 Welcome everybody to Design on the Front Lines. Welcome from the Health Design Lab. Welcome from Cooper Hewitt. During the past two years, our team in the Jefferson Health Design Lab has been repurposing our own skills and our resources to meet the needs that have been created by the pandemic. And that's been going on all across the world. And so today we asked three of our favorite designers who have been finding great ways to solve problems during the pandemic to join us and share their stories. During the session, please put all of your questions in the Q&A box. After the three speakers present, we will have time for a question and answer session. This session will be recorded, and it will be available to watch at cooperhewitt.org. And for podcast lovers, it'll be available on Design Lab Pod with Van Koo. And a special thank you to production by Rob Polisi, Eva Rosas, graphics by Jennifer Tobias, and live closed captioning by AI Media. We're looking forward to a great show today. Let's get started. Back to you, Ellen. Yay, I'm so excited to be here again. Greetings from Cooper Hewitt's exhibition, Design and Healing, Creative Responses to Epidemics. Our exhibition is open all year, so please come and visit us in New York City or online. And our new book, Health Design Thinking Second Edition, dropped in February of this year. Some of today's speakers are featured in the book and the exhibition, so look for some more information there and these great resources. I'm going to share with you a taste of our exhibition content. Human beings have known for centuries that protective clothing protects disease. Drawings of medieval plague doctors show a figure covered head to toe in a protective long cloak. This dude is also wearing a hat and boots and gloves and goggles and a bird-like mask. And he would put inside the beak of the mask aromatic herbs with the hopes that that would ward off evil air. Don't think that really worked. Sorry, plague doctor. And that stick that he's holding, that's for social distancing. He would use that stick to prod the bodies of dying or dead people. So that's pretty creepy. Sorry for that. Here's a happier image. This is a beautiful handmade cotton mask decorated with fried eggs. And it was created by Mobile Mask Machine, one of many organizations that created masks for neighbors and families and frontline workers during the pandemic. Mobile Mask Machine distributed their masks in this adorable wooden cabinet that they placed in neighborhoods around New York City. And here is Naomi Osaka. The pandemic collided with global outrage against racial violence in the summer of 2020. Naomi Osaka wore seven different face masks during the US Open, each one bearing the name of a black person killed by police. Here she is wearing a mask with the name Philando Castile. Osaka donated all seven masks to the Smithsonian Institution, and we are so proud to have this in our historic collection. Fashion designer Katia Lozanova designed a hooded face shield that buckles securely under the arms. It's sporty and techy and very fashionable. New mask designs also address cultural differences. Model Halima Aidan, who is herself a former health care worker, designed a mask that loops around a matching hijab. Designer Timsy Batra belongs to the Sikh community whose members cover their hair with a turban. This adjustable cotton mask has wide long straps that fit over a turban. Sky Kubakub designs clothing for queer and disabled people. Their brightly colored textile patterns celebrate beauty and difference. Sky's clear fronted mask helps people who are deaf or hard of hearing visualize speech. Masks and face shields and respirators created for health care workers are actually medical devices. And we're going to hear from some of our speakers talking about the process of creating PPE for that very special community. But first, Morgan's going to introduce our first guest. Thank you, Ellen. And I'm so excited to see the exhibit of design and healing at the Kubria Museum next week. I have the pleasure of introducing our first guest, Dr. Monique Smith. Dr. Smith is the founding executive director of Health Design ED, the acute care design and innovation center at Emory University. She's an emergency physician at Grady Memorial Hospital and a thought leader on design thinking and health care. With expertise nationally and across the globe in service design and system strengthening, Dr. Smith leverages design to reimagine the spectrum of acute care within a large health system from the moment the patient experiences symptoms to long after they leave the hospital's doors. Dr. Smith has appeared in The New York Times and CNN, and she currently serves as a health equity and innovation advisor for Fortune 100 companies, as well as on the White House's Health Equity Round Table. Prior to joining Emory, she advised early stage companies on tech-enabled care for seniors, digital vaccines, and virtual quick care platforms. Globally, she's worked across five continents to deploy data and technology in expanding access to care, address supply chain challenges, and systematically tackling health inequity. Dr. Smith is an innovation leader passionate about cross-market solutions that drive equitable tech in acute care. Monique Smith, thank you so much for joining us. Thanks so much for that introduction, Morgan, and Helen, thanks so much for having me. It's great to be amongst this group and also to be in such great pairs and excited about all the conversation we're going to have today. Health Designs launched back in 2009, and we had a very clear vision of wanting to make acute care effortless and bring equity to well-being. And within that, we had a very clear initiative that we launched around equitable technology and able to care. We wanted to center equity in everything that we built, everything that we delivered across our very diverse population that we have here in Atlanta, but also thinking about that from not just the national, but also a global perspective. And in our first few months, we were faced with a pandemic, right? A pandemic which uncovered a lot of ways we could leverage technology to impact the health and well-being of communities, right? And how we started to do that was certainly at the very beginning of COVID. We were really fortunate that we had some expertise amongst our faculty who were part of the H1N1 response and the Ebola response. And in existing relationships with a deep technology partner called VITAL who had software that existed in our actual emergency department. And in anticipation of the patients and the influx that would happen with the pandemic, we very quickly across the period of two to three weeks set up a website called c19check.com. So in the first three months of the pandemic, reached over a million people globally, right? And within that, it was essentially a free online COVID-19 risk assessment tool, right? That through a few clicks, through a few screens, it allowed individuals really a level that was, you know, comprehensible to some of the elementary education to kind of self-sort and understand their COVID risk, understand and mix this influx of information on a device that was connected to the web, how to fit through information that was relevant to them and through the sphere to understand what they should be doing during this very sensitive time. And, you know, in doing that, we also started to understand that that's one way. You know, we know that just smartphones or not just smartphones, cell phones have a 96% penetration rate in the US, but there's still a lot more that we can think about that from a global perspective, right? And to have the ultimate impact in the reach of this technology, we had to think of ways to eliminate pieces of the digital divide. We had to think of different ways to reach people who might not have heard about it. And so we did things like one, experimenting with the idea of what can we do on basic phones? What can we do with those text message flows, a USSD flow globally, to reach people who were accustomed to being reached through their phones, but might not have that web connection, right? And then we really landed from a US perspective in what we call the COVID messaging campaign. And this is the idea of using different channels, different ways of engaging people and using a trusted messenger, someone who would be received on the other end, right? So really ranging across 10 different sectors and really using trusted anchor partners in a way that was pretty untraditional for healthcare systems to collaborate. Everything from, you know, our healthcare providers and our communities from our federally qualified health centers to some of our small minority-owned businesses, to large corporations with frontline workers, to grassroots organizations and faith-based organizations and social clubs and payers. And really combining them all, with voices in each of those entities that could reach people and reach people to tell them about, you know, what was COVID prevention? What was the best information we had about that? What was the best state of information around testing? And then ultimately around vaccination and throughout it all also wrap around resources, services that people were needing throughout the pandemic and might not know what to get locally. They were a fundamental part, not just of their health, but of their wellbeing. And in that we established a COVID texturing, right? So that on your phone, on your device, you would get a ping from us really across, you know, every few weeks over the course of what happened to the eight to 12 months where we would kind of send you some information around, well, who we are. This individual that you trust is going to be sending you messaging around COVID. And these are information that you should know about COVID screening. So leveraging again that website C19 check, that ability to triage and understand your risk, letting people know about testing that was available in their area. What to do with a test, understanding the test, and then also understanding, you know, again, what sorts of resources might be available in the community for people who might have, be facing challenges with accessing food, really understanding the flu season in the midst of COVID and understanding accessing things around your mental health and then ultimately around the vaccine itself. And really creating what was a trusted line of communication that happened to be through technology. And that trusted line leverage not just texting as a possibility, but also leverage social media and different social media challenge challenge from Instagram to Twitter, but also partnering with partners like Essence to make sure they're reaching very specific communities and reaching people where they needed to be met in a way that was fundamentally accessible. You know, in that, we knew that, you know, 96% of Americans, you know, have a cell phone, we're still going to miss 4%, but technology gave us a way to scale and a way to start. A part of what we also did with some of our grassroots outreach locally in Atlanta was really live in a data-forward way. You know, really kind of thinking through how we would leverage a community needs index, a dashboard that really kind of thought of how we prioritize people from what was still a community-based perspective at the Census, CHAS, and zip code level to understand who they are and what they were experiencing and where we could deploy resources and reach people best. And this is an area that has continued on in our work. An area where we've been able to think of this as a data sandbox, right? Knowing that people live in a context that has data in every single part of it. And that's a fundamental part of innovation as we see it today. And you know, the healthcare system, we often just think of the data that people bring into our system in terms of electronic health record, things that are easily captured. But there are all the other ways in which, you know, from someone's latest tweet or post on Instagram to the things that our government has done to make publicly available data sets that allow us to actually innovate in the healthcare and technology space. And so that's part of what we've continued to do is not only the legacy, but building on what we started in COVID to really create a health equity data sandbox. You know, at the same time as we were launching some 19 tech, we were also partnering with some of our folks in our bioinformatics core. And part of what we were doing then was creating an auto triage tool to really capture vital signs the moment when we walked into an ED. So using facial recognition software to figure out is your oxygen level low? Do you have a temperature? How should we kind of make sure that we land in the right place in the ED in a timely fashion? And it's something that we spun up pretty quickly and pretty kind of low tech locality and realized that we had a great training data set but not a perfect one. One that needed to have a diverse set of faces to be able to accurately reflect things. And so as an academic center, we published it, we put it out there. But that's the sort of thing that the health equity data sandbox is meant to solve for. It's meant to solve for that piece of innovation that allows us to more equitably center innovation no matter what sort of technologies we're putting out there. And you know, we're certainly more than 18 months in and out into our journey and really have kind of been thinking through not just the sandbox, not just the way we use different technology channels but really also how we provide virtual care. I mean, you know, really kind of doing that in a way where we're able to reach people in rural Georgia and reach people across elements of the digital divide. And that's the way that we kind of bring together not only technology but also the way we bring together communities and really rethink healthcare outside of the walls of what has traditionally been the emergency department and think about it upstream. You know, as a physician, one of the hardest pieces is that, you know, I often sit at a place where people are coming to me in crisis and the ability to work upstream, to design upstream, it's an absolute luxury. So, you know, I'm excited to hear about what the other folks have been building on their end to have more of this discussion. That's really great, Monique. Thanks so much. If you have questions from Monique, please put them in the Q and A and we'll get everybody talking after we hear from some more of our speakers. We've been talking a lot about how to design trust in this series. So, I'm really excited to hear more from you about how you do that, how you create that sense of trust. Our next guest is Adam Wentworth. Adam is an engineer, maker, designer, teacher and dreamer at MIT and Brigham and Women's Hospital in Boston in Cambridge. He developed drug delivery prototypes in the lab of Robert Langer and Giovanni Traverso. He currently works in Mayo Clinic's anatomic modeling lab using modern AI technology to develop anatomic models and surgical guides. So, lots of AI today, that's exciting. Adam, how about you get started telling us about the work you did at MIT, designing scalable and reusable N95 respirators during the pandemic. Welcome, Adam. Absolutely, thank you, Alan. So, yeah, early on in the pandemic, we noticed that the standards of care were changing. Supply chains were hurt and we needed to think about what kind of solutions were sustainable and lasting in times like these. So, we developed a transparent elastomeric adaptable and long-lasting respirator. I'm just gonna go over our approach, some successes, some setbacks and the lessons we learned and where we are now. So, these are the kind of problems that we faced early on in the pandemic. We saw broken supply chains, first of all. We saw healthcare providers wearing masks that were hurting their faces, leaving bruises, just generally uncomfortable. As we've seen with a lot of recent news, there's been accumulation of pollution and we've kind of got metrics on that now. And also communication was an issue. So, that leads to one of our design features which is making it transparent. On the left, you see the standard respirator that was used at Brigham and Women's Hospital 3M1860 N95. So, this isn't really your consumer level mask. These are surgical respirators and those have a few requirements that are additional to an N95. So, we thought from a design concept that we would have a two-part system. Essentially, all the parts that you can reuse aside from a filter would be a reusable component and then a filter could be separate. And in order to meet all the design criteria, really that boiled down to having the manufacturing process be an injection molding process made with liquid silicone rubber which is the material used for this anesthesia mask. This brings the cost extremely, it brings the cost way down for purchasing considerations and is a scalable technique meaning you can make millions of these. From the filter component, what's found in surgical masks is pretty much standard across the board which is a spun bond and melt-blown polypropylene and there's multiple layers in there. And these are the criteria that the design has to meet. They have a high efficiency for filtration. They have to be breathable. There has to be low flammability and there has to be a liquid barrier and they use a synthetic blood test for that. Adam, can I ask you a quick question? Yeah, absolutely. The respirator you're showing on the top in the previous slide, is that an existing product? This is an anesthesia mask. So, it doesn't filter it, but it serves a similar purpose. Thanks, thanks. And so, this is an iterative design process and that's why I have this kind of loop and this is the knowledge base that we had to acquire. So, it's really making, testing and learning and doing that over and over again. And one way to really shorten this process, I would say, is initially talking to a lot of experts. I'm definitely not a mask expert and was not at the beginning of this pandemic but I learned a lot about filters. I learned a lot about the qualifications that they need to meet. A lot about wearable components, a lot about manufacturing. So, really you're just going around and around and this is not a one-person job, this is not a two-person job, this is a job for a team and so relying on your resources, aside from experts, having a team that can help out in each of these components is extremely helpful. Let's see, it's taking a second. Here we go. So, these are some of our early prototypes. So, we use 3D printing and really speed is of the essence when you're making these prototypes. So, being able to 3D print and test, form and fit is crucial. For our initial filters, we cut these out of existing N95 masks. So, these are kind of a control that says we're going to at least filter, at least at the efficiency that we need to be filtering. And the initial tests are really about the fit and form of the mask itself. So, this injection molded component that you can see or you can barely see on this mannequin. We utilize Protolabs for the injection molding process and which is great because it's a high efficiency manufacturing suite with lots of different technologies. We were able to design and the injection molding process only took about a week to get these masks made and delivered, which is incredible. If you're going actually for production level injection molds, it takes several months because the molds, what they call tools, need to be made out of different materials. As you can see, the filters are separated so the mouth is visible in this mask. We then underwent two clinical trials of fit testing, a version one and a version two mask and a total of 60 healthcare workers. This consisted of ER staff, physicians and nurses. This is one of those critical time points in the production of prototypes where if this wasn't successful, we might not be where we are today. So we were thankful to see that 100% of people passed all of these fit tests. We got really valuable feedback from user testing where we saw ER staff who really were a little bit more brutal than I would have liked with the masks but it was good to see a real life use of it and we were able to- So what do you mean brutal? Give us a picture of that. Okay, so what I would say is the method of putting on an N95 is kind of cupping it in your hands and letting the straps drape over your hand and you put it up to your face and you pull the straps back over your head. And so the force at which people are manipulating and stretching the mask was something that I hadn't expected but also could lead to potential failures. So really identifying when you're doing prototyping, identifying potential failure modes is one of the most critical parts of doing that process because you don't want failures at a time where you've invested a lot of time and money to making a good product or what you think is good. So getting the user feedback at a bunch of stages is a really important part of the process. I would say one of the downsides of doing this kind of testing is that it's really qualitative. You don't get numbers back. It's a short-term test so they're only wearing the mask for maybe 10 or 15 minutes. So breathability maybe they don't have a good sense of it or if they're under a stressed situation or you may not get that kind of feedback and there may be potential bias because these are kinds of people that my colleagues know or have potential relationships with. So those are the shortcomings of a study like this. Then we did performance testing. So this is where we relied on external groups to do filtration testing. The example of the machine you can see in the bottom left here which gives us filtration efficiency or how many percentage of particles can get through your mask and also a pressure differential. So it will measure an example of an inhalation and an exhalation and it will measure how much pressure builds up inside your mask and this is kind of a resistance to breathing. This is one of the critical factors of being able to pass regulatory approval to get a mask approved has to can't build up a lot of pressure inside the mask when you breathe. And the other two are flammability and synthetic blood penetration which the materials themselves are qualified for and have no problem passing. These are four papers that we published to really go after those aims we had initially of communication. So we did a communication study with some hearing impaired folks. We had a prospective study of, is this mask feasible? Do people like wearing it? Is it comfortable? And we also had a pollution study at how much waste is this mask going to reduce compared to the standard of care now? And then some setbacks. This graph on the left shows that with a specific mask material and area fixed area on the face you can follow along this black line which shows that if you increase the thickness of the mask you will filter more particles out but it will also be harder to breathe. This green box in the lower left corner represents what will pass regulatory numbers. And so you can see that if you stick with a certain amount of area and a certain material you may never get into that green zone. And what's required to get into that area is more area of a mask or a better filtering technology. And so what we did is get a little bit of both. We actually are using a wool blend which is one sustainable because it's using special sheep from New Zealand as we like to say. And also we have a little bit more area from a redesign of the filters. Some of the other setbacks I would say are high costs of prototyping. That proto labs injection mold is not cheap. Injection molding itself is not cheap. So you need to be confident in your design before you go forward with something like that. And then speed I would say was an issue early on where we need to rely on offsite testing for some of this filter stuff. And that takes time to happen. So getting as many things in-house as possible is advantageous from prototyping and speed consideration. From going from prototype to product there are a lot more steps than just making a minimum viable product in the lab. And these are things that the company that was incorporated has had to go through over the past I would say eight months to a year. A lot of contracting and quality management systems, market research and then finally submission to regulatory. And so that's where I like to say that we will be submitting to regulatory hopefully sometime this month with the mass that we've developed. The lessons are think big. If you don't think big you'll never even attempt a solution like this. It takes a team. So really it was much more than our group that had participated and contributed to this project. It takes luck. So at all those different time points where there's always a potential to fail. If we didn't pass on those we may not be here and nothing is perfect. So sometimes as a designer it becomes your baby and you don't like to hear criticisms about your design but I would say all those inputs are valuable. So it's nice to receive those. This is where we are now. So this is our company Teal Bio. We have a website and this is the latest prototype that we will be submitting. And James and the Lord left here and myself for the primary members at the beginning of the pandemic. As everyone else was working from home we went to the lab every day and we're grinding it out. Yeah. So thank you. That's amazing, thank you. So exciting to see the whole design process and these issues that come up that an ordinary person wouldn't expect like that you need more field and that filter like the filter has to be bigger in order to be functional. I would not have expected that. So I'm sure we'll have some questions for you about what you learned in all those studies. I really wanna hear more about that. Sabrina, Paceman is our next guest. Sabrina is the CEO of Fix The Mask. Previously she was a product designer, product design engineer at Apple developing products from concept to mass production. She holds degrees from Cornell University in biological engineering and mechanical engineering. So Sabrina, get us started. What is Fix The Mask and where did the idea come from? Absolutely. Thank you so much for the intro. Let me share my screen. So thank you for the intro. I'm Sabrina and today I'm going to be guiding you through the process of how we develop our solution, the essential mask brace. And the real theme for our presentation today is how to design solutions for reality. And by that I mean how you design solutions within the constraints of today's day and age. There's a lot of changes from previous times, I feel like in the pandemic. So as we all know in March of 2020, there is a mask shortage for healthcare workers. And the main approaches that were taken by most folks were twofold. The first were either making T-shirt masks, masks out of available materials in people's homes that they could sew together quickly or going the 3D printed or a 3D concept mask route. And unfortunately, both of these weren't really solving the heart of the issue. The problem statement as it was posted to the public was there's a mask shortage for healthcare workers. But the real problem underneath that was actually that thousands of people were getting sick from an airborne disease. And so what does that mean? Let's break down that problem. Thousands of people means that the solution has to be scalable. It needs to be able to be made millions immediately, right? And the second was people are actually getting sick meaning it has to be effective. And so if we go back to each of these two solutions, the T-shirt masks, even with the studies at the time were showing that they only filtered 20% of particles, they're not effective and therefore this can't actually solve the problem. And with the 3D respirators, they're not scalable. A lot of these were proposed to be made by 3D printing and it takes hours to print a single mask. And so in order to solve this problem, not necessarily a viable solution. And the second part was that these filters that were used inside of these 3D printing masks, there was no real guarantee that the filter material was available. So when our team saw this problem, we wanted to take a different approach. And the way that we figured out how to do that was we looked at the NND5 respirator. And so while it is effective, we realized that it wasn't scalable, hence the problem that we were in. So our next question was why? Why each of these things? So we dove down real deep into effectiveness of NND5 respirators. It turns out they're effective for one of two reasons. The first is that the filtration of these is excellent. Why is it excellent? It uses this special material called melt-blown fabric that is engineered very strongly to not only be breathable, but also filter strongly because it's electrically charged. And this material is not something that you can just substitute necessarily. You can't just make it out of cotton and you can't do anything else. And so this was honestly a real limiting factor as we were going about our design solution approach. The other thing that we found of why NND5 respirators are good is because they fit well. So we'll keep those two things in mind as we move forward. But we changed our solution basically to our problem statement rather to say effectivity means that it uses melt-blown fabric and secondly, that it fits well to your face. So now to tear down the second half of this problem statement, like how do we make something that is scalable? What does scalability actually mean? So we looked into how NND5 respirators were manufactured and we found some astounding things. The first thing was that NND5 respirators, the cup respirator that was so popular at the beginning of the pandemic had 33% material waste in its process. You can see here, this is how they make those respirators and giant swaths of this melt-blown fabric are just being completely wasted. And given that we were in a global shortage of this specific material that was required to make punctual masks, it was sort of astonishing to me that this is the best that we could do. Sabrina, can you walk us through what's happening in this image? It's really fascinating. Totally. So in the first slide, basically the way that these masks are made, you can imagine them as like a giant sheet of material. They're then sort of individually punctured, not punctured, but sort of formed into the little dome shapes that you see. And then they're cut out. Like, I don't know if you've ever made ravioli before, but they're sort of sliced around until you get your little individual mask ravioli shapes. But all of that extra dough, quote unquote, is just thrown away. That's something that cannot be repurposed or reused. And that's what you see in the second slide. The second slide is that cut out of the extra dough that they just basically throw straight into the trash. And the third one there is basically seeing the individual little raviolis of masks that you can see there. And so it was, the first time I saw this, it was blown away by how inefficient it was, given the fact, especially that this material itself wasn't shortage. So looking at this piece of the problem, new for a fact, like these manufacturing lines are designed with efficiency in mind. And if this is the best that they could do at that time, like revamping this is not gonna be fast enough to actually address the shortage in the shortest amount of time. And so what our team did was instead, looked for other available resources of this milk and fabric that potentially were also available. And what we found, which is exciting was that surgical masks use similar milk and fabric, but they have much less material waste. So they're basically just big rolls of sheets that are cut into pieces. So it's more kind of like going off my pasta allergy, more like making a spaghetti than a ravioli or you don't have extra dough. Basically all of it is used in each individual mask. So that alone was very interesting and sort of drew us to like learn more about surgical masks. The other astonishing thing was that surgical masks are way faster to manufacture than NNU5 respirators. At the time, only 0.6 million NNU5 respirators were able to be made per day, whereas surgical masks, they can make 200 million per day. So in my mind, when I was looking at this problem, you have a shortage of material, we need to figure out how to utilize it as quickly and as efficiently as we can. It seemed like a no-brainer to basically switch all of our resources of milk and fabric into surgical masks at that point. But there was obviously a caveat, I'm sorry, let me go back. So that when we've resided our problem again, we are saying that now we know what effectivity means, we know what scalability means. So where do we go from here? And I was saying surgical masks looked very exciting as a solution. They use milk and fabric, which is one of the things that we wanted to do. They have minimal material waste and a quick to manufacture, which means that we solve the effectivity problem and we also solve the scalability problem. And the only remaining thing is that they don't fit well to your face. And that changed everything. So that made our problem statement very clear. We just needed to find a way to make a surgical mask fit well to people's faces in order to immediately unlock millions of NNU5s for people. So that's exactly what we did. This was our very first concept that we drew and sketched out. We knew from the very beginning that it had to be scalable, mass-producible. So we knew it had to be a single sheet that would sort of fit over the outside of the surgical mask. And the really exciting thing also about surgical masks is that they were widely available all over the world, not just in first world countries but also third world countries. And that's when we sort of rapidly went into our prototype and test phase. And this is reiterated off of the previous design presentation we just saw but doing this concept prototype test phase as fast as possible is critical to creating a relevant solution. So we had our concept. Sabrina, can you just describe what we're seeing here? We kind of moved from ravioli to spaghetti. Like what is the fundamental idea? It's like a rubber band around your face in a way. Help us see that. Totally. So this piece is a exterior rubber sheet that you could place over the outside of a surgical mask. And understanding the problem statement of our goal is basically to get surgical masks to fit better to the face. We created a concept for sort of a strap that could sort of be placed over the outside. And here we went through the first prototyping stage. I didn't have any rubber sheet in my house at the time. So I used rubber bands because that's what I had. And this was the super drinky looking, but so simple. Like it really, I was astounded the first time I put this on like how well it worked even from the very beginning. And while it literally is just through our bands this is something that actually potentially could mimic the efficacy of an M95 respirator. And so we are taking something that is widely available, easy to make by people from personal countries, third world countries. And like basically this is the heart to solving the problem the shortest period of time. So after we made this prototype, we tested it with the very loose method of seeing if it sealed well. We put the hand over the mouth and saw that our mask was sucking in with the vacuum and then as you breathe out it sort of loosened. But we wanted to go deeper, right? So the problem with these rubber bands, unfortunately was that they, you know, not the most comfortable thing to wear and also not the easiest to sanitize. And we knew that for healthcare workers that just wasn't an option. It needed to be something that was easy to clean. So our second concept was something a little bit cleaner. One giant sheet that could be cut out of a rubber sheet. And we went really hard on the prototyping for this iteration, realizing that the angles of every single aspect of the rubber design were critical for comfort and for function. We also up their testing game and we actually got this system, which is called the Port Account Pro. It's what hospitals actually use to test 95 respirators before they got onto the field. And so really iterating quickly and efficiently in this phase allowed us to get to something that we actually published online and got hundreds of thousands of downloads immediately which we want to try it for ourselves. So this is the funny part of this whole process. I was feeling very high at this point saying, oh my gosh, look at me. This is the solution to the pandemic and you can see like the pain in my face here. My sister tried on this product and she has like stated this is the most uncomfortable thing I've ever felt. Like what is this, this is ridiculous. And I was very humbled by that. And we again went back to drawing board of our problem statement or like this that needs to be comfortable. So going into the final concept of something that is actually three dimensional in nature to have comfortable nose cushions that can actually conform to multiple face shapes. And here again, we did not go the 3D printing route. I think a lot of folks at this stage would have tried to do elastomeric 3D printing or something like that. And as a engineer that has actually been an industry 3D printing is the slowest manufacturing method and not relevant for like injection molding at scale. So found a way to actually prototype small scale real rubber and real silicone rubber. And that's all of the work done here. Testing this, we also expanded our head sizes. So knowing that that single prototype of the rubber version worked well on me but not on my sister. So we got the head forms and started testing that and verified that this new design that we came up with worked out quite well. So I know I'm a little over time but this is how we achieved a mask that is available effective and affordable for the wide variety of the population. And to answer the original question of how design for reality can see that we went through so many different problem statements throughout our time here. But in order to design for reality, the real solution is to keep asking better and better questions until you can find a solution that can answer all of them. Beautiful, thank you. Thank you. Thank you so much, Sabrina. It's a pleasure to see you again. Thank you for joining and thank you to all of our panelists. I would like to invite you all to rejoin us on camera for question and answer sessions. I have so many questions for you three and I am going to try to be kind to our audience who's asked some questions too and start with an audience question. So Jordan Wackett asks, Dr. Smith, what effective any did the COVID-19 text journey tool have on EDUs for patients with COVID and did it seem to reduce unnecessary ED visits? And as an emergency doctor myself, I'm just going to add a little bit to this question. If it didn't have the effect that you thought or if there could be some potential for improving that effect, what do you see as the answer there? A great question. I'll answer it in two ways. The one, the C19 text tool was the piece that was around ED version, right? The idea that if you use self-sort, maybe you won't show up in the ED with questions that have to do with, am I really sick? Do I need to be admitted? And I think the fact of the matter and more of you can be honest on this is what we saw in emergency departments is if you want to test, they know where else to get it. So people that were showing up were less about am I sick? They were more about, do I have COVID, yes or no? And that you can never solve the technology, right? Well, different types of technology. But not this particular piece of technology. You know, what we did with the COVID-19 messaging campaign was actually link it to other things. So thinking about whether or not we were nudging people to testing, whether or not we were nudging people to vaccines. So we didn't just use it in Metro Atlanta. Our partners with this were in on health and they actually have a base in Denver. And so some of the data that they saw from Denver was really quite interesting in that enabling the messaging campaign across multiple channels. So not just text using social media, using radio, using email. They really want to drive up testing over the course of this, you know, one particular weekend in December. And they were able to essentially increase it 2X, right? So they went from around 6,000 tests in a day to 12,000 tests in a day. And their goal was just to get to 10K. And that's the power of messaging. That's the power of the behavioral nudge, right? So I mean, I think there's multiple ways in which you can spin, did this have the results that I wanted? In the idea of a campaign where you're having continued link and a continued communication and continued conversation, there are many opportunities to change behavior. Whereas that single piece of one tool, one Simpson Checker, which you can ask any of the major Simpson Checker companies out there, whether or not they work. And they've got data that says that they probably do change behavior. That's actually the way that you communicate the information, right? And whether or not someone's actually seen it and adopted it. It's part of the answer for all that. Beautiful. I have a question for Adam. So we had a great theme here of waste and manufacturing. And I know your product is intended to be reusable, which addresses waste head-on. How about in the manufacturing process? Is your product ravioli or spaghetti? I would say it's a spaghetti product. So the injection molding process will just directly apply a lot of pressure to a liquid silicone to fill and mold cavity. It will cure inside that cavity with some heat and then it'll be able to remove it and then pump in a new one. So I would say it's a low waste process. Great. That's terrific. Sabrina, your story of that sort of aha moment when you started to think about using rubber bands and sort of like easy household supplies to fix the mask is actually one of my favorite stories of design during the pandemic. I think that was just like so cool. And I remember reading about it back then and being like, oh, it's so inspiring. We can all design. Like that's great. And so tell me about that aha moment. Like now that it's been two years since that moment or maybe even longer, what would you, what advice would you give yourself back then if you could go back and tell yourself something? And I'd love to ask the other panelists the same questions afterwards too. Absolutely. I think in my own life and design career, I think that was also one of just the highlights, everything sort of clicked. And I, you know, in design school and engineering school, they always teach you prototype quickly and be scrappy, but like what does that actually mean? And I think that was really put into the most obvious simple terms like when looking into masks for the pandemic, but to reiterate, like this is something that everyone can do in all fields of design and all fields of improving any concept, right? It's basically how can you answer the most basic question as quickly as you can before you have on hand? And I think oftentimes a lot of people get stuck on, I need to have like the fanciest equipment. I need to like wait until this manufacturing process is gonna give me answers. But no, in reality, you can like answer a lot of your own questions if you take the time to look around and be scrappy. I wanna come back to this question of trust, which I think actually all of you touch on. And Monique, I'd love to know from you, how do you get people to trust your product and trust the behaviors that you're asking them for? Whether it's getting a vaccine or being tested or not running to the emergency room, if you think you're sick, what are some techniques for creating trust, designing trust? You know, for us, particularly in kind of the additionally able world, where we're talking about a lot of things that have to do with communication, it's about the messenger, right? And there's really great data out there that says people that trust people who look like them, they trust people who come from known brands, that come from known locations, known places. So in our design, we really started with the idea of who are our community anchor groups and who are those trusted messengers within those anchor groups, right? You know, it's one thing for Monique Smith, emergency physician to talk to you in emergency department in a trusted environment. It's a totally other thing to get, you know, as a text message with five digits on it, saying I'm from blah, blah, blah healthcare systems, right? But knowing that that message is from someone you might have heard of, might have seen before, might connect with in some way, whether it's your pastor or whether it's the, you know, not the HR rep, but someone who's well known within your, you know, large corporation, it has meaning. There's a willingness for you to actually be engaged with that message in a very different way. And so for us, it was leveraging those voices in a channel that was consistent and the same, and that also linked out to really what reliable sources. And I think what we saw very early in the pandemic is that there were too many sources, there were too many messages. And so we became part of this information overload of who can I trust and what can I trust? So we tried to reduce that down by creating it in one channel of connected communication with the trusted messenger being the same each time. And that works for a lot of people, you know, for the, you know, more than 300,000 folks that we reached in Atlanta. It was very much kind of in that fact until we asked, well, how did this work for you? They said, thanks for this resource, somebody's used that a month. You know, I thought- And the different users- The different users get their message from a different messenger? They did. They did. Wow, that's cool. It was part of the group they were in. And it's part of how you think about accessing people that you might not have access to, right? The person that goes to, you know, the oil bar would sell oils locally at, you know, five different stores in the community is very different than the person who, you know, visits our healthcare system versus a person that works for the large corporation. And we leverage each of those channels in the fact that they already had a trusted way of communicating. They had phone numbers. And the way of kind of continuing that messaging in a way that also was wrapped in medical knowledge. And frankly, then was also free for all of those folks to deliver as a service for their community. That's amazing. Thank you. Adam, I love the TL reusable respirator. I think it's so cool for so many reasons, you know, like wearing respirators and N95s and masks every day for the past couple of years. The comfort aspect is so important and you are thinking more and more about the sustainability. One thing that I think is really cool about your solution is that ability for people to see your face while you're speaking with them. And I think there've been a lot of solutions in PPE where the goal is to be able to see the person you're talking to. And there's been just a lot of challenges to success in that space. And, you know, along the lines of trust, it's of course difficult on a population level to build trust with new designs. But on that individual trust with patients that we experience in the hospital, it's really hard when they can't see your face. You know, I feel like that takes so much away. So I'm curious what you think, you know, are we there? Like, is this a solution to that or do you think that there's a secret to like what needs to happen to get to the point where we have the right solution? So yeah, I think that's definitely, it is definitely a key. My boss during this time is a physician and a few other folks in our lab are physicians as well. So they have this experience talking to patients with masks on and saw that difficulty. And so that was a key component early on was we need to have this feature because this feature doesn't exist in a lot of N95 level respirators. It just is not out there. And we saw very positive feedback from the studies that we conducted as well. So I think it's definitely key. I think it's also a material challenge, you know, as you breathe in masks, they tend to fog. So you need specific materials inside the mask that have coatings that don't fog. So I think ultimately that is the solution. We have a question from Jennifer Tobias about the regulatory process. And she points out that when a bike helmet is designed, you have to design the entire bike helmet before you can get it approved. And that seems so counterproductive because shouldn't you be learning from the approval process? So it is maybe Sabrina, you could speak to what you went through to have your product approved by regulators. Absolutely. Was that for Adam or for me? I think it probably applies to both of us. Yeah. Yeah. So the regulatory process is robust for a reason, right? Obviously you don't want to have something that is under qualified or under tested on users. And what's surprising is that the regulatory process is a lot deeper than just does your product work or not and doesn't work or not repeatedly. The regulatory process goes a lot deeper into all the materials that you're using consistent and reliable are the processes that you're using to make your product consistent and reliable. And they're not just saying like, does this one off of your product work? They're really saying, does this entire manufacturing run of your product is it good enough? Does it meet all of the regulatory constraints required? And it was a process to ensure that all of those things were met and up to standard. It is unfortunate that it takes so long though because a lot of times when you have a solution that works, I guess I've learned to not say like this solution works. Like there's actually a lot more nuance to, does it work for six months? Does it work like when it's like 300 degrees outside or like in your car and then you put it on, does it work? There's so many different nuances to that question and the regulatory process basically guides you through every single possible edge case to really give you the most confidence to make sure that your product will work at full scale. So yeah, there's just a lot of testing involved. I'm sure Adam also experienced the same thing with his product. Adam, do you wanna add anything about the regulatory process? You're in that process. Yeah, so I undergo design review meetings all the time for our product currently. And one of the things I was exposed to is a quality management system which is required for any medical device. So you're starting with a long list of user needs and those go to design inputs and design outputs and how you validate and how you verify each of those design inputs. Aside from that, you are thinking of every way this device could fail and then how it may hurt the person and how likely it is to hurt the person and then you identify a level of risk for each of those. And those feed into how often you need to test your products as they're manufactured. So that's essentially a big picture of what it takes to get a product through. Cost money to do that, right? I love Adam what you said about getting feedback on your baby and how it's so helpful and so it's painful and it's helpful at the same time. And sometimes that's the most useful moment in a process of designing something new. And so I was curious, Monique and Sabrina, was there a moment like that for you where you got feedback that was hard to hear but really sort of one of the most helpful moments that you're both nodding, I love that. Monique, I guess. I think for us it was been working with the community. Building coalitions is hard, right? We had a great idea that was free that we knew could reach people but the core part of it is we had to have people trust us through people that were already trusted, right? And so building that framework and building that way of doing things, having already built the thing, it's just like it's a core classic design issue. Are you actually co-designing or did you build something and then recruit some other people to help you deliver it, right? And so that's the consistent aha moment of when you're moving quickly and you're trying to get to that end solution that you know can have impact. The steps that you take early on in the design process are fundamental, right? I mean, I'm sure both Debra and Adam have had experience on that side as well. Yeah, absolutely. I really resonate also with a sort of Adam experience when you know getting it first in the hands of users, I think like as a designer you spend so much time thinking about it and like you feel that you've thought of everything you possibly think about, you're so invested emotionally and getting the first bit of like, oh, this is extremely uncomfortable. I cannot wear this for like more than five minutes it like hurts my soul, but also like it is necessary to make a product better, right? So I think that all, you know, as I hampered in my presentation like changing the problem statement happens all the time. Like it's something that is completely flexible and you need to be able to adapt to that as many times as needed to make something that actually is good that people actually enjoy. I'm gonna ask the last question and give this one to Adam and then Morgan can wrap up our event. So Adam, how do you get people to accept a new product? This is a new paradigm for what a respirator looks like. Yes, absolutely. And I think Elon Musk said it pretty well is that if you're gonna make a product you don't need to make it a little bit better you need to make it a lot better for people to actually adopt it. And as you know that mass companies these days are very large companies. Everybody knows 3M, everybody knows Honeywell, et cetera, et cetera. And especially in healthcare, right? These are things where changes can be slow. So I think proving it out with these clinical trials is very important. You need to highlight the differences between what this mask provides versus what hospitals are using currently. You saw hospitals rapidly pivot though when they had to start reprocessing N95s, right? So they did do something fast when it had to happen. So as changes are necessary, I would say our product, you can highlight things like the lifetime cost of N95s, right? If you can reuse the mask 10 times that means that you're actually spending less money than buying 10 N95s. So points like that, I think drives the reality home. I think more people these days are susceptible to sustainable solutions and saying that yes we need to move in that direction. So I think just highlighting those attributes are really important to starting to move the ball in the right direction and getting adoption to happen. Great, thanks so much. Thank you so much. And thank you to all of our speakers, Sabrina Paceman, Dr. Monique Smith, Adam Wentworth. It's a pleasure to speak with you. And this is such a cool conversation for us to have today. I'd like to again thank our production, Rob Felici and Eva Brodsis, Graphics by Jennifer Tobias and Close Caching by AI Media. You can check this out on the Cooper Hewitt website. I just dropped into the chat or on Design Lab Pod with Bon Koo. And please join us again on May 6th for the third episode of this season. Thank you so much. Great to see you all.