAT HAVE
NOW TRANSLATED INTO FOR AND
NON-PROFIT COMPANIES AND
PRODUCTS SERVING PATIENTS
GLOBALLY.
>> I'M ACTUALLY NEW TO MATERNAL
HEALTH AND I'M CARDIAC SURGEON
AND LONG-STANDING INTEREST IN
PUBLIC HEALTH AND SINCE 2015 I
LED JOINT TUFTS MEDICAL SCHOOL
AND MITT COME UP WITH
FUNDAMENTALLY DIFFERENT RATE TO
MEASURE BLOOD PRESSURE AND WE
ARE WORKING ON APPLYING
TECHNOLOGY IN MATERNAL HEALTH
AND PLEASURE TO BE HERE.
>> GREAT. THANK YOU.
OKAY. DO WE HAVE NEXT SLIDES?
GREAT. NEXT SLIDE.
OKAY. GREAT. IT THIS IS MINE.
I WILL TAKE IT. PEDIATRIC
HEMATOLOGIST CLINICALLY AND
PROFESSOR OF BIOMEDICAL
ENGINEERING AND TECHNOLOGY BORN
IN LABORATORY I LEAD AND FULL
DISCLOSURE HERE.
WE WORK ON ARE SEVERAL
TECHNOLOGIES THAT ARE RELATED TO
SOMETHING THAT IS VERY NEAR AND
DEAR TO MY HEART IS ANEMIA THAT
IS ASSOCIATED WITH MATERNAL
HEALTH AS MANY KNOW THAT
PREGNANT WOMEN WHO ARE ANEMIC
HAVE HIGHER RISK OF
COMPLICATIONS.
GOING TO THE NEXT SLIDE.
ONE TECHNOLOGY WE HAVE DEVELOPED
IS AN APP THAT CAN
NON-INVASIVELY ESTIMATE
HEMOGLOBIN VALUES DOING BY
AI-BASED ALGORITHM AND DO A
FINGER NAIL SELFIE AND CLINICIAN
NOSE WHEN PATIENT HAS ANEMIA
DIFFERENT BODY PARTS GETTING
MORE PAIL AND LOOKING AT ALL
BODY PARTS AND COMING TO
ACCESSIBILITY AND USABILITY
FINNINGER NAILS ARE BETTER BODY
PARTS TO CHOOSE FROM AND
SANGUINA IS MOVING THIS FORWARD
WITH DIFFERENT POPULATION GROUPS
AND MULTIPLE DIFFERENT AREAS OF
THE WORLD TRYING TO MULTIPLY
THIS AND MATERNAL HEALTH AND
ROLE CURRENTLY EXPLORING THAT
AND NEXT WE WILL GO DOWN.
OKAY. GREAT.
WANT TO STAY THERE?
YEAH. I THINK YOU ARE -- MAKE
SURE YOUR MIC IS ON.
>> GREAT. STANDARD OF CARE
MEASURING BLOOD PRESSURE AND
USING AN AUTOMATIC OSLOMETRIC
CUFF AND FUNDAMENTAL ISSUES WITH
IT AND STUDIES SHOW IN REAL LIFE
AS MUCH AS 10 MILLIMETERS IN
MERCURY 50% OF THE TIME AND
OTHER ISSUES PROVIDES SINGLE
TIME MEASUREMENT BLOOD PRESSURE
CHANGES MINUTE BY MINUTE AND
WHAT IS THE ISSUE WITH THAT?
PEOPLE OF CHRONIC HYPERTENSION
ARE WRONGLY DATA IS CONSISTENT
AND WRONGLY DIAGNOSIS 30% OF
PEOPLE WITH MASS HYPERTENSION
AND BLOOD PRESSURE NOT MEASURED
AND RATE OF MORTALITY AND
HOSPITALS LEADS TO MONITORING
GAP AND CURRENTLY USING BLOOD
PRESSURE AND KNOW ABOUT ISSUES
FOR LAST 50 OR 60 YEARS AND ALL
EXISTING METHODOLOGIES THAT TRY
TO ADDRESS BLOOD PRESSURE USE
PULSE TRANSIT TIME AND VOLUME
CLAMP SO ON AND SO FORTH NEED A
CUFF STILL TO CALIBRATE THEM AND
HAVE THOSE ISSUES PRIMARILY AND
SECONDLY ARE BASED ON SKIN BLOOD
FLOW AND SKIN COLOR AND MANY
OTHER THINGS THAT CAN EFFECT
SKIN BLOOD FLOW AND MOTION
ARTIFACT IS A MAJOR ISSUE
ADDRESSING NIH CALL FOR AND
FUNDING ONE OF THE TEAMS THAT
WAS US.
WE WENT BACK TO BASICS OF
PHYSIOLOGY AND WAY TO UNDERSTAND
TECHNOLOGY AND FEELING THE
PULSE, WHAT YOU FEEL IS FORCE
TRANSMITTED FROM PRESSURE INSIDE
OF THE BLOOD PRESSURE AND
OPTOMIC CAN CAL -- DOESN'T
DIRECTLY LOOK AT SKIN BY PIECE
OF POLYMER AND LOOKS AT POLYMER
DEFAMATION AND SKIN COLOR WON'T
BE ISSUE TAKING THIS DIRECTLY
FROM LARGE VESSEL AND TAKING
CONTINUOUS IMAGES NEXT SLIDE,
PLEASE.
OKAY. THERE IS VIDEOS SUPPOSED
TO PLAY. ESSENTIALLY WE
RECONSTRUCT THE PRESSURE WAVE
AND FROM EACH PRESSURE WAVE WE
FIGURE OUT WHAT IS THE --
DIRECTLY MEASURING MAXIMUM
MEASURE THAT IS SYSTOLIC AND
BASELINE PRESSURE THAT IS
DIASTOLIC AND DO IT CONTINUE
WOULD USUALLY AND DO IT WITHOUT
GETTING DETAILS AND CARDIO
OUTPUT AND CARDIAC PARAMETERS
AND THRESHOLD RATE PARAMETERS
AND OUTPATIENT STUDIES COMPARED
TO GOLD STANDARD TECHNOLOGIES
AND IT MEASURES BLOOD PRESSURE
AND LOOKING AT BLOOD PRESSURE IN
LAST 100 YEARS REAL CHALLENGE IS
REAL WORLD BLOOD PRESSURE AND
ONE THING TO ADDRESS REAL WORLD
BLOOD PRESSURE HOW DO YOU DO IT
ON SOMEBODY THAT IS ACTUALLY
MOVING RISK AND [INDISCERNIBLE]
SO ON AND SO FORTH?
AS I SAID WE ARE TAKING
CONTINUOUS IMAGES AND APPLYING
LATEST IMAGE TECHNIQUES AND
MISSION LEARNING MOVING RISK OF
FINGER ABLE TO ISOLATE IT MOVING
IT FROM REAL TIME AND LOOKS LIKE
VIDEO IS NOT PLAYING. NEXT
SLIDE, PLEASE.
THIS IS A REAL-LIFE SITUATION WE
SEE IN PATIENT TO ADDRESS MOTION
ARTIFACT AND WHAT WE ARE DOING
IF NO YOU IS GOLD STANDARD
AVAILABLE NOW IS
[INDISCERNIBLE].
WE ARE DOING STUDIES IN PATIENTS
IN ICU AND OPERATING ROOMS
COMPARED AGAINST [INDISCERNIBLE]
AND CENSOR IN OPPOSITE
[INDISCERNIBLE] OF THE PATIENT
THAT CAN MOVE AND IS NOT
RESTRICTED AND WE ARE ABLE TO
SHOW THAT WE CAN GET ACCURATE
20-SECOND MEASUREMENTS IN
PATIENT AND COMPARED TO
[INDISCERNIBLE].
HAVING DONE THAT, WE HAVE TO
SHOW THAT IT REALLY WORKS ACROSS
PATIENT POPULATIONS AND
INITIATING MULTICENTERED TRIAL
AND WHERE WE ARE LOOKING AT WAYS
AND BMI AND HEMODYNAMIC
TRANSITIONS AND OTHER
[INDISCERNIBLE] SO ON AND SO
FORTH.
SO, ONE GOAL FOR US IS TO BRING
THIS EXPERIENCE INTO MATERNAL
HEALTH THAT WE HAVE ACTUALLY
INITIATED STUDY FUNDED BY NHLBI
WHERE PREVIOUS PANELISTS SAID
THAT FIRST OF ALL IT IS A
DIFFERENT PHYSIOLOGY.
IT MAY OR MAY NOT BE
[INDISCERNIBLE] AND
[INDISCERNIBLE] DEVICES LOOK AT
OSCILLATION AND VASCULAR CHANGES
AND UNDERESTIMATES BLOOD
PRESSURE AND WE HAVE HUGE
VARIANCE IN [INDISCERNIBLE]
VARIANCE IN BLOOD PRESSURE AND
FOR REASONS TECHNOLOGY HAS TO BE
CALIBRATED TO PREGNANT MOTHERS
THAT IS ONE THING WE ARE DOING.
AND SECOND MAIN OBJECTIVE FOR S
IS SHOWING TRUE BLOOD PRESSURE
PROFILE IN PREGNANT AND PEOPLE
WITH THAT. YOU KNOW,
HYPERTENSIVE DISEASE OF
PREGNANCY AND GESTATIONAL
HYPERTENSION AND PRECOLLAPSIA
AND 24 HOUR BLOOD PRESSURE
PROFILE AND SECOND MAJOR EFFORT
AND THIRD IS CAN WE PREDICT AND
HAVE DONE MISSION LEARNING
MODELS IN CRITICAL CARE ABLE TO
PREDICT ACUTE EVENTS AND CAN
THAT EXPERIENCE BE BROADENED IN
TERMS OF MATERNAL HEALTH?
LASTLY MOST THING IS ABLE TO
DIRECTLY WORK WITH OUR END
CUSTOMERS THAT IS THE MOTHERS
AND WE ARE GOING TO STUDY AND
WORK WITH NEW YORK PUBLIC HEALTH
SYSTEMS AND WIDE RANGE OF ETHNIC
POPULATIONS AND PARTICULARLY
BLACK MOTHERS AND ABLE TO WORK
WITH THEM AND GET INPUTS WILL BE
REALLY CRITICAL FOR US.
THANK YOU.
>> GREAT.
OKAY. NEXT SLIDE, PLEASE?
>> THANK YOU.
YEAH. SO, I -- I AM A PHYSICIAN
IN MY PAST LIFE AND BIOMEDICAL
ENGINEERING BY TRAINER
ANDOSMOSIS AND IS DIFFERENT
TYPES OF PROJECTS THAT MY
STUDENTS AND COLLABORATORS HAVE
LOOKED AT IN OUR CENTER IN MY
LAB AND RINGSIDE VIEW OF MORE OF
THE PROCESS HOW SOME THINGS HAVE
SUCCEEDED AND SOME ARE ON THE
MARKET AND SOME ARE NOT AND
STARTING WITH ONE WITH TEST THAT
IS SMALL AND PROJECT WORKED BY
UNDERGRADUATE STUDENTS AT
HOPKINS PART OF THE DESIGN CLASS
AND DESIGNED EXTREMELY EXPENSIVE
PROTEINURIA KID COULD BE TAKEN
TO DOOR STEP OF -- INNOVATION
THERE WAS REENGINEERED
BIOCHEMISTRY OF DIP STICK AND
PUT IN HIGH LIGHTER PEN AND
COMMUNITY HEALTH WORKERS WOULD
HIGHLIGHT THAT IN LANARD AND
MANUFACTURER TEST STRIP AT POINT
OF LOCALLY AVAILABLE PIECE OF
PAPER THAT WE GOT SIGNIFICANT
FUNDING FROM USAID A DIV AWARD
WINNER AND DID CLINICAL STUDY
AND SHOWS IT ENDED UP HAVING
HIGHER DENSITY SPECIFICITY THAN
DIP STICKS FINDING AT PHARMACY
AND 1/3% OF TEST THAT DIDN'T GET
TO MARKET.
WAS ABOUT 10 YEARS AGO AND
REASONS RELATE TODAY BUSINESS
MODEL APPROPRIATENESS AND
ERRONEOUSLY SELECTED
MANUFACTURING PARTNER THAT IS
NOT HELPING MOTHERS IN WORLD
TODAY DESPITE SIGNIFICANTING
FUNDING BEHIND IT AND CONTRAST
THAT WITH ONE RIGHT BELOW THAT
NON-INVASIVE HEMOGLOBINO METER
THAT WE DEVELOPED STARTING BACK
IN 2012 THAT IS, AGAIN,
SIMILARLY WITH AIM OF TAKING
MATERNAL ANEMIA SCREENING TO
DOORSTEP OF RURAL WOMEN IN SUBIS
A HARRANT AFRICA AND
[INDISCERNIBLE] ON A
[INDISCERNIBLE] CENSOR AND
CUSTOM TO DESIGN MACHINE
LEARNING OUTCOMES FINALLY DOG
THE TRICK AND ITERATIONS THAT
WERE 5 OR 6 THAT WERE DEVELOPED
IN THE LAB AND PARTNER WITH BOSH
THEY DEVELOPED SOME CUSTOM
HARDWARE FOR CENSOR AND DEVICE
YOU SEE INSET IN THE BOTTOM
RIGHT OF THAT IS THIS HAS BEEN
ANALYZED AND LAUNCHED IN INDIAN
MARKET AND ABOUT TO BE LAUNCHED
IN COUNTRIES IN AFRICA AND
HOPEFULLY EVEN THOUGH IT IS --
IT HAS BEEN COMMERCIALLY
INTRODUCED AND WHO KNOWS
TECHNOLOGIES COMING OUT OF YOUR
LAB SDR DISRUPTING THIS MIGHT
NOT NEED A CENSOR BUT APP.
>> MANY WAYS TO SKIN A CAT;
RIGHT?
>> ABSOLUTELY. I RAISE POINT
WITH BOSH LEADERSHIP TO BE
PREPARED FOR DISRUPTION AS
SCIENCE EVOLVES AND ONE ON TOP
RIGHT OF THE SLIDE IS A PARTO
GRAM AND THOSE IN OBSTETRICS
KNOW WHAT A PARTO GRAM IS NOT
COMMONLY USED IN UNITED STATES
BUT REST OF THE WORLD OBSTETRICS
PRACTICE USES [INDISCERNIBLE] A
PAPER TOOL USED BY DEVICE AND
MOSTLY MIDWIVES AND NURSES TO
MAKE APPROPRIATE DECISIONS IN
MANAGEMENT OF LABOR THAT TRACKS
12 OR 13 VARIABLES OF LABOR AND
DELIVERY WITH MATERIAL WELLBEING
AND PROGRESS OF LABOR AND WORK
WITH [INDISCERNIBLE] AND NGO AND
MATERNAL HEALTH AROUND THE WORLD
AND WORKING WITH THEM WE
DEVELOPED LOW-COST ELECTRONIC
VERSION OF THE PROGRAM WITH
EPARTO GRAM, IF YOU WILL.
SEVERAL ITERATIONS OF THAT, TWO
ARE SHOWN IN-BETWEEN AND SHOWING
DESIGN OF PRODUCT IS ITERATIVE
ALWAYS AND THERE IS A DINLTIZING
[INDISCERNIBLE] THAT COULD BE
MADE FOR $10 AND CUSTOM MADE.
YOU KNOW?
EINK KINDLE VERSION OF
[INDISCERNIBLE] AND FINALLY WE
HAVE SOMETHING ON A SMARTPHONE
THAT IS REALLY CHEAPER AND NOW
HAS 7 OR 8 DIFFERENT VERSIONS
AND MULTIORGANIZATIONS AROUND
WORLD HAVE TAKEN THIS UP AND
PUTTING OWN FLAVOR TO IT
INCLUDING SEVERAL DIGITAL HEALTH
TECH AND THIS IS ALSO NOW IN --
UNDERGOING CLINICAL TRIALS
PUBLISHED AND SOME WORK ON
EFFECTIVENESS AND ELECTRONICS
HAVE BEEN PUBLISHED BY
[INDISCERNIBLE] AND WHO CHANGED
MATERNAL HEALTH GUIDELINES AND
SOME KNOW THAT A YEAR AGO. ALL
BASIS OF THIS PARTO GRAM NOW HAS
TO BE REDONE. GLOBAL GUIDANCE
OF HOW -- YOU KNOW, OF LABOR AND
TLIFRY SHOULD BE MANAGED IS
CHANGED BY WHO RECENTLY AND
TAKING INTEREST OF TIME AND LAST
ONE ON BOTTOM RIGHT. THAT IS A
DIGITAL HEALTH NON-PROFIT
STARTED BY PHD STUDENT AND
MYSELF AND A BUNCH OF OTHER
STUDENTS AT THE CENTER THAT IS
NOW CROSSED.
BASIS IS LIKE [INDISCERNIBLE]
SERIES FOR COMMUNITY HEALTH AND
EXPORT ENABLED TELEMEDICINE
PLATFORM TO AUTONOMOUSLY PERFORM
CERTAIN TASKS AND MEDICAL
HISTORY AND DOING ANTI-NATAL
VISIT THAT IS COMPLETING THAT
AUTONOMOUSLY AND CONNECTING WITH
CLOUD NETWORK ABDUCTORS MINIMAL
TIME OF EFFORT OF DOCTORS AND
HIGH QUALITY BASE CARED FOR
CLIENT AND COMPREHENSIVE PRIMARY
CARE AND THIS IS DEPLOYED IN
MULTIPLE AREAS IN INDIA AND
TRIBAL AREAS ESPECIALLY
PARTICULARLY IN PHILIPPINES FOR
ANTI-NATAL SERVICES THAT IS NOW
ALSO IN SYRIA HELPING VARIOUS
INTERN DISPLACED POPULATION AND
EMPOWERS [INDISCERNIBLE] TO
PERFORM AT CERTAIN LEVEL
CROSSING LANDMARK FIRST PHD
STUDENT FIRST START-UP PART OF
THE PHD AND ONE LESSON FROM THAT
ONE IS OUR STUDENTS ACTUALLY
WENT AND LIVED WITH COMMUNITY
HEALTH WORKERS IN THEIR HOUSES
JUST UNDERSTANDING PERSONA AND
UNDERSTANDING HOW CARE BEHAVIOR
PERCEPTIONS ARE. NEXT SLIDE,
PLEASE.
VERY BRIEFLY, I WANT TO TALK
ABOUT THE PROCESS.
TAKING, YOU KNOW, SOLVING A
CLINICAL PROBLEM AND COMING UP
WITH ACTUAL TECHNOLOGY MAKING
IMPACT ON PATIENTS IN LARGE
NUMBERS REQUIRES THAT YOU
NAVIGATE A RANGE OF ISSUES IN
CLINICAL AND PUBLIC HEALTH
DOMAIN RELATED TO PATIENT
PERSPECTIVES AND PROVIDER
ISSUES, ET CETERA IMPLEMENTATION
AND REGULATORY POLICY AND COULD
BE DESIGN AND ACTUAL CORE
TECHNOLOGY AND THE EVIDENCE THAT
NEEDS TO BE GENERATED OR COULD
BE STRATEGIC FUNDRAISING TEAM,
ET CETERA.
NEXT SLIDE, PLEASE.
PROCESS THAT WE FOLLOW IS WHAT I
WOULD LIKE TO LEAVE YOU WITH.
IT IS IN EVERY SUCCESSFUL HEALTH
CARE TECHNOLOGY THAT HAS BEEN
TRANSLATED YOU CAN START YOUR
JOURNEY THROUGH WITH A CLINICAL
PROBLEM LIKE IN CLINICAL
QUADRANT OR COULD BE WITH NEW
DISCOVERY HAPPENING IN A LAB
THAT HAPPENS IN ACADEMIC
MEDICINE DOING CLASSICAL BEFRNL
TO BEDSIDE MODEL AND LARGE
CORPORATION YOU MIGHT HAVE
PRIORITIES WE ARE NO. 1 IN
SUTURES WHAT IS NEXT WE CAN DO
AND NO. 1 BLOOD PRESSURE COMPANY
WHAT IS NEXT THING WE CAN DO?
POINT IS YOU HAVE TO INSTEAD OF
TAKING LINEAR APPROACH WHERE YOU
EITHER SOLVE TECHNOLOGY FIRST
AND THEN TRY TO FIND OR NAIL
THAT NUMBER OR AS TYPICALLY IS
DONE [INDISCERNIBLE] TO BEDSIDE
MODEL YOU DO RESEARCH AND
UNDERSTAND CLINICAL USE CASE AND
THINK ABOUT NOW HOW DO WE GET
THROUGH FDA AND HOW DO WE
GENERATE EVIDENCE FOR IT?
A MODEL THAT HAS WORKED WELL AND
WHAT WE TEACH AT OUR CENTER TO A
NEW GENERATIONINO VATORS IS
TAKING INNOVATIVE APPROACH AND
ADDRESSING ALL ISSUES AT
APPROPRIATE LEVEL OF DEPTH FOR
INNOVATION IS AND DON'T IGNORE
ISSUES AND WHEN THINKING OF NEED
AND OF A PROBLEM THINKING ABOUT
REGULATORS AND SCIENTIFIC HURDLE
TO OVERCOME WHAT DOES EVIDENCE
LOOK LIKE CLASS 2 ADVICE AND
CLASS 2 ET CETERA, ET CETERA.
TAKING NEXT STEP AND EACH
ITERATION THINKING IF HYPOTHESES
HOLDS TRUE DO YOU MODIFY IT OR
[INDISCERNIBLE] PROJECT AND
EVOLVE AND LEARN AND HEART OF
MOST SUCCESSINOVATIONS AS WELL
AS LESSONS LEARNED FROM ME THAT
ARE THINGS THAT DIDN'T GO TO
MARKET IS WE YOU KNOW TRY TO PAY
ATTENTION TO ALL THESE ISSUES
ITERATIVELY OPPOSED TO A LINEAR
FASHION.
THANK YOU.
>> THANK YOU!
>> GREAT.
>> THANK YOU. IT IS ALMOST THE
PERFECT REAL-LIFE ILLUSTRATION
OF YOUR LAST SLIDE.
I THINK IT IS A GREAT
TRANSITION.
AS I MENTIONED, I WILL TALK A
LITTLE ABOUT SOME OF OUR WORK IN
RWANDA SPECIFICALLY WORKER LED
HOME-BASED CARE AND AFTER
DELIVERY AND FOCUS ON CARE
ACCESS AND OUTCOMES FOR WOMEN IN
VERY RURAL PARTS OF RWANDA AND
RECOGNIZE THAT LOTS OF FOLKS HAD
HERE ARE FOCUSED ON US-BASED
APPLICATIONS AND TALKING BEFORE
PANEL STARTED ABOUT ALL DIGITAL
INNOVATIONS HAPPENING IN SUBIS A
HARRANT AFRICA AND GLOBALLY AND
LEARNING FROM US AND DIGITAL
INNOVATIONS AND HAPPY TO SHARE
THAT WORK WITH YOU.
I WANT TO START WITH OUR TEAM A
SNAPSHOT OF SCIENTIFIC
LEADERSHIP THAT IS REPRESENTING
A VERY BIG AND
MULTI-DISCIPLINARY TEAM AND FOR
ME, REASON IT IS IMPORTANT TO
START WITH THE TEAM IS GOING
BACK TO THE QUESTIONS AROUND
IMPLEMENTATION AND TRANSLATION
AND IMPACT.
SO, I TRULY BELIEVE THAT THE
REASON THAT WE ARE ON TO
SOMETHING, A TECHNOLOGY
INNOVATION THAT IS NOT ONLY
INTERESTING FROM A TECHNOLOGY
POINT OF VIEW, BUT ALSO HAS A
REAL POTENTIAL TO INFLUENCE CARE
THAT WOMEN RECEIVE IS BECAUSE
OUR TEAM IS SO
MULTI-DISCIPLINARY.
WE ARE NOT TECHNOLOGY LOOKING
FOR A PROBLEM TO SOLVE BUT CAME
AT THIS FROM A PROBLEM-CENTERED
APPROACH. NEXT SLIDE, PLEASE.
WHAT IS THAT PROBLEM?
WHAT ARE GAPS THAT WE ARE TRYING
TO ADDRESS?
WOMEN AFTER CRESSARIAN DELIVERY
HAVE HIGH RATES OF COMPLICATION
AND HIGHER IN RURAL RWANDA IT
THAN YOU WILL SEE IN MUCH OF THE
US AND COMPLICATION WE FOCUS ON
MOST IS SURGICAL SITE INFECTIONS
OCCURRING IN 10% OF SESARIAN
DELIVERIES IN CONTEXT WHERE I
WORK AND COMPLICATIONS TRYING TO
ACKNOWLEDGE THAT MANY
HIGHLIGHTED ON PREVIOUS PANEL
AND SECOND CHALLENGE WE ARE
TRYING TO ADDRESS IS POST-OP
ITERATIVE CARE FOR WOMEN
DELIVERING VIA C SECTION IS
DIFFICULT FINANCIALLY AND
PHYSICALLY FOR WOMEN TO GO BACK
TO HOSPITALS TO RECEIVE THAT
CARE.
WHY WE ARE TRYING TO USE A
DIGITAL TOOL TO SUPPORT
COMMUNITY HEALTH WORKERS TO
FOLLOW WOMEN IN THESE CONTEXTS,
ONE, IT GIVES OPPORTUNITY TO DO
TIMELY DIAGNOSIS OF
COMPLICATIONS AND REMOVES
WOMEN'S SPECIFIED BARRIERS OF
GOING BACK TO HEALTH FACILITIES
AND I THINK THAT THE LAST POINT
IS IMPORTANT BECAUSE
SPECIFICALLY TALKING ON POINTS
WHAT DO WOMEN WANT AND WHAT TYPE
OF CARE THEY WANT TO RECEIVE AND
BELIEVE THAT THIS TYPE OF CARE
IS PATIENT CENTERED AND FOCUSES
ON DIRECT REQUEST FOR PATIENT'S
CARE AND EXCITING TIME TO DO
THIS IN RWANDA FOUR YEARS AGO
LAUNCHED [INDISCERNIBLE] WHICH
IS FIRST SMARTPHONE MADE ON
AFRICAN CONTINENT AND MADE
COMMITMENT TO GET SMARTPHONES IN
HANDS OF 60,000 HEALTH WORKERS
IN RWANDA. NEXT SLIDE.
TWO EXAMPLES OF TECHNOLOGY
INNOVATION IN THIS WORK.
I DON'T THINK THAT ALL
INNOVATION HAS TO BE TECHNOLOGY.
THIS IS A TECHNOLOGY PANEL AND I
WANT TO FOCUS ON THAT.
FIRST ON THE LEFT IS TALKING
ABOUT SURGICAL SITE INFECTION
DIAGNOSTIC TOOLS AND OVER COURSE
OF SEVERAL STUDIES WE CONTINUE
TO COLLECT WOUND IMAGES AND GP
SURGICAL SITE INFECTION
DIAGNOSIS BASED ON PHYSICAL
EXAMS AND HAVE USED DATABASE OF
IMAGES AND DIAGNOSIS TO DEVELOP
IMAGE-BASED DIAGNOSTIC
ALGORITHMS THAT CAN RUN ON
MOBILE PHONES AND FIRST ON TOP
IS USING PHONE IMBEDDED IN
SMARTPHONES YOU TAKE PHOTO OF
WOUND DEVELOPING COMPUTER VISION
TECHNOLOGY TO STANDARDIZE
QUALITY AND ROTATION OF THE
IMAGES AND USING IMAGE FROM THE
PHONE THAT CAN GO ON WITH
RELATIVELY HIGH ACCURACY
PREDICTING WHETHER OR NOT THAT
WOMAN IS HIGH RISK OF HAVING
SURGICAL SITE INFECTION NEEDING
TO REFER BACK TO CARE AND BOTTOM
ONE IS ONE WE ARE EXCITED ABOUT
THAT REQUIRED A THERMAL CAMERA
ADD-ON. $200 PER DEVICE ADD-ON
AND ACHIEVING HIGHER ACCURACY OF
SURGICAL SITE INFECTIONS AND
EXCITED FOR THIS. PREVIOUS
ALGORITHM IS DEVELOPED FOR WOMEN
IN RURAL RWANDA THAT IS SPECIFIC
TO SKIN COLOR AND THERMAL IMAGE
TECHNOLOGY GIVES OPPORTUNITY TO
EXPAND TO OTHER SKIN COLORS
BESIDES THOSE OF PATIENT
POPULATION AND SECOND TECHNOLOGY
ON RIGHT IS LOW TECH INNOVATION
THAT IS REALLY IMPORTANT AND
TOOLS THAT SUPPORT COMMUNITY
HEALTH WORKERS TO WALK WOMEN
THROUGH CLINICAL DIAGNOSIS AND
SUPPORTS ENGAGEMENT OF WOMEN IN
TERMS OF COUNSELING AND AROUND
POSTPARTUM DEPRESSION AND HAVING
CONVERSATIONS AROUND INTIMATE
PARTNER VIOLENCE AND ISSUES THAT
COMMUNITY HEALTH WORKERS AND
MOTHERS IDENTIFYING TO BE ISSUES
TO SUPPORT ADDRESSING AND LOOK
FORWARD TO QUESTIONS AND ALSO
HEARING MORE ABOUT OTHER
TECHNOLOGIES.
>> OKAY. GREAT. THANK YOU.
NEXT SLIDE, PLEASE.
>> HI.
>> WHENEVER YOU ARE READY.
>> SO, THIS IS MY HEALTHY
PREGNANCY DIGITAL HEALTH
PLATFORM. AS I MENTIONED, WE
ARE AN EARLY STAGE SPIN OUT FROM
THE UNIVERSITY OF PITTSBURGH AND
CARNEGIE MELON UNIVERSITY AND
YOU SEE ON THE LEFT PATIENT
FACING [INDISCERNIBLE]. IT THIS
IS PRESCRIBED TO PREGNANT
INDIVIDUALS AT THEIR FIRST
PRENATAL APPOINTMENT BY HEALTH
CARE PROVIDERS AND IT OFFERS
KIND OF EDUCATION THAT IS
TAILORED TO THEIR GESTATIONAL
WEEK AND TO BASELINE RISK
INFORMATION AND INFORMATION THEY
SHARE THROUGH THE APP THROUGHOUT
THE COURSE OF THEIR PREGNANCY
AND CONNECTS THEM ALSO TO
RESOURCES THAT ARE RESPONSIVE TO
RISKS IDENTIFIED IN THE TOOL.
AND THEN WE ALSO USE THAT
INFORMATION THAT IS SHARED
THROUGH THE TOOLS TO DO BACKEND
ALGORITHM MIC DEVELOPMENT TO DO
EARLY RISK IDENTIFICATION AND
WHAT YOU CAN SEE ON THE RIGHT
THAT IS A PROVIDER PORTAL
INTEGRATED INTO THE INDIVIDUAL'S
HEALTH RECORDS THAT ARE
PROVIDERS THAT CAN GO IN AND SEE
SPECIFIC RISKS THAT ARE
IDENTIFIED IN REAL TIME AS THEY
HAVE. SOMETHING TO NOTE IS
DESIGN APPROACH THAT WE HAVE
TAKEN WITH THIS IS WE DON'T ASK
ANYBODY ANYTHING OR MONITOR ANY
KIND OF RISK FACTOR THAT WE
DON'T IMMEDIATELY GIVE THEM
ACTION PACKED. THEY ARE NOT
ELIAANT ON A PROVIDER AND OFFERS
OPPORTUNITY TO PROVIDERS TO SEE
ALSO WHAT IS HAPPENING WITH
THEIR PATIENT.
NEXT SLIDE, PLEASE.
>> SO, OUR TEAM COULD HAVE BEEN
KIND OF WORKING ON THIS IN THE
ACADEMIC SPACE FOR A WHILE AND
WE WANTED TO BUILD SOMETHING TO
ADDRESS THREE KEY PROBLEMS WE
SAW HAPPENING IN ENTIRE CYCLE OF
PREGNANCY CARE AND FIRST PROBLEM
IS REALLY ONE OF IDENTIFICATIONS
AND HOW DO WE IDENTIFY RISKS AS
EARLY AS POSSIBLE IN BETWEEN
ROUTINE PRENATAL VISIT SNZ.
IDEALLY BEFORE THEY START TO
MANIFEST?
HOW CAN WE REALLY FOCUS ON RISK
IDENTIFICATION WITH THE GOAL OF
PREVENTIVE KAIR?
NEXT PIECE WE FELT THAT WAS
CRITICAL WAS REALLY TRYING TO
ENGAGE BETTER WITH PATIENTS WHEN
WE ARE DOING THAT
IDENTIFICATION.
SO, IT IS NO GOOD TO IDENTIFY
RISK IF YOU CAN'T REALLY WELL
COMMUNICATE WHAT SHOULD BE DONE
WITH RISKS AND WHAT PATIENT
OPTIONS ARE AND NEXT STEPS ARE.
THIS ENGAGEMENT IN TERMS OF
COMMUNICATION AND IN TERMS OF
TRUST BUILDING TOO.
WE WANT IT TO BE ABLE TO
INCORPORATE THAT INTO OUR
PLATFORM AND LAST PIECE OF THE
CYCLE OF CARE WE WANTED TO
REALLY ADDRESS WITH THIS TOOL IS
CONNECTIONS AND IDENTIFYING RISK
TRAJECTORY AND COMMUNICATING
SOMETHING TO THE INDIVIDUAL WHO
MAY BE AT RISK.
HOW DO WE THEN CONNECT THEM TO
THE SERVICES THAT THEY NEED
ESPECIALLY GIVEN THIS IS
DISCUSSED ALREADY. CONSTRAINTS
THAT ARE WITH RESOURCES AND HOW
WE STREAMLINE CARE TO MAKE SURE
INDIVIDUALS THAT NEED IT MOST
ARE ACTUALLY RECEIVING IT.
ON RIGHT WHAT YOU CAN SEE IS
INITIAL RESULTS FROM A RECENT
BETA TEST WE DID WITH OUR TOOL
IN UMPC HEALTH CARE SYSTEM FROM
19,000 PATIENTS PRESCRIBED OUR
APP AND ROLLED OUT AROUND MARCH
OF 2020 THAT WAS AN INTERESTING
ROLLOUT TIME AND TIME THAT LOTS
OF PEOPLE WERE ENGAGING WITH
DIGITAL TOOL AND TRANSITIONING
TO TELEMEDICINE AND IN THAT
SENSE WAS A REALLY GOOD LEARNING
EXPERIENCE TO TRY TO BE
COLLECTING DATA DURING THAT
TIME.
WHAT WE FOUND IS FOCUSING ON
KIND OF THREE KEY RISK FACTORS
FOR MATERNAL MORTALITY THAT WE
BELIEVE ARE MODIFIABLE AND
ADDRESSABLE RESOURCES IN OUR
SYSTEM AND FOUND WE ARE ABLE TO
IDENTIFY SIZABLE NUMBER OF
PATIENTS THAT WERE DEVELOPING
DEPRESSION SYMPTOMS NO THE
RECEIVING TREATMENT AND CARE --
LOTS OF OPTIONAL SCREENING TOOLS
IMBEDDED AT PLATFORM AND WANTING
TO BE CONNECTED TO CARE AND
DESIGN AND GIVING PEOPLE OPTIONS
WHEN THEY WANT TO SEEK CARE AND
SHARE AND DISCLOSE WITHOUT
HAVING TO TAKE NEXT STEP.
WE SEE ENGAGEMENT IN TOOL AND
PARTICULARLY AMONG COLOR AND
BENEFICIARIES OF MEDICAID AND
AMONG FIRST-TIME MOMS AND
ENGAGEMENT AMONG MOMS WITH
HIGHER PREGNANCY COMPLICATION AS
WELL.
WE HAVE BEEN FAIRLY SUCCESSFUL
CONNECTING PEOPLE TO CARE FOR
SPECIFIC RISKS AND WE HAVE
LEARNED FROM TOOL THAT HELPED US
TO CHANGE OWN CARE PRACTICES AND
HEALTH CARE SYSTEM AND WHAT
EMERGED ROLLING THIS OUT AND
TESTING IT IS WE NEED TODAY
REALLY DEVELOP A DEDICATED
NURSING TEAM TO BE RESPONSIVE TO
THOSE SHARED IN THE TOOL AND
PART OF THE BETA TESTING WE PUT
THAT TEAM TOGETHER AND FOUND IT
WAS A MUCH MORE EFFECTIVE WAY
CONNECTING PATIENTS THAN HAVING
PROVIDERS HAVE JUST ONE MORE
TASK THAT IS ADDED TO THEIR LOAD
FOR MONITORING PATIENTS AND
HAPPY TO TALK ABOUT THAT LATER
TODAY.
YEAH.
>> GREAT. THANK YOU.
ALL PANELISTS HAVE TALKED ABOUT
-- NOPE. NO LUNCH YET. ARE YOU
STAYING UNTIL 12:35 OR SO. NOW
YOU KNOW WHERE ALL PANELISTS ARE
COMING FROM IN TERMS OF
TECHNOLOGIES AND WHAT WE WILL
WORK ON AND DOING IN NEXT 15
MINUTES OR SO IS DOING A
DISCUSSION AMONGST OURSELVES AND
PRETEND YOU ARE WATCHING A TALK
SHOW RIGHT NOW. PRETEND I'M
JERRY SPRINGER AND HE IS DEAD
DON'T PRETEND THAT PRETEND I'M
OPRAH AND I WILL OPEN PANELS AND
QUESTIONS AND ANYONE PLEASE KIND
OF CHIME IN AND AFTER 15 MINUTES
WE WILL TAKE Q & A FROM AUDIENCE
AND IN PERSON AND ONLINE AS
WELL.
ANY PANELIST SNZ.
PLEASE TALK ABOUT WHAT YOU THINK
ARE BIGGEST CHALLENGES AND GAPS
DEVELOPING AND IMPLEMENTING
TECHNOLOGY SPECIFIC FOR MATERNAL
HEALTH. ANYONE, PLEASE CHIME
IN.
>> COME ON.
>> I'M HAPPY TO TALK ABOUT OUR
EXPERIENCE.
I THINK THAT THE BIGGEST ISSUE
THAT WE FACED MOVING OUT OF
ACADEMIA AND COMMERCIALIZING IS
THINKING ABOUT HOW TO DO
SCALABILITY IN OUR HEALTH CARE
SYSTEM NATIONWIDE THAT IS VERY
FRAGMENTED AND EVERY HEALTH CARE
SYSTEM MAKES THEIR OWN DECISION
AND BRINGS ON OWN TOOLS AND JUST
REALLY YOU KNOW IT IS A HUGE
LIFT TO GET INTEGRATED INTO ONE
SYSTEM TO TAILOR WHAT YOU ARE
DOING INTO ONE SYSTEM AND HOW
YOU SCALE THAT UP TO A TOTALLY
DIFFERENT SYSTEM.
SO, FOR SOMETHING THAT IS
COMMERCIAL TO BE SUSTAINABLE,
YOU NEED TO REALLY BE IN SEVERAL
HEALTHCARE SYSTEMS AND NEED TO
BALANCE THAT OUT WITH, YOU KNOW,
REALLY MAKING SURE WHAT YOU ARE
OFFERING IS ADDRESSING PATIENTS
NEEDS IN THAT SYSTEM AND BIG
PROBLEM FOR US AND FOR
TECHNOLOGY.
>> SOMETIMES WE GIVE THIS WITH
DIGITAL HEALTH PLATFORMS SO EASY
TO SCALE AND DON'T HAVE TO MAKE
ANYTHING AND DIGITAL PLATFORMS
HAVE OWN SETS OF CHALLENGES IN
TERMS OF SKILL.
>> MY THOUGHT ON THAT WAS AN
EXTENSION OF YOUR COMMENT THAT
IS JUST WHAT WE ARE ATTRACTED TO
FROM FUNDING PERSPECTIVES.
SO, FUNDERS LOVE TO FUND BRIGHT
AND SHINY OBJECTS AND LOTS OF
WAYS COST FOR OUR WORK IS AROUND
COMMUNITY ENGAGEMENT COMPONENT
THAT IS AROUND MAINTAINING
SERVERS SO THEY CAN STILL RUN
ALGORITHMS WE ARE TRYING TO RUN
AND THERE IS A LOT OF RESOURCES
HAVING TO GO INTO MAINTENANCE OR
ADAPTATION.
AND, YOU KNOW, I GET GREAT
REVIEWS SOMETIMES AND THEY SAY
YOU HAVE DEVELOP AN ALGORITHM
WORKING IN RWANDA NOT INNOVATIVE
TO SHOW IT COULD WORK AND
ADAPTING FOR MEXICO AND THERE IS
AN ACTUAL REAL COST TO DO THAT
AND WE AS A COLLECTIVE
COMMUNITY, AS WE THINK ABOUT HOW
TO EXPAND THIS TO FOR MATERNAL
HEALTH ADVOCATING FUNDERS
RECOGNIZE THE FULL COST THAT IS
INVOLVED IN THIS WORK.
>> I WANT TO ADD TO THAT MAKING
NOT FULLY THINKING THROUGH LATE
STAGE FAILURE MODES AND BUSINESS
MODEL RELATED QUESTIONS AND
IMPLEMENTATION RELATED QUESTIONS
SUCH AS COMMUNITY ENGAGEMENT AND
SUCH AS GETTING THROUGH
REGULATION AND EVIDENCE
GENERATION THAT WILL BE NEEDED
WAY PAST REGULATION FOR
ADOPTION, ET CETERA, ET CETERA.
EARLY STAGE INNOVATORS IN
ACADEMIA ESPECIALLY IS REALLY
THINKING ABOUT HOW TO CREATE AND
HOW YOU PUBLISH PAPERS CREATING
CUTTING ENL SCIENCE AND SOME HOW
YOU BUILD TECHNOLOGY AROUND IT.
IT IS ALMOST MORE OFTEN THAN NOT
I HAVE SEEN WITH COLLEAGUES THAT
THEY ARE THINKING ABOUT LATE
STAGE ISSUES A BIT LATER AND
SOME SPECTACULAR FAILURES AFTER
YOU BURN THROUGH MULTIPLE R01S
OR YOU KNOW SOME TRANSITION TO
SCALE GRANT FROM SAVING LIVES AT
BIRTH GRAND CHALLENGES THAT GOES
NOWHERE. YOU REALIZE, OOPS.
THIS IS A CLASS 3 DEVICE. WHAT
IS THAT?
SO, I THINK FROM BATTLE SCARS,
MY -- MY ADVICE TO MY STUDENTS
THESE DAYS IS THINK ABOUT, YOU
KNOW, ALL OF THE ISSUES FROM
LATE STAGE TO EARLY STAGE AND
TYPICALLY TRY TO HAVE
MULTI-DISCIPLINARY PARTNERS ADD
FROM THE TABLE FROM DAY 0.
MOST PROJECTS WE WON'T
COMMISSION A PROJECT UNLESS WE
HAVE AND OF COURSE CLINICIANS
AND ENGINEERS AND BASIC
SCIENTISTS AT TABLE AND ALSO
SOMEONE THAT IS REPRESENTING
REGULATORY VOICE AND BUSINESS
MODEL THINKING VOICE AND THEIR
CONTRIBUTION TO THE PROJECT AT
INITIAL STAGES MIGHT BE VERY
LITTLE AND CONTRIBUTIONS
INCREASE LATER ON AND FACT THEY
ARE AT TABLE AT CONVERSATION
THAT HELPS PREVENT CATASTROPHIC
FAILURE MODES.
>> ALL RIGHT. SOMETIMES
TECHNICAL PROBLEM SOMETIMES IS
NOT BIGGEST PROBLEMS; RIGHT?
WE SOMETIMES FORGET ABOUT THAT.
YOU KNOW, THESE OTHER
SURROUNDING ISSUES THAT CAN
OFTEN BE EVEN GREATER. WANT
ANYTHING TO ADD?
>> YEAH. I CAN SPEAK TO THIS
FROM OUR OWN EXPERIENCE.
AS I SAID, MY BACKGROUND IS MORE
ON CHRONIC HYPERTENSION OR
IN-PATIENT CARE. IT HAS BEEN A
LEARNING EXPERIENCE TO EVEN
UNDERSTAND WHAT IS A PROBLEM
WHEN IT COMES TO HYPERTENSIVE
DISEASES OF PREGNANCY AND ONE
THING SHOCKING TO ME IS HOW
LITTLE DATA IS OUT THERE IN
TERMS OF LOOKING AT
[INDISCERNIBLE] MEASUREMENTS AND
TO EVEN UNDERSTAND THE PROBLEM
THAT IS NO. 1.
SECOND, THERE -- ALSO MORE
SURPRISING WAS VERY FEW DEVICES
ACTUALLY LOOKED AT IT
PARTICULARLY CALIBRATING IT.
FOR US, IT HAS BEEN A CHALLENGE
TO EVEN UNDERSTAND THE PROBLEM
AND REASON TO COME HERE IS TO
LEARN FROM AUDIENCE HERE.
SECOND IS I COULD SEE CHALLENGE
IS HOW YOU FUND A TECHNOLOGY
LIKE THIS ADVANTAGE ON PLATFORM
TECHNOLOGY AND SHOWING CRITICAL
CARE MARKET HYPERTENSION MARKET
GOING THROUGH TYPICAL VENTURE
FUND EVERYONE WANTS TO BUILD A
VARIABLE AND REASON TO DO THIS
IS THROUGH GRANT FUNDING AND
COULD SEE POTENTIAL CHALLENGES
YOU HAVE IF MATERNAL HEALTH
FOCUSED TECHNOLOGY TO GET THOSE
COMMERCIALIZED AND FUNDING.
>> DESIGNS AND GAPS AND
CHALLENGES NOW AND NO SHORTAGE
OF THEM COMING TO MATERNAL
HEALTH AND CONTEXT OF
UNDERSERVED POPULATION AND
EXPERIENCE AND SOLUTIONS AND
LESONES LEARNED IN HOW TO GET
NEW TECHNOLOGIESINO VATTIVE AS
THEY ARE TO PATIENT POPULATIONS
NEEDING THEM THE MOST AND FROM
YOUR OWN EXPERIENCE OR WORDS OF
ADVICE?
>> YEAH. I ECHO KIND OF HAVING
KEY STAKEHOLDERS INVOLVED FROM
THE BEGINNING AND THINK THOSE
ARE KEY STAKEHOLDERS WITH LIVED
EXPERIENCE AND I THINK THAT TAKE
TG THROUGH DIGITAL PLATFORMS AND
TAKE TG FURTHER THAN PERSON
CENTERED AND HUMAN CENTERED
DESIGN AND HAVING REALLY YOUR
DESIGN AND YOUR PURSUITS DRIVEN
BY VOICES OF PEOPLE THAT ARE
TRYING TO SERVE WITH THEM AND
BECAUSE PEOPLE WON'T ENGAGE WITH
THINGS OR WANT THEM IF THEY
DON'T REALIZE THEIR VALUE.
SO, I THINK THAT HAS BEEN AN
IMPORTANT PART OF OUR
PHILOSOPHY.
I THINK THERE IS A TECH PANEL
THAT I THINK THERE IS A REALLY
IMPORTANT KIND OF ELEMENT OF
WORK AND INNOVATION TO BE DONE
ON HUMAN SUPPORTS FOR TECH
NAVIGATION AS WELL.
SO, AS WE ARE INNOVATING WITH
TECHNOLOGY WE NEED TO REALLY
THINK ABOUT WHAT IS THE HUMAN
INFRASTRUCTURE THAT IS NEEDED TO
HELP KIND OF GUIDE PEOPLE WITH
TECHNOLOGY AND MAKE OR KEEP A
CHECK ON TECHNOLOGY AND WHERE IT
IS GOING AND THAT IT IS ACTUALLY
SERVING PEOPLE'S NEEDS AND WHO
IT IS INTENDED FOR IS ANOTHER
PIECE WE HAVE BEEN THINKING
ABOUT A LOT.
>> OUR WORK IN RWANDA, NONE
STARTED OUT AS A TECHNOLOGY
QUESTION.
AND ALSO ALL OF THE DATA GOING
INTO ALGORITHMS THAT WE ARE
DEVELOPING WERE JUST BYPRODUCTS
OF OTHER GRANTS THAT WE HAD.
SO, VERY SPECIFIC SUGGESTION WE
HAVE AND QUESTION AROUND
PARTICULARLY ADDRESSING MATERNAL
HEALTH ISSUES USING TECHNOLOGY
TO ADDRESS MATERNAL HEALTH
ISSUES IN COMMUNITIES
TRADITIONALLY NOT ENGAGE THE IN
DATA COLLECTION WE NEED TO
CALIBRATE VARIOUS TECHNOLOGIES
IS RATHER THAN LOOK FOG R
TECHNOLOGY GRANT LET'S GO TO
SUCCESSFUL GRANTEES LEADING
IMPACTFUL MATERNAL HEALTH
PROJECTS IN COMMUNITIES
UNDERSERVED THINKING ABOUT
INNOVATIVE WAYS TO INTEGRATE
TECHNOLOGY INTO EXISTING
MECHANISMS WITH SUPPLEMENTAL
FUNDING AVAILABLE TO DO THAT SO
WE CAN SEE YOU HAVE THIS
INCREDIBLE COMMUNITY CONNECTION
AND I AS A TECHNOLOGIST
SHOULDN'T MAKE A CONNECTION AND
WORKING WITH YOU TO HEAR HOW
COMMUNICATIONS COULD BE
CALIBRATED WITH THAT AND
OPPORTUNITY TO BE EFFICIENT TO
HOW WE ARE SPENDING RESEARCH
EFFICIENTLY.
>> NOT MUCH TO ADD TO THAT ALSO
BUT ADDING TO ECHO SOMETHING
THAT YOU SAID ABOUT COMMUNITY
ENGAGEMENT AND THINKING OF
TECHNOLOGY TAKING AS A PACKAGE
AND I HAVE SEEN A LOT OF VALUE
IN THINKING ABOUT USER'S
PERSPECTIVE AND THINKING ABOUT
HUMAN CENTERED ISSUES THAT
TYPICALLY AS ACADEMICS YOU KNOW
SITTING IN A LAB AND ISSUES THAT
TAKE CARE LATER ON AND IS
SURPRISING HOW LOTS OF
MAINSTREAM FUNDERS ACTUALLY
DON'T FULLY YET RECOGNIZE THAT.
SO, IF YOU ARE -- IF PROPOSAL OR
PACKAGE THAT IS GOING IN IS VERY
HUMAN CENTERED DESIGN CENTRIC
AND IS NOT A BIG AND SHINY THING
AND OBJECT THAT WE WILL PRACTICE
NEW LARGE LANGUAGE MODEL GPT
MEETS SOME CENSOR IT IS NOT
FUNDMENT AND TALKING ABOUT HUMAN
CENTERED DESIGN AND THAT IS TO
PUT THAT OF P MANY OTHER
POTENTIAL ISSUES HERE.
>> AGAIN, FROM OUR EXPERIENCE
AND SO YOU KNOW WE HAVE -- AREA
OF WORK IN HIGH BLOOD PRESSURE
AND YOU SEE MAJOR POPULATIONS
IMPACTED TO SERVE PARTICULARLY
BLACK MOTHERS FOR US WHEN WE
DECIDED TO WORK IN THE SPACE IS
MADE SENSE TO WORK WITH US AND
POPULATIONS AND IN OUR OWN
EXPERIENCE WANTING TO WORK OR
USED TO WORK WITH LARGE ACADEMIC
CENTERS IN BOSTON AREA WE ARE
UNABLE TO REACH POPULATIONS AND
GOING AHEAD AND SEEING WHERE WE
COULD ACCESS POPULATIONS THESE
ARE LARGE COMMUNITY HEALTH
CENTERS THEY DON'T HAVE
BANDWIDTH TO DO THAT RESEARCH OR
BE INVOLVED IN ANY TECHNOLOGY
DEVELOPMENT.
SO, CURRENTLY THEY ARE WORKING
WITH NEW YORK CITY PUBLIC HEALTH
SYSTEM AND ABLE TO DO IT BECAUSE
I'M FROM MEDICAL FIELD AND CAN
MAKE CONNECTIONS AND I THINK
THAT IT IS IMPORTANT TO WORK
WITH POPULATIONS WHERE NEED IS
AND GETTING ACCESS TO THEM IS A
CHALLENGE.
>> THANKS. ONE LAST QUESTION
FROM ME AND GOING TO Q & A FROM
AUDIENCE AND ONLINE. THERE IS A
LOT OF TECHNOLOGY DEVELOPERS
ONLINE.
I THINK YOU MENTIONED AN ADDAGE
WE TELL ENGINEERING COLLEAGUES
AND TRAINEES DON'T BE THIS
HAMMER LOOKING FOR A NAIL AND
FIND OUT WHAT CLINICAL NEEDS ARE
AND FIND OUT WHAT POPULATIONS
YOU ARE TRYING TO SERVE AND
SERVE THE PROBLEM. YOU ARE
REALISTICALLY A HAMMER WITH A
NAIL AND THAT IS WAY THINGS ARE
SOMETIMES AND BASIC SCIENCE AND
DEVELOPING NEW TECHNOLOGIES AND
DEVELOP THIS. NOW WHAT?
RIGHT?
WHAT IS OVERALL DEVICE FOR
HAMMER SNZ.
>> ITERATIVE APPROACH TO IT.
WE SAY BEST QUADRANT THINKING
ABOUT FOUR QUADRANTS CLINICAL
BUSINESS AND TECHNICAL AND
STRATEGIC. IT IS GREAT TO START
ON CLINICAL QUADRANT WITH A NEED
AND PROBLEM AND YOU COULD START
WITH TECHNOLOGY BREAKTHROUGH OR
NEW BIOMARKER LET'S SAY HAS BEEN
DISCOVERED OR SOMETHING; RIGHT?
QUICKLY LOOK AT WHAT CLINICAL
APPLICATIONS ARE FOR IT.
YOU KNOW?
WITH APPROPRIATE LEVEL OF DEPTH
AND IF LOW RESOLUTION LOOK EVEN.
DON'T JUST GO WORK IN THE FIRST
CLINICAL AREA YOU THINK IT WOULD
BE A COOL APPLICATION AND
EVALUATE MULTIPLE POSSIBILITIES
OF THAT APPLICATION AND LOOK AT
PARALLEL BUSINESS MODELS AND
STUDENTS WE HAVE THEM PROTOTYPE
BUSINESS MODELS 18 TO 20
BUSINESS MODELS FOR GIVEN
TECHNOLOGY NOT JUST FIRST THAT
COMES TO MIND PROTOTYPING
MULTIPLE ENGINEERING APPROACHES
TO SOLVE SAME PROBLEM DOING WITH
BUSINESS AND NOT STARTING IN
CLINICAL QUADRANT AND BUSINESS
QUADRANT AND IN TECH QUADRANT
AND LAB DEEP DEMAIN EXPERTISE ON
SOMETHING 20 YEARS OF RESEARCH
COME UP WITH SOMETHING AND SPEND
TIME THINKING ABOUT APPROPRIATE
TRANSLATIONAL MODEL ITERATING ON
IT AND EVALUATING ALTERNATIVES
NOT JUMPING AT FIRST
COLLABORATOR THAT COMES YOUR
WAY.
>> ANYTHING TO ADD?
>> YEAH. I THINK WE NEED A
CULTURE SHIFT AND SHOULDN'T BE A
HAND LOOKING FOR A NAIL. I
WOULD SAY PEDAL IT BACK,
ACTUALLY.
I THINK THAT THERE HAS BEEN THIS
KIND OF FAIL FIRST MENTALITY IN
SILICON VALLEY AND GET COOL IDEA
DOESN'T WORK OUT FINE GET
ANOTHER ONE AND SELL DATE THAW
IS TOXIC TO TRUST BUILDING AND
COMMUNITY WORKWE HAVE BEEN
TALKING ABOUT AND IN THIS
POST-OPS WORLD WE ARE LIVING IN
WE HAVE TO THINK REALLY
CAREFULLY ABOUT WHAT IT MEANS TO
COLLECT INFORMATION FROM PEOPLE
AND TREAT THINGS AND CUT A
PROJECT OFTEN.
>> IT IS ANOTHER ONE WITH
ACTUAL [INDISCERNIBLE].
GOING TO Q & A.
FEEL FREE AUDIENCE JUMP IN WITH
A MICROPHONE.
WE CAN GO ONLINE DR. ANDERSON,
ANYTHING ON CHAT THAT WE CAN
MAYBE ONE HERE.
WE WILL ALTERNATE.
>> MY QUESTIONS TO YOU
REGARDING THE DEVICE AND USING
24 HOUR AND BLOOD PRESSURE
DEVICES PREVIOUSLY AND RECENTLY
MY TEAM IS COMPLETING
METAANALYSIS ASSESSING ABILITY
TO PREDICT HYPERTENSIVE
DISORDERS INCLUDING PRECOLLAPSIA
AND COMPARED TO DEVICE AND
COMPARING YOU STATED PREDICTS
PRECOLLAPSIA AND WONDERING WHICH
TRIMESTER MEASUREMENT IS MOST
PREDICTIVE AND TERMS WHICH
PARAMETERS ARE BETTER IN TERMS
OF PREDICTING PRECOLLAPSIA.
THANK YOU.
>> ANSWERING YOUR QUESTION WE
STARTED TO WORK ON THIS SPACE
AND HAVING LOOKED AT IN TERMS OF
WHAT ARE CONTINUOUS BLOOD
PRESSURE METRICS WHAT ARE BETTER
PREDICTORS?
ONE IS 24 HOUR BLOOD PRESSURE
AND GETTING A SNAPSHOT AND OTHER
IS NIGHTTIME BLOOD PRESSURE OR
NIGHTTIME BLOOD PRESSURE
VARIABILITY THAT IS GOOD
PREDICTOR OF FUTURE MORTALITY
COMING TO STROKE AND HEART
ATTACKS AND OTHER AREA WORK WE
ARE DOING IS LOOKING AT BLOOD
PRESSURE VARIABILITY PRESSURE
CHANGING IN DAY AND WEEK AND
MONTH AND WORKING ON COGNITIVE
DISFUNCTION AND LATER RISK FOR
DEMENTIA AND IS LOTS OF DATA OUT
THERE ON CONTINUOUS BLOOD
PRESSURE PARAMETER AND ABLE TO
HAVE [INDISCERNIBLE] PARAMETERS
ABLE TO COMBINE THIS AND SEE
WHETHER THERE IS POTENTIAL
BENEFIT COMING TO WHAT I HEARD
TODAY IS CAN YOU MORE ACCURATELY
DIAGNOSE PREDICT VALUE IN
HYPERTENSIVE [INDISCERNIBLE]
VERSUS PREGNANCY AND WE ARE
STARTING TO COLLECT THAT DATA.
>> THANK YOU. TAKING A
QUESTION ONLINE?
NO.
>> GOT IT.
>> FIRST QUESTION HOW IS
OPERATION COST RUNNING SUCH APP
AS AND WHAT ABOUT SETUP COSTS?
>> [INDISCERNIBLE].
>> SURGICAL SITE INFECTION
DIAGNOSTIC ALGORITHM AND TOOL IF
THIS WASN'T ALREADY A PLAN IN
PLACE AND RWANDA AND HANDS --
FEASIBLE INTERVENTION TO
INTEGRATE INTO THE HEALTH CARE
SETTING IN TERMS OF THE SYSTEM
AS THERE IS NOW AND APP AND
TESTING THIS YEAR COULD BE
UPLOADED TO PHONES WITH
RELATIVELY LOW COSTS WITH
COMMUNITY INTERVENTIONS GOING TO
MOTHERS HOMES BUT IS STILL COST
OF MAINTENANCE AND TALKING ABOUT
LONG TERM TECHNOLOGY UPGRADES
AND REQUIRES A FEW PEOPLE
FULL-TIME IN MINISTRY OF HEALTH
TO MAKE SURE THIS APP IS
FUNCTIONING WAY IT IS INTENDED
TO FUNCTION AND WE ARE PURSUING
THIS BECAUSE THERE WAS
INFRASTRUCTURE IN PLACE TO
INTEGRATE IT INTO TO KEEP IT LOW
CO
COST.
>> I DON'T THINK IT CAPTURES IT
WELL AND THINK SOMETHING LIKE A
DIGITAL TOOL COMPARED TO HEAVY
MEDICAL DEVICE AND YOU CAN START
LEAN AND YOU EVENTUALLY HAVE
DONE THAT POINT PRELIMINARY
TESTING SCALING BIG COSTS IN
TERMS OF DATA SECURITY AND
MAINTAINING UPDATES AND THINKING
ABOUT EXECUTIVE MANAGEMENT COSTS
THAT IS SOMETHING THAT IN MY
ACADEMIC WORLD I NEVER REALLY
THOUGHT ABOUT AND I WAS USED TO
RUNNING A LAB AND THINKING ABOUT
HOW YOU START YOUR LAB. I
HADN'T REALLY THOUGHT ABOUT THE
DIFFERENCES IN KIND OF STAFFING
A COMPANY AND WHAT THOSE NEEDS
LOOK LIKE. SO, THAT IS
SOMETHING THAT I THINK IT WAS
MENTIONED ALREADY THINKING ABOUT
THAT BUSINESS PLAN BEFORE YOU
EVEN START TO THINK ABOUT A
BUSINESS WILL HELP YOU TO
EVALUATE WHAT COSTS WILL BE AND
WHEN THEY WILL HIT.
>> QUESTION.
>> GOOD AFTERNOON. I'M NOLA
KOVINGTON AND STARTING A COUPLE
START-UP COMPANIES AND ONE IS
LOOKING PRIMARILY AT LOOKING AT
DIVERSE PATIENTS IN CLINICAL
TRIALS AND PARTICULARLY TRYING
TO FOCUS ON COMMUNITIES AND
OTHER IS A START-UP THAT REALLY
LOOKS AT INTEGRATING A VARIETY
OF DIFFERENT THERAPIES AND
SOLUTIONS, IF WILL YOU, OVER AI
DIGITAL PLATFORM AND WHY I'M
SAYING THIS QUESTION.
PART OF THE REASON THAT I WANT
TO DO THIS AND BEEN TO MANY
MEETINGS AND HAD WONDERFUL
CONVERSATIONS AND WHAT FOLK YUTS
IS AND TRYING TO SERIOUSLY IN MY
OPINION ADDRESS ISSUES RELATING
TO BLACK AND BROWN WOMEN IN
PARTICULAR CHILD AND MATERNAL
HEALTH AND I'M INTERESTED IN
CHANGING THE PARADIGM AS YOU
MENTIONED TO MAKE SURE THAT NOT
ONLY COMMUNITIES ARE INVOLVED
BUT MAKE SURE THAT DIVERSITY OF
COMMUNITIES WITHIN DIVERSE
COMMUNITIES.
ARE INCLUDED AT EACH AND EVERY
PART OF THE TECHNICAL BUILD OUT
AND TALKING ABOUT GETTING
OPINIONS AND ONCE IT IS DONE AND
IT IS TALKING ABOUT BUILDING THE
NEED INTO THE SOLUTIONS.
AND THEN DRIVING THAT THROUGHOUT
EACH AND EVERY PART OF THE
PROCESS SO IT IS NOT PATIENT
CENTERED BUT PATIENT DRIVEN AND
QUESTION TO YOU IS I LOVE MODEL
THAT IS DONE INTERNATIONALLY AS
WE TALK ABOUT THE FRAGMENTATION
OF US SYSTEM IN PARTICULAR.
WHAT ARE YOUR THOUGHTS HOW TO
REALLY DRIVE THAT DIVERSITY
COMMUNITY APPROACH INTO THE
PROCESS RELATING TO TECHNOLOGY
IN BUILDING OUT SOLUTIONS?
THANK YOU.
>> EXCELLENT QUESTION. MY
RESPONSE WILL FALL SHORT FOR
SURE. WE WERE TALKING ABOUT TO
SOME DEGREE MY WORK IN RWANDA
MIGHT BE EASIER SINGLE NATIONAL
HEALTH SYSTEM COMMUNITY HEALTH
WORKERS ARE ALL ENGAGED IN THAT
SYSTEM AND FOR ME OUR WORK IN
RWANDA, THERE IS MULTIPLE WAYS
WE DO THIS AND I THINK THAT SOME
OF THAT COULD BE TRANSLATED HERE
AND THINK THAT HAVING
CONVERSATIONS IS A START.
I THINK REALLY BEING AS CLOSE TO
COMMUNITY AS YOU CAN AND NOT --
YOU KNOW, THERE IS ONLY -- I MAY
NOT IDENTIFY WITH THE COMMUNITY
BUT DIDN'T MEAN I CAN'T BE IN
COMMUNITY; RIGHT?
THAT IS A REALLY IMPORTANT
COMPONENT AND ANOTHER WAY TO
RESPOND TO YOUR QUESTION LOTS OF
WHAT I DO IN RWANDA IS ACTUALLY
BRIDGING THE DIVIDE BETWEEN
THOSE WHO HAVE SKILLS AND THOSE
WHO DON'T HAVE SKILLS IF IN BOTH
DIRECTIONS; RIGHT?
SO, YOU KNOW, I MIGHT HAVE --
I'M A BIOSTATISTICIAN AND TRAIN
FOR DECADES TO DO STATISTICS
THAT IS NOT A SKILL THAT I CAN'T
SHARE WITH OTHER PEOPLE AND
CHANGING THAT.
I'M ALSO NOT A COMMUNITY HEALTH
WORKER. THERE IS ALL KINDS OF
UNDERSTANDING HOW TO DELIVER
CARE AND COMMUNITIES TO BE
TRAINED ON AND REALLY DEVELOPING
MODELS WHERE WE SHARED SKILLS
AND KNOWLEDGE TO REALLY LEVEL
WHAT DO WE VALUE AND HOW DO WE
GET VOICES TO THE TABLE IS A
STRATEGY WE ARE ADOPTING THAT
COULD BE DONE WITH PROJECT
HERE'S AND I'M SURE FOLKS DO US
CENTRIC WORK THAT COULD OFFER
BETTER RESPONSES.
>> THANK YOU. WONDERFUL
QUESTION AND MY RESPONSE WILL
PROBABLY FALL QUITE SHORT. I
WANT TO IN RESPONSE TO YOUR
QUESTION ECHO SOMETHING THAT THE
SPEAKER FROM THIS MORNING SAID
VERY ELOQUENTLY EMPATHY THAT IS
ONE WAY TO GET TO THAT OUTCOME
THAT YOU ARE MENTIONING.
SO, WE TRIED TO DO THAT IN
SEVERAL OF OUR GLOBAL PROJECT
WHERE'S STUDENTS HAVE TO
ACTUALLY SPEND. THEY ARE ALL
YOUNG INNOVATORS THAT ARE FRESH
OUT OF UNDERGRAD AND GRAD SCHOOL
AND IN THE COMMUNITIES TRYING TO
BE PART OF THEM AND
UNDERSTANDING AND DEVELOPING
THAT EMPATHY AND NOT SYMPATHY
BUT EMPANELY ARE DIFFERENT
THINGS; RIGHT?
OTHER IS SOMETHING YOU
MENTIONED. I GUESS HUMILITY
THAT WE ARE -- WE DON'T KNOW IT
ALL. WE JUST KNOW SOME THINGS
IN SILOS AND THERE IS A LOT TO
LEARN.
WHEN STUDENTS GO ABROAD OR IN
PROJECTS HERE WE HAVE DONE MANY
IN BALTIMORE FOR INSTANCE.
TO BE OPEN TO LEARNING NOT JUST
SOLVING A PROBLEM YOU ARE
HELICOPTERED INTO AND THINK YOU
HAVE MAGIC PROCESS AND WAND BUT
HAVE HUMILITY YOU ARE HERE TO
SERVE AND CONTRIBUTE IN MANY
WAYS AND LEARN A LOT FROM
EXPERIENCES IN LIFE DON'T
OVERLAP WITH YOUR EXPERIENCES
AND THOSE ARE TWO SMALL DATAS.
>> THANK YOU.
>> I IT THINK WE HAVE ONLY TIME
FOR ONE QUESTION AND WE WILL DO
IT ONLINE AND YOU HAVE TWO MORE
QUESTIONS HERE AND PANELISTS
WILL STICK AROUND ONLINE.
>> QUESTION ABOUT TIMING AND
FOR EXAMPLE EARLY DETECTION.
HOW TECHNOLOGIES CAN BE USED TO
ANSWER THESE TIMING ISSUES AND
PERTAINING TO ANOTHER QUESTION
THAT IS FOR EXAMPLE DIGITAL
HEALTH THAT IS HOW DIFFICULT IT
IS TIMING TO KEEP PATIENT ENGAGE
THE IN CARE AND RESEARCH THAT IS
INVOLVING TECHNOLOGIES THAT IT
FALLS IN ISSUE OF TIMING.
>> ANYONE WANTING TO JUMP IN?
>>.
>> I COULDN'T HEAR QUESTION
WELL.
>> COULD YOU REPEAT QUESTION.
>> YEAH. SO, IT SORT OF FALLS
INTO THE SAME CATEGORY AND ONE
IS HOW DEVICES COULD BE USED FOR
EARLY DIAGNOSIS.
AND THEN TIMING LIKE WE HEARD
FROM THE CLINICAL PANEL AND
POSTPARTUM PERIOD OR HOW EARLY
THAT FIRST TWO WEEKS IS
IMPORTANT HOW YOU CAN DO DEVICES
TO ANSWER THOSE AND HOW
TECHNOLOGIES COULD BE FOR
EXAMPLE YOUR APP COULD EXTEND TO
POSTPARTUM PERIOD AND DIFFICULT
TIME TO KEECH PATIENTS ENGAGED
IN CARE AND RESEARCH THAT IS
INVOLVING TECHNOLOGIES.
>> MAYBE I CAN TAKE A CRACK AT
IT.
>> ONE OVERARCHING THEME COULD
BE FOR US HEALTH CARE SYSTEM
WITH SO MUCH COSTS AND
UNSUSTAINABILITY LOOMING ON
HORIZON USING TECHNOLOGY SMART
WAY FOR SETTING OF CARE AND
SETTING TO LESSER SKILL SETTING
THAT IS HOW IT IS DONE IN
SEVERAL LOW AND MIDDLE INCOME
CLASSES AND PROGRAMS ARE GREAT
LEARNING OPPORTUNITY AND
HEALTHCARE SYSTEM CAN LEARN LOTS
FROM THAT AND HEALTH CARE HAS
ROLE IN EARLY DETECTION AND
MANAGEMENT PATIENT ENGAGEMENT ND
BEHAVIOR AND ADHERENCE TO
MANAGEMENT PLANS AND ALL THAT
DEVELOPING SMART THINGS USING
MULTI-DISCIPLINARY APPROACH
SHIFTING ONUS IN HOME CARE
SETTINGS.
>>
>> JUST TO ADD TO THAT IS EARLY
DIAGNOSIS IS POINT OF CARE
QUESTIONS FOR WHICH AT LEAST
ACCURACY OF MISSION IS VERY
CRITICAL.
NEEDS TO BE ACTIONABLE IS ONE
POINT.
SECOND ANYTHING YOU DO HAS TO BE
ALIGN THE WITH DELIVERY RATE
CAN'T BE STANDALONINOVATION IN
HEALTH CARE DLIFYS AS WELL AND
PARTICULAR TO THIS COUNTRY IS
PAYMENT AND HAS TO BE ALIGNED
WITH PAYMENT.
THESE ARE CHALLENGES COMING TO
IT.
>> OKAY.
>> YEAH. SO, TO THAT FIRST
QUESTION AROUND TIMING I HAD
MADE ACTUALLY A NOTE AND ELIZA
IT WAS YOUR TALK THAT IS ABOUT
HOW IMPORTANT IT IS TO DIAGNOSE
THINGS EARLY AND EARLY DIAGNOSED
SURGICAL INFECTIONS ARE EASY TO
TREAT AND PROGRESSED INFECTIONS
ARE IMPOSSIBLE TO TREAT AND
LEADING CONTRIBUTOR TO MORTALITY
IN LEADING CONTEXT AND IS SO
IMPORTANT.
TO A LARGE DEGREE IT REQUIRES
DATA AND WE ARE ABOUT TO DO
VALIDATION OF 10 DAY SCREENING
TOOL TO PREDICT 10 DAY DIAGNOSED
INFECTIONS AND DOING THAT WE GET
DAY 3 IMAGES THAT WOULD GIVE US
MAYBE ANOTHER PATIENT POPULATION
TO MONITOR CLOSELY HUGE AND
IMPORTANT AREA NEEDING
INVESTMENT AND HIGH RISK AND
MOST OF WORK IS IN POSTPARTUM
CARE AND IS SO NEGLECTED AND
INCUBATOR OF BABY NOT WHAT
HAPPENS TO MOTHER WEEKS AND
MONTHS AFTER AND IS IT WAS
COMPLEX PREGNANCY ITSELF AND
THINKING ABOUT FOLLOWING WOMEN
THROUGH PREGNANCY ADD IING COST
AND THINKING OF STUDIES TO
SUPPORT THEM IN WAYS DURING
POSTPARTUM PERIOD.
>> ADDING TO THAT CALL TO
FUNDERS POSTPARTUM PERIOD IS
NEGLEC
NEGLECTED.
>> YOU LEAVE PLACE YOU GIVE
BIRTH AND GO HOME AND ARE ON
YOUR WAY IN A RISKY TIME WHEN
RISK IDENTIFICATION YOU ARE ALL
IN.
YOU WOULD BE ABLE TO SHARE
SYMPTOMS AND YOU ARE AWARE WHAT
IS HAPPENING AND YOU ARE HOME
ALONE WITH THIS BABY AND TAPPED
IF INTO YOUR BODY AT THAT TIME.
WE HAVE BEEN WORKING ON FINALLY
WORKING IN PARTNERSHIP WITH
COMMON WEALTH OF PENNSYLVANIA TO
EXTEND MODEL TO POSTPARTUM
PERIOD AND TO FUNDERS THIS IS
SOMETHING WE TRIED AND TRIED AND
TRIED TO GET FUNDED AS WELL.
GIVEN THERE IS NOT A GOOD
BUSINESS MODEL IN COMMERCIAL
SPACE TO ADDRESS THIS EARLY KIND
OF FIRST 6 WEEKS OR FIRST YEAR
POSTPARTUM THAT I THINK THAT IS
SOMETHING THAT WOULD BE AN IDEAL
FOCUS FOR NIH TO THINK ABOUT.
WE WILL GET STARTED WITH THE
COMMUNITY ENGAGEMENT MANL
PANEL. I'M EXCITED TO SHARE THE
WONDERFUL SPEAKERS WE HAVE THE
COMMUNITY ENGAGEMENT PANEL I I'M
JOIA AND WE HAVE A WONDERFUL
PANEL THAT IS READY FOR YOU
TODAY AND THEIR DISCUSSION WILL
FOCUS ON SOCIAL AND STRUCTURAL
DETERMINANTS OF HEALTH THAT
CONTRIBUTE TO MATERNAL HEALTH
DISPARITIES AND WHAT ARE HEALTH
TECHNOLOGIES WE CAN USE TO
DEVELOP AND IMPLEMENT AND
ADDRESS THOSE DISPARITIES AND WE
HAVE A WONDERFUL MODERATOR DR.
JOIACREAR-PERRY WHO IS A
PHYSICIAN AND ADVOCATE FOR
TRANSFORMATIONAL DUSTIS AND
FOUNDER OF NATIONAL HEALTH
COLLABORATIVE EQUITY. I'M
DELIGHTED TO HAVE HER HERE. SHE
WILL GUIDE THIS FACILITATED
DISCUSSION WITH OUR PANEL AND
THAT IS BY FOCUSING ON TWO
THEMES, FIRST WILL BE ROLE OF
COMMUNITY ENGAGEMENT TO ADDRESS
MATERNAL HEALTH DISPARITIES AND
SECOND THEME WOULD BE HOW
TECHNOLOGY COULD UTILIZE AN
EQUITY LENS TO ADDRESS MATERNAL
HEALTH DISPARITIES AND WILL HAND
IT TO DR. JOIA WHO WILL KICK OFF
INTRODUCTIONS BY PANELS SHARING
WITH YOU HER WORK AND COMMUNITY
ENGAGEMENTS.
THANK YOU SO MUCH.
>> HEY. GOOD AFTERNOON. HOW
ARE YOU FEELING? HOW ARE WE
FEELING ALL RIGHT TODAY? GOOD?
OKAY. GOOD. WE WILL START WITH
MY SLIDES IF YOU DON'T MIND.
NEXT SLIDE, PLEASE, WHOEVER IS
MANAGING THEM.
>> THIS IS OUR OBJECTIVE AND
THIS IS ME AS MODERATOR AND OUR
ORGANIZATION NATIONAL BIRTH
EQUITY COLLABORATIVE WE ARE 8
YEARS OLD AND STARTED WITH
ROBERT WOOD FOUNDATION AND IT IS
HARD TO GET PRIME WITH YOU ALL.
LETTING YOU KNOW. NEXT SLIDE.
THIS IS THE MISSION THAT I NEED
TO READ. WE KEEP EXPANDING IT.
I HAVE BRILLIANT, 40 DIFFERENT
BLACK AND BROWN WOMEN WORKING
FOR OUR ORGANIZATION COMING UP
WITH AMAZING NEW IDEAS ALL THE
TIME AND SEXUAL REPRODUCTIVE
HEALTH AND WELLBEING THAT IS NOT
JUST HEALTH ABOUT MENTAL AND
PHYSICAL WELLBEING OF BIRTHING
PEOPLE AND WORLDWIDE THAT
CREATES TRANSNATIONAL SOLUTIONS
OPTIMIZING BLACK MATERNAL HEALTH
NOT JUST SURVIVE BUT THRIVE AND
OPTIMIZE AND BLACK MATERNAL
HEALTH TRANSNATIONAL NOT GLOBAL
YOU SEPARATE GLOBAL FROM US AND
INFANT SEXUAL REPRODUCTIVE
WELLBEING AND SHIFT SYSTEMS AND
CULTURE THROUGH TRAINING AND
RESEARCH TECHNICAL ASSISTANCE
POLICY ADVOCACY AND COMMUNITY
CENTERED COLLABORATION. WE DO
ALL IT. THAT WE WANT BLACK
MAMAS AND BABIES TO THRIVE.
NEXT SLIDE, PLEASE.
THIS IS THE DEFINITION OF BIRTH
EQUITY THAT IS CREATED ABOUT 8
YEARS AGO. IT IS ASSURANCES AND
JOB IS NOT TO BLAME AND SHAME
COMMUNITIES ABOUT WHAT THEY DO
AND DON'T DO AND RESEARCHERS
PEOPLE WITH POWER SITTING IN
INSTITUTION IS PROVIDING
ASSURANCES FOR OPTIMAL VERSE
PUTTING TOGETHER BIG POLICIES
BIG P AND WHO YOU DECIDE AND
FUND AND WORK WITH AND WHO YOU
LISTEN TO OR LITTLE P AND IF
ENSURE THERE IS ACCESS TO
COMMUNITY FOR OPPORTUNITIES AND
GRANT OPPORTUNITIES AND BOTH
HAVE TO DO WITH A SUSTAINED
EFFORT AND WE LOVE GETTING A
THREE YEAR GRANT WE WON'T END
RACISM IF IN THREE YEARS. NEXT
SLIDE MRAF I GET TO COME FROM
MOVEMENT OF REPRODUCTIVE JUS
JUSTICE.
ANYBODY HEARD ABOUT IT? IN
RIGHT ROOM FOUNDED BY BLACK
WOMEN IN 1926 AND AT POINT WE
HAVECISM RIGHTS AND YOU HAVE
REPRODUCTIVE RIGHTS AND ALSO
JUSTICE WORK.
THIS IS A COMPILATION OF ALL
THOSE THINGS AND UNDERSTAND
THERE SAY RIGHT TO OWN PEOPLE
AND IS A RIGHT IN THIS COUNTRY
TO ENSLAVE PEOPLE GIVING A RIGHT
TO SOMETHING DOESN'T MEAN IT IS
JUST OR FAIR AND TENANTS OF
REPRODUCTIVE JUSTICE HAVING
ABILITY TO HAVE PERSONAL BODILY
AUTONOMY AND IF I DON'T WANT TO
LARK YOU CAN'T MAKE ME WANT TO
LARK. I CAN CONTROL MY OWN BODY
AND HAVE RIGHT TO HAVE CHILDREN
AND IF I WANT TO HAVE 12 KIDS I
GET TO. IF I WANT TO HAVE NO
KIDS I HAVE RIGHT TO HAVE NO
CHILDREN. I'M VALUABLE BECAUSE
I EXIST NOT HERE TO REPRODUCE
CHILDREN TO KEEP THE FARM GOING
AND THOSE DAYS GREW UP ON FARMS
I LOVE FARMS DON'T HAVE MUCH
ROOM FOR THAT ANYMORE AND
UNDERSTANDING WE HAVE TO BE ABLE
TO RAISE CHILDREN IN SAFE AND
SUSTAINABLE COMMUNITIES AND NOT
WORRYING IF COMMUNITIES ARE SAFE
AND SUSTAINABLE THIS COUNTRY HAS
WORST HEALTH OUTCOMES OF ANY
INDUSTRIAL NATION AND ABILITY TO
HAVE SAFE AND SUSTAINABLE
COMMUNITY AND IS FUTURE AND
WHERE TECHNOLOGY IS GREAT
OPPORTUNITY FOR US NOT ALL DOOM
AND GLOOM AND SMART PEOPLE
THINKING THROUGH HOW TO USE
TECHNOLOGY TO ENSURE WE MEET
THESE AND THESE ARE FRAMEWORK
THAT BIRTH AND EQUITY COMES FROM
AND LOTS OF FRAMEWORK YOU COULD
HAVE EUGENICS FRAMEWORK AND
WHITE SUPREMACY FRAMEWORK AND
REPRODUCTIVE JUSTICE FRAMEWORK
AND LOOK AT RESEARCH AND DECIDE
WHERE IT LIES.
NEXT SLIDE, PLEASE.
THIS IS THE POINT OF THIS,
REALLY.
YOU PICK INDICATORS AND
INDICATOR COULD BE HOW MANY
C-SECTIONS A PERSON HAD OR
PLACENTA IS IN THE RIGHT PLACE
AND RESEARCH RESIDENT CREA-10
NEEN LEVELS OF BLACK WOMEN AND
HOW IT HAS TO DO WITH
PREECOLLAPSIA AND LOOK BACK ON
RESEARCH 20 YEARS AGO WHAT IS
EVERYONE THINKING ABOUT BLACK
CREAT ANYONE OR ACTIVITY WHY
WOULD THAT MAKE ANY LOGICAL
SCIENTIFIC SENSE? SPENT A YEAR
WHY DOES IT MAKE SENSE AND
INDICATOR AND THINKING OF
SCIENCE THAT IS MEASUREMENT
LIMITED BY CURRENT UNDERSTANDING
OF SCIENCE SINCE WE KNOW NO
BLACK GENE OR KIDNEY OR HEART OR
BLACK LUNGS IF STUDYING THEM
STUDYING SOMETHING THAT DOESN'T
MAKE BIOLOGICAL SENSE AND
PRODUCT OF CURRENT UNDERSTANDING
OF PUBLIC HEALTH AND SCIENCE.
WE UNDERSTAND PUBLIC HEALTH
AFTER COVID NEEDS A LOT MORE
INFRASTRUCTURE AND LISTENING TO
COMMUNITY AND YOU WOULD
REIMAGINE INDICATOR YOU ARE
USING TO DO YOUR WORK AND
SYSTEMS OF POWER AND OF SYSTEMS
IN YOUR HOUSE AND SYSTEMS
EVERYWHERE CURRENT INDICATORS
THEY ARE USING AND GO TO PLACES
COW PLEASE STOP MEASURING BLACK
URINE.
IT IS HARD TO STOP THEY HAVE
BEEN DOING IT 20 YEARS YOU CAN
STOP I PROMISE AND WHAT IS A
FRAMEWORK?
IT COULD BE A VISION AND WAY FOR
US TO THINK ABOUT WHAT WE WOULD
DO DIFFERENTLY AND HOW COULD WE
EXPAND IT AND WHAT WOULD YOU
MEASURE IF YOU WANT JUSTICE AND
JOY FOR ALL PEOPLE IF YOU TRULY
UNDERSTAND AND TRANSNATIONAL
COMMUNITY DEPENDING UPON PEOPLE
HOW YOU WOULD DO YOUR RESEARCH
AND THINK ABOUT DOING YOUR
TECHNOLOGY FUNDAMENTALLY
DIFFERENTLY?
ALLOWING US TO THINK ABOUT NEW
LANGUAGE AND COULD SAY THINGS
LIKE WHITE SUPREMACY AND I'M NOT
CALLING YOU BAD NAME AND
WHITENESS WITH SKIN COLOR AND
FROM NEW ORLEANS THIS IS NOT
ABOUT SKIN COLOR BUT BELIEF AND
HIERARCHY OF HUMAN VALUE BASED
ON THINGS LIKE SKIN COLOR AND
COUNTRY OF ORIGIN LIKE LANGUAGE
AND GEOGRAPHY AND END BELIEF
HIERARCHY OF SKIN COLOR AND
GENDER AND RACE AND GEOGRAPHY
ENSURING WE ARE ALL ONE HUMAN
RACE AND QUESTIONING HISTORICAL
CONSTRUCTION HOW WE DWOT HERE
AND HOW NIH GOT HERE AND HOW WE
DECIDED ON ALL OF US LOOKING ON
GENETICS FOR THE CURE NOT SOCIAL
DETERMINANTS OF HEALTH?
SO, NEXT SLIDE, PLEASE.
THAT IS END OF WHO I AM AND WHAT
WE ARE DOING AND WOULD LIKE
PANELISTS TO INTRODUCE
THEMSELVES STARTING WITH NATALIE
HERNANDEZ, MY FRIEND.
>> HI. THANK YOU, JOIA.
JUST A LITTLE ABOUT ME. I WILL
LATER TALK ABOUT HOW I DO MY
WORK AND I'M A CISGENDER
APHRO-LATINA WOMAN AND MOTHER OF
TWO EXPERIENCING POSTPARTUM
DEPRESSION AND PERINATAL ANXIETY
GROWING UP IN SOUTH-BRONX NEW
YORK ONE OF THE POOREST COUNTIES
IN THE UNITED STATES AND FAMILY
WHERE EVERY SINGLE WOMAN HAD A
P
PRETERM BIRTH AND PRIOR TO
RESEARCH WORKED FOR CIVIL RIGHTS
ADVOCACY AND WORKING A LOT WITH
COMMUNITY HEALTH WORKERS AND
THROUGH EXPERIENCES I BECAME
FRUSTRATED WITH HOW RESEARCH WAS
CONDUCTED AND -- REPRODUCTIVE
HEALTH AND THUS SHAPING HAD HOW
I DO MY RESEARCH AND I HAVE
TAKEN THIS AS A FOUNDING
EXECUTIVE DIRECTOR OF CENTER FOR
MATERNAL HEALTH EQUITY.
AT MOORE HOUSE SCHOOL OF
MEDICINE AND INSIDER
POSITIONALITY IS HOW I FORMULATE
RESEARCH QUESTIONS AND HOW I
INCORPORATE COMMUNITY ORGANIZING
AND SOCIAL JUSTICE APPROACHES TO
WORK I DO AND HOW I VALUE
CENTERING OF LIVED EXPERIENCES
IN ALL MY WORK.
AGAIN, HOW I DISSEMINATE MY WORK
AS WELL. THAT IS A LITTLE ABOUT
DR. NATALIE D HERNANDEZ AND
NAMING IS BIRTH AS WELL, BY THE
WAY.
>> GOOD AFTERNOON, EVERYONE.
I'M INGER BROOU NET SDIGLER AND
CLINICAL PSYCHOLOGIST AND.
IN ADDITION TO MY ROLE AS A
FACULTY MEMBER IN THE
DEPARTMENT, I AM ALSO AN
ADVOCATE FOR EQUITY AND MENTAL
HEALTH PARTICULARLY IN BLACK
COMMUNITIES.
ADDITIONALLY I HAVE DIRECT LIVED
EXPERIENCES WITH THE MATERNAL
HEALTH CONDITIONS EXPERIENCED BY
SO MANY BLACK WOMEN HAVING
EXPERIENCE OF PREECOLLAPSING OF
COLLAPSIA WITH SO -- MY WORK IS
REALLY CENTERED AROUND
DEVELOPING CULTURALLY TAILORED
INTERVENTIONS THAT ARE RELEVANT
TO DIVERSE COMMUNITIES
PARTICULARLY BLACK WOMEN AND
IMPLEMENTED IN COMMUNITY-BASED
HEALTH CENTER SETTINGS.
>> GOOD AFTERNOON, EVERYONE.
HONOR TO BE HERE AND PROBABLY
ONLY NONSCIENTIST ACADEMIC
CLINICIAN IN THE ROOM. I'M
VANESSA POLARD.
I ALSO CO-CHAIR OUR GLOBAL LIFE
SCIENCES PRACTICE AND FOOD AND
DRUG LAWYER AND HELPING HEALTH
CARE PROVIDERS ON ASPECTS
RELATED TO REGULATIONS AND
TECHNOLOGY SOFTWARE SOLUTIONS TO
THE MARKET AND I'M FOUNDING
MEMBER AND BOARD MEMBER TO MED
TECH COLOR A NON-PROFIT FOUNDED
5 YEARS AGO WITH GOAL
DIVERSIFYING TECH I'M A MOTHER
AND PATIENT AND CONSUMER ARE
ECONVENIENT SHAL TO HOW I AND WE
LIVE AND IS A PLEASURE TO ALL OF
US.
>> ABIGAIL IS JOINING ON ZOOM
AND DON'T KNOW IF YOU CAN BRING
HER ON THE --
>> LAST PANEL WAS AMAZING AND
EXCITED TO BUILD ON THAT.
QUESTION NO. 1.
>> A HEALTH CENTER IN SEATTLE,
WASHINGTON AND INDIAN HEALTH
CARE SERVICE AND CLINICAL
PROVIDER FOR URBAN INDIANS IN
SEATTLE POOUNL ET SOUND AREA AND
CISGENDERED WOMAN WITH TWO
CHILDREN WHO HAD BLESSING TO
SHAPE MY ADVOCACY IN WORK AND
MATERNAL CHILD HEALTH BASED ON
EXPERIENCES OF EXPERIENCING
BLASANT RACISM IMPACTING
DELIVERY OF BOTH MY CHILDREN AND
BLESSED TO SEE DIFFERENCE IN
COMMUNITY ENGAGEMENT IN
PROVIDING RESOURCES IN
CULTURALLY SPECIFIC WAYS
SPENDING MUCH OF CAREER IN
RESEARCH AND PROVIDING DIRECT
RESEARCH AND HAPPY TO BE HERE
WITH BRILLIANT VOICES.
>> I LEARN FROM ABIGAIL. WHAT
A TREAT. -- TO ADDRESS MATERNAL
HEALTH DISPARITIES. NATALIE CAN
YOU TAKE FIVE MINUTES TO LET US
KNOW AND PULL UP HER SLIDES.
>> IF YOU CAN PULL UP MY
SLIDES, THANK YOU.
AS THEY GET PULLED UP, I WILL
TELL YOU ABOUT THE CENTER FOR
MATERNAL HEALTH EQUITY AND WE
WERE FOUNDED IN 2019 THROUGH
ADVOCACY EFFORTS AND DIRECT
RESPONSE TO INEQUITIES STATE OF
JORNL YA FACED AROUND MATERNAL
MORTALITY AND SEVERE MA THE
TERNAL MORBIDITY IN THE NATION
AND COMPARABLE TO OTHER
COUNTRIES AROUND THE WORLD AND
WE DO OUR WORK IN -- OUR MISSION
IS PURSUING EQUITY IN MATERNAL
MORBIDITY AND MORTALITY AND
LOCALLY AND NATIONALLY.
>> NEXT SLIDE, PLEASE.
>> SORRY.
>> THERE WE GO.
>> NEXT SLIDE.
>> NEXT SLIDE. I HAVE NO
DISCLOSURES.
NEXT SLIDE. YEAH. THAT IS A
LITTLE MOR HOUSE SCHOOL OF
MEDICINE HISTORICALLY BLACK
MEDICAL COLLEGE GOING ON IFFIST
YEARS AND HAVE ONLY BEEN AROUND
THAT LONG OF A TIME.
YOU WILL SEE HOW MUCH WORK WE
HAVE BEEN ABLE TO ACCOMPLISH IN
THE LAST THREE YEARS
PARTICULARLY WITH OUR CORRECTOR.
NEXT SLIDE.
A LITTLE OF OUR VISION THERE WAS
A PANEL TALKING ABOUT
PRECONCEPTION AND WE KNOW WE
HAVE TO GO BEYOND THAT AND
VISION IS TO END HEALTH
INEQUITIES ACHIEVING LIBERATION
IN WOMEN'S HEALTH ACROSS THE
LIFESPAN.
NEXT SLIDE.
WE DO OUR WORK IN THREE
DIFFERENT WAYS AND YEAH.
ANOTHER IMPACT AND WITH RESEARCH
AND SO WE REALLY DO WORK ACROSS
TRANS DISCIPLINES FROM VERY
BASIC SCIENCE WHERE WE HAVE
INVESTIGATORS LOOKING AT
PLACENTAS ALL THE WAY TO
POPULATION HEALTH AND SOCIAL
BEHAVIORAL SCIENTIST AND WORK IS
CENTERED AROUND POPULATION
HEALTH AND CENTERING LIVED
EXPERIENCES AND QUALITATIVE
RESEARCH AND DEVELOPMENT AND
TESTING OF INTERVENTIONS AND
HAVE NUMEROUS CLINICAL TRIALS
TESTING TYPES OF INNOVATIONS WE
ARE TALKING ABOUT HERE TODAY AND
BIG FOCAL POINT AND WHAT CENTERS
THE CENTER IS OUR COMMUNITY
ENGAGEMENT WORK.
WE SEE OURSELVES AS A RESOURCE
HUB FOR OUR COMMUNITIES AND IS
SO MUCH INFORMATION THAT GETS
OUT THERE. NONE IS A WAY THAT
RESONATES WITH COMMUNITIES WE
SERVE AND WE ENSURE THAT, THAT
INFORMATION IS A WAY THAT IS
PALATABLE TO THEM AND IS
CULTURALLY RELEVANT AND
RESONATES WITH THEM AND CENTERS
THEIR LIVED EXPERIENCES AND
THROUGH COMMUNITY ENGAGEMENT
ENSURE THAT RESEARCH TRANSLATES
INTO ACTION WITH COMMUNITIES AND
INFORMS POLICY AND POLICY
INITIATIVES AND RESEARCH PROJECT
MATERNAL NEAR MISS STORYTELLER
PROJECT AND STORIES USED AS
TESTIMONIES TO PAST POSTPARTUM
MEDICAID EXTENSION IN THE STATE
OF GEORGIA WE DO CAPACITY
BUILDING AND WE KNOW THAT
COMMUNITIES HAVE HAD ANSWERS FOR
A LONG TIME AND NIH EVIDENCE AND
THEY NEED PILOT STUDIES AND THEY
NEED FUNDING AND PROVIDE
TECHNICAL ASSISTANCE AND
CAPACITY BUILDING SO INNOVATIONS
AND TECHNOLOGIES AND INNOVATION
AND INTERVENTIONS CAN GET TO THE
NEXT LEVEL.
WHERE MEDICAL SCHOOLS, WE ARE
ONE AND WE HAVE A VARIETY OF
TRAINING PROGRAMS AND DO
INTERDISCIPLINARY LEARNING AND
TRAIN THE TRAINER AND DEVELOP
COMMUNITY BASED PERINATAL
PATIENT NAVIGATION PROGRAM
NIHR01 TESTING CLINICAL
EFFECTIVENESS OF THAT AND LOTS
OF WAYS OF TRAINING WITHIN OUR
INSTITUTION.
NEXT SLIDE.
MEANINGFUL COMMUNITY ENGAGEMENT,
HOW DO WE DO THAT?
BY CENTERING JOY AND PAIN AND
CENTERING VOICES OF COMMUNITIES
THAT ARE MOST EFFECTED BY THE
ISSUE AND CENTERING EXPERIENCE
PARTICULARLY OF BLACK WOMEN WHO
IS MOST EFFECTED BY THE ISSUE IS
AN OPPORTUNITY TO RETHINK
CONVENTIONAL RESEARCH PRACTICES
THRU BY IDENTIFYING PATHWAYS TO
CONTRIBUTE KNOWLEDGE ASSOCIATED
WITH MATERNAL HEALTH.
IN PARTICULAR OUR STUDIES
UNDERSCORE VALUE OF GRASSROOTS
EMPOWERMENT OPPORTUNITIES FOR
WOMEN TO UNDERSTAND HUMAN RIGHTS
AS THEY RECLEAT TO SYSTEMIC
INEQUITIES POWER DYNAMICS AND
SOCIAL STRUCTURAL CONTEXT AND WE
WANT TO ALSO MENTION THAT WE
RECOGNIZE THAT WOMEN'S LIVED
EXPERIENCES ARE LEGITIMATE
SOURCES OF DATA THAT WE CAN
UPLIFT THEM; RIGHT?
WE ARE A QUANTITATIVE SORT OF
FIELD OR WAY THAT PEOPLE THINK
ABOUT PUBLIC HEALTH AND WHY LOTS
OF INTERVENTIONS AND RESOURCES
WE SPEND HAVE NOT REACHED DOWN
TO THE COMMUNITY AND WHY WE
HAVEN'T REALLY MADE DENTS TO
MORTALITY AND MORBIDITY RATES
AND OTHER THING WE DO PART OF
COMMUNITY AND OPERATIONALIZING
COMMUNITY FOR US IS
MULTI-FACETED AND WE ALSO
CENTRALIZE BIPOC RESEARCHERS AND
HAVE KNOWLEDGE AND EXPERTISE
THEY ARE OFTEN LEFT OUT OF THE
TABLE AND SOME ADVISORY CAPACITY
AND FULL WELL -- THAT EXIST AND
EXECUTIONS OF SOLUTIONS AS
INDICATED WITH LIMITED FUNDING
AND SOMETIMES CONDITIONAL
FUNDING THAT WE RECEIVE IN
ACADEMIC SPACES AND FOR US
WORKING WITH COMMUNITY IN
MEANINGFUL WAYS ALLOWS US TO
MOVE AWAY FROM A RESCUE
NARRATIVE THAT HAS PERPETUATED
LOTS OF RESEARCH THAT EXISTS AND
WHERE LOTS OF THE SCHOLARSHIP
EXISTS THAT IS AIMED AT
MARGINALIZED WOMEN AND OTHERS
COMING IN SAYING THEY WILL
RESCUE US. WE CAN RESCUE
OURSELVES AND COMMUNITIES HAVE
BEEN RESCUING THEMSELVES FOR A
LONG TIME. YOU KNOW, LOTS OF
WHAT WE DO, AGAIN, IS
DECENTERING THE INDIVIDUALS AND
COMMUNITY AND RATHER THAN USING
RISK FRAMEWORKS AS DR. JOIA
POINTED OUT.
WE FOCUS ON FRAMEWORKS THAT
CHALLENGE STEREOTYPES AND
EMPLOYING FRAMEWORKS LIKE
INTERSECTIONALITY AND
REPRODUCTIVE JUSTICE
[INDISCERNIBLE] SYNDROME AND
CRITICAL RACE THEORY GIVING
POWER TO WOMEN AND ATTENTION TO
VOICES THAT ARE PRIVILEGED IN
PRODUCTION OF SCHOLARSHIP AND
ARE PICTURES OF COMMUNITY EVENTS
WE HAVE DONE AND GRADUATING OUR
FIRST COHORT. NEXT SLIDE.
SO, LESSONS LEARNED IN DOING
THIS WORK.
YOU KNOW, WE HAVE TO SET CLEAR
DEFINITIONS AND SOMETIMES LOTS
OF US GET INTO AGREEMENTS WHEN
WORKING WITH COMMUNITIES AND
SOMEONE MENTIONED IT AND WE DO
HELICOPTER APPROACHES.
WHEN WORKING IN COMMUNITIES YOU
HAVE TO SET CLEAR BOUNDARIES
DEFINING WHAT IT LOOKS LIKE AND
ADDITIONALLY BUILDING THAT
TRUST. YOU KNOW, IT TAKES A
WHILE TO DO IT AND WHY WHEN WE
TALK ABOUT FUNDING WE NEED MORE
THAN ONE YEAR OR THREE YEARS OF
FUNDING AND IN TWO YEARS IT
TAKES TIME TO BUILD TRUST AND
REPOIRE WITH COMMUNITIES WE ARE
WORKING WITH ENGAGING WITH AND I
CAN'T EVEN SEE.
BE FLEXIBLE. YEAH. YOU HAVE TO
BE FLEXIBLE. THIS WORK IS NOT
EASY AND THERE ARE TIMES WE ARE
MEETING AT 11 O'CLOCK AT NIGHT
AND IS ONLY TIME WE CAN MEET OR
7 IN THE MORNING. WE WANT TO BE
FLEXIBLE IN HOW WE WORK
TOGETHER. PLANNING TO BE IN IT
FOR THE LONG HALL AND WORKING
WITH COMMUNITIES AGAIN THERE IS
SO MUCH DISTRUST AND HAVING TIME
AND WE ARE FLEXIBLE AND IN IT
NOT DOING WHAT COMMUNITY CALLS
DRIVE BY RESEARCH THAT IS
CONVENIENT FOR YOU TO COME IN
AND DIP OUT WHEN IT ENDS AND
WORKING WITH COMMUNITIES TO
CREATE THINGS THAT ARE SUSTAIN
THE AND I WILL STOP THERE. I
HAVE FIVE MINUTES. THANK YOU.
>> IT IS WELL UNDERSTOOD THAT
-- NEXT SLIDE, PLEASE.
OOPS. THAT DIDN'T WORK RIGHT.
GO BACK.
IT IS WELL UNDERSTOOD THAT
SOCIAL DETERMINANTS INCLUDING
INCOME AND POVERTY AND STRESSORS
AND RISK TO TRAUMA.
NEIGHBORHOOD VIOLENCE AND ACCESS
TO HEALTH CARE AND INSURANCE ARE
ALL KEY SOCIAL DETERMINANTS AND
MY INTEREST IS PARTICULARLY IN
THE ROLE OF STRESS, RACISM AND
EXPOSURE TO TRAUMATIC STRESS AND
A NUMBER OF NATIONAL
EPIDEMIOLOGIC STUDIES
DEMONSTRATE THAT BLACK WOMEN
HAVE EQUAL RATES AS A NUMBER --
TO A NUMBER OF MENTAL HEALTH
CONDITIONS SUCH AS DEPRESSION
AND ANXIETY AND WE KNOW THAT
THEY CARRY DISPROPORTIONATE
BURDEN OF STRESS THAT INCREASES
THEIR RISK FACTORS FOR A NUMBER
OF POOR MENTAL HEALTH OUTCOMES
AND MAINLY BLACK WOMEN HAVE HYER
RATES OF UNEMPLOYMENT AND HIGHER
RATES OF POVERTY AND EXPOSURE TO
STRESS RACISM AND DISCRIMINATION
AND HIGHER RATES ARE ENSURED AND
DE-STRESSORS FOR BLACK WOMEN
INCREASE NEED FOR MENTAL HEALTH.
NEXT SLIDE, PLEASE.
DISPROPORTIONATE BURDEN OF
STRESS -- WHEREBY BLACK WOMEN
HAVE GREATER RISKS FOR -- OH, MY
GOSH. I CAN'T SEE.
>> EARLY HEALTH DETERIORATION
AND DIABETES AND CARDIOVASCULAR
DISEASE AND POOR MATERNAL HEALTH
OUTCOMES ACCELERATED AGING AND
LIFE EXPECTANCY AND LOOKING AT
ROLE AND LIVES OF BLACK WOMEN
AND TARGETING STRESS AND
INTERVENTION TO IMPROVE OUTCOMES
FOR MENTAL HEALTH AS WELL AS
PHYSICAL HEALTH.
I CONSIDER MYSELF TO BE A
SCHOLAR THAT IS FOCUSED ON
EFFECTIVENESS IMPLEMENTATION
RESEARCH THAT CENTERS SQUARELY
ON COMMUNITY PARTNERSHIP AND I
WOULD LIKE TO TALK BRIEFLY ABOUT
TWO COMMUNITY ENGAGED RESEARCH
PROJECTS I HAVE CARRIED OUT FOR
THE LAST COUPLE OF YEARS AND ONE
PROJECT IS FUNDED WITH SUPPORT
OF NIMHD THAT HAS BEEN A
FIVE-YEAR RANDOMIZED CONTROLLED
TRIAL TO TEST EFFECTIVENESS AND
IMPLEMENTATION OF A MINDFULNESS
BASED INTERVENTION DELIVERED TO
WOMEN WITH SYMPTOMS OF
DEPRESSION IN A FEDERALLY
QUALIFIED HEALTH CENTER THAT IS
CALLED NEAR NORTH THAT IS A
NETWORK OF 8 HEALTH CENTER AS
CROSS CHICAGO LAND AREA
PROVIDING HEALTH CARE SERVICES
TO MOST UNDERSERVED ACROSS THE
CITY AND MAJORITY OF PATIENTS
NEAR NORTH LIVE AT OR BELOW
FEDERAL POVERTY LEVEL AND MANY
HAVING UNMET MENTAL HEALTH NEEDS
AND IN THIS WORK WE HAVE
MULTIPLE AIMS AND ONE IS TO BE
ABLE TO DELIVER A CULTURALLY
COMPETENT EVIDENCE-BASED MENTAL
HEALTH INTERVENTION FOR BLACK
WOMEN IN COMMUNITY.
TWO, TO BE ABLE TO TRAIN
IMBEDDED HEALTH PROVIDERS TO
DELIVER THE INTERVENTION
UNDERSTANDING THAT WHILE
RESEARCHERS COME IN AND OFFER A
HIGH QUALITY INTERVENTION THEY
OFTEN LEAVE AND TAKE KNOWLEDGE
GAINED WITH THEM.
PART OF THIS WORK WAS TO BE ABLE
TO DEVELOP SKILLS IN COMMUNITY
SO THEY COULD REMAIN IN
COMMUNITY AND BE IN THE HEALTH
CENTER AND COMMUNITY AT LARGE
AND WE SOUGHT TO EXPLORE
EFFECTIVENESS OF IT ITSELF AND
IMPLEMENTATION FACTORS IN
FEDERALLY QUALIFIED HEALTH
CENTER CONTEXT LOOKING AT THINGS
LIKE TRAINING OF PROVIDERS AND
LOOKING AT THINGS LIKE HOURS
WHERE INTERVENTION COULD BE
PROVIDED OR BARRIERS TO PROVIDE
IN SERVICES LIKE THIS LIKE
TRANSPORTATION AND CHILDCARE AND
THE LIKE AND ARE CURRENTLY IN
YEAR 5 OF 5 OF THIS STUDY AND
HAVE SUCCESSFULLY ENROLLED OVER
250 PARTICIPANTS AND TRAINED
FIVE HEALTH EDUCATORS AND BY
FORCE OF COVID AND IN PERSON
DELIVERY OF INTERVENTION.
NEXT SLIDE, PLEASE.
>> SO I'M SUMMARIZING FROM
MEMORY AND NEXT PARTNERSHIP I
WOULD LIKE TO SHARE IS
PARTNERSHIP BETWEEN NORTHWESTERN
UNIVERSITY AND COMMUNITY
ORGANIZATION THAT IS CALLED
PACPI CALLED THE MOTHER AND
CHILD ALLIANCE AND THIS
COMMUNITY-BASED ORGANIZATION
PROVIDES ENHANCED CASE
MANAGEMENT TO PREGNANT AND
PARENTING WOMEN LIVING WITH H
ICHI
SIMILAR TO MODEL.
IN ORDER TO ADDRESS UNIQUE NEEDS
OF BLACK WOMEN AND PREGNANT AND
PARENTING BLACK WOMEN WITH
COMORBID CHRONIC HEALTH
CONDITION.
PART OF WORK WE RECEIVED
FEEDBACK FROM WOMEN THEMSELVES
WHAT PARTS OF INTERVENTION WERE
MOST HELPFUL AND CRITICAL
ELEMENTS THEY NEEDED HELP WITH
ADDRESSING STRESSORS AND WHAT
THEY NEEDED FROM CULTURES OR
TRAINERS DELIVERING INTERVENTION
TO THEM.
PART OF THE WORK WE WERE ABLE TO
GIVE FEEDBACK FROM KAIS WORKERS
THEMSELVES AND IMPLEMENTATION
PIECE WHAT IT TAKES FOR SYSTEMIC
PERSPECTIVE WHAT IT TAKES TO
SUCCESSFULLY IMPLEMENT SUSTAIN
AND DISSEMINATE THIS
INTERVENTION IN COMMUNITY BASE
ENHANCEMENT COMMUNICATION
PROGRAM. NEXT SLIDE, PLEASE.
RESEARCHERS COME IN WITH
PRIORITIES THAT ARE MISALIGNED
WITH COMMUNITY AND PARTICULARLY
OVERWHELMED AND STRETCHED HEALTH
CENTERS THOSE PRIORITIES ARE IN
LINE AND KEY TO SUCCESSFUL
RESEARCH PARTNERSHIP THAT WILL
HAVE MEANINGFUL OUTCOMES IN THE
COMMUN
COMMUNITY.
I WILL CLOSE SIGHING THAT
COMMUNICATION IS IMPORTANT
PARTICIPATING ACTIVELY IN THE
COMMUNITY NOT SHOWING UP TO DO
YOUR RESEARCH AND ATTENDING
COMMUNITY EVENTS OFFERING
RESEARCHERS AND SERVICE TO THE
COMMUNITY ARE FACTORS HELPING TO
BUILD TRUST AND OUTCOMES.
>> MARIE, THANK YOU.
MARIE?
>> NEXT SLIDE. THANK YOU.
THIS WAS TAKEN AFTER FIRST
APPOINTMENT 15 YEARS AGO AND
TOLD DOCTOR RIGHT AWAY I'M NOT
FEELING LIKE MYSELF BUT FEELING
REALLY SAD AND WITHOUT MISSING A
BEAT SHE SAID I SHOULD BE HAPPY
I WAS HAVING A BABY AND AT THAT
MOMENT I FELT I WAS WAVING A RED
FLAG.
SHE LET ME GO I WOULD PROCEED TO
GO TO 29 DIFFERENT PROVIDER
OFFICERS THERAPISTS AND CALLING
HEALTH INSURANCE BEFORE I WAS
ABLE TO GET HELP 190 DAYS IN MY
PREGNANCY AT THIS POINT I DIDN'T
KNOW WHAT WAS GOING ON IN HEALTH
SYSTEM AND THEY DIDN'T KNOW WHAT
TO DO WITH ME. FAST FORWARD A
COUPLE YEARS AND THOUGHT WAS
THIS JUST MY STORY?
WAS I UNIQUE? I PICKED UP A
VIDEO CAMERA AND I SPOKE WITH
WOMEN ACROSS US AND DOCTORS AND
RESEARCHERS THAT LAID WORK FOR
CREATING MAMMHA FEMME TECH AND I
WORKED WITH NATIONAL COALITION
FOR MATERNAL HEALTH AND LED
NATIONAL AWARENESS CAMPAIGNS AND
IN THAT MOMENT SITTING IN
CONFERENCES WITH PEOPLE WHO HAD
LOST THEIR WIVE AND PARTNERS AND
DAUGHTERS AND THAT YOU GET THIS
MOMENT WHERE YOU ARE LIKE A
CHANGE IN KNOWLEDGE IS NOT
ALWAYS EQUAL TO CHANGE IN
BEHAVIOR AND COULD RAISE
AWARENESS UNTIL COWS CAME HOME
WOULDN'T CHANGE -- I WAS A MOM
TRYING TO FIGURE THIS OUT SET TO
WORK IN THE UN AND LIFE WAS
DISRUPTED I DON'T KNOW WHY I'M
HERE I HAVE TO MAKE IT BETTER.
ONE WAS LIKE TO WHAT EXTENT
COULD WE INCREASE PHYSICIAN
SCREENING HITTING FAILURE POINTS
WHY THEY WEREN'T SCREENING?
COULD INCREASE IDENTIFICATION
KNOWING WHAT WE KNOW BY TALKING
TO DOCTORS AND WOMEN?
SECOND PIECE HAD TO KNOW TO DO
SCREENING PIECE THAT WAS EASY
AND SECOND HOW YOU GET WOMEN
INTO CARE AND TO WHAT EXTENT
COULD TECHNOLOGY CLOSE THESE
GAPS AND BE AN EQUALIZER HELPING
PHYSICIANS AND WOMEN?
NEXT SLIDE, PLEASE.
SO WE CREATED MOMMA THAT IS A
STREAMLINED PHYSICIAN STARTING
WITH PHYSICIANS ENDING WITH
MOTHERS AND NOW FATHERS AND
STARTING TO CATCH FATHERS IF IN
THE NICU.
THANK YOU. WITH VERY HIGH
SUICIDALITY WHICH IS CHANGING MY
PARADIGM COMPLETELY.
SO, WE HELPED PHYSICIANS SCREEN
AND THEY GET SCORES BACK COMES
WITH TALKING POINTS IF SHE
SCREENS POSITIVE MOMA CARE
COORDINATOR IS THERE FOLLOWING
UP ON SPOT WITH THAT PHYSICIAN
AND PATIENT AND LIKE CANDICE AND
THAT MOTHER WE HEARD HER STORY
TODAY SHE WAS LET GO WITH THAT
PHOTOCOPIED PIECE OF PAPER THAT
NEVER HAPPENS WITH THIS SOLUTION
AND MOMA IS ALWAYS FOLLOWING UP
100% NO WOMANLE IS EVER LOST TO
A FILE AND SENT ON HER WAY AND
WE KNOW AND CREATED THIS AND
WERE WOMEN IN THIS SITUATION AND
INVITED ONE WOMAN 18 TIMES TO A
SUPPORT GROUP. SHE NEVER CAME
AND CAME THAT 18TH TIME AND SHE
NEVER LEFT.
SHE SAID, YOU KNOW, I FINALLY
FEEL I'M NOT ALONE. WE DIDN'T
GIVE UP WE UNDERSTAND DEPRESSION
AND ANXIETY AND NEW MOERNL HOOD
AND UNDERSTAND THAT TERRIBLE
THING THAT HAPPEN AND WITH MOMA
WOMEN ARE 5 TIMES MORE LIKELY TO
ENGAGE WITH CARE AND SOME ARE
SLIPPING THROUGH THE GAPS AND
ABLE TO UP THAT AND PHYSICIAN
SCREENING WE KNOW THROUGH HEATUS
SCORES LESS THAN 20% OF
PHYSICIANS ARE SCREENING
PATIENTS AND FELT IDENTIFICATION
IN WOMEN IN PERINATAL PERIOD IS
IMPORTANT TO GET THEM TO CARE.
WE INCREASED THEM 40% AND
INCREASED PHYSICIAN SCREENING
NOW BY 83 OR 88% AND MADE IT
EASIER AND THEY NEVER HAVE TO
LIKE I DON'T KNOW WHAT TO DO
WITH HER.
WE WILL TAKE CARE OF EVERYTHING
AFTER THAT POSITIVE SCREEN.
NEXT SLIDE, PLEASE.
THIS IS MORE IS STUFF WE LEARNED
AND YOU KNOW BIGGEST THING IS
THAT WE THOUGHT THAT WOMEN JUST
NEEDED TO BE PUT INTO THERAPY.
ONLY 40% OF WOMEN THAT SCREEN
POSITIVE WENT INTO THERAPY. 16%
ENDED UP GETTING ON MEDICINE AND
16% TO SUPPORT GROUPS AND 90%
ENGAGED WITH MOMA CARE
COORDINATOR WITH 67 WEEKS WITH
INTERACTIONS BACK AND FORTH THEY
WERE NEVER ALONE AND SOMEONE WAS
ALWAYS CHECKING IN ON THEM HOW
ARE YOU DOING AND SLEEPING? HOW
IS YOUR MOOD?
WE FOUND LOOKING AT OTHER HEALTH
SYSTEMS AND SOLUTIONS AROUND THE
WORLD THERE IS LOW MENTAL HEALTH
PARITY THAT WE COULD LEARN IF
YOU TOOK SOME SKILLS LIKE COPING
SKILLS AND COGNITIVE BEHAVIORAL
THERAPY SKILLS AND GAVE TO PEER
SUPPORT SPECIALISTS WOMEN WITH
LIVED EXPERIENCES WE COULD KEEP
WOMEN OUT OF THERAPY AND HELP
THEM FEEL BETTER FASTER THAT IS
A LOT FASTER AND GOING FOR
EMPLOYERS AND GOING FOR WOMEN
WHO CAN PAY OUT OF POCKET FOR
THIS AND LESSON IS STICK TO WHAT
GOAL IS. WE -- IT IS A VERY
LONG PATH. WE HAVE BEEN
COMMITTED THIS IS A SOLUTION FOR
ALL WOMEN NOT JUST SOME WOMEN
AND IN IT FOR LONG GAME AND
COLLEAGUE UP HERE SAID THAT I
REALLY LOVE THAT IS WHAT WE ARE
HERE FOR AND OTHER THING THAT
GUIDED US IS THAT YOUR TOOL
MIGHT NO THE BE BEST SOLUTION TO
MY PROBLEM AND THINK THAT IS WHY
THIS WORKS SO WELL. IT IS BUILT
BY MOTHERS AND PHYSICIANS
TOGETHER AND WHY IT WORKS.
THANKS SO MUCH.
>> THAT IS BEAUTIFUL. YAY!
OKAY. LAST BUT NOT LEAST, WE
HAVE -- WE ARE MOVING TO NEXT
QUESTION. SORRY THANK YOU THEME
ONE. THEME 2, THANK YOU.
QUESTION IS WHAT IS YOUR VISION
HOW TECHNOLOGY COULD UTILIZE
EQUITY LENS TO ADDRESS MATERNAL
HEALTH DISPARITIES AND WE HAVE
ABIGAIL HERE SHE IS. IF YOU
COULD REMEMBER TO SAY NEXT SLIDE
AND WE CAN KEEP IT GOING.
>> ALL RIGHT. NEXT SLIDE.
GOOD AFTERNOON, EVERYONE. IN
ADDITION TO MY WORK AS EXECUTIVE
VICE PRESIDENT OF SEATTLE HEALTH
BOARD TRIBAL EPIDEMIOLOGY CENTER
IN COUNTRY IT FOCUSES ON URBAN
DWELLING ALASKA NATIVES THAT
ISSEST% OF NATIVES LIVE OFF
RESERVATION AREAS AND LARGE
URBAN SETTINGS ACROSS THE UNITED
STATES AND I WORK ACROSS TRIBAL
NATIONS IN ADDITION AND STARTING
TO TALK ABOUT WHAT CURRENT
STATUS OF MATERNAL MORBIDITY AND
AMERICAN INDIANS AND ALASKA
NATIVES AND WHAT WAS PRESENT
FORD BLACK SISTERS AND THOSE WHO
BIRTH AND WE EXPERIENCE WHAT ARE
CALLED VERY HIGH RATES OF SOCIAL
DETERMINANTS OF HEALTH I DON'T
CALL THEM THAT. OUR FRIEND
MENTIONED EARLIER THAT WE HAVE
TO ADDRESS IMBEDDED RACISM AND
WHITE SUPREMACY THAT DIRECTLY
IMPACTED ABILITY OF PEOPLE TO
BIRTH BABIES IN WAYS THAT THEY
WERE MEANT TO AND CALL THEM
COLONIAL DETERMINANTS OF HEALTH
LOOKING AT SOCIETAL DETERMINANTS
OF RELATIVES AND PEOPLE OF
TRIBAL NATIONS WE HAVE
INCREDIBLE BEAUTIFUL CULTURE AND
COMMUNITY CAN'T BE ASSOCIATED
WITH IMBEDDED RACIST SYSTEMS
THAT ARE CURRENTLY HARMING US
AND TERM THEM COLONIAL
DETERMINANTS OF HEALTH THAT
DIRECTLY IMPACTED HIGH RATES OF
POVERTY AND HIGH RATES OF
UNEMPLOYMENT AND HIGH RATES OF
SUBSTANCE MISUSE AND OTHER
THINGS THAT ARE OFTEN JUST
DIRECT SYMPTOMS OF ONGOING
COLONIALISM THAT EXIST HERE IN
THE UNITED STATES AND WE CAN'T
TALK ABOUT TECHNOLOGY AND
ABILITY FOR S TO MAKE CHANGES
WITHOUT TALKING ABOUT RACISM
THAT CURRENTLY EXISTS AND
LOOKING AT TECHNOLOGY AND
BRINGING EXPERIENCE OF WORKING
ON MORE THAN 26NIH-FUNDED
PREDOMINANTLY LARGE R01S AND
WORKING ACROSS TRIBAL NATIONS
AND URBAN INDIAN COMMUNITIES ONE
SITUATION WE HAD TO DO WAS TO
FIGURE OUT HOW TO ACTUALLY MAKE
OUR IMBEDDED KNOWLEDGE SYSTEMS
THAT WERE ONLY WAY THAT WE WERE
GOING TO IMPROVE HEALTH AND WELL
BEING OF COMMUNITIES WORK WITHIN
STRUCTURE OF BUREAUCRACY AND
IMBEDDED STRUCTURAL RACISM THAT
IS WHAT NIH GRANTS ARE AND AS WE
LOOK AT EVEN NOW EXPANSION OF
FOCUSING ON BRINGING FORWARD
TECHNOLOGY SDOOE VICES AND
RESEARCH ASSOCIATED WITH THAT
COMING FROM FRAMEWORK PEOPLE OF
COLOR ARE A PROBLEM TO SOLVE AND
WHEN YOU START WITH US AS A
PROBLEM TO SOLVE YOU ARE
IMMEDIATELY STARTING WITH
IMBEDDED RACISM THAT SEES US AS
A PROBLEM NOT OF ANSWERS AND
DIRECT RESULT OF THAT TECHNOLOGY
SOLUTIONS HARMED COMMUNITIES AND
MOVE FORWARD HEALTH AND WELL
BEING AND I WILL TALK ABOUT DATE
THAW COULD BE APPLIED IN VARIETY
OF DIFFERENT THINGS AND KNOW
WHETHER IT BE MACHINE LEARNING
AND LOOKING AT AI NOW AND WAY
THAT DATA IS COLLECTED AND KNOW
DEVICES FOR EXAMPLE ON CERTAIN
SKILL COLOR DOESN'T WORK WELL
WITHIN HOSPITAL SYSTEMS RESEARCH
WASN'T DONE THAT WAY AND LOOK AT
WAY WE ARE MADE INVISIBLE AND
TECHNOLOGY IS PUT FORWARD. THEY
ARE LIKE IT DIDN'T WORK.
YOU DIDN'T USE IT. WE WEREN'T
GIVEN ACCESS TO IT.
THINKING ABOUT RESEARCH AND WAY
IT IS DONE AND ALSO DATE THAW IS
PRODUCED BY PRINCIPLE
INVESTIGATORS FOR AMERICAN
INDIANS AND ALASKA NATIVES HAS
UNIQUE EFFECT NEXT SLIDE.
UNIQUE EFFECT IS THAT WE ARE
LEGALLY UNDER TREATIES THAT ARE
A RESULT OF STOLEN LAND THAW SIT
ON RIGHT NOW TODAY.
OUR TREATIES MANDATE THAT UNITED
STATES GOVERNMENT GIVES US
RESOURCES FOR QUALITY
FISSION-LED HEALTH CARE IN
ADDITION TO SOCIOECONOMIC
RESOURCES DIRECT RESULT OF LOSS
OF LAND IN TREATIES AND THOSE
TREATIES ARE APPLIED BY HAVING
DATA.
SO, WHEN YOU HAVE RESEARCH
STUDIES THAT ARE NOT INCLUSIVE
OF AMERICAN INDIANS AND ALASKA
NATIVES AND SMALL SAMPLE SIZE
YOU DON'T REPORT OUT DATA
CORRECTLY.
THAT IS USED BECAUSE I SEE IT
ALL THE TIME AND FIGHT IT ALL
THE TIME BY UNITED STATES
GOVERNMENT TO JUSTIFY NOT GIVING
RESOURCES WE NEED TO ADDRESS
CRISIS OF MATERNAL MORBIDITY AND
MORTALITY THAT, THAT GOVERNMENT
CREATED.
I WILL GIVE AN EXAMPLE.
RECENTLY ASKED TO CONSULT ON A
VERY LARGE NATIONAL BEHAVIORAL
HEALTH STUDY SPECIFICALLY FOR
YOUTH WHY IMPORTANT WHEN
THINKING OF MATERNAL MORBIDITY
AND AVERAGE AGE AND LIFESPAN IS
51 YEARS OLD AND 25 IS
CONSIDERED MIDDLE AGE IN THAT
COMMUNITY AND WE HAVE A LARGE
NUMBER OF YOUTH WHO HAVE BABIES
EARLY ON, YOU KNOW?
AND IN THEIR EARLY TO LATE TEENS
BECAUSE OF THE SOCIETAL
CONDITIONS THAT HAVE BEEN
CREATED BY COLONIAL DETERMINANTS
OF HEALTH THAT IS VERY IMPORTANT
TO ME TO LOOK AT WHAT WE WANT TO
LOOK AT PERINATAL PERIODS
SITTING OUT ASKING WE HAVE A
SMALL SAMPLE SIZE LAST TIME WE
DID LARGE NATIONAL STUDY DOING
OVERSAMPLE LOOKING AT HOW THEY
CALCULATED THEIR DATA AND ASKED
WHY ARE YOU ONLY USING SINGLE
RACE AMERICAN INDIANS AND ALASKA
NATIVES HAS IMBEDDED IN HOSPITAL
EHR SYSTEMS IMBEDDED IN WAY THAT
CLINICAL INVESTIGATORS AND
OTHERS ARE GATHERING DATA AND
ASKED WHY ARE YOU USING SINGLE
RACE? WHAT DOES IT MEAN?
ANSWER OF VERY LARGE WON'T SAY
NAME OF WHO IT WAS FEDERAL
AGENCY, IT THIS AIS WAY WE HAVE
ALWAYS DONE IT.
SCIENCE ON THAT, THERE IS NO
SCIENCE.
IT IS JUST WAY IT ALWAYS HAS
BEEN DONE AND WHY DOES IT
MATTER? USE OF SINGLE RACE
AMERICAN INDIANS AND ALASKA
NATIVES IF WE INTERMARRY AND
BECOME INTERCULTURAL WE
DISAPPEAR INTO MELTING BOT A
REAL THING IN THE UNITED STATES
AND DIRECT RESULT OF THAT DATA
DOESN'T EXIST THAT WOULD BE USE
THE TO ALLOCATE RESOURCES OF
TRIBAL COMMUNITIES ADDRESSING
COLONIAL DETERMINANTS OF HEALTH
IMPROVING YOUTH THAT WILL BIRTH
BABIES IN EARLIER AGES BECAUSE
THEY DON'T LIVE PAST AGE OF 51.
DIRECT IMPACT SINGLE RACE
AMERICAN INDIANS AND ALASKA
NATIVES ARE A HOLD OVER OF BLOOD
QUANTITIUM THAT FEDERAL
GOVERNMENT CREATED WITH
INTENTION OF MAKING SURE WE WERE
ELIMINATED IN DATA AND LIST OF
OTHER WAYS THAT DATA IS USE THE
TO ELIMINATE US AND TEAMS GOING
ACROSS HOSPITALS AND EITHER
DON'T HAVE A BOX FOR OUR PEOPLE
TO CHECK THEY ARE AMERICAN
INDIAN OR ALASKA NATIVE NOT
BEING GATHERED SAME WITH
CLINICAL RESEARCH STUDIES IF
BEING GATHERED IT IS NOT BEING
DONE IN WAY THAT COUNTS AS
MULTICULTURAL PEOPLE AND
DIRECTLY ELIMINATES US AND THIS
IS THE NEXT SLIDE AND PHENOMENON
I CALL DATA GENOCIDE AND COIN
THIS TERM SPECIFICALLY DIRECTLY
RESULTING IN DEATHS OF RELATIVES
I SERVE EVERY DAY AND HEALTH
BOARD PAYS FOR FUNERALS I PAY
FOR COUGHINS OF 2 MONTH YEAR
OLDS AND COUGHINS OF MOTHER AND
HER TWINS THAT DIED AS A DIRECT
RESULT OF COLONIAL DETERMINANTS
OF HEALTH AND TECHNOLOGY THAT
DIDN'T ENGAGE CORRECTLY WITH
HER. IT HAD NEVER ASSUMED THAT
SHE WOULD BE PART OF IT.
INDIGENOUS DATA GENOCIDE IS A
DIRECT RESULT OF THAT WHAT
HAPPENS RESOURCES OF FEDERAL
GOVERNMENT THAT IS SUPPOSED TO
ALLOCATE TO US DON'T COME
BECAUSE WE WEREN'T INCLUDED AND
TECHNOLOGY HAS OPPORTUNITY NOW
TO CHAFK THAT. NEXT SLIDE.
ONE KEY THING WE LEARNED IS MOST
FOLKS DON'T KNOW THAT IS WHAT
STRUCTURAL RACISM DOES AT ITS
BEST YOU ARE PARTICIPATING IN
SYSTEM OF INDIGENOUS DATA
GENOCIDE AND NEED TO POINT
DIRECTION WHAT CHANGE CAN LOOK
LIKE AND RESEARCH HAS A KEY PART
OF DOING THAT WHEN DONE WELL.
I WORKED AND DID A STUDY SOME
YEARS AGO WE LOOKEDALITY MORE
THAN A VERY LARGE PACIFIC
NORTHWEST LOOKING AT CLINICAL
INVESTIGATORS WITH R01 LEVEL
GRANTS AND ASKED HOW MANY HAD
COMMUNITY ENGAGEMENT WITH
SPECIFICALLY SET ASIDE RESOURCES
COMMUNITY ENGAGEMENT IN 5 YEAR
R01S AND OUT OF THAT NUMBER
PROBABLY 66 ONLY ONE DID THAT
WAS SPECIFIC TOWARDS COMMUNITIES
EXPERIENCING WORST DISPARITIES,
ONE ORGANIZATION AND ONE
PRINCIPLE INVESTIGATORS AND NEED
TO SEE STRATEGIC CHANGES AND
OPPORTUNITIES AND RESOURCES AND
FUNDING TO ENSURE TO ENGAGE
FOLKS IN TECHNOLOGY IN WAY THAT
IS ENGAGING COMMUNITIES THAT ARE
MOST IMPACTED. TECHNOLOGY IS IF
NOT FOR US OR BY US IT WON'T
HAVE IMPACT WE NEED TO SEE AND
ANOTHER ISSUE WE HAVE TO STAY
VIL VIGILANT FOR UNINTENDED
CONSEQUENCES OF GOOD INTENTIONS
AND SIT DOWN WITH INVESTIGATORS
WITH GOOD INTENTIONS AND RACIST
OUTCOMES NOT PROBLEM TO SOLVE
ALL ANSWERS HAS TO BE INCLUDED
IN TECHNOLOGY IN WAY WE LOOK AT
WHETHER IT IS COLLECTING DATA
YOU TO DOING RESEARCH ON NEW
DEVICES TO MACHINE LEARNING AND
AI AND WITHOUT THAT TECHNOLOGY
WILL PERPETUATE INSTEAD OF
CHANGE AND NOW IS THE TIME AND
NOW IS THE TIME FOR OPPORTUNITY
FOR TRUE ENGAGEMENT AND
COMMUNITIES ARE WAITING AND WHAT
WILL YOUR ANSWER BE TO THEM.
>> LAST BUT NOT LEAST.
>> IS.
>> I'M GOING TO TALK ABOUT AND
TRY TO BRING TOGETHER ALL THEMES
WE HEARD TODAY THAT ARE SO
POWERFULLY DELIVER TODAY
REGULATE REGULATORY INITIATIVES
AND COMMUNITY PARTNERSHIPS AND
INNOVATION TO DRIVE DIVERSITY
AND INCLUSION AND JUSTICE IN MED
TECH ECOSYSTEM.
IN TERMS OF DISCLOSURES ON BOARD
OF MED TECH COLOR AND DON'T
RECEIVE COMPENSATION FOR ROLE
AND NIH IS A FINANCIAL DONOR AND
GRANTOR OF MED TECH COLOR AND
PARTICIPATING IN INITIATIVES AND
NEXT SLIDE.
WHAT ALL OUR SPEAKERS HAVE
TALKED ABOUT TODAY IS SORT OF
ILLUSTRATED ON THIS SLIDE. I
HAVE BEEN A MEDICAL DEVICE
LAWYER FOR 23 YEARS OF PRACTICE
AS A LAWYER AND ROLE AT FDA
ASSOCIATE CHIEF COUNCIL AND HAVE
SEEN EVOLUTION IN MED TECH AND
HEALTH CARE ECOSYSTEM AND WHAT I
LIKE TO CALL A CONNECTED PATIENT
AND THIS SLIDE ILLUSTRATES
PATIENT OR CONSUMER INCREASINGLY
USING MOBILE APPS AND WEARABLES
AND OTHER SOFTWARE THAT IS
COLLECTING LARGE AMOUNTS OF
DEMOGRAPHIC AND BIOMETRIC DATA
AND IN CASES THESE DEVICES ARE
DIAGNOSING DISEASE AND
PROGRAMMING WEARABLE DRUG
DELIVERY DEVICES OR MONITORING
CARE.
INSIDE OF THIS ECOSYSTEM IS MANY
DIFFERENT STAKEHOLDERS WHO ARE
LOOKING TO LEVERAGE DATA SETS
FOR DIFFERENT PURPOSES AND YOU
HAVE HEALTH CARE PROVIDERS
LOOKING TO LEVERAGE IT FOR TELLE
MEDICINE AND FOR TOOLS LIKE MOMA
AND SIMILAR TOOLS AND CAREGIVERS
LOOKING TO LEVERAGE PATIENT DATA
TO CARE FOR PATIENTS THAT MIGHT
BE VULNERABLE ELDERLY OR
PEDIATRIC PATIENTS WORKING
THROUGH MENTAL HEALTH ISSUES TO
MONITOR THEIR CARE.
WE HAVE RESEARCHERS IN MED TECH
AND BIOTECH INDUSTRY LOOKING TO
LEVERAGE DATA SETS FOR RESEARCH
AND WE HAVE EMPLOYERS AND PAYERS
AND OTHERS WHO ARE MAKING
DECISIONS ABOUT CARE THAT ARE
LEVERAGING THESE DATA SETS AND
DATA IN MED TECH HAS REALLY
BECOME THE COMMODITY.
AS ABIGAIL POINTED OUT IT HAS
POTENTIAL TO CREATE INEQUITY AND
OFFERS US THE POWER TO TRY TO
MITIGATE AND ELIMINATE SOME
HARMS AND DISPARITIES.
NEXT SLIDE.
AS A LAWYER, I ALWAYS ENCOURAGE
PEOPLE WHO ARE WORKING IN
JUSTICE EQUITY, INCLUSION AND
INNOVATION TO UNDERSTAND
REGULATORY LANDSCAPE.
I WILL FOCUS A LITTLE ON FDA.
WHAT I ALWAYS EMPHASIZE IS IN
ORDER TO REALLY MOVE THE NEEDLE,
IT IS VERY IMPORTANT TO
UNDERSTAND YOU HAVE ALL THESE
DIFFERENT REGULATORS WHO HAVE
EITHER EXPRESS AUTHORITY OVER
MED TECH SOFTWARE AND INNOVATIVE
TECHNOLOGIES OR HAVE TREMENDOUS
AMOUNT OF INFLUENCE HOW PRODUCTS
GET TO MARKET.
A KEY IS UNDERSTANDING THEIR
INTEREST THAT IS OFTEN DIVERGENT
AND NOT ALWAYS TALKING TO EACH
OTHER AND HOW YOU CAN LEVERAGE
THEIR PRIORITIES AND POLICIES
AND INITIATIVES TO SOLVE SOME
PROBLEMS THAT WERE ADDRESSED
TODAY.
NEXT SLIDE.
I WILL FOCUS ON FDA I'M A
MEDICAL DEVICE LAWYER AND FDA IS
INCREASINGLY FOCUSED ON PATIENT
CENTERED PRODUCT DEVELOPMENT AND
IN PARTICULAR HOW DEVELOPERS AND
REGULATORS CAN LEVERAGE REAL
WORLD DATA AND TECHNOLOGY TO
DRIVE INCLUSIVITY AND BETTER
OUTCOMES AND WHEN WE ARE TALKING
ABOUT MATERNAL HEALTH AND
DEVELOPMENT OF PRODUCTS AND
SOLUTIONS TO CLOSE GAPS AND
SOLVE PROBLEMS, I LIKE TO
EMPHASIZE GETTING TO KNOW YOUR
REGULATOR AND WITH FDA THERE IS
OFFICE OF WOMEN'S HEALTH THAT IS
ACTUALLY OVERSEEING RESEARCH AND
INITIATIVES TO FORCE AND
ENCOURAGE DEVELOPERS TO BE MORE
INCLUSIVE TO INCLUDE WOMEN AND
CHILDREN AND PEOPLE OF COLOR IN
THEIR RESEARCH INITIATIVES AND
PRODUCT DEVELOPMENT.
AGENCY ALSO HAS A DIVISION OF
PEDIATRICS AND MATERNAL HEALTH
THAT IS FOCUSED ON DRUG
DEVELOPMENT AND ENSURING
LABELING INSTRUCTIONS FOR USE
AND DATA DRIVING DRUG AND
BIOLOGICS DEVELOPMENT THAT IS
INCLUSIVE AND INCREASINGLY
BECAUSE HEALTH CARE HAS BECOME
DIGITAL, FDA HAS AN OFFICE OR
DIGITAL HEALTH CENTER OF
EXCELLENCE THAT WORKS WITH ALL
DIFFERENT CENTERS WITHIN FDA AS
WELL AS EXTERNAL STAKEHOLDERS IN
DRIVING POLICIES AND SOLUTIONS
TO BRING SOFTWARES AND MEDICAL
DEVICE AND OTHER INNOVATIVE
TECHNOLOGIES TO MARKET AND DO IN
CONJUNCTION WITH OFFICE OF
SCIENCE AND ENGINEERING
LABORATORIES THAT IS LOOKING AT
THINGS LIKE DIVERSITY AND BIAS
THAT IS BUILT INTO AI AND
PROMULGATING STANDARDS AND
REQUIREMENTS TO TRY TO SOLVE
THOSE ISSUES AND THERE IS A LOT
GOING ON.
WE ARE AWARE OF PROBLEMS AND
ENGAGING WITH REGULATORS THROUGH
DIFFERENT INITIATIVES IS A WAY
TO START TO DRIVE SOLUTIONS AND
USE REGULATORY PROCESSES TO
FORCE CHANGE.
NEXT SLIDE.
THAT BRINGS ME TO MED TECH COLOR
THAT IS MY PASSION AND MED TECH
COLOR HAS THREE PROGRAM AREAS.
ONE IS FOCUSED ON BUILDING
COMMUNITY FOR PROFESSIONALS AND
EXECUTIVES IN MED TECH AND OTHER
WE HAVE A PITCH COMPETITION WE
GIVE AWAY A QUARTER OF A MILLION
DOLLARS IN MONEY AND SERVICES TO
EARLY STAGE MED TECH COMPANIES
THAT ARE LED OR FOUNDED BY BLACK
OR LATINX FOUNDERS 7ING THOSE
COMMUNITIES AND FDA INITIATED
PROGRAM SEVERAL YEARS AGO CALLED
COLLABORATIVE COMMUNITIES ANY
GROUP OR PERSON THAT IS SOLVING
PROBLEM -- MED TECH COLOR
COLLABORATIVE COMMUNITY IS FOCUS
THE ON HOW WE CAN SOLVE ISSUE OF
LACK OF INCLUSIVITY AND LACK OF
AWARENESS OF DIVERSE COMMUNITIES
IN PRODUCT DEVELOPMENT AND
CLINICAL RESEARCH AND FOUR
INITIATIVES AND ONE IS DISEASE
AWARENESS SUB-COMMITTEE AND
SIGNATURE PROGRAMS IS A HEART TO
HEART PROGRAM. WE CONDUCTED A
SERIES OF FOCUS GROUPS ACROSS
SEVERAL STATES BLACK WOMEN
SUFFERING FROM CARDIAC DISEASES
AND TO ALL POINTS ON PANEL
INCLUDING NATALIE'S WE ARE NOT
JUST GETTING DATA FROM WOMEN ON
HOW THIS DISEASE IMPACTS THEIR
HEALTH JOURNEY AND ONE THING WE
FOUND IS TRANSPORTATION OR LACK
OF IT IS ACTUALLY A BIG FACTOR
IN DISEASE PROGRESSION AND LACK
OF ACCESS TO CARE. WE GOT DATA
AND WE PROVIDED A GRANT THAT IS
SPECIFICALLY FOCUSED ENSURING
THAT WOMEN CAN HAVE GREATER
ACCESS TO TRANSPORTATION AND IS
NOT JUST ABOUT TAKING FROM
COMMUNITIES GETTING INFORMATION
BUT THINKING ABOUT ALSO HOW WE
POOR BACK INTO THEM AND WE HAVE
RECRUITMENT AND RETENTION
COMMITTEE THAT IS FOCUSED ON HOW
TO GET MORE DIVERSE PIS IN
CLINICAL RESEARCH STUDIED FOR
DEVICES AND SOLUTIONS THAT ARE
BEING DEVELOPED AND DOING IT IN
A COUPLE WAYS AND WE HAVE TO
FIND THEM AND ADDRESS THE FACT
THAT SOMETIMES THEY DON'T HAVE
RESOURCES AND TRAINING AND
FUNDING SO THAT THE DRUG AND
DEVICE COMPANIES WILL ACTUALLY
ACCEPT THEM. WE ARE TRYING TO
FIGURE OUT HOW TO CLOSE THAT
GAP. EVIDENCE DEVELOPMENT, WE
ARE TRYING TO UNDERSTAND DISEASE
PATHWAYS AND MORBIDITIES FOR
COMMUNITIES OF COLOR AND WE WANT
TO HEAR FROM THEM.
SO, WITHIN OUR COLLABORATIVE, WE
HAVE PATIENT GROUPS AND NIH AND
CMS AND FDA AND MED TECH COLOR
HAS 2500 INDIVIDUALS OR ENTITIES
THAT ARE CONNECTED TO US.
THEY ARE TRYING TO SOLVE SOME OF
THESE PROBLEMS AND WE ARE ALSO
LOOKING AT HOW WE CAN SOLVE THE
PROBLEM THAT WAS IDENTIFIED BY
ABIGAIL AND NATALIE AND MANY
OTHERS AND MANY DEVICES USED TO
DIAGNOSE PEOPLE OF COLOR OR
TREATING PEOPLE OF COLOR ARE
NEVER TESTED OR DEVELOPED WITH
US IN MIND.
THAT IS 4TH AREA WE ARE WORKING
ON AND THERE ARE SOLUTIONS AND
WE ARE FOCUSED ON FINDING
SOLUTIONS AND INVITE YOU AND
EVERYONE IN YOUR COHORT TO GET
INVOLVED.
THANK YOU VERY MUCH.
>> ALL RIGHT. WE STARTED A
LITTLE LATE AND TOOK -- WE HAVE
A LITTLE TIME AND HOPE THAT DR.
BETA FOR QUESTIONS FROM THE
AUDIENCE.
GREAT. THANK YOU.
DR. KIESHA I WAS GOING TO CALL
YOU OUT. TO MY PARTNER OUT
THERE HOW ARE YOU DOING, LOVE?
WANT TO GO TO MICROPHONE AND ASK
QUESTIONS WHILE PEOPLE ARE
COMING? I KNOW YOU ARE NOT SHY
COME TO MICS PLEASE. GOOD. YOU
ARE COMING UP. I CAN MAKE UP
ONE.
>> CAN YOU HEAR ME OKAY.
>> YES.
>> I'M PETER AND CO-FOUNDER AND
CEO OF IVANA HEALTH AND QUESTION
FOR LIFE SCIENCES
ENTREPRENEURSHIP DEVELOPMENT
SIDE OF THINGS I COULDN'T AGREE
MORE WITH IMPORTANCE OF
COMMUNITY ENGAGEMENT AND
PATIENT-DRIVEN AS SOMEONE SAID
EARLIER DEVELOPMENT PANELS.
WHAT IS APPROPRIATE RESPECTFUL
TIME TO START TO ENGAGE ON THAT
SIDE WHEN TRANSLATING FROM SAY
PRECLINICAL I WORK IN
THERAPEUTICS.
THERE IS LOTS OF RESEARCH
AROUND THERAPEUTIC DOING WHAT I
THINK IT WILL DO AND BRINGING TO
COMMUNITIES SOONER AND COULD BE
RESPECTFUL BEING TOO EARLY AND
NAVIGATING THAT AND CASH
STRAPPED PERSPECTIVE BEING
RESPECTFUL TO ASK COMMUNITY
MEMBERS TO BE GIVING TIME AND BE
RESPECTFUL OF IT BUDGET CAN'T
KEEP TO PROGRESS AND SERVE
PATIENT LATER AND QUESTION HOW
YOU THINK THROUGH WHEN TO ENGAGE
AND HOW TO NAVIGATE THAT STAGE
APPROPRIATENESS MAKING SURE YOU
MANAGE YOUR BUDGET AND YOU ARE
RESPECTFUL TO PEOPLE ACTUALLY
HELPING YOU ALONG THE WAY TOO.
THANK YOU.
>> GREAT QUESTION.
FOR [INDISCERNIBLE] IS PART OF
THE REASON WE EXIST AND FINDING
COMMUNITY MEMBERS AND SAY IT
DOESN'T WORK LIKE THAT. WE HAVE
TO ACTUALLY SEE WHAT IS
HAPPENING AND WOULD LOVE TO HEAR
FROM PANELISTS BEFORE I TAKE IT
OVER AND THINKING ABOUT WHEN TO
ENGAGE AND HOW AND IF SOMEONE IS
SHOWING UP AND THEY HAVE A
PRODUCT WE NEED PRODUCTS THAT
ARE ALREADY BUILT AND MIGHT HAVE
BEEN BUILT SAY INJECTION FOR
PRETERM LABOR WITHOUT HAVING
COMMUNITY ENGAGED AND WHAT IT
LOOKS LIKE POST ENGAGEMENT.
>> IS IT OKAY IF I START?
ALL RIGHT. REALLY GREAT
QUESTION.
>> LIFE CYCLE AND LOTS OF
COMPANIES BEFORE THEY DEVELOP A
TECHNOLOGY OR WHEN THEY ARE
TRYING TO DETERMINE WHAT TO DO
WITH A MOLECULE THAT THEY MAY
HAVE A LICENSE TO, THEY DO VOICE
OF CUSTOMER RESEARCH WITH
CLINIC
CLINICIANS.
VERY FEW OF THEM I FIND
REPLICATE THAT CUSTOMER PARADIGM
WITH PATIENTS.
THAT IS A VERY SIMPLE WAY TO TRY
TO CREATE PARITY EARLY ON AND
WHENEVER DOING VOICE OF CUSTOMER
ENGAGEMENT WITH CLINICIANS TO
FIND OUT WHAT YOU NEED AND WHAT
YOUR PATIENTS NEED AND WOULD YOU
USE THIS TECHNOLOGY, I THINK
BUILDING TO THAT EARLY
DEVELOPMENT CYCLE AND PATIENT
ENGAGEMENT AND USEE WAYS TO DO
IT, YOU KNOW, REACH OUT TO
EVERYBODY ON THIS PANEL AND
PEOPLE IN THIS ROOM TO HELP THEM
HELP YOU FIND CONNECTIONS AND
FROM A FINANCIAL STANDPOINT,
SOMETIMES INDIVIDUALS OR GROUPS
HAVE GRANT RESOURCES THAT ARE
ABLE TO PARTNER YOU WITH WAYS TO
PROVIDE INCENTIVE FOR PATIENTS
TO REACH TO TALK TO.
>> YEAH.
>> YEAH. MY EXPERIENCE I
WORKED IN EVERYTHING GENETICS TO
GENOMICS SITTING ON NIH TRIBAL
ADVISORY FOR [INDISCERNIBLE]
INITIATIVE TO SOCIAL LIFE
SCIENCES BECAUSE I'M -- I SERVE
MY COMMUNITY IN ANY WAY THEY
NEED TO AND INDIGENOUS
RESEARCHER PERSPECTIVE -- GATHER
INFORMATION FROM AMERICAN INDIAN
ALASKA NATIVE PEOPLE AND THOSE
THAT SERVE THEM I MAKE THEM QUIT
CALLING THEM PATIENTS AND ONLY
CALL PEOPLE THAT ACCESS
RESOURCES RELATIVE AND SHIFTING
WAYS TALKING ABOUT GETTING
INFORMATION FROM A RELATIVE THAT
CHANGES WAY THAT YOU THINK ABOUT
IT I HAVE SEEN A SHIFT IN WAY
THOSE THAT ENGAGE WITH OUR
COMMUNITY HAVE TO THINK ABOUT
AND ENGAGE WITH PEOPLE AS
RELATIVES IT CHANGES THE WAY
THAT THEY DO THAT.
COMMUNITY ENGAGEMENT IS
CONTINUOUS AND CAN'T BE
DEPENDENT ON A BUDGET I WORK AD
CROSS EVERY NIH GRANT THERE IS
AND AT THIS TIME WILL IS 16
INSTITUTES AND IF WE ONLY THINK
ABOUT COMMUNITY ENGAGEMENT BASED
IN BUDGET I UNDERSTAND WHAT YOU
ARE TALKING ABOUT IN TERMS OF
INCENTIVES, ET CETERA.
COMMUNITY NEEDS TO SEE YOU
CONTINUOUSLY SHOW UP AND HIRE
PEOPLE WHO ARE REPRESENTATIVE OF
THE COMMUNITIES AND
REPRESENTATION MATTERS SO YOU
ENGAGED COMMUNITY PERSPECTIVE.
WE ARE SCIENTISTS AND HAVE
KNOWLEDGE AND LOTS OF TIMES
BASED ON STRUCTURAL RACISM AND
REASON WE DON'T EXIST ON TEAMS
HIRING IS DONE IS NOT ENGAGING
US IN APPROPRIATE WAY TO TRULY
PARTICIPATE RECOGNIZING
COMMUNITY ENGAGEMENT IS LONG
TERM NOT BASED ON 3 OR 5 YEAR
GRANT.
I HELPED TO START ONE VERY FIRST
GRANT RESEARCH PROJECT CAME FROM
REQUEST SERVE YEARS PRIOR AND
WORKING WITH ACUTELY SUICIDAL
AMERICAN INDIANS AND ALASKA
NATIVES LONG TERM ENGAGEMENT
PROMISE TO COMMUNITY DOING IN
WAY THAT WAS APPROPRIATE TO THEM
WAS PART OF THAT AND BUILDING
LONG TERM COMMUNITY RIGHT NOW
I'M WORKING WITH FOLKS WHO THEY
HAVE BEEN VESTED SO LONG TERM
AND DR. PERRY SAID THERE IS A
DEVICE ALREADY CREATED AND ABLE
TO GO AND GATHER INFORMATION IN
LESS THAN A COUPLE MONTHS
BECAUSE OF LONG TERM
RELATIONSHIP THEY ESTABLISHED
AND BE READY AND KNOW THERE IS
INCREDIBLE OUTCOMES AS A RESULT
OF PUTTING IN LONG TERM
ENGAGEMENT AND THAT RESULTS IN
WHAT WE ARE ALL HOPING TO SEE
AND WON'T HAPPEN QUICKLY.
>> MIC NO. 1.
>> OKAY.
>> HI. MY NAME IS ADRIANA SOTO
AND FOUNDER OF MINE PLUS A
START-UP IN MIAMI AND HAVE BLACK
AND BROWN WOMAN WITH HIGH RISK
PREGNANCIES WITH MENTAL HEALTH
FOCUS AND MY EXPERIENCE WORKING
WITH UNDERSERVED POPULATIONS AND
QUESTION IS ABOUT HOW YOU COULD
GUARANTEE OTHERANCE AND
SUSTAINABILITY OVER TIME WITH
POPULATION THAT DOESN'T HAVE
SMARTPHONES OR WEARABLES AND
EVERYTHING LOOKS SUPER NICE AND
PROBLEM AND I DON'T HAVE ENOUGH
SPACE AND SMARTPHONE IS SUPER
OLD AND DON'T HAVE WI-FI AND
EVERYBODY HAS APPS AND DOESN'T
CARE ABOUT THIS FUNDAMENTAL
PROBLEM AND GO BACK AND MAKE WEB
APP FOR EXAMPLE.
NOT JUST YOU AND OTHER PANELISTS
ARE SHOWING VERY BEAUTIFUL APPS.
YOU KNOW?
HOW DEAL WITH THAT?
>> BROADBAND AND RURAL AMERICA
AND GETTING WI-FI.
>> PANEL, WE HAVE COME ACROSS
THAT AND DEVELOPED APP PM3 FOR
ME PART OF POSTPARTUM APP AND A
LOT IS DOG WEB DESIGN AND
ENSURING IF YOU DON'T HAVE
BROADBAND ACCESS STHAU HAVE AND
CAN ACCESS RESOURCES AND TOOLS
FOR IT AND GOING GLOBAL USING
THE WEB AND BUILDING IN RESEARCH
BUILDING IN INFRASTRUCTURE TO
PURCHASE PHONES AND THINGS
COMMUNITIES NEED THAT IS BIG
INCENTIVE FOR THEM TO
PARTICIPATE IN RESEARCH AND
SUSTAINING THAT THEY ACTUALLY
GET SOMETHING OUT OF AS WELL.
THOSE ARE TWO EXAMPLES AND
PANELISTS THAT ARE FELLOWS MIGHT
HAVE SOME AS WELL.
>> I'M IN MIAMI TOO. WE NEED
TO CONNECT.
>> WE UTILIZE WEB AND APP AND
WE HAVE PHONE CALLS AND TEXTING
AND WE USE MULTIPLE PATHWAYS TO
REACH WOMEN IN A NUMBER OF WAYS.
WHICHEVER IS EASIEST FOR THEM TO
ACCESS CARE AND NAVIGATION AND
SUPPORT AND THAT. WE USE ALL OF
IT.
>> I THINK SHE MENTIONED THAT
PERSISTENCE.
PEOPLE'S PHONES GET CUT OFF AND
FIGURE OUT AND CALL CUZZIN AND
TOLD TO WRAP UP AND APOLOGIZE.
WE WILL BE AUP HERE FOR
QUESTIONS AND BROUGHT YOU TO
INFORMATION TO FEEL COMFORTABLE
WITH AND THESE WORDS ARE NOT
COMMONLY SAID IN HOMES I'M AWARE
OF THAT I OPEN MY MOUTH IN ANY
SETTING AND I'M CLEARLY AWARE
THIS IS NO THE SOMETHING
HAPPENING FREQUENTLY WITH
NATIONAL INSTITUTES OF HEALTH
AND FOR US TO THRIVE WE
RECOGNIZE OUR CURRENT MOMENT AND
WORLD WE ARE IN AND THOSE THAT
WE NEED TO BE ABLE TO SAY
WITHOUT FEELING SHAMED OR GUILD
AND TRUTHFULLY WE ARE RELATIVES
AS MY SISTER ABIGAIL SAID AND
ONE HUMAN RACE AND FOR US TO
THRIVE WE HAVE TO BE ABLE TO
UNDERSTAND ROOT CAUSES OF
INEQUITY OF HEALTH AND WORK
TOGETHER SO SECNOLOGY IS NOT
USED TO HARM US BUT TO ENSURE WE
CAN ALL THRIVE. THANKS VERY
MUCH.
>> OBJECTIVE OF PANEL IS TO
DISCUSS IMPORTANCE OF TECHNOLOGY
AND USING IMPLEMENTATION OF
SCIENCE AND THIS PANEL CAME OUT
OF A RECOGNIZED NEED AS
TECHNOLOGY DEVELOPERS AND
BUILDING PRODUCTS IN REAL WORLD
-- EXIST FOR WIDESCALE UPTAKE
AND TECHNOLOGY AND PANEL
DISCUSSION WILL INCLUDE HOW TO
USE IMPLEMENTATION SCIENCE AND
TECHNOLOGY FOR MATERNAL HEALTH
AND DIVERSE POPULATIONS AND LOOK
FORWARD TO ENGAGING PANEL THAT
WILL BE MODERATED BY DAVE CLARK
CHIEF IMPLEMENTATION SCIENCE
BRANCH AT NATIONAL HEART, LUNG,
AND BLOOD INSTITUTE AND DAVE HAS
A LONG HISTORY WORKING IN NUMBER
OF PROJECTS AND PROGRAMS AND WE
LOOK FORWARD TO HEARING FROM OUR
PANELIST SGLZ THANK YOU CO-LEAD
WITH KAREN IN THE PANEL AND
GREETINGS, EVERYONE. THANK YOU
FOR STICKING AROUND.
BEFORE INTRODUCE PANEL MEMBERS A
FEW THINGS TO KICK OFF AND FIRST
FOR ORGANIZERS AND OPPORTUNITY
TO PRESENT WITH AMAZING PANEL
TODAY AND THANK YOU TO THE
AUDIENCE FOR OUTSTANDING
IMPLEMENTATION SCIENCE QUESTIONS
YOU ASKED ALREADY AND THUMBS UP
TO YOU AND THANKS TO THE
PREVIOUS PANEL FOR PILOT TESTING
THE KINKS.
WE WILL HAVE TWO QUICK PANELS
FROM THE PANELISTS TO CALIBRATE
THE SESSION AND QUESTION OF
SESSIONS TO POSE TO PANEL AND
WILL DO BEST TO MAKE SURE TO
SAVE TIME AT END FOR QUESTIONS
FROM AUDIENCE BOTH PHYSICAL AND
VIRTUAL AND I WILL START GIVING
A FEW SUPER BRIEF INTRODUCTIONS
FOR THE PANEL AND FULL AND
AMAZING BIOS ARE FOUND IN
MEETING MATERIALS AND SHAMEFUL
TRUTH COMES OUT AND BIOFOR DR.
ACCEPT UL VEDA IS OUTDATED AND
WHEN SHE IS WORKING ON DOCTORATE
AND GRADUATING 2017 I HAVE GOOD
NEWS AND CONGRATULATIONS AND I
WILL TALK ABOUT THAT MORE IN A
MOMENT.
SO, FIRST OF ALL LET ME START I
WILL RANDOMIZE AND DECIDE TO GO
IN THE ORDER THAT IS GIVEN TO ME
AND FIRST I WILL START
INTRODUCING KATE WHO IS
PROFESSOR OF OBSTETRICS AND
GYNECOLOGY AT UNIVERSITY OF
NORTH CAROLINA IN SCHOOL OF
MEDICINE AND HAVE PRIVILEGE OF
WORKING WITH HER AND HER TEAM IN
HER WORK AND WELCOME, KATE.
NEXT UP IS APPLE ACCEPT UL VEDA
PROFESSOR AND VICE CHAIR FOR
EQUITY AND INCLUSION AT
UNIVERSITY OF SCHOOL OF
MEDICINE, APPLE. APPLE IS AN
OCCUPATIONAL THERAPIST WHO
BRANCHED OUT SHE IS A PEDIATRIC
OCCUPATIONAL THERAPIST AND IS
CURRENTLY AS WE KNOW ONE PHD IS
NEVER ENOUGH.
WELCOME, APPLE. NEXT UP IS
SONYA WHO IS DIRECTOR OF RENÉ --
RESEARCH FOCUSES CULTIVATING
MATERNAL HEALTH AND WELLNESS ENL
ENGAGING CAPACITIES FOR LEARNED
COMMUNITIES AND WELCOME AND
SAVING BEST FOR LAST PERHAPS AND
NEXT IS ELIZABETH WHO IS
HARRISON DISTINGUISHED PROFESSOR
AND CHAIR OF DEPARTMENT AND
OBSTETRICS OF.
I'M HAPPY FOR THE CHANCE TO HAVE
HER AND THAT BEING SAID WE WILL
KICK OFF FIRST TALK AND WILL
HAVE DR. MENARD TO GIVE A BRIEF
INTRODUCTION TO CAL BRAELT US ON
IMPLEMENTATION SCIENCE IN
CONTEXT OF MATERNAL HEALTH.
>> COULD YOU PLEASE BRING UP MY
SLIDES FOR ME?
>> THAFRMGS YOU FOR INVITING ME
TO BE HERE. GOING TO NEXT
SLIDE, PLEASE.
STARTING WITH DISCLOSURES AND
ASKED TO GIVE BRIEF ON
INMREMENTATION SCIENCE BUT NOT
EXPERT IN IMPLEMENTATION SCIENCE
AND STUDENT OF THIS WORK AND
VERY MUCH A FAN OF THIS WAY OF
THINKING. I'M A CONVERT AND
WORKING IN IMPLEMENTATION
SCIENCE AND SPACE IN MY ENTIRE
CAREER FOCUSING ON SUPPORTING
SYSTEMS FOR EFFECTIVE MATERNITY
CARE AND QUALITY IMPROVEMENT IN
PAST FIVE OR SO YEARS THAT I
HAVE COME TO APPRECIATE VALUE
AND RIGOR THAT IMPLEMENTATION
SCIENCE BRINGS AND PERHAPS AN
OKAY PERSON TO INTRODUCE TO
FOLKS WHO DON'T REALLY WORK IN
THIS SPACE AND WANT TO LEARN
ABOUT IT.
THOSE THAT DO, CHECK E-MAIL OR
SOMETHING AND COME BACK TO ME IN
EIGHT MINUTES WHEN I TELL YOU
ABOUT OUR PROJECT.
YOU MIGHT READ NEXT SLIDE,
PLEASE.
ONE MIGHT READ A NUMBER THAT I
WILL GO OVER AMD IT IS A FEW
DEFINITIONS AND A LITTLE ABOUT
OUR PROJECT.
CONDITIONS TO SUCCESSFULLY
IMPLEMENT AND SUSTAIN NEW
PROGRAMS AND INNOVATIONS AND
OPERATIVE WORSE IS A PROCESS
RESULTING IN SUSTAINABLE CHANGE
AND NEXT SLIDE. IT HAS BEEN
WIDELY REPORTED THAT
EVIDENCE-BASED PRACTICES TAKE
AVERAGE OF 17 YEARS TO BE
INCORPORATED INTO ROUTINE
GENERAL PRACTICE AND HEALTH CARE
AND CAN'T WORK WITH THAT AND
EVEN WITH THAT TIMEFRAME, A
SMALL FRACTION ARE REALLY FULLY
IMPLEMENTED FOR POPULATION
BENEFIT IN SUSTAINABLE MANNER
AND THIS DIAGRAM TAKES IF THERE
IS 100% EFFECTIVE EVIDENCE-BASED
INTERVENTION ABOUT 50% OF
PROVIDERS IN ORGANIZATIONS
ADOPTED.
NOW WE ARE DOWN TO 50 AND 50% OF
THOSE ADOPTED DO IT WITH
FEDELITY AND DO IT RIGHT AND ARE
DOWN TO 25 AND 50% OF THOSE
REACH DOWN TO POPULATION THAT
NEED IT MOST AND NOW WE ARE DOWN
TO 6 THAT IS ABYSMAL IN COMES
IMPLEMENTATION SCIENCE TO
IMPROVE ON ABYSMAL 6% FULL
IMPLEMENTATION.
NEXT SLIDE.
SO, WHAT IS IMPLEMENTATION
SCIENCE?
IMPLEMENTATION SCIENCE IS,
AGAIN, YOU WILL HEAR DIFFERENT
DEFINITIONS THAT IS A SYSTEMATIC
STUDY OF VARIABLES AND
CONDITIONS LEADING TO FULL AND
EFFECTIVE USE OF EVIDENCE-BASED
PROGRAMS AND EFFECTIVE
INTERVENTIONS IN TYPICAL HUMAN
SETTINGS STUDYING THINGS IN A
FISH BOWL AND CLINICAL TRIAL
LABORATORY SORT OF SETTING AND
FIGURING OUT HOW TO GET INTO A
TYPICAL KIND OF HUMAN SERVICE
SETTING.
NEXT SLIDE.
THIS IS A REAL SIMPLE WAY OF
THINKING ABOUT IT. CLEAR AND
BASIC ACHIEVING WHY WHICH IS
IMPROVED MATERNAL CHILD AND
FAMILY COMMUNITY OUTCOMES THEN
WE NEED THE WHAT THAT IS
EFFECTIVE INTERVENTION
EVIDENCE-BASED INTERVENTION AND
WE NEED EFFECTIVE IMPLEMENTATION
AND THAT IS THE HOW. HOW WE GO
ABOUT DOING IT AND WE NEED
ENABLING CONTEXT WHO AND WHERE
AND IF ANY BOXES IN PURPLE ARE
ZERO AND IF WE DON'T HAVE HOW OR
AN EFFECTIVE HOUSE OR DON'T HAVE
EFFECTIVE IMPLEMENTATION CONTEXT
AND THOSE ARE 0S, WHY IS 0. IF
ANY IS SMALL OR MARGINALLY
OPERATIVE, WE HAVE A VERY SMALL
MAGNITUDE OF THE WHY.
SO THIS IS WHERE IMPLEMENTATION
SCIENCE COMES IN TO KIND OF MAKE
MIDDLE BOXES NICE AND ROBUST.
NEXT SLIDE, PLEASE.
THERE IS A LOT OF DIFFERENT VERY
THOUGHTFUL AND PROVEN FRAMEWORKS
FOR IMPLEMENTATION SCIENCE AND
PRACTICE AND CUT MY TEETH ON
ACTIVE IMPLEMENTATION FRAMEWORK
WHICH IS DESCRIBED BYTISMED
[INDISCERNIBLE] AND COLLEAGUES
AT UNC AND IN THIS KIND OF
PROVIDING DIAGRAMISTS COMPLEX
AND SIMPLE AT SAME TIME
STRUCTURE.
HERE INCLUDES A LOT OF DETAIL
TAKING USABLE INTERVENTION ON
FAR LEFT DESCRIBING IT WELL AND
GOING THROUGH A STAGE-BASED
PROCESS OF PUTTING IT INTO
PRACTICE AND IS ONE OF MANY
FRAMEWORKS.
NEXT SLIDE.
AT THE CORE, AT LEAST IN MY
VIEW, VARIOUS FRAMEWORKS ARE ALL
SIMILAR AND THE [INDISCERNIBLE]
ARE DIFFERENT AND BUILD UPON
EACH OTHER AND IMPLEMENTATION
SCIENCE ONE BEGINS WITH
EVIDENCE-BASED INTERVENTION,
ALWAYS THAT. THAT IS THE WHAT;
RIGHT?
HOW IS IT IMPLEMENTED?
THIS IS ADAPTED FROM
[INDISCERNIBLE] FRAMEWORK HOW IT
IS IMPLEMENTED DEFINES
STRATEGIES HOW IT IS IMPLEMENTED
IN THE REAL WORLD AND STRATEGIES
ARE RIGOROUSLY MEASURED ALONG
THE WAY AND WE KNOW WE ARE
IMPLEMENTING IT IN REAL WORLD
AND IS COMPLIANCE WITH
MEDICATION, IF WILL YOU, ALONG
THE WAY AND FOR THOSE THAT DO
CLINICAL DRUG TRIALS THAT IS ALL
CENTRAL TO THE WORK.
IT -- IN THE END, WE HAVE
IMPLEMENTATION OUTCOMES THAT ARE
MEASURED AND ULTIMATELY
EFFECTIVE OUTCOMES AND NEXT
SLIDE.
SO, IN ADDITION TO BEING
EFFECTIVE INTERVENTIONS NEED TO
REACH INTENDED PATIENTS AND
POPULATIONS AND NEED TO BE
ADOPTED BY PROVIDERS AND
PRACTICE SETTINGS AND NEED TO BE
IMPLEMENTED WITH FIDELITY AS
DESIGNED AND NEED TO BE
MAINTAINED OVER TIME THAT IS
REAIM FRAMEWORK. NEXT SLIDE.
IF WE WANT TO REALLY TALK ABOUT
HEALTH DISPARITIES,
IMPLEMENTATION OF HEALTH
DISPARITIES, REACH IS POPULATION
YOU ARE REACHING REPRESENTATIVE
OF INTENDED POPULATION AND
IMPORTANTLY IF LOOKING AT HAEMTH
DISPARITIES ARE YOU REACHING
THOSE AT GREATEST RISK?
ADOPTION ARE SETTINGS AND
PROVIDERS ADOPTING OR
REPRESENTATIVE OF OVERALL
POPULATION?
AGAIN, IF WE LOOK AT
DISPARITIES, ARE PROVIDERS AND
SETTINGS WHO WORK WITH THOSE
GREATEST RISK ADOPTING THE
INTERVENTION?
ARE THEY ABLE TO ADOPT
INTERVENTION AND RESOURCES TO
ADOPT INTERVENTION? NEXT SLIDE,
PLEASE.
WE HAVE A BIT OF CONVERSATION
ABOUT COMMUNITY ENGAGEMENT AND
THIS IS THE CORE TO ADDRESSING
HEALTH DISPARITIES ISSUES AND
ACUTE ENGAGEMENT WE HEARD FROM
COLLEAGUES TODAY NEEDS TO BE
ENTWINED THROUGHOUT AND
COMMUNITY ENGAGEMENT WHEN YOU DO
IT AND WHEN YOU DO THAT YOU ARE
IDENTIFYING THE PROBLEM FROM THE
VERY START AND SELECTING
INTERVENTION TO TARGET THE
PROBLEM ENGAGING COMMUNITY WHEN
ASSESSING INTERVENTION WHERE IT
WILL FIT WITH PRACTICE CONTEXT.
ENGAGE THE COMMUNITY WHEN YOU
SELECT, FINALLY SELECT
IMPLEMENTATION STRATEGIES
DEVELOPING IMPLEMENTATION PLAN
AND CONTINUE TO ENGAGE COMMUNITY
WHEN YOU EVALUATE IMPLEMENTATION
AND EFFECTIVENESS OUTCOMES.
NEXT SLIDE.
I WILL TAKE A FEW MINUTES TO
TALK ABOUT THE PROJECT THAT WE
ARE WORKING ON.
IT WAS A COALITION IN NORTH
CAROLINA ACHIEVE PRODUCT
STANDING FOR ADVANCING COMMUNITY
AND CLINICAL CARE FOR CHILDBIRTH
RELATED HYPERTENSION ENGAGEMENT
AND VALUING EQUITY AND WHERE
THIS STARTED I WORK WITH NORTH
CAROLINA MATERNAL HEALTH
INNOVATIONS GRANT AND FOR REGION
FAR BEFORE RFA CAME OUT AND WE
WERE TASKED WITH GOING TO
PRACTICES IN OUR REGION TO ASK
WHAT CAN WE DO IN THE COMMUNITY
AND NOW IN CLINICS AND
OUTPATIENT SETTING WHAT WE CAN
DO TO IMPACT MATERNAL MORBIDITY
AND MORTGAGE ALET THAT CLOSE THE
GAP WE SEE IN NORTH CAROLINA IN
ADVERSE OUTCOMES AND THEME WE
HEARD IS THAT WE NEED TO FIGURE
OUT HOW TO TREAT HYPERTENSION
BETTER IDENTIFYING PREELAMBSIA
AND TREATING IN TIMELY MANNER WE
HAVE TO DO BETTER AND RESONATED
WITH ME.
I HAVE WORKED WITH QUALITY
IMPROVEMENT FOR A WHILE NOW
INCLUDING IMPLEMENTING AIMED
HYPERTENSION BUNDLE IN OUR STATE
AND ACROSS THE COUNTRY AND
MOVING INTO OUTPATIENT SETTING
IS A COMPLETELY DIFFERENT STORY.
I HAD -- I WAS ENLIGHTENED BY
MENTORS AND OTHERS AT UNC TO
KNOW IT WASN'T GOING TO BE SAME
AND WE NEEDED TO KIND OF THINK
ABOUT ADAPTING IT AND APPLYING
DIFFERENT PERFECT INSIMS TO DO
IN OUTPATIENT SETTING AND NEEDED
COMMUNITY ENGAGEMENT TO DO IT AS
WELL. CAME GRANT FROM NHLBI TO
DO MATERNAL HEALTH ENGAGEMENT
IMPLEMENTATION PROJECT AND LET'S
GO FOR IT AND RFA CAME TO
ATTENTION AND SEEMED LIKE PLACE
WE ARE MEANT TO BE AND APPLIED
AND GRANTED PHASE 1 AND THIS IS
ILLUSTRATION WE DECIDED TO DO IN
PHASE 1. ASSEMBLED COULD HE
ALISTING OF ALREADY ESTABLISHED
COMMUNITY PARTNERS PROVIDING
HIGH RISK CARE IN FCS FOR
REGIONS FOR MANY YEARS AND HAD
IN BEGINNING OF TRUST AND DIDN'T
DO LOTS OF RESEARCH IN THAT
COMMUNITY AND WE HAD ALREADY A
TRUSTED RELATIONSHIP.
WE -- WE -- THESE WERE FEDERALLY
QUALIFIED HEALTH CLINICS THAT WE
DID KEY INFORMATIVE INTERVIEWS
WITH PRENATAL CARE PROVIDERS IN
THREE CLINICS AND FOCUS GROUPS
THAT BOTH HAVE BLACK GROUPS AND
WITH SPANISH-SPEAKING GROUPS AND
PATIENTS AND THEIR RELATIVES AND
DECIDED WITH INPUT THEN DECIDED
TO FOCUS IMPLEMENTATION
STRATEGIES WITHIN THE BUNDLE
CERTAIN ELEMENTS OF THE BUNDLE
TAKING BLOOD PRESSURE PROPERLY
AND GOOD TECHNIQUE MAKING SURE
EARLY WARNING SIGNS AND
RECOGNITIONING WITH WELL
UNDERSTOOD AND EVALUATION AND
TREATMENT WAS APPROPRIATE AND
ESCALATION WAS BEING DONE PRO
EPTLY AND THIS WOULD BE FIRST
STEP AND NOT ALL INCLUSIVE AND
WAS REALLY THROUGH THE COURSE OF
YOU COULD SEE ACROSS THE BOTTOM
WE ENGAGE COMMUNITY ALL ACROSS
THAT.
WHAT WE LEARNED FROM THIS GROUP
IS IT WASN'T ENOUGH AND WE
REALLY NEEDED TO DO IN THE
CONTEXT OF DOING THIS, WE NEEDED
TO MAKE SURE WE WERE DOING IT
COMPLETELY IN -- IN -- YOU KNOW,
IN CONTEXT OF PROVIDING
RESPECTFUL CARE IN MANNER
ACCEPTABLE TO THOSE OF GREATEST
RISK AND NEEDED TO MAKE SURE WE
WEREN'T MISSING MARK AND HEARD
LOUD AND CLEAR FROM THE
COMMUNITY INPUT AND INCORPORATED
THAT INTO OUR PHASE 2 PLAN.
NEXT SLIDE.
AT END OF PHASE 1 COALITION CAME
TOGETHER THAT IS AN ILLUSTRATION
OF THAT CONVERSATION.
IF I HAD A POINTER, I WOULD
POINT YOU TO THE MIDDLE OF PINK
SORT OF LOWER AREA IT SAYS
ENGAGE GENUINELY AND WHAT WE
HEARD FROM OUR COALITION AND
WHAT WAS WORKING AND WE NEEDED
TO CONTINUE TO DO.
WE NEEDED TO QUOTE MOVE AT SPEED
OF TRUST, UPPER RIGHT-HAND
CORNER. IN DOING SO GO BEYOND
PATIENTS AND FAMILIES AND DARKER
BLUE UPPER SECTION GOING BEYOND
FAMILIES ENGAGING CAREGIVERS AND
FAMILIES AND NEEDED TO ENGAGE
WHERE PEOPLE WERE IN THE
COMMUNITY INCLUDING CHURCHES AND
SO ON AND IMPORTANTLY RIGHT
LOWER QUADRANT WE NEEDED TO
CHANGE THE SYSTEM NOT PEOPLE.
SO, THIS IS SORT OF INSPIRATION
FOR US TO MOVE INTO PHASE 2.
NEXT SLIDE, PLEASE.
THIS IS KIND OF A SNAPSHOT WHAT
WE ARE DOING IN PHASE 2.
PLANNING FOR YOU -- CALLING ON
PHASE 1 LEARNINGS WE ARE TESTING
STRATEGIES IN 20 CLINICS IN OUR
REGION AND WITH PATIENT AND
PROVIDER LEVEL AND BROADER
COMMUNITY INPUT THROUGHOUT WE
ARE PROVIDING CLINIC WITH
TRAINING COACHING STIM YOU'LL
ACE ON RECOGNITION RESPONSES TO
SEVERE HYPERTENSION AND PATIENT
INFORMED EDUCATION PROCESSES AND
PATIENT INFORMED EFFORTS TO
DELIVER RESPECTFUL CARE AND PLAN
TO RIGOROUSLY DO IMPLEMENTATION
OUTCOMES AND SUCCESS IN HOW WE
ENGAGE COMMUNITY AND DIFFERENCE
THAT CAN MAKE AND YOU SEE ON
RIGHT-HAND SIDE THAT OUR -- WE
HAVE IMPLEMENTATION OUTCOMES
LISTED THERE AND OUR CLINICAL
OUTCOMES IN THE YELLOW BOX.
AND TIME IS LIMITED. I WILL
STOP THERE.
I WILL GO TO THE NEXT PANELIST.
>> THANKS SO MUCH,
KATE. THAT WAS FANTASTIC. NOW
ON TO THE NEXT SPECTACULAR
PRESENTATION AND TURNING THINGS
OVER TO DR. SEP UL VEDA FOR
IMPLEMENTATION ON TECHNOLOGY AND
IMPLEMENTATION SCIENCE.
>> THANK YOU. HI, EVERYONE.
SUCH AN HONOR TO BE HERE TODAY
AND THANKS FOR THE INSIGHT.
NEXT SLIDE, PLEASE.
SO, MATERNAL DEPRESSION IS A
VERY COMMON OBSTETRIC
COMPLICATION AND 20% OF
PHYSICIANS SCREEN FOR DEPRESSION
HOWEVER 15% OF WOMEN THAT ARE
SCREENED ONLY GET ACCESS TO
CARE.
I'M NOT A PHYSICIAN BUT AN
OCCUPATIONAL THERAPIST AND HAVE
OPPORTUNITY TO ACCESS WOMEN THAT
ARE DEPRESSED THAT HAVE MISSED
SCREENINGS FROM PEDIATRICIANS
AND OUR INNOVATION IS MAMA. YOU
HEARD MAUREEN TALK ABOUT THIS
SCREENING AND REFERRAL AND
ONGOING SUPPORT TOOL THAT
STREAMLINES MATERNAL DEPRESSION
SCREENING AND NOTIFIES PROVIDERS
ABOUT THE RESULTS OF THIS
SCREENING AND PROVIDES THEM
TALKING POINTS AND TRIAGE
NUMBERS TO HELP THESE IN CASE
THEY NEED CONSULTATIONS AND ALSO
THESE MAMA HAS CARE COORDINATORS
TO LINK MOTHERS TO REFERRALS AND
PROVIDE PSYCHOEDUCATIONAL
SUPPORT AND PROVIDES WARM
HAND-OFF TO MENTAL HEALTH
PROVIDERS IF NEEDED.
NEXT SLIDE, PLEASE.
YES. THAT IS OUR INNOVATION.
AND SO MOMA HAS BEEN IMPLEMENTED
IN NICUS AND OBGYN CLINICS AND
I'M NOT A PHYSICIAN.
I'M AN EARLY INTERVENTION
OCCUPATIONAL THERAPIST THAT
SERVES FAMILIES OF CHILDREN WITH
DEVELOPMENTAL DISABILITIES AND
THESE ARE FAMILIES THAT ARE
COMING FROM THE NICU AND THESE
MOMS THAT ARE VERY -- THEY ARE
EXPERIENCING LOTS OF STRESS
BECAUSE THEIR BABIES ARE AT RISK
FOR DEVELOPMENTAL DELAYS OR HAVE
PREMATURITY OR ANY CONGENITAL
DISORDERS.
NEXT SLIDE, PLEASE.
I USE IMPLEMENTATION FRAMEWORK
AND IMPLEMENTATION SCIENCE TO
LEVERAGE USE OF MOMMA IN EARLY
INTERVENTION MOMMA UTILIZES A
MINDFUL APPLICATION OF
IMPLEMENTATION FRAMEWORKS WHICH
INTEGRATES KNOWLEDGE CREATION
AND ACTION CYCLES TO TAILOR TO
NEEDS OF POPULATION THAT IS THE
PATIENTS IN EARLY INTERVENTION
SETTINGS THAT ALSO USES
CONSOLIDATED FRAMEWORK FOR
IMPLEMENTATION RESEARCH THAT IS
DETERMINED FRAMEWORK TO GIVE
LOTS OF INFORMATION ABOUT
FACTORS THAT INFLUENCE USE OR
IMPLEMENTATION OF INNOVATION AND
WE USE BEHAVIOR-CHANGED THEORIES
TO INFORM US OF IMPLEMENTATION
MODULES THAT ARE SUCH AS
BEHAVIORAL CHANGE AND
[INDISCERNIBLE] DIFFUSIONS OF
INNOVATIONS AND WE WILL FINALLY
CONSIDER REAIM FRAMEWORK AS KATE
WAS TALKING ABOUT TO EVALUATE
OUTCOMES AND TODAY I WILL
DISCUSS IN DETAIL THIS C FOR
MODEL CONSOLIDATED FRAMEWORK FOR
IMPLEMENTATION RESEARCH.
SO, CONSOLIDATED FRAMEWORK FOR
IMPLEMENTATION RESEARCH OR C FOR
IS DETERMINATING FRAMEWORK THAT
INFLUENCES IMPLEMENTATION OF
INNOVATIONS AND ILLUSTRATES A
ROADMAP THAT ORGANIZES
CONSTRUCTS WITHIN DOMAINS THAT
IDENTIFY AND EXPLAIN FACTORS AND
JOINING FROM 19 THEORIES AND
MODELS AND FRAMEWORKS AND C FOR
HAS FIVE MAJOR DOMAINS THAT ARE
INTERVENTION AND OUTER SETTING
AND INNER SETTING AND INDIVIDUAL
CHARACTERISTICS AND PROCESS AND
I PARTICULARLY USE C FOR TO
IDENTIFY BARRIERS AND
FACILITATORS OF UPTAKE OF MOMA
WITH EARLIER INTERVENTION
TALKING TO STAKEHOLDERS AND
POTENTIAL USERS OF MOMMA AND
CURRENT USERS AND WE DETERMINE
THE THAT THERE ARE DIFFERENT
FACILITATORS AND BARRIERS WITHIN
5 CONSTRUCTS AND SO FOR
INTERVENTION CHARACTERISTICS WE
FOUND THAT COMPLEXITY AND COSTS
ARE DETERMINANTS AND IT IS SO
COMPLEX THAT EARLIER
INTERVENTION PROVIDERS SCREEN
FOR DEPRESSION BECAUSE WE ARE
NOT PROVIDERS FOR MOTHERS AND WE
ARE PROVIDERS FOR CHILDREN AND
IN OCCUPATIONAL THERAPIES WE ARE
VERY CHILD FOCUSED AND TALKING
ABOUT CHILD'S MOM'S MENTAL
HEALTH MAKES THERAPISTS APP
REHENCESIVE AND HAVE TO
DETERMINE THAT BARE WHIER TO
SCREENING AND COST AND WE GO BY
FEE-FOR-SERVICE MODEL. THERE IS
NO REIMBURSEMENT FOR SCREENING
FOR POSTPARTUM DEPRESSION AMONG
EARLY INTERVENTION CLIENTS AND
FOUND IN OUTER SETTINGS PEER
PRESSURE AND EXTERNAL POLICIES
AND INCENTIVES ARE BARRIERS.
NO ONE ELSE IS DOING IT AND NO
PEER PRESSURE TO SCREEN FOR
DEPRESSION AMONG CHILDREN WITH
DISABILITIES RECEIVING EARLY
INTERVENTION AND IS NO POLICIES
IN PLACE AND WE FOUND IT AS A
BARRIER. WE WERE USED TO
BUSINESS AS USUAL AND THIS IS
HOW CARE IS PROVIDED AND WHY WE
NEED TO CHANGE IT AND ANOTHER
INDIVIDUAL CHARACTERISTICS UNDER
CONTRACTS OF INDIVIDUAL
CHARACTERISTICS WE FOUND THAT
FACILITATORS ARE MOTIVATION OF
PROVIDERS AND ALSO BELIEF THAT
SCREENING IS GOOD.
SCREENING PARENTS ALSO HELPS
BABIES AND SO THEY -- THESE --
THE PROVIDERS THAT SCREEN ARE
VERY MOTIVATED TO HELP THESE
PARENTS AND BLEF THAT EARLY
INTERVENTION MODEL IS MORE
FAMILY CENTERED VERSUS CHILD
CENTERED AND WE FOUND OUT THAT
IN CONSTRUCTS OF INNER SETTING
IMPLEMENTATION CLIMATE IS VERY,
VERY IMPORTANT AND IS DEGREE OF
RECEPTIVENESS OR SUPPORT THAT
PROVIDERS RECEIVE WITHIN
ORGANIZATION HOW MUCH SUPPORT
THE ORGANIZATION GIVES TO THEM
IS VERY, VERY IMPORTANT IN
SETTING UP THE, YOU KNOW, THE
INNOVATION TO MAKE SURE THAT
INNOVATION IS IMPLEMENTED AND
SUCCESSFUL AND LASTLY IN PROCESS
CONSTRUCT IS IMPORTANT ENGAGE
USERS IN PLANNING, ENGAGING,
EXECUTING AND IN EVALUATION AND
REFLECTION OF LEARN IING EVERY Y
THEY PRACTICE THIS EARLY
INTERVENTION PROVIDERS ARE
OCCUPATIONAL THERAPISTS DOING
THIS WORK ARE NOT VERY
COMFORTABLE WITH JUST THIS
SCREENING THAT ALONE IS USING
THE APP.
IN THAT SENSE, THAT IS HOW I USE
THE IMPLEMENTATION FRAMEWORK TO
HELP P ME INFORM WHAT ARE
FACTORS THAT INFLUENCE
IMPLEMENTATION OF THE APP AND
NEXT SLIDE, PLEASE.
USING SAME FRAMEWORK WE
IMPLEMENT GOALS AND
IMPLEMENTATION STRATEGIES THAT
IS VERY STRATEGIC AND
SYSTEMATIC.
WE DETERMINE THAT GOALS ARE TO
GARNER BUY-IN TO EDUCATE MORE
PROVIDERS ABOUT IMPORTANCE OF
FAMILY CENTERED CARE AND NOT
FOCUSING REALLY ON JUST THE MOM
OR CHILD BUT MORE OF THE FAMILY
AND ENGAGING IN OTHER POLICY
LEADERS ABOUT ALTERNATIVE WAYS
TO INCENTIVIZE EARLY
INTERVENTION PROVIDERS AND SO
THAT THEY CAN USE SCREEN MORE OR
USE OF APP MORE.
NEXT SLIDE, PLEASE.
USING THE PROCTORS TAXONOMY, WE
ARE ABLE TO ALSO IMPLEMENT, USE
IMPLEMENTATION STRATEGIES AND
IMPLEMENTATION OUTCOMES THAT IS
VERY, VERY IMPORTANT IN
TECHNOLOGY. IT IS IMPORTANT
THAT TECHNOLOGIES ARE LATER
ADOPTED VERSUS SUSTAINABLE AND
IT IS PENETRATED IN USE FOR
ROUTINE PRACTICE. NEXT SLIDE,
PLEASE.
NEXT STEPS AS EARLY RESEARCHER
IS USING MIXED METHODS DESIGNED
TO USABILITY AND ACCEPTABILITY
OF MOMMA IN DEPRESSION SCREENING
REFERRAL AND SUPPORT IN EARLY
INTERVENTION.
THANK YOU.
>> THANK YOU SO MUCH FOR A
FANTASTIC PRESENTATION. SO, WE
ARE GOING TO JUMP INTO QUESTIONS
THAT I HAVE DONE IN ADVANCE THAT
CIRCULATED THAT WILL BRING
ENTIRE PANEL AND DO START TO
THINK ABOUT QUESTIONS FROM THE
STUDIO AUDIENCE AND FIRST
QUESTION TO POSE IS HOW DO YOU
INTEGRATE COMMUNITY ORGANIZATION
AND COMMUNITY PERSPECTIVE INTO
WHAT YOU DO?
SUBQUESTION TO THAT IS OUR WAY
OF IMBEDDING EQUITY TO WORK FOR
ROLLOUT OF PROJECTS?
ELIZABETH, WOULD YOU MIND
TERRIBLY IF I STARTED WITH SNU.
>> NO. THANK YOU SO MUCH FOR
INCLUDING ME THIS AFTERNOON.
IT WAS A PLEASURE TO HEAR BOTH
PRIOR SPEAKERS AND LEARNED A LOT
FROM DR. MENARD. I'M NOT AN
IMPLEMENTATION SCIENTIST BUT A
BEGINNER AND APPRECIATE WORK I
SEE MY COLLEAGUES HERE DO AT PEN
AND IN THIS SPACE AND WHEN I
THINK ABOUT THIS AND YOU ASKED
ME AND I'M THINKING ABOUT
MATERNAL HEALTH COMMUNITY
ORGANIZATIONS AND TECHNOLOGY AND
HOW WE THINK ABOUT THIS AND MAKE
SURE THAT COMMUNITY IS PART OF
THE PROCESS.
I'M A HEALTH SERVICES RESEARCHER
AND SORT OF THINK ABOUT MATERNAL
HEALTH WITH A SORT OF ROOT
CAUSES OF STRUCTURAL RACISM AND
THINK ABOUT THE PATIENT
CLINICIAN AND COMMUNITY AND
SYSTEM FACTORS AND WANT TO JUST
POINT OUT THAT IN EACH OF THE
STAGES THAT WHEN WE THINK OF
UNDERLYING FACTORS CAUSING
MATERNAL HEALTH IN EQUITIES,
THERE IS A ROLE OR A PLACE FOR
COMMUNITY AND COMMUNITY
ORGANIZATIONS TO BE PART OF
THAT. AND TO HELP OUR
UNDERSTANDING. AT ANY POINT YOU
CAN THINK ABOUT PATIENT LEVEL
FACTORS AND EDUCATION AND RACE
ETHNICITY AND OTHER THINGS TO
THINK ABOUT AND NEIGHBORHOODS
WHICH PEOPLE LIVE AND
COMMUNITIES WHICH THEY LIVE AND
CLINICIAN BIAS AND THEY ALL FORM
SORT OF THE STATUS OF A BIRTHING
PERSON WHETHER OR NOT THEY HAVE
DEPRESSION OR NOT OR HAVE
ANOTHER COMORBIDITY AND GET TO
FINAL OUTCOME AND KEY POINT TO
MAKE HERE IS AROUND THE CARE
CONTINUUM AND PRECONCEPTION
ANTI-NATAL AND POSTPARTUM ARE
TIMES THAT WE CAN INTERVENE AND
HAVING PERSPECTIVE ON
INTERVENTION FROM TIME POINT
FROM COMMUNITY ORGANIZATIONS AND
PATIENT VOIZE IS INCREDIBLY
IMPORTANT AND THEMES TO BRING IN
HERE, ONE, QUALITY OF CARE IS SO
CRITICAL AND WHETHER OPTIMIZING
PRECONCEPTION HELP OR
STANDARDIZING LABOR AND DELIVERY
PRACTICES WITH BUNDLES YOU HEARD
ABOUT OR OTHER FACTORS OR
SIMULATIONS.
WHATEVER WAY QUALITY OF CARE IS
REALLY IMPORTANT AND LAST FACTOR
I WANTED TO MAKE SURE WE THINK
ABOUT THINKING ABOUT
TECHNOLOGIES ROLE IN THIS SPACE
IS SOCIAL DETERMINANTS OF HEALTH
AND ADDRESSING PRACTURED CARE
YOU ARE EXPERIENCING AND HOUSING
AND TRANSPORTATION BARRIERS AND
ALL THOSE THINGS AND YOU HEARD A
POWERFUL PANEL BEFORE COMMUNITY
ORGANIZATIONS AND HEARING FROM
DR. MENARD THINKING ABOUT IT
FROM VERY BEGINNING HOW I GO
ABOUT THIS AND THINKING OF TWO
DIFFERENT FRAMEWORKS DEPARTMENT
CLINICAL HEALTH FIRST AND
FOREMOST IS PATIENT'S VOICE AND
COMMUNITY ORGANIZATIONS AND SO I
WILL START WITH REALLY QUICKLY A
EXAMPLE ON RESEARCH SIDE AND HOW
WE MIGHT THINK ABOUT THIS.
STARTING A STUDY AND HAVING IT
ONGOING FUNDED BY NIH AND
CALLING IT VIBE STUDY LOOKING AT
STRUCTURAL RACISM AND COVID
PANDEMIC AND PARTICULARLY
ECONOMIC STRESS AND POSTPARTUM
OUTCOMES AND ARE UTILIZING
TECHNOLOGY AND WAY TO HEALTH
PLATFORM TEXTING BLOOD PRESSURE
MEASUREMENT AND OUTCOME IS BLOOD
TRAJECTORIES IN LAST FEW MONTHS
AND BROUGHT COMMUNITY PARTNERS
IN FROM VERY BEGINNING AND
STARTED BY SORT OF HAVING A
MOMENT OF REFLECTION FOR ALL OF
US ABOUT WHO WE ARE AND WHERE WE
COME FROM.
YOU ARE HEARING ABOUT
POSITIONALITY AND UNDERSTANDING
CONTEXT OF THE PEOPLE TRYING TO
ROLL OUT INTERVENTION AND
UNDERSTANDING EVERYONE AN THE
TABLE TALKING ABOUT
UNDERSTANDING BUY IN AND RIGHT
PROBLEM THEY CARE ABOUT THIS
ISSUE AND WANT TO WORK ON IT
WITH YOU.
EXPRESSING THOSE, YOU KNOW,
HAVING EVERYONE TALK ABOUT IT.
WE STARTED OUR PROCESS THAT WAY
AND HAD ACTUALLY A COUPLE
POWERFUL SESSIONS THAT WAY AND
WE MOVED ON TO MAKING SURE THE
COMMUNITY -- OUR COMMUNITY
REPRESENTATIVES LOOKED AT ALL
OUR SCALES WE HAD ON RACISM AND
MICRO AGGRESSIONS, ET CETERA.
DID THEY BUY THEM OR NOT? WE
DID WORK IN THAT SPACE AND NOW
MOVING THROUGH COLLECTION OF
DATA AND DOING ANALYSIS WE
CONTINUE TO SHAIR DATA GETTING
IMPACT LAND BE WORKING WITH THEM
FOR DISSEMINATION AND THIS IS A
RESEARCH STUDY NOT ALL ABOUT
IMPLEMENTATION SCIENCE AND
MESSAGE STARTING FROM BEGINNING
HAVING INPUT WORKING WITH YOU ON
EACH STAGE MAKING SURE YOU GET
INVOLVED ABOUT CONTEXT IN WHICH
USERS WILL BE OR YOUR POPULATION
THAT YOU ARE TRYING TO SERVE.
WHO ARE THEY AND WHAT ARE THEIR
NEEDS IS AN IMPORTANT PART OF
THE PROCESS. I WILL STOP THERE
AND WILL ANSWER MORE QUESTIONS
ON THIS LATER.
>> THANK YOU SO MUCH. KATE,
WANT TO JUMP IN?
>> YEAH. BRIEFLY I THINK SHE
DID A GREAT JOB EXPLAINING HER
PERSPECTIVE ON THIS AND THINK I
TOUCHED ON IT IN MY PRESENTATION
ALREADY AND BEGINNING TO END AND
ANSWER TO HOW DOING IT TAKING
TIME WITH RELATIONSHIPS AND
STARTING WITH ACHIEVED PROJECT
AND PROPOSAL AND PROVIDERS IN
FQHCS WE COULDN'T WORKING OUT OF
UNIVERSITY OUR EXPERIENCE WAS
DIFFERENT THAN WORKING IN FQHC
AND STARTED DEFINING THAT AS OUR
COMMUNITY AND COMMUNITY
PROVIDERS WOULD HELP SELECT
WHICH ELEMENTS OF BUNDLE TO
FIRST IMPLEMENT AND SO ON AND
SAME TIME NO, NO, NO. WE CAN'T.
THAT IS NOT ENOUGH AND WE NEED
TO ENGAGE INDIVIDUALS AND
PREGNANT INDIVIDUALS WE ARE
CARING FOR IN THE CONVERSATION
AND WE PIVOTED AND WENT TO SAY
AND THEY WANTED TO TALK ABOUT
RESPECTFUL CARE AND WE ASKED
PATIENTS IN FOCUS GROUPS WHAT
RESPECTFUL CARE MEANS TO YOU AND
ASKED PROVIDERS IF FQHCS WHAT
RESPECTFUL CARE MEANS TO YOU AND
LEARNING THAT AND MAGICALLY
THERE WAS SOME OVERLAP AND ALSO
SOME LEARN THAGZ CAME OUT OF
THAT.
SO, IF NOW IN THE SECOND STAGE
PHASE 2 OF PROJECT WE HAVE
COMMUNITY PROVIDERS AS DEFINING
COMMUNITY THAT WAY THEY ARE
COMMUNITIES SO DIFFERENT THAN
UNIVERSITY-BASED RESEARCHERS.
WE HAVE PREGNANT INDIVIDUALS
THEY ARE CARING FOR AND
POSTPARTUM INDIVIDUALS AND HAVE
BROADER COMMUNITY INFLUENCERS
AND COMMUNITY-BASED
ORGANIZATIONS.
>> THANK YOU SO MUCH.
>> MOVING TO SECOND QUESTION IF
YOU HAVE OTHER PANELISTS THAT
WOULD LIKE TO JUMP IN RAISE
VIRTUAL OR PHYSICAL HAND AND LET
ME KNOW AND WE WILL PAUSE TO
MAKE TIME FOR YOU. NEXT
QUESTION WHAT IMPLEMENTATION
STEPS ARE CRITICAL TO ADJUST AND
INCLUDE FOR THOSE IN LOW
RESOURCE AND UNDERSERVED
SETTINGS.
APPLE COULD I TAG YOU FIRST?
>> YES. THANK YOU. ISSUE IS
UNDERSERVED OR UNDERRESOURCED
ARE USING TECHNOLOGIES OR
INNOVATIONS THAT ARE DEVELOPED
AND EVALUATED WITHOUT THEM
TAKING PART IN RESEARCH AND
EFFICACY RESEARCH IS NOT
REACHING REALLY THE UNDERSERVED
AND SO I RECOMMEND THAT REALLY
FOCUSING ON REACH AND REACH
THOSE UNDERSERVED COMMUNITIES
BEFORE YOU DO RESEARCH.
DESIGN RESEARCH WITH
IMPLEMENTATION IN MIND.
RIGHT?
THAT THINK ABOUT THE HOW. IS
THIS GOING TO BE ADAPTABLE?
CAN THIS BE TAILORED IN
DIFFERENT CONTEXT?
ALSO DO PARTICIPATE --
COMMUNITY-BASED PARTICIPATORY
RESEARCH AND LET COMMUNITY
PARTICIPATE IN ASKING RIGHT
QUESTIONS AND LET THEM HELP YOU
FORMULATE QUESTION AND HAVE
THEIR OWN SOLUTION AND MAYBE
THEY ARE NOT RESEARCHERS ABOUT
YOU HAVE LIVED EXPERIENCE AND
CAN HELP YOU GENERATE SOLUTIONS
AND ALSO BALANCING BETWEEN
EFFICACY AND EFFECTIVENESS,
RESEARCHERS ARE FOCUS OF EVERY
RESEARCHER IS THIS INNOVATION
EFFECTIVE AND EFFICACIOUS AND
NOT REALLY THINKING ABOUT HOW
AND AS WELL IF THIS IS EFFECTED
OR NOT.
>> FANTASTIC. THANK YOU,
APPLE.
ELIZABETH, ANYTHING TO ADD TO
THIS?
>> POINTS ARE WELL TAKEN AND
REALLY IMPORTANT TO THINK ABOUT
HOW AND HAVE THAT VOICED FROM
THE BEGINNING AND YOU KNOW I
DON'T HAVE MUCH TO ADD. I WAS
GOING TO GO DOWN SAME PATH
THINKING ABOUT THIS AND THINK
THAT LOTS OF COMMUNITIES HAVE A
RESILIENCE FACTOR AND SUCCESS IN
REALLY LEARNING THOSE FACTORS
COMING IN WITH TRYING TO
UNDERSTAND THAT SIDE OF THE COIN
THAT IS ANOTHER IMPORTANT PART
OF THE PROCESS TRYING TO THINK
ABOUT FACILITATORS TO SORT OF
MAKING SURE THAT WHAT YOU ARE
TRYING TO IMPLEMENT CAN ACTUALLY
WORK.
>> GREAT. THANK YOU,
ELIZABETH.
NEXT QUESTION, FOR DIGITAL
PROGRAMS AND APPS AND WEARABLE
DEVICES AND EMERGING
TECHNOLOGIES WHAT ARE BENEFITS
FOR IMPLEMENTATION SCIENCE IN
EARLY AND LATE STAGES FOR
PROGRAM TECH DEVELOPMENT. SONIA
COULD I TAG YOU FIRST?
>> SURE. FIRST OF ALL, THANK
YOU FOR THE INVITATION TO BE
HERE AND WELCOME, EVERYONE AND
FOR WONDERFUL PRESENTATIONS TO
KICK US OFF.
MY THOUGHTS AND RESPONSE TO THIS
QUESTION IS REALLY INFORMED BY
THE WORK I HAVE DONE IN PART
FOCUS ON PREVENTION AND
TREATMENT OF DEPRESSION DURING
PERINATAL PERIOD AND RESEARCH
PROGRAM IN PARTICULAR MINDFUL
MOOD BALANCE THAT IS ESSENTIAL
TO CONSIDER IMPLEMENTATION
SCIENCE IN EARLY AND LATE STAGES
OF THIS WORK AND ALL MIDDLE
STAGES TOO.
SO, IT IS NOT AN EITHER OR ANLTD
PREFACE IT FORTUNATE TO WORK
WITH A GREAT TEAM OF PEOPLE AND
[INDISCERNIBLE] AT KAISER
INSTITUTE FOR HEALTH RESEARCH
AND LAUREL HICKS AT INSTITUTE
AND STARTED WORK WITH QUESTION
WHAT PEOPLE ACTUALLY WANT TO
SUPPORT THEIR MENTAL HEALTH
DURING PERINATAL PERIOD AND IN
SOME WAYS GOING TO POINTS DR.
SEP UL VEDA RAISED TAKING
PARTICIPATORY APPROACHES AND
FRAMEWORKS AND HEALTH CARE
SYSTEMS RESPOND TO PROBLEM OF
DEPRESSION DURING PERINATAL
PERIOD PRIMARILY DESCRIBING
ANTIDEPRESSANT P MEDICATION AND
EARLY WORK SHOWED THAT IS NOT
WHAT IN EARLY STUDY IS FOCUSING
ON NEW AND EXPECTANT MOTHERS AND
80% WANTED NON-PHARMACOLOGICAL
OPTIONS AND WHAT WE LOOKED AT IS
WHAT ARE BEST AVAILABLE
EVIDENCE-BASED APPROACHES AND
ONE IN PARTICULAR THAT BLENDED
MINDFULNESS WAS COGNITIVE
BEHAVIORAL THERAPY STUDYING WITH
THOUSANDS OF PEOPLE MULTIPLE
COUNTRIES MINDFULNESS BASED
COGNITIVE THERAPY AND LOOKED AT
IMPLEMENTING IN PRENATAL CARE
SETTINGS THINKING ABOUT ULTIMATE
USE CONTEXTS AND DELIVERING THIS
INITIALLY IS IN-PERSON PROGRAM
AND BEING REALLY EXCITED ABOUT
FINDINGS IN TERMS OF CAPACITY TO
HELP NEW AND EXPECTANT MOTHERS
PREVENT DEPRESSION RELAPSE FOR
PEOPLE AT ELEVATED RISKS HAVING
EXPERIENCED DEPRESSION IN THE
PAST AND WE WERE REALLY EXCITED
ABOUT FINDINGS AND WHAT WE
UNFORTUNATELY ALSO FOUND BY
ATTENDING SOME IMPLEMENTATION
SCIENCE FRAMEWORKS AND
CONSTRUCTS WAS THAT BARRIERS
WERE TOO HIGH WITH THAT APPROACH
WITH REGARDS TO FIDELITY AND
REQUIREMENT FOR TRAINING
PROVIDERS AND APPROACH AND
SUSTAINING IT AND EFFORT TO KEEP
A PROGRAM GOING WHEN SETTINGS
DIDN'T SEE IT AS CORE PRIMARY
MANDATE AND IF MAYBE WE WILL
TALK LATER ABOUT REQUIREMENTS ON
INDIVIDUAL NEW AND EXPECTED
APPEARANCE IN TERMS OF THEIR
ENGAGEMENT.
DIGITAL PROGRAM MINDFUL MOOD
BALANCE ESSENTIALLY DEVELOPED
CORE SKILLS AND PRACTICES IN
SELF-GUIDED COACH AND SUPPORTED
WAY THAT WE DESIGN WITH A TEAM
OF NEW AND EXPECTED PARENTS
WORKING CLOSELY AS DESIGN
PARTNERS WITH US AND ARE
STUDYING THAT NOW IN LATER
PHASES OF THIS WORK FOCUSING
DIRECTLY ON EFFECTIVENESS OF
IMPLEMENTATION OUTCOMES SOOND
THAT IS ONE EXAMPLE THAT I THINK
IS OF HOW THESE FRAMEWORKS AND
CONSTRUCTS AND METRICS ARE
RELEVANT AT ALL PHASES OF THE
RESEARCH PROCESS.
>> GREAT. THANK YOU SO MUCH.
APPLE, ANYTHING TO ADD?
>> I WOULD LIKE TO ADD ONE MORE
THING.
IN EARLY STAGES OF INNOVATION OF
TECHNOLOGY IT IS IMPORTANT TO
INTEGRATE IMPLEMENTATION
RESEARCH. IT HELPS YOU MAKE
SURE THAT THESE -- YOUR
INNOVATION IS ACCEPTABLE OR
FEASIBLE.
OR USABLE.
THEN IN LATER STAGES, YOU KNOW,
AS YOU GO AND IMPLEMENTATION
RESEARCH IN EVERY STAGE AND
LATER STAGES COW IMPLEMENTATION
RESEARCH YOU COULD USE TO MAKE
SURE THERE IS COST EFFECTIVE AND
IT IS SUSTAINABLE AND ADAPTABLE
TO DIFFERENT POPULATIONS ACROSS
THE BOARD.
SO, THAT IS WHY IT IS VERY
IMPORTANT TO THINK ABOUT THAT.
>> GREAT. THANK YOU.
I'M ON TO MY LAST QUESTION AND
DOING A QUICK TIME CHECK. HOW
ARE WE -- PERFECT. AS I GET TO
THE LAST QUESTION, IF YOU THINK
OF YOUR SUPER AWESOME QUESTIONS
IN THE AUDIENCE TYPE THEM INTO
THE ZOOM CHAT OR IF YOU WANT TO
MAYBE GET IN CUE FOR MICROPHONES
THIS WILL BE LAST FORMAL
QUESTION AND WE WOULD LOVE TO
GET TO YOUR QUESTIONS AS WELL
AND LAST QUESTION FOR THE PANEL
IS WHAT DO YOU THINK ARE KEY
CHALLENGES AND IN IMPLEMENTING
TECHNOLOGY-BASED SOLUTIONS FOR
MATERNAL HEALTH?
KATE, CAN I START WITH YOU ON
THIS ONE?
>> YOU CAN. I WANTED TO ALMOST
TAKE THIS TO THAT SAFER
FRAMEWORK IF YOU WANTED TO. YOU
KNOW, WHEN YOU THINK ABOUT -- I
THINK IF YOU THINK ABOUT OUTER
SETTING ISSUES, IT -- WITH
TECHNOLOGY AND IN PARTICULAR
THAT INCLUDES RESOURCE NAZ IS
BROADBAND AND AVAILABILITY OF
THAT AND INCLUDING POLICIES AND
EXTERNAL POLICIES TO MAKE THAT
BILLING AND PAYMENT POLICIES AND
THAT SORT OF THING THAT WILL
MAKE IT DIFFICULT.
I THINK THAT ADOPTION OF MANY OF
THESE TECHNOLOGIES WILL REQUIRE
US FOR BROADBAND TO BE LIKE
CLEAN WATER IF OUR SOCIETY, YOU
KNOW, TO REALLY GET IT OUT THERE
KIND OF EQUITABLY AND INNER
SETTING READINESS AND CULTURE
AND THE COMMUNICATIONS SYSTEMS
AND INNER SETTING, YOU NEED
PEOPLE WHO ARE -- YOU KNOW, WHO
ARE -- THEY NEED TO BE READY TO
DO THAT AND HAVE -- THERE ARE
OTHER PRIORITIES THAT ARE
GETTING IN THE WAY AND THAT
OFTEN IS AN ISSUE GENERALLY WITH
WOMEN'S HEALTH INITIATIVES AND
THINKING ABOUT HEALTH SYSTEMS
PRIORITIZING OTHER THINGS
UNFORTUNATELY WE ARE NOT ALWAYS
AT THE TOP OF THE LIST AND NEED
TO BE THERE AND ARE DOING BETTER
IN THAT AREA AND CHARACTERISTICS
WITH INDIVIDUALS AND
SELF-EFFICACY AND MOTIVATION AND
GENERATIONAL GAPS FOCUSING ON
PEOPLE OF BIRTHING AGE AND THAT
SORT OF THING AND TECHNOLOGY
WILL BE PICKED UP VERY QUICKLY
AND MAYBE FOR SOME PROVIDERS
THAT WON'T PICK IT UP AS FAST
AND SOME OF THOSE THINGS THOSE
ARE THINGS THAT I HAVE SEEN IN
ADOPTION OF APPS AND DIFFERENT
COMPUTER APPLICATIONS AND THINGS
LIKE THAT, THAT HAVE COME ALONG.
>> THANK YOU, KATE.
>> CAN I CALL ON YOU NEXT?
>> SURE. THERE IS A NUMBER OF
IMPORTANT CHALLENGES TO CONSIDER
AND ONE IS IT IS COSTLY TO
DESIGN AND UPDATE AND MAINTAIN
UPDATES OF PROGRAMS AND RELATING
TO THAT IS THINKING CRITICALLY
ABOUT INTERSECTION OF TECHNOLOGY
AND COMMUNITY ENGAGEMENT AND
TAKES TIME AND HAS BEEN
EMPHASIZED REPEATEDLY AND
NEEDING TO BE EMPHASIZED AGAIN
AND INSTITUTE THAT I DIRECTED
OUR DESIGN CYCLE IS GROUNDED IN
BUILDING TRUSTED TEAMS THAT IS
NOT SOMETHING TO BE RUCHED AND
THINKING CRITICALLY ABOUT HOW
THE TWO INTERSECT WITH EACH
OTHER AND OTHER THING IN
ADDITION TO DR. MENARD MENTIONED
ISSUE OF ACCESS WE HAVE TO THINK
CRITICALLY ABOUT ENGAGEMENT
FACTORS AND USE AND ACCESS ARE
NOT SAME THING.
SO I THINK THAT I WOULD GO BACK
TO ACTUALLY ONE THING YOU SAID
IN THE BEGINNING ABOUT WHAT
IMPLEMENTATION SCIENCE IS ABOUT
AND IT IS ABOUT STRUCTURE AND
CONDITIONS NECESSARY TO
SUCCESSFULLY IMPLEMENT PROGRAMS
AND LOOKING AT IN PARTICULAR
RATES OF ENGAGEMENT AND NEW AND
EXPECTED APPEARANCE WITH SOME
DIGITAL PROGRAMS IS SYSTEM THAT
IS PLACED WHERE WE NEED TO SEE
IMPROVEMENTS AND NEED TO SEE
INCREASES IN LEVEL OF ENGAGEMENT
THAT WE OFTEN FOCUS ON THE
INDIVIDUAL IN THIS CASE AND WE
HAVE TO HAVE EQUAL ATTENTION TO
WHAT IS THE CONTEXT AND WOULD
SAY WHEN WE PAY ATTENTION TO
REALITY OF CONTINUED LACK OF
PARENTAL LEAVE AND LACK OF
AFFORDABLE CHILDCARE AND LACK OF
PAID SICK LEAVE AND LACK OF
REASONABLE OPTIONS FOR ELDER
CARE WE HAVE A BROAD CONTEXT
THAT DEVALUES WORK OF CARING IN
OUR COUNTRY AND WHEN WE EXPECT
PEOPLE TO ENGAGE IN
INTERVENTIONS THAT DO TAKE TIME
TO LEARN, IT IS WITHIN THE
CONTEXT WHERE TIME IS SUCH A
PRECIOUS AND RESOURCE THAT IS
ALSO -- IT HAS A LOT OF
INEQUALITY IN TERMS OF
AVAILABILITY AND DISTRIBUTION
AND WE NEED TO ATTEND TO BOTH
NATURE OF PROGRAM AND EXPERIENCE
OF PEOPLE ENGAGING WITH THESE
PROGRAMS AND BROADER CONTEXT OF
THE LIVES OF NEW AND EXPECTANT
PARENTS IN OUR COUNTRY.
THANK YOU.
>> THANK YOU. WE REALLY
APPRECIATE THAT. THAT CONCLUDES
QUESTIONS THAT I HAD. WE WILL
OPEN IT TO QUESTIONS FOR THE
AUDIENCE AND PLEASE FEEL FREE IF
PHYSICALLY HERE TO COME UP TO
THE MICROPHONE.
KAREN, DO WE HAVE QUESTIONS IN
THE Q & A?
>> I CAN GET STARTED WITH ONE
REALLY QUICK.
SO S
SO, THINKING OUTSIDE OF THE MANY
VARIABLES OF DIFFERENT TYPES OF
TECHNOLOGY THAT WITH WOULD
IMPLEMENTED SO MUCH TO THINK
ABOUT AS FAR AS POPULATION AND
PHYSICAL IMPLEMENTATION SPACE
FOR PROVIDERS DELIVERING AND
DIFFERENT STAGES OF
PRECONCEPTION AND PREGNANCY
POSTPARTUM THERE IS A LOT TO
LEAD TO CONTEXT SPECIFIC FACTORS
AND WHAT ADVISE TO GIVE TO
NOVICE TRYING TO INCORPORATE
IMPLEMENTATION SCIENCE INTO
THEIR RESEARCH.
>> I SEE YOU ARE ALL SUPER
ANXIOUS TO ANSWER THE QUESTION
FIRST.
DO YOU HAVE ANY THOUGHTS ON
THIS, KATE?
>> JUST IN A NUTSHELL QUESTION
OF HOW DO YOU -- HOW DOES A
NOVICE INCORPORATE
IMPLEMENTATION SCIENCE INTO
THEIR WORK.
>> YES.
>> WELL, I THINK PROBABLY GOING
BACK TO -- IF YOU HAVE THE
EVIDENCE BASED INTERVENTION, YOU
HAVE TO START THERE; RIGHT?
IF YOU HAVE EVIDENCE-BASED
INTERVENTION, I THINK THAT IN
DESIGNING AN IMPLEMENTATION
PRACTICE IT MAY BE THE FIRST
THING TO DO AND HAVING OR
MAPPING OUT PRACTICE WHERE YOU
THINK ABOUT THE HOW AND WHO AND
WHERE TO GET YOUR OUTCOMES AND
THEN YOU BUILD AROUND THAT YOU
BUILD SCIENCE OF TESTING THOSE
AND MEASURING OUTCOMES THAT IS
FOR A NOVICE THAT IS A STEPWISE
APPROACH TO COMING AND INTO
IMPLEMENTATION PRACTICE FLASH
IMPLEMENTATION SCIENTIST. MAKE
SENSE?
>> CAN I ADD I THINK IT IS
REALLY IMPORTANT TO THINK ABOUT
THE DOING OF THE SCIENCE AS A
COMMUNITY ACTIVITY AND EFFORT ON
ITS OWN AND IN ITSELF AND SO TO
KNOW THAT IN GETTING.
[START OF CLASS]ED, THINK ABOUT
WHO CAN BRING COLLABORATIVE
EXPERTISE THAT DOESN'T HAVE TO
ALL BE YOU IN TERMS OF GETTING
STARTED. IT IS REALLY ABOUT
DESIGNING A TEAM AND BRINGING
PEOPLE WITH MULTIPLE VOICES AND
SOURCES OF EXPERTISE THAT CAN
WORK TOGETHER THAT MAKES THE
PROCESS MUCH LESS DAUNTING AND A
LOT MORE FUN
>> GREAT. THANK YOU AND THANK
YOU, KATE.
SO, WE HAVE A QUESTION.
PLEASE JUMP IN.
>> YEAH. HI. CHRISTINE ROWEN
AND CEO OF BASO WATCH A START-UP
DEVELOPING CLINICAL SUPPORT
SYSTEM FOR REDUCING RISK FOR
POSTPARTUM HEM RANL AND NO ONE
MENTIONED ER INTEGRATION AS
BARRIER TO IMPLEMENTATION
SUCCESS. WHEN THINKING OF EASE
OF CLINICIAN USE TAKING AWAY
SOME PAPE ERR WORK SEEMS LIKE
LOGICAL BARRIERS AND HAVE BEEN
TOLD WHERE YOU HAVE TO GET IN
LINE AND EVIDENCE-BASED SOLUTION
DON'T HAVE TO GET INTEGRATED
INTO EHR AND WHAT IT DOES FOR
CHANCES OF SUCCESS AND CONTEXTS
THAT YOU COULD GIVE US?
>> I WILL COME ON THAT. YOU
ARE ABSOLUTELY RIGHT.
INTEGRATION IS A BARRIER AND
MANY INNOVATIONS THAT WE -- THAT
WE ARE TALKING ABOUT ACTUALLY
WORK AROUND THAT. IT HAS BEEN
SO HARD IN A LOT OF SENSES TO
INTEGRATE THEM AND SOME HAVE
BEEN SUCCESSFUL BRINGING FOR
EXAMPLE HOMEOWNER BLOOD
PRESSURES AND MONITORING
DIABETES AND THAT SORT OF THING
INTO HR THAT IS AN UPHILL
BATTLE.
>> DO I HAVE A SOLUTION? I
HAVE TO SAY WE HAVE TRIED AND I
DON'T.
>> THANK YOU.
>> SOMEBODY ELSE CHIME IN NOT
DEBBIE DOWNER.
THAT IS A HARD ONE.
>> GREAT.
>> MALIA HAS A QUESTION IN THE
BACK.
>> CAN YOU HEAR ME, KAREN?
>> YES. THANK YOU.
>> QUESTION WHERE HEALTH
ECONOMICS FITS INTO
IMPLEMENTATION SCIENCE AND HOW
MOMMA DEFINES COST
EFFECTIVENESS?
>> THAT IS A VERY GOOD
QUESTION. WE ARE STILL
DETERMINING COST EFFECTIVENESS.
RIGHT NOW WE ARE PILOTING AN
EARLIER INTERVENTION AND WE ARE
NOT BILLING FOR SCREENING AND WE
ARE LUCKILY HAVING A PARTNERSHIP
WITH MOMMA AND DO IT WITH NO
LONG COST THAT IS SUSTAINABLE
AND NEXT PLAN TO FIGURE OUT HOW
WE CAN GET THIS SUSTAINABLE SO
EVERYBODY COULD USE IT. RIGHT
NOW MOMMA IS BEING PILOTED AT
EARLY INTERVENTION SETTINGS FOR
STATE OF MAINE AND ARE CONTRACTS
TO BE DEVELOPED BUT IT IS NOT
SUSTAINABLE AND WHAT OUR GOAL
IS, IS TO REALLY JUST BUILD AN
INFRASTRUCTURE AND TEST IT AND
THEN IMPLEMENTATION SCIENCE USE
IT TO BUILD COST EFFECTIVENESS
MEASURES WHETHER OR NOT STUDY
OUTCOMES OF DEVELOPMENT OF
CHILDREN OR HAVE MOMS AND LESS
VISITS TO ER AS MEASURES FOR
REIMBURSEMENTS BECAUSE THE
SYSTEM IS BROKEN AND IT IS A
VERY HARD PROBLEM TO FIX.
>> I WOULD ADD IN GENERAL
MATERNAL HEALTH IS HARD TO TALK
ABOUT COST EFFECTIVENESS STUDIES
WE DON'T INCORPORATE LONG-TERM
IMPACTS AND IF WE CONTROL BLOOD
PRESSURE POSTPARTUM NOT ONLY CAN
WE POTENTIALLY INTRODUCE
EMISSIONS IN FIRST YEAR OR WORSE
OUTCOMES AND LONG TERM HEALTH OF
WOMAN AND CARDIOVASCULAR
RESEARCH LONG TERM MIGHT BE
IMPACTED GESTATIONAL DIABETES
AND DON'T DO WELL THINKING OF
LONG TERM OUTCOMES AND CURRENT
INTERVENTIONS THAT ARE ACTUALLY
IMPACTING THEM.
>> GREAT. THANK YOU APPLE AND
ELIZABETH AND WE HAVE TIME FOR
ONE MORE QUESTION.
MALIA, HAVE ONE?
>> YES. SHAUNA, TO KEEP A
PROGRAM GOING DO YOU THINK IT
COULD BECOME A [INDISCERNIBLE]?
>> I THINK THAT IT IS -- I LOVE
THE QUESTION.
I ABSOLUTELY THINK THAT POLICY
AND LEGISLATIVE CHANGES HAS A
CRITICAL ROLE IN CREATING BROAD
AND SYSTEMIC AND STRUCTURAL
CHANGES THAT WE WANT TO SEE
EMERGE FROM SCIENCE WE ARE
DOING.
I THINK IT IS A GREAT QUESTION.
>> OKAY. ALL RIGHT. THANKS TO
OUR INCREDIBLE PANEL MEMBERS AND
TO AUDIENCE FOR FANTASTIC
QUESTIONS AND BELIEVE WE WILL
WRAP IT UP AND CALL THIS SESSION
OVER. THANK YOU ALL OF YOU!
>> EVERYBODY, WE WILL GO INTO A
10-MINUTE BREAK AND NEXT SESSION
WON'T BE IN HERE AND WILL BE
CONCURRENT SESSIONS THAT ARE
MEETING ACROSS THE HALL IN
MEETING ROOMS AND IN MEETING
ROOM E1/E2 WE HAVE IDENTIFYING
AND OVERCOMING INNOVATION
BARRIERS FOR MATERNAL HEALTH
HEART LUNG AND SLEEP HEALTH AND
WE HAVE IDENTIFYING GAPS AND
OPPORTUNITIES IN INNOVATIVE
TECHNOLOGIES TO IMPROVE MENTAL
HEALTH AND SUBSTANCE USE
DISORDER DIAGNOSTICS AND
TREATMENTS AND PLEASE MEET IN
ONE OF THE ROOMS IN 10 MINUTES
AND WILL MEET BACK HERE AT END
OF THE DAY AT AROUND 5:10 P.M.
AND WILL HAVE MODERATORS FROM
EACH OF THE SESSIONS COME UP AND
GIVE MAIN POINTS THAT WERE
DISCUSSED AND HAVE WRAP UP
BEFORE TOMORROW. THANK YOU ALL
VERY MUCH.
>> THANK YOU EVERYONE FOR BEING
HERE UNTIL THE VERY END. WE
WILL START A VERY QUICK WRAP-UP
SESSION. YES, YES, YES. I WILL
CALL YOU --
THANK YOU EVERYONE FOR STAYING
UNTIL THE VERY END. WE WILL DO
A QUICK WRAP-UP SESSION WHERE
MODERATORS FROM THE DEEP DIVE
AND CONCURRENT SESSIONS WILL
REPORT OUT THE KEY POINTS THAT
WERE DISCUSSED DURING THE PANELS
AND FIRST WILL CALL UP THE
MODERATOR FROM CONCURRENT
SESSION 1, PAULINE TO COME
REPORT OUT TO THE GROUP WHAT KEY
MAIN POINTS WERE THAT CAME UP.
>>.
>> THANK YOU, EVERYONE. NOW
THAT WE ARE WAITING FOR THE
SLIDE TO POP UP ON THE SCREEN,
WE WILL WAIT FOR THAT. WHAT A
GREAT SESSION WE HAD. DR. SAADE
JOINED ME.
YEAH. WE FOCUSED ON INNOVATION
BARRIERS SPECIFICALLY RELATED TO
HEART, LUNG, BLOOD AND SLEEP
INNOVATION AND HAD A VERY
THOROUGH CONVERSATION RELATED TO
WHAT ARE THE KEY CHALLENGES AND
WHO ARE CRITICAL STAKEHOLDERS
THAT ARE NEEDED AND MOVING TO
THE NEXT SLIDE AND QUICK
INTRODUCTION AS TO WHO I AM AND
FOR THOSE THAT DON'T KNOW ME I'M
MOLINE. THANK YOU, GEORGE. I'M
PROFESSIONALLY AN INNOVATION
ENABLER AND CAREER EXPERT AND
DOING THAT MORE THAN 15 YEARS
AND PERSONALLY I'M VERY EFFECTED
BY THIS TOPIC AS MANY OF US ARE.
PERSONALLY FOR ME I HAD A
PRETERM BIRTH AT 23 WEEKS
COMPLETELY UNEXPECTED AND AFTER
5.5 MONTHS IN THE NICU LOST MY
SON. I REMEMBER SITTING IN THE
KANGAROOING CHAIR, WHAT CAN I DO
AS A MOTHER, AS A PATIENT TO
HELP ENABLE MEDICAL INNOVATION
AND SWITCHED GEARS FOCUSING 100%
IN MEDICAL INNOVATION AND OUR
TEAM ADVISORS HELPING ENABLE
INNOVATORS AND PROGRAM MANAGERS
TO THINK ABOUT HOW TO NAVIGATE
THE COMPLEXITY THAT IS
INNOVATION?
SPECIFICALLY IN THE HEALTH CARE
SPACE?
I WAS CO-MODERATED WITH DR.
GEORGE SAADE.
>> I'M MATERNAL FETAL MEDICAL
SPECIALIST AND CLINICIAN ANDEND
USER OF ALL OF THE INNOVATIONS.
WE WILL GET RIGHT INTO SOME
HIGHLIGHTS AND SUMMARIES OF OUR
PANEL. GOING TO THE NEXT SLIDE,
ONE OF THE BIGGEST QUESTIONS WE
ASK IS WHAT ARE THE DIFFERENT
ROLES AND WHAT ARE THE DIFFERENT
STAKEHOLDERS THAT ARE NEEDED?
THERE IS A LOT LISTED ON THE
PAGE THAT IS MEANT TO BE
INTIMIDATING. THIS IS
ROOETALITY WHETHER YOU ARE AN
INNOVATOR OR SUPPORTING
INNOVATION. SO MANY INDIVIDUALS
WERE PRESENT ON THE PANEL TO
REPRESENT DIFFERENT STAKEHOLDERS
AND ARE SOME EXAMPLES AND SOME
NOT LISTED ON SLIDE ARE PRIVATE
PAIRS AND PUBLIC PAIRS AND
NURSES AND BEDSIDE CLINICIANS
AND SO MANY PEOPLE ARE INVOLVED
IN ORDER TO CREATE AND INNOVATE
AND HELP ADOPT AND IMPLEMENT NEW
INNOVATIONS WITHIN HEART, LUNG,
BLOOD AND SLEEP.
NEXT SLIDE. THIS IS THE VISUAL.
WE UNDERSTAND AND REALIZE IT IS
VERY INTIMIDATING COMPLAEVENLD
AND MUCH OF THE CONCURRENT
CONVERSATION SESSIONS WAS ABOUT
NAVIGATING DIFFERENT
COMPLEXITIES AS WELL AS ENGAGING
AND LEVERAGING PEOPLE AT AN
EARLIER STAGE THAT YOU MIGHT
ANTICIPATE.
NEXT SLIDE.
CAPTURED HERE, LOTS OF WORDS.
WE HAD THREE MINUTES TO FINALIZE
SLIDES BETWEEN THE SESSIONS AND
GO OVER KEY LESSONS LEARN THE
AND CONVERSATIONS AND PANELISTS
SHARED WITH AUDIENCE AND THEIR
DIFFERENT LEARNED EXPERIENCES
AND A COUPLE KEY THEMES
POPULATED OUT. ONE OF WHICH IS
RELATED TO MULTIPLE STAKEHOLDERS
REQUIRED IN ORDER TO COLLABORATE
AND REACH SUCCESS.
ONE OF THE BIGGEST TAKEAWAYS IS
PULLING IN THOSE REPRESENTATIVE
PERSPECTIVES AT AN EARLY STAGE
AND ONE AUDIENCE MEMBER CAME UP
AND ASKED BY THE TIME I ENGAGE
THE COMMUNITY, IT IS ALREADY AN
END PRODUCT AND PUSHED BACK
SAYING IT IS NEVER TOO EARLY TO
ENGAGE PERSPECTIVES FROM THE
COMMUNITY WHETHER CLINICIANS OR
PATIENT ADVOCACY GROUPS OR
INDIVIDUALS THAT IMPACT ADOPTION
AND IMPLEMENTATION AND CONCEPT
OF HUMAN CENTERED DESIGN WAS
TOUCHED UPON AND ENGAGING END
USERS EARLY AND HAVING
INTEGRATED PARTNERS IN TERMS OF
STAKEHOLDERS AND SAW FROM THE
PREVIOUS SLIDE ALL DIFFERENT
PEOPLE YOU NEED TO THINK ABOUT
TO IMPROVE CHANCES FOR YOUR
INNOVATION TO BE IMPLEMENTED AND
ADOPTED AND A BIG TOPIC ON
RETURN ON INVESTMENT ALSO CAME
UP AS WELL.
WHEN YOU SAY RETURN ON
INVESTMENT, WE ELABORATED ON THE
FACT IS NOT JUST FINANCIAL ROI
BUT OFTEN TIMES SOCIAL IMPACT
ESTABLISHING MESSAGE AS TO IF
THE INNOVATION DIDN'T EXIST,
WHAT IS THE DIFFERENCE?
OTHER THINGS THAT WERE ALSO
HIGHLIGHTED TOO IS IMPORTANCE OF
ELABORATING AS INNOVATOR FROM
STAKEHOLDERS TO AGENCY
STANDPOINT TOO THAT WAS
HIGHLIGHTED IN TERMS OF USING
MULTIPLE PROGRAMS CROSS-CUTTING
ACROSS MULTIPLE AGENCIES AND NIH
AND FDA FOR EXAMPLE HAD SEVERAL
PROGRAM AND INITIATIVES
SUPPORTIVE FOR HELPING
INDIVIDUAL AND IN GENERAL NEVER
TOO EARLY TO START AND IS
COMPLEX AND DON'T BE INTIMIDATED
BECAUSE OF THE COMPLEXITY AND
YOU DON'T HAVE TO BE THE ONE
THAT KNOWS IT ALL AND TEAM UP
WITH PEOPLE WHO HAVE
COMPLEMENTARY SKILLSETS TO HELP
OFFSET INNOVATION CHALLENGES YOU
MIGHT BE FACING.
>> GEORGE, I WOULD LIKE TO ADD
WE SHOULD BE THINKING OF WHY IT
IS SO HARD TO INNOVATE IN
PREGNANCY AND MATERNAL HEALTH
COMPARED TO OTHER FIELDS AND
START TO DESTROY AND BRING DOWN
SOME OF THE WALLS AND DECREASE
BURDEN OF INNOVATION AND
MATERNAL HEALTH AND THINK THERE
IS FOR A LONG TIME HAVE BEEN A
LOT OF BURDEN AND LOTS OF
BURDENS IN INNOVATION AND
MATERNAL HEALTH AND WE SHOULDN'T
HAVE THEM.
SO, WE THOUGHT THAT EVERYBODY
SHOULD WORK TOGETHER.
DECREASE THESE HURDLED AND BE IT
REGULATORY AND BE IT COST AND BE
IT REIMBURSEMENT FOR INNOVATIONS
AND I THINK THAT IT IS TIME THAT
WE ADDRESS THEM FROM A
LEGISLATIVE ASPECT AS WELL AS
FROM A SCIENTIFIC ASPECT.
>> THANK YOU.
>> THANK YOU VERY MUCH. NOW WE
WILL HAVE PATRICIA CARVOS COME
UP AND GIVE THE SUMMARY OF THE
CONCURRENT SESSION THAT SHE
MODERATED. THANK YOU SO MUCH.
>>.
>> HI, EVERYONE. I'M PATTY AND
PROFESSOR OF PSYCHIATRY AT
WASHINGTON UNIVERSITY SCHOOL OF
MEDICINE AND WATCHING THEMES
COME UP WITH INTRODUCTION AND
WHAT IS DRIVING THIS AND BEING
ABLE TO MODERATE SESSION AND
HEARING INNOVATIVE WORK THAT IS
HAPPENING IS INSPIRING TO ME AND
HUMBLED TO BE ABLE TO MODERATE
THE SESSION AND WORK WITH SOME
COLLEAGUES OVER COURSE OF WEEKS
TO PLAN THIS SESSION OUT.
TOPIC OF THE SESSION IS A BIG
GOAL. WE ARE GIVEN THE TASK TO
IDENTIFY GAPS AND OPPORTUNITIES
AND DEVELOPMENT AND
IMPLEMENTATION OF INNOVATIVE
TECHNOLOGIES THAT ARE FOCUSED ON
ADDRESSING MATERNAL HEALTH AND
SUBSTANCE USE DISORDERS AND ABLE
TO MODERATE THE SESSION AND
WORKING CLOSELY WITH DR. JULIAN
AND KEESHER FROM NIH TO PLAN THE
SESSION OUT. NEXT SLIDE.
WE HAVE A LOT OF PANELISTS IN
OUR SESSION AND WANT TO GIVE
SPECIAL THANKS TO EACH OF YOU.
I KNOW WE WORK TOGETHER AND HAD
SEVERAL MEETINGS TODAY AND
REALLY TO KIND OF QUICKLY AND
CONCISELY DESCRIBE YOUR
INNOVATION AND WHAT PROBLEM
AREAS AND SOLUTIONS AND WANT TO
THANK ALL PANELISTS AND SOME
OTHER FOLKS WHO CHIMED IN AS
WELL TO TALK ABOUT CUTTING EDGE
INNOVATIONS ADDRESSING MATERNAL
HEALTH AND SUBSTANCE USE
DISORDERS AND NEXT SLIDE,
PLEASE.
IN TERMS OF SOME OF THE THEMES
THAT CAME OUT AND OPPORTUNITIES
FOR DEVELOPING INNOVATIVE
TECHNOLOGIES, THINKING ABOUT THE
USE OF ARTIFICIAL INTELLIGENCE
TO PROVIDE REMINDERS TO INCREASE
SUSTAINABILITY AND WE HEARD SOME
TECH DISCUSSED TODAY WE HAVE A
HUMAN COMPONENT WHETHER A PEER
RECOVERY COACH AND COUNSELOR AND
PROVIDER AND OPPORTUNITIES TO
LEVERAGE AI TO DELIVER SOME
INTERVENTIONS.
IN ORDER TO BE MORE EFFICIENT OR
COST EFFECTIVE.
WE DON'T ALSO WANT TO LOSE THAT
HUMAN TOUCH AND IT CAME OUT
THROUGHOUT THE COURSE OF THE DAY
AND IN TERMS OF POWER AND
EMPATHY IS BEING AN IMPORTANT
THEME; RIGHT?
USING AI AND ALSO NATURAL
LANGUAGE PROCESSING AND SKILL
BASIS TO HELP WORK WE DO AND NOT
REALLY TAKE AWAY THE HUMAN
COMPONENT AND IN TERMS OF
NATURAL LANGUAGE PROCESSING,
THERE IS AN IDEA THAT CAME OUT
ABOUT EFFICIENTLY RECOGNIZING
WARNING SIGNS AND HOW WE CAN BE
PREVENTIVE AND PROACTIVE AND HOW
TECHNOLOGIES COULD LEAD TO
BETTER SCREENING AND MORE
EFFICIENT SCREENING PRACTICES
AND IDENTIFYING CLIENTS AT RISK
AND WORK TO TAILOR THE
INTERVENTION AND ALERT PROVIDER
TO CARE ONE NEEDS IN THE MOMENT
THAT THEY NEED IT AND GOAL
REALLY TO REFER BIRTHING PEOPLE
INTO CARE. AGAIN, AT THE TIME
THAT THEY REALLY NEED IT AND
ADDRESSING SYMPTOMS THAT THEY
ARE EXPRESSING AND ARE WAYS THAT
WE CAN KIND OF MOVE OUR
TECHNOLOGY FORWARD IN THAT WAY.
ALSO, THE THOUGHT ABOUT CREATING
DIGITAL PEER SUPPORT COMMUNITIES
AND WE HEARD IN THE PANEL AND
THROUGHOUT THE COURSE OF THE DAY
IMPORTANT EMOTIONAL AND RECOVERY
SUPPORT FOR INDIVIDUALS WITH
MENTAL HEALTH PROBLEMS AND
SUBSTANCE USE DISORDERS AND
TECHNOLOGIES COULD BE USE THE TO
SUPPLEMENT TRADITIONAL CARE AND
CAN'T EMPHASIZE ENOUGH HOW MANY
PEOPLE WITH THESE PROBLEMS AND
STRUGGLES FEEL STIGMATIZED.
THAT REALLY WORKS AGAINST THE
CARE THAT THEY SHOULD BE
RECEIVING.
SO, HOW CAN WE LEVERAGE
TECHNOLOGIES TO REDUCE STIGMA
AND GET PEOPLE INTO THE CARE
THAT THEY NEED?
ALSO, DELIVERING PEER SUPPORT
AND USING TECHNOLOGIES TO DO
THAT AND THINKING EARLIER TO THE
SPEAKER THIS MORNING WHERE ONE
OF THE KEY FACTORS TO HER
REMOVING FORWARD IN HER RECOVERY
WAS NOT FEELING ALONE. THAT IS
A CRITICAL ASPECT OF HER FEELING
SUPPORTED.
HOW CAN WE LEVERAGE TECHNOLOGIES
FOR THAT?
IN TERMS OF EVIDENCE-BASED
INTERVENTIONS, WE CAN'T FORGET
SCIENCE THAT WE HAVE ALL
CONTRIBUTED TO; RIGHT?
CAN WE USE TECHNOLOGY TO DELIVER
EVIDENCE-BASED INTERVENTIONS?
THERE IS POTENTIAL FOR THAT WHEN
SYMPTOM IS BEING EXPERIENCED
DELIVERING RIGHT EVIDENCE-BASED
INTERVENTION AT THAT MOMENT THAT
SOMEONE IS FEELING THAT WAY AND
ACCESS TO MENTAL HEALTH IS LOW
AND DEVASTATING STATISTICS ARE
REPORTED FOR PEOPLE GETTING
MENTAL HEALTH CARE WHEN NEEDED
AND TECHNOLOGY USED TO DELIVER
TREATMENTS AND THINKING ABOUT
ADAPTING THESE INNOVATIONS AND
IN A CULTURALLY MINDFUL WAY AND
WE NEED TO BE CONSCIOUS OF
INTERVENTIONS, THEY WEREN'T
DESIGNED FOR END USERS AND WE
NEED TO THINK ABOUT CULTURAL
ADAPTATION AND BE CAREFUL AND
MINDFUL OF THAT. THERE IS
RESEARCH COMING OUT AND LET'S
ADAPT ACCORDINGLY AND
EFFICIENTLY IN A TIMELY WAY AND
THINKING ABOUT WHAT END USERS
ARE TELLING US INCLUDING BOTH
CLIENTS AND PROVIDERS.
NEXT SLIDE.
THERE ARE OPPORTUNITIES FOR
IMPLEMENTATION AND
COMMERCIALIZATIONINOO --
INNOVATIVE TECHNOLOGIES THAT ARE
DESCRIBED IN THE PANEL. I WOULD
SAY ALMOST 10 OF THEM THAT TO
ME, AGAIN, ARE INNOVATIVE WAYS
TO DELIVER EFFECTIVE AND TIMELY
CARE. WE CAN, FOR EXAMPLE,
USING DIGITAL TECHNOLOGIES TO
EDUCATE PHYSICIANS FOR EARLY
SCREENING FOR PERINATAL
DEPRESSION AND IMPACT NOT ONLY
CLIENTS BUT ALSO PHYSICIANS IN
ADDITION PROVIDING IMMEDIATE
CONNECTIONS TO HEALTH
SPECIALISTS THROUGH MOBILE APPS
AND OPPORTUNITIES WE HAVE TO
SHIFT CLINICAL CARE AND HAVE TO
THINK ABOUT MOVING TECHNOLOGIES
INTO THE REAL WORLD AND THINK
ABOUT TECHNOLOGIES NOT ONLY
HELPING CLIENTS BUT PROVIDERS
AND A KEY QUESTION CAME UP WITH
COMMERCIALIZATION AND SEEMS TO
BE POTENTIAL FOR
COMMERCIALIZATION AND NO CLEAR
PATHWAY AND HOW DO WE MOVE IN
THIS DIRECTION?
CAME UP AND THESE ARE A FEW MORE
INTERVENTIONS DESCRIBED USING
ECOLOGICAL MOMENTARY ASSESSMENT
TO REDUCE STIGMA AND KEEPING
PREGNANT AND POSTPARTUM PEOPLE
IN TREATMENT AND HAVE THEM
INITIATING AND RETAINING
TREATMENT AND NEED TO THINK
ABOUT FOLKS THAT ARE RULE AREAS
AND ARE AS A TEAM DEVELOPING
TECHNOLOGY TO SUPPORT CARE
DELIVERY IN REMOTE AND RURAL
AREAS AND USE OF DIFFERENT
TECHNOLOGIES ARTIFICIAL
INTELLIGENCE AND MACHINE
LEARNING AND NATURAL LANGUAGE
PROCESSING AND IDEA OF SUPER
APPS THAT ARE HARD TO NAVIGATE
THEMSELVES AND GOING ONLINE TO
FIND RESOURCES THAT IS HARD FOR
US SOMETIMES AND THINKING OF
CLIENTS UNDER STRESS AND DON'T
HAVE LOTS OF TIME AND CAN WE
DEVELOP APPS THAT ARE USER
FRIENDLY WITH COMPREHENSIVE
INFORMATION TO ADDRESS NEEDS OF
OUR CLIENTS?
NEXT SLIDE.
THINKING ABOUT NEXT STEPS WHERE
DO WE GO NEXT?
I WILL START WITH IT THIS IS A
VERY GOOD CONVERSATION AND THERE
WASN'T ENOUGH TIME FOR SURE AND
THINKING ABOUT SUSTAINABLE THE
FOR TECHNOLOGIES IS CHALLENGING
FOR US TO RELY ON GRANTS AND
SPOKE TO MANY COLLEAGUES
THROUGHOUT THE COURSE OF THE DAY
AND IN SECTIONS THINKING ABOUT
GRANTS, GRANTS, GRANTS AND
THINKING OF SCALING UP
SUSTAINABILITY REIMBURSEMENT
MODELS PAYERS GETTING IN THE
ROOM HAVING THEM COLLABORATE
WITH US AND THERE HAS BEEN
SUCCESS IN THIS AND IT TAKES I
HAVE HEARD SOMETIMES IT COULD
TAKE YEARS FOR THIS AND WE NEED
TO DO THIS AND MOVE THIS MORE
QUICKLY IN TERMS OF DEVELOPING
NEW AND EFFICIENT BUSINESS
MODELS AND THINKING HOW TO FUND
THIS TECHNOLOGY BEYOND GRANTS.
UNFORTUNATELY, WHAT I HEARD A
LOT WAS CHALLENGES WITH BUSINESS
MODELS THAT CURRENTLY EXIST.
AND, AGAIN, ANOTHER THING I
HEARD WAS THAT WE DIDN'T HAVE
ENOUGH PEOPLE IN THE ROOM. IT
WAS AN ELVANT IN THE ROOM THAT
IS IDEA OF PAYERS AND HAVING
EXPERTISE TO EVEN HELP TO GET
THESE TECHNOLOGIES REIMBURSED
AND IS NOT A CLEAR PATHWAY AND
THERE IS NOT ENOUGH
COLLABORATION WITH STATE
AGENCIES AND/OR THE PAIR
COMMUNITY AND RECOGNIZING THAT
THIS COLLABORATIONS WILL TAKE
TIME.
THERE SHOULD BE AN INCENTIVE FOR
PAYERS TO MAKE CHANGE AND
INTEGRATE REIMBURSEMENT MODELS
AND WAY TO MOVE THE NEEDLE FOR
US TO WORK AND UNDERSTAND AND
INFORM AND UPDATE THE REGULATORY
LANDSCAPE. TECHNOLOGIES WE NEED
THEM FOR PAYMENT PROCESS FOR
TOOLS TO THRIVE AND SURVIVE AND
WRAPPING UP QUICKLY WITH
PARTNERSHIP FOR COMMUNITY TAIK
HOLDERS HAVE TO TRUST
COMMUNITIES THAT THEY KNOW
ANSWERS AND THINKING ABOUT
MEANINGFUL COMMUNITY ENGAGEMENT
AROUND ITERATING TECHNOLOGY SO
USES END USERNAMES AND NEEDS
THAT IS IMPORTANT FOR
TECHNOLOGIES TO HAVE END USERS
IN MIND AND WE NEED TO
RECOGNIZE, AGAIN APPS CAN BE
OVERWHELMING TO NAVIGATE AND
PERSON CENTERED AND HUMAN
CENTERED DESIGN AND WANT TO MAKE
TECHNOLOGY ACCESSIBLE FOR THOSE
WHO NEED THAT INCLUDES BLACK AND
BROWN BIRTHING PEOPLE AND THIS
THEME CAME UP CONSISTENTLY AND
MY IMPRESSION IS IT WILL
CONTINUE TO COME UP IF IN TERMS
OF MAKING TECHNOLOGIES
ACCESSIBLE FOR THOSE WHO MOST
NEED IT OR TECHNOLOGY HAS STRONG
POTENTIAL TO DO GREAT. TO SOLVE
BIG PROBLEMS AND DON'T WANT
TECHNOLOGIES TO CAUSE HARM OR BE
VIGILANT OF TECHNOLOGIES AND
DON'T PERP PETTATE OR ASS
HERBATE HEALTH TECHNOLOGIES THAT
IS BY US AND FOR US AND LOVE
THAT PHRASE I HEARD TODAY AND
ENCOURAGE ALL OF US TO LIVE BY
THAT PHRASE I KNOW I WILL FROM
NOW ON AND TECHNOLOGY WE NEED TO
HAVE IT AND BE BIASED AND FOR
US.
THANK YOU.
>> THANKS SO MUCH TO ALL OF THE
MODERATORS FOR BEING ABLE TO SUM
THAT UP NICELY AND QUICKLY ON
THE SLIDES AND FELT I GAVE YOU
ANNOYING SCHOOL PROJECTS YOU
HAVE 10 MINUTES TO PUT SOMETHING
TOGETHER AND APPRECIATE YOU
DOING THAT SO NICELY FOR ALL OF
US.
THANK YOU TO THOSE WHO CAME
TODAY IN PERSON AND THOSE
JOINING VIRTUALLY OVER ZOOM. WE
WILL BEGIN AGAIN TOMORROW
MORNING AT 9 A.M. AND TOMORROW
FOCUS WILL BE ON TRANSLATION OF
INNOVATIONS AND TO THAT END WE
WILL HAVE PANELS ON GOVERNMENT
FUNDING AND NAVIGATING
REGULATORY PATH FROM MATERNAL
HEALTH SOLUTIONS INTRODUCING
INNOVATIONS FROM MATERNAL HEALTH
ROLE OF PAYERS AND MATERNAL
HEALTH SOLUTIONS INVESTOR
PERSPECTIVE AND FOUR SESSIONS OF
PITCH TALKS TO GIVE INSIGHTS TO
MATERNAL HEALTH INNOVATIONS
CURRENTLY BEING DEVELOPED AND
BEING TOLD TO ANNOUNCE EVERYONE
COMING ON SHUTTLE BUSES FROM
HOTEL TOMORROW TOMORROW MORNING
SHUTTLE BUSS WILL RUN AT 715 AND
745 A.M. IF YOU MISS THE SECOND
SHUTTLE BUS YOU HAVE TO MAKE
YOUR OWN WAY HERE AND WE WILL
BEGIN TO START PROMPTLY TOMORROW
AT 9 A.M.. THANK YOU SO MUCH
FOR JOINING AND LOOKING FORWARD
TO SEEING YOU ALL AGAIN AT DAY TWO