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with
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so it's a great pleasure to be here i've enjoyed the symposium enormously because
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yeah i've learned something and be i disagree with that if my predecessors that always
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these do not that i disagree i start from a different point of view
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that many of my predecessors although it turns out that we talk about many of the same
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subjects so among other reasons for thinking that they've covered many of the ideas that
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need to be covered in s. and i will go quickly over some parts and slowly over some other parts just to make the difference
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so let me start by saying that resource limited means
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a lot of different things you could me congo
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it can mean a whirl clinic in india it can mean an emergency word in a hospital
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and we tended to focus on in yeah and congo
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rather than the murders you wrong but certainly rather
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than the central hospital the needs for the central hospital there are overlaps and there are also differences
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but i think if i could save i get some of my talk let me some of my talk for you so that
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those are you fit along day can then take a relaxing time and and your email or go to sleep
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it turns out in my opinion in this field at this time there's
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an enormous amount of good technology really interesting solutions to technical problems
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in fact this history says that many of these technologies will never become a big deal
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and the question is fires or are they not technically good no they're technically exit now the problem is the money
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so as an academic researcher what i'm going to tell you is that it's all the money and so forgive me for
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that it's bad manners but i'm gonna do it anyway so let me start with a couple points of background
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with this is one of the points of difference this is a curve for the united states
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but it it's horse holes for much of europe and japan as well and in parts
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what it says is that we spend presently eighty percent
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growing up the gross domestic product for health care
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and that's a lot of money it's not actually supported
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much of that eighty percent is spent toward and of life because
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much of the developed world as the point of view that
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every human life is important and there is an ethical obligation on the part of the medical system to keep people alive
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question is is that a correct assumption in resource limited world well a good question
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this is a curve which is plotted ran with the these twice this
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is the amount of health care spending that is dollars per capita
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and this is the life expectancy is a kind of surrogate for surrogate for health care quality
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from eighty four years up here is seventy four years down here give you span
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and you see there's a rough correlation i looked before i get is
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talking i can't find switzerland on here which means who knows what
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but what i can't is fertile non here is right about i. c. h.
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b. o. okay to run over there is the issue okay good
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receipts what someone's doing well because you get a little bit
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more life expectancy per dollar united states is the outlier
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united states is over there and we spend enormous amounts of money i with
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rather bit results and for those of you like this kind of thing
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it's interesting to read this block us hell
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multifunctional multinational perspective shorter lives for elf
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and it says that compared to twenty other countries or something like that according to a series of
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metrics for healthcare united states comes and last or
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second to last in every category except
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access to physicians so it's basically rotten system but it
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works it works very well to invent new stuff
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now the problem that i think all of us are dressing is this question of
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diagnostics and what role it plays and things and there's an old adage in
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medical school that if you can't make sure it you can't manage
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so what are we interesting in in managing well one issue is
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the genuineness third world problem the developing world problem of what you
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do when you basically don't have access to medical system
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and this slide illustrates two point one is that if
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you go to go doctor got brownies specially clinic
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you might or might not go but a you pay out of pocket and more importantly you had zero
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confidence that the test these anything because the quality in the developing world is is quite poor
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the second thing is that you actually can't get to the clinic because you usually live somewhere else where
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you don't have to to it's at all so it's a very different problem then the emergency room
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the other kind of problem that we happen to be interested in i think
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is more similar to this then you might as expected for the day
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and that is what you do when a variety of circumstances when
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you have a terrific healthcare system as in switzerland and in principle united
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states but it's not really accessible of one or another reason
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you get patients in nursing homes or you have patients and very rural environments
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absolutely it is possible to you in principle cards and to hospital but it's really
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hard and expensive and difficult to do this is an ambulance kind of thing
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what about getting a blood sample and sending it well as we've heard a
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blood sample send it diagnose it's in the results back that's too long
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so if you're in a circumstance like this at a nursing home and
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those of us who are older have more and more interested in
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nursing homes so those of you young should pay attention to this
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um if you if you are in this kind of circumstance
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you really have more limited access to many kinds of health care particularly time limited health
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care that you might imagine so the two are different but there are some similarities
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now i think i'm going to pass by this because it is
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is something which i use as a slide when i'm particularly annoyed with the academic world
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but what it basically says is that if you think about science
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on this attitude in engineering on this and the squadron
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you you ask here's edison who is purely a a applied side is to
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use bore who is given credit for being purely of fundamental scientist
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test your looked for problems that were high and potential for use
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by the characteristic that's the science was not available this is
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call pastor quite a resurgence what many of us do
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the point that i think is maybe worthwhile paying attention to for some of you is this quadrant which
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is low in fundamental quality and low in applications
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in washington used is often called universally quad
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and that's not a good idea
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now the underlying fifteen and what i want to talk to about is simplicity
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and i am a great great admirer of the idea
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that if you want to have something ultimately implemented
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you want it to be simple inexpensive you know whatever simple to design something
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to make simple to learn simple to use simple to interpret simple to
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pay for all those things decrease the barrier to entry for a new technology
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and they're not barriers to entry that anything you can do helps
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and all i'm not in the business of showing for box
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i want to recommend a book to you to recommend to read if you're interested in the subject by a guy named
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berger and it's called the idea factory in is the story of bell laboratories and it basically
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has to do with this subject of innovation which is what we're all trying to do
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mister gardner makes a very interesting point first he
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said that if you think about bell laboratories
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the picture that your friends in physics will often preach teach whatever
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is that bell labs was a place where brilliance this is is a noon flattered by financial constraints
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invented transistors invented the microchip invented the modern world this was wonderful thing
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it is true that they were brilliant then try for and then darlene and
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the rest these guys home or were unquestionably brilliance is is is however
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the reason they were doing it was to make it more profitable telephone
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system to that nothing to do with finals lines at all and
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baker who is the head here talk about innovation in terms of four steps
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why for and i think the answers we have four fingers so people come for steps
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so the first step was science which she says is cheap and
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easy you can get anywhere invention by which in nantes
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prototyping a product and much of what we've heard about today as they
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had to prototyping a product and perhaps a little further than that
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the first step is what he caught development and development is the hard business of regulatory clearance
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manufacturing for yeas oh no quality control shelf life all the rest of
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these things that one thinks about when you have a new product
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and he says it when you get finished with these first three steps what you
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have is a product and uses the value of this product is zero
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that is no this makes any difference at all
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and the only thing it makes a difference is the force yep which is a market
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and the market is something in which you have created something of sufficient value
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that people will demonstrate the value to you by paying you money for
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and the ability to write a check the willingness to write a check is perhaps the
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most fundamental an intimate if human interactions with this is really a big deal
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so you know the question of who throughout what we're talking about should not be
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in a sense what is the technology that we're developing on the theory
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that that will be used for the actually but what is the market for
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which we're developing a solution and it's a very different point of view
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so the agenda for the lecture this is all background what problem we're interested in or the core technologies
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and we we use paper and paper devices there are other things that will work equally well
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paper in biochemistry simple devices but there's a real point i want to emphasise here
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which is that i think in our work and in much of what we've heard
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the technology that's available solves the problem of developing the
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technology that is it's really there's lots of options
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the problem with the second problem the problem of the biochemistry
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is much more difficult for this repeatedly in terms of
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the quality of essays and available via via markers and things of that sort
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and connecting all of that to something it's a market is the real problem
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so some things that i'll talk about i'm not going to talk about maybe the all this i do want to talk about this for amusement
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but what i really want to lead up to is the question of transition or translation
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how do we get a technical capability into in marketed product
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and you say is this just an american capitalist talking well yes and no
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but the characteristic of market driven stuff is that some but you make something somebody gives
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you money returned you take that one in you invested in building a better something
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which then goes back which creates a wider range of applications for which people pay you money
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which enables you to do get more so capitalism when it
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works in the sense create a widening steer of
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cap of technical capability which can in due course actually change
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things and i really think about how the internet developed
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because there was absolutely no way in which anyone at the beginning goodbye understood that the first transistors
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which were sold at little tin cans one transistor the time could lead to face broke and the fact that
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either you or your children are heading your mind to be wired by the fact that you no
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longer have to do anything you only have to look it up so it's an interesting well
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so the problem that we have is hardly the lever clinically useful information in
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resource limited whatever that means you can mean a lot of things environments
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how do you reduce the cost of health care in the developed world this is something which
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i mentioned at the beginning how do you use technology that is simple
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for high technology problems i'll give you a sketch of that
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i'm not gonna spend too much time on this but i'll mention a couple points and my
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summary answer as i say is that it's the money so pay attention to that
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so
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what have we done and the core methods are summarised here
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using what my talking about when we started this the idea was what we wanted was a technology
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which enabled us to create and control pattern flow
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of fluids as reliably inexpensively as possible
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how would you do that and so we settle on paper for reason i think
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now go back after a moment paper but the pattern in
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the argument was what we could use as a model
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would be the technology known as printing which was used in newspapers and comic books
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they actually works pretty well it involves making outlines which in our case are
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the intended to channel flow and and colours which are the same thing
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as registered colours which are the same thing as as diagnostic creations
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and so this is a technology which it it finally comes
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to work is applicable to reel to reel printing
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and if you want to do something in real volume the way to do it is real real
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printing i mean the manufacturing costs in this area would be very very small but at volume
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so that's what we're going to do
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now what are the issues that we have to pay attention to
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first is you have to think about the sample collection and we agree that finger prick is probably the
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most efficient way of getting at by all markers that are in blog or going through and less
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perhaps convinced about urine and tears and things of this kind because not so much because they are present in volume
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but because the actual concentration varies a lot with the person
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the circumstance but there are cases where be useful
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let me point out there is an intrinsic problem here which is that particularly when
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you're trying to deal with things like viral disease in treatment or in remission
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fifty micro leaders may not give you enough volume to action detect one molecule of
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the thing that you're working with so this is not going to be
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in uniform a correct answer the problem but it is something which is pretty uniformly possible
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containers for fluids i'll show you how we do that the biochemistry and the
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reagents is usually the biggest issue and much bigger than the micro flicks
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and then they're interesting problems of technical problems in in time enveloping indexing
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and then detection transcription little bit interesting their stuff there are now come
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back to it and of course cloud connectivity which we've heard about
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now what are the problems on the other side the
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translation side validation is difficult and expensive regulatory clearance
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is actually one of the bigger problems because not so much because it's difficult
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to do people but it's really expensive and time consuming to do
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manufacturing setting up the first manufacturing lines are very expensive
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and then these issues of once you've got something manufactured you have to think
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about who's going to pay for them what the systems are involved there
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how do you train the people to use it how do you train maintenance people how do
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you set up major maintenance systems that are you minimise maintenance and then cycles of development
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so weak and that is we and the discovery community
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tend to work in this sort of area
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and probably the real problems are in this area where often we don't spend so much time
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and it's the final thing that you come down to is
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this all of these and all these require money
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so what we're really talking about is not a shortage of ideas and really no shortage problems but how do
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you get the money that's required to develop the technology in translate into the market and you do that
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what about tape is a cross section two piece of paper one typically thinks about paper in terms of
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all white sheet we think about it in terms of the series of hyper fill like bile compatible
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fibres and use the spaces between the fibres that are interesting because those are micron scale capillaries
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so this is a little micro capillary system in which the capillaries come for free you don't have to fabricate them
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but i know there's some things about paper the really interesting and one which you don't think
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about is the one that showed for example here and what that does is it creates
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an interesting me although you can talk about glass and polymers of
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which i think are very interesting materials they're not crucible
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the nice thing about increase is that you can build systems that are
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three dimensions are had mentioned or have interesting properties to them
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and although i'm not going to spend much time talking about today the ability to go into three dimensions enables you to do
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things that are three dimensional micro flick systems by printed in two
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dimensions and fold it and that's a very interesting capability
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so the argument for paper open channels compelling you don't require energy capillary flow does it
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it's very compatible with biological systems you can change the surface properties anyway you want to
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you can find it anywhere good mechanical properties if it's we had um you can ask is it
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best for everything but is actually very easy to find papers that are very good what straight
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easy compartment lies i'll show you about that very interesting characteristic
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is that if you put a fluid in people
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it's stationary you shake the paper nothing happens and that means you can do
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control of diffuse it mixing very efficiently with paper and
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this has some important implications for electro chemistry
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integrates well with things that other issues but these the major ones from the point of view of this particular talk
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so where do we start it's this kind of thing this is a copy
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rank which typically occurs when you spill coffee on your best napkin
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and this is a device the first device which is a higher phobic polymer
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printed on a piece of paper there's a read or die here the turns red on contact with your
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and put a drop of your and your works its way up distributes here read indicates on
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sure it indicates glucose urine and blue indicated protein in your and so this
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is the beginning of a very quality test for of kidney function
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but i know something here which i'm going to come back to and you
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say how do you quantify this or how do you quantify that
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and this is one of the subjects this issue qualification
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he's one of those subjects where they're just of differences of opinion you can make something too good
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so when you talk to people who come from a conventional biological roadside you wanna
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quantitative or qualitative this one quality what they mean is i wanna number
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oh what a number means is totally different from being quantity
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because the number comes with and certainly in systematic error
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more the point is at least in the medical profession what they typically
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do then it's been the number so anything over three hundred
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is one thing anything below one hundred is something else so they actually don't want it to be quantitative because
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they use it qualitatively they just like the assurance of having a number well okay which is all
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how do we make these things probably familiar to most of you but there's a point which is neat
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that if you make your design on a computer you exported to a solid ink printer
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the solid in printer's ink jet printer which prints a wax which
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is the melting point of about a hundred and thirty degrees
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it has a little plot team so you warm up the wax imprinted
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is like wood but then it turned solid when it's paper
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so what you do is you warm the paper and the wax
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weeks through and makes barriers and these barriers then provide
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the way of differentiating different regions of the paper into those that are
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accessible to fluid in those that are not accessible to fluid
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the very efficient way of doing it it the important thing about it is you can go from here to here in an hour
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so you can basically prototype any paper microphone boutique system in our two
00:22:05
and that gives you the potential for doing lots of inventive stuff very quickly
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that was a key point simplicity and to give you an
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example this was the first experiment done by andreas martinez
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and two o. seven this is a piece of filter paper or little blue dye weeks it's way up
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he took the same piece of filter paper same kind of paper and a piece of wax paper
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and hot soldering iron and simply printed wax this way and we got beautiful controlled wiki
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now an important numbers this to hear this is five years and
00:22:43
that's a device they went into field trials in vietnam
00:22:47
so to be able to go from the very first experiment to
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feel trials on a couple hundred people for that trial
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is actually for technology point of view pretty astonishing thing it says
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that basically everything worked as it was supposed to do
00:23:05
but there's a very interesting feature do this and you know people say well this is a
00:23:09
low technology solution if you can't really equal open channel microphone medics and so on
00:23:16
it's actually not quite true and i'll give you one of many examples
00:23:21
and follow the bouncing red ball here these regions in grey or hide or phobic
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and in this particular example i have for either fill like spots here was followed the red
00:23:34
well we have here is a higher for big barrier the black holes are where they're holes to this
00:23:40
micro fruit to this barrier this is of course just filter paper
00:23:45
and what this is is actually double sided adhesive carpet tape
00:23:49
it's what you used to stick the tape down on the floor and we poncho also so you put
00:23:54
a drop of something here body goes to that because to this point it works its way there
00:23:59
and goes down through that hole into this we're works its way through
00:24:03
these barriers and that goes brings it to there and each one
00:24:07
of these goes then to the same thing again and so this point
00:24:12
ends up being of sixteen points down here in this illustration
00:24:17
and you really can't do that with p. m. s. micro fluid fun you certainly
00:24:21
can't do it with class and things of that kind of that extraordinary effort
00:24:25
i just give you an illustration although this is done with
00:24:29
these four different colours here to make the case
00:24:32
if i have one central point here i can distribute the fluid with very good
00:24:38
uniformity into about a thousand points by this kind of kept very process
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each distance from the central point to the point there is the
00:24:46
same so there's no differential partitioning by instruction on the surface
00:24:51
and in principle although we certainly haven't done it in principle each one of these could be individually
00:24:57
addressed each one of these points with a different colour metric or or i'll watch chemical reagent
00:25:03
so that the idea of doing multiplexing at the scale of one to a thousand
00:25:09
is actually a perfectly plausible thing to do we have not done that
00:25:12
we've done multiplexing at the level of twenty four numbers like that
00:25:18
applications
00:25:20
here is the system then we'll talk about most and it measures lever function
00:25:28
why do you care about liver function interesting really if you talk to general
00:25:32
practised physicians we if we talk to them project in the developing world
00:25:37
they would put liver function somewhere in the top ten for what they would like have
00:25:43
and what are some of the applications jelly which stands for drug induced liver injury
00:25:49
the substantial number of congress particular new ones is they go into the clinic
00:25:54
or in the practised you find that there is a small but non zero
00:25:58
population of patients who just don't do well unless they're lovers have problem
00:26:02
this is a very serious problem when the first any retrovirus were introduced for h. i. d.
00:26:09
and the data rates in not politically southeast asia will pretty startling
00:26:14
hepatitis a. b. c. cirrhosis particular combinations cirrhosis and hepatitis
00:26:21
is a very major one in eastern europe
00:26:24
epstein by a bar virus fatty liver disease liver cancers alcoholism a bunch of other things
00:26:30
your numbers are very important organ and you'd like to know whether it works now
00:26:35
and you like to do so vertically in the developing world easily so the test here is finger prick
00:26:41
you take the finger prick the drop of blood you apply it to one side of one of these scripts
00:26:47
the writer sites are filtered out what comes out on the other side is clear zero
00:26:52
which is distributed in the spots and then you read the spots colour magically
00:26:58
this is the simplest approach that we can think of to this kind of problem and you say okay terrific you got also all
00:27:05
and the answer is what we have here in principle is a prototype of a product
00:27:10
but we don't know anything about manufacturing regulatory clearance and on on so we're
00:27:16
getting there with this but it's it's much slower after the fact
00:27:20
id fabricate you simply make this region harder phobic with either for a spot here put on a desk
00:27:28
clamp on top of that uh the other side i think our metric reagents input
00:27:33
pieces of tape to avoid evaporated losses and things of that kind of both sides
00:27:38
you end up with this this particular test and most of what we do measures to enzymes which are out and asked
00:27:45
and then um we may do protein i think we're going to end up doing double ribbon for the three
00:27:52
energy this is intended primarily to give you an indication of a
00:27:56
visual reading by nurses or by people on the layout
00:28:01
of the colour intensity relative to a colour
00:28:05
chart or colour bar by comparison
00:28:08
these two things and you can see is a reasonable fit to a sigmoid function
00:28:13
and there is you know acceptable on certainly these are standard deviations in this
00:28:18
and the three times sigma in this cases here the limits of detection fifty three years
00:28:24
earlier in thirty four units per leader which are in pretty good clinical rotations
00:28:31
so how about names we've done trials now over you know some marginal thousand patients
00:28:39
various places this one is in the hospital for tropical disease and coaching and city and why they are
00:28:45
and the answer is that this particular hospital is a specialist for
00:28:50
treatment of patients with aids who often have to be
00:28:54
at the same time and they're constantly getting stuck with needles all the time for various trees
00:29:00
and they're actually pretty cool walking so there's no problem in getting samples
00:29:04
the nurses their view of this kind of system was late hours fine the only problems
00:29:09
they had with it was a problem with several people mentioned which is timing
00:29:14
resist test take about twenty minutes to develop to you know to take
00:29:18
a blood sample to looking at the colours about twenty minutes
00:29:21
and the nurses say look you know we're sitting here we're perfectly happy to come back in twenty minutes what we've uh all sorts of other stuff
00:29:27
going on and it's there's a car crash or some patient crashes or something
00:29:32
happens we really can't remember to come back and read the test
00:29:36
so we need a test that has the characteristic that it is colour stable
00:29:41
regardless the time between you take time take a blood sample and the tiny read it and
00:29:46
the time you do that velvet than the time you come up with the final answer
00:29:51
and we have solutions that have that characteristic i won't go through them
00:29:56
but they're not completely satisfactory so what you find for those of you are technologist
00:30:01
that these areas of sample preparation and read out or actually still very
00:30:07
important and very rich and problems that remain to be solved
00:30:13
yeah you can make the system is a little bit more interesting complicated but complicated with things in this sort
00:30:19
this isn't in you know as say and what one has here is what we call a paper machine
00:30:25
what we have done is to make a paper devices all paper but it has
00:30:30
a sliding strip that in this case you just pull out the hand
00:30:34
and the strip as a series of markers that indicate when you stop now
00:30:38
and then it carries things to assure remote works in just a moment
00:30:42
but here again is you may not i mean or essay read on a grey scale this kind for something
00:30:48
on interesting okay that's that's i. g. g. and just is a test system and the the um
00:30:55
limit of detection here looks like about somewhere between ten squared intent
00:31:00
you would become or or something in the order of
00:31:05
yeah i mean i would just leave it up so that so you know
00:31:10
not ideal for everything but it works pretty well for this kind of system
00:31:16
i should mention and i think this is an important point for those of you
00:31:19
were thinking about this that metabolic essays are you know how to develop them
00:31:26
oh no point of care i'm sorry of molecular diagnostics i'll show you in a moment i hate
00:31:33
you know assets i just can't stand in your asses and the reason for that is that they're so hard to develop
00:31:41
we first you need a good any body and that's difficult to combine and then you have to be very
00:31:46
careful about the conditions that you use for bar for
00:31:50
four controls for all that kind of thing
00:31:53
and one of the characteristics of that is it makes it difficult to
00:31:56
imagine exactly how you're going to run massively multiplex team you know
00:32:00
essays it's just not a straightforward thing to think about you can do
00:32:04
it but they're they're much slower developed another kind of essay
00:32:08
so as a machine like this work and the answer is sort of sketched here here's how you make
00:32:14
it not so important but you take a cross section through this device and looks like this
00:32:19
so you put an example a drop of sample blood whatever it might
00:32:22
be it goes through this region here which is the whole
00:32:27
sliding strip and then is simply pull down into a pad of
00:32:31
paper this blow so it's prompt like apple directly down here
00:32:35
when you got the system loaded what you do is pull this region here to here
00:32:41
where water or both or what have you done goes through and washes it here it wash your it's watch
00:32:48
and then here the last point you load reagents from
00:32:52
somewhere else and then after probably time for now
00:32:55
so what you do is to take out the steps that are pie padding
00:32:58
and washing the common isaacson well plates you replace it by something else
00:33:03
so why would you do that when it's so straightforward to do in roche laboratory any
00:33:08
answers are not inner roche laboratory rural india so it's a different kind of probable
00:33:15
this is an example of something which is actually a very
00:33:18
good um point of here i'm a biker diagnostic system
00:33:25
the we've worked out the the um a set of primers that works very
00:33:29
well we happened use lamp type passes or rolling masses of various sorts
00:33:35
but the temperature control that you can get on these is sufficiently good now that
00:33:39
i think if you wanted to do conventional p. c. aren't could do that
00:33:43
the problem with it is not that it doesn't work it works for this was originally developed for pediatrics aids
00:33:50
and it would also work for sega since all these are maybe strand viruses maybe strand already viruses
00:33:57
but the problem is that if you ask what would be the amount of money roughly that would be required to get a
00:34:03
class to to buy safety device clearance on this assuming it works as well as it does
00:34:08
in the laboratory and the answer is that would be ten maybe fifteen billion dollars
00:34:14
i meant talk a little bit more about for that price comes from but it's just
00:34:18
out of reach in less you know what the market is going to be
00:34:24
so let me talk about electric industry just a bit and i also we
00:34:30
also are enthusiastic about like to chemistry for a number of reasons primarily
00:34:35
virtual electric industries it doesn't really care about the colour of the sample so should we do things like
00:34:41
p. c.'s and have brown colours you can have wised wide you can be in the unwind
00:34:46
yeah and much of the roles damn you can it dust it doesn't
00:34:50
actually like the chemistry is not much influenced by those things
00:34:54
and then because the signals electrical it can be uploaded to the web
00:34:58
straightforwardly so it's a good combination of good combination of characteristics
00:35:04
and all of you are familiar with this kind of thing and you know when i
00:35:08
talk to less sophisticated audience is they say well isn't the water chemistry little exotic
00:35:15
but as you know this is gonna look meter what you may not know
00:35:19
is that the number blood glucose test taking every day is
00:35:23
greater than the total number of all other diagnostic tests
00:35:27
so but glucose by lecture chemistry demonstrates that electric industry is good
00:35:32
for high volume work and that's a useful thing that on
00:35:37
now we got interested in and what do goes a little bit ago and
00:35:41
i said to a very good applied physics post doc and the group
00:35:46
alex that never aussie ours might actually take this and see if
00:35:51
we can adapted for use with other essays resident lookups
00:35:56
alex took it apart and looked at it and said yes you could maybe but it actually is
00:36:01
very specialised for the voltage to do cause when you save why owners would you do that
00:36:07
and i say well because it's there but he said yes i remember that this device
00:36:12
is based on nineteen made nineteen sixties electronics
00:36:16
and it is so incredibly out of date that there's no conceivable
00:36:20
reason that anyone would think about using that level of technology
00:36:24
so alex who knows how to do this kind of thing went off and bought a
00:36:27
bunch of up bands and things of that kind which cost pretty much nothing
00:36:31
and put them together into something of this kind of no show you how it performs in just a moment
00:36:37
but eight point then i'm going to return to is a very interesting point and that is that if you this device here
00:36:45
of which is a really model with characteristics that
00:36:49
are designed for a particular purpose well
00:36:53
this device was really intended to be used in a low and setting with a lecture chemistry
00:36:59
but what we've subsequently found is that we can basically make these devices
00:37:06
even at very high levels of sophistication for very small amounts of money
00:37:11
so this thing which if you look here this this is the performance
00:37:16
if you look at the technical performance um these are very very good the perform very
00:37:22
well and you could probably make that device in quantity for in the order of
00:37:28
no five dollars invites i'm making that up but the cost of the parts that you buys about twenty dollars and
00:37:35
if you were to make it in quality you would fare the single circuit there'd be much much before
00:37:40
so just look at these kinds of things in there some interesting characteristics psychic for transitory
00:37:45
those who are who who are lighter cameras will recognise that this is with glucose that the
00:37:51
dark line is the conventional methodology red line
00:37:55
is the methodology using this device
00:37:59
kroner actor on battery almost can't be done in the real world because requires an absolutely
00:38:04
stationary solution but the fluid and a paper
00:38:08
devices absolutely stationary so get beautiful results
00:38:12
this is a rather sophisticated of them waveform four square report penetrate
00:38:17
and it's used for measuring having novels and the the only point of interest
00:38:21
here is that these concentrations are well below the w. h. o. limits
00:38:25
and so that's very good and potential how much are you this is sodium potassium so on the electric lights and the
00:38:33
this the performance is very good what is not good and what i'm not going to talk about
00:38:38
today's alternative the electrodes which are not yet good although there are solutions to this problem
00:38:45
but this technology racism really interesting point in something that we didn't think of at the time
00:38:50
here is how you would do this convention million depending upon who you buy it from and circumstances
00:38:56
it'll cost you somewhere between twenty and fifty thousand dollars to buy the electronic around
00:39:00
the mystery pieces and the electrodes go up to a thousand dollars a pop
00:39:05
so here's a device that is in the order of let's say ten dollars in this
00:39:10
particular case it was put together for work with an old g. too nokia phone
00:39:16
first the question of why do it this way and the answer is that
00:39:20
although people were enthusiastic about smart phones and i'm sure they won
00:39:25
well so that's more phones of the future the answer is yes ultimately that's
00:39:29
true but not in africa and not an significant parts of china
00:39:34
and the reason for that is not the smart phones are not available but the
00:39:39
the the network is not available you simply the population density isn't large enough in much
00:39:45
of africa and western china to support the construction of the necessary to ours
00:39:52
and in africa the experience has been that if you build a tower and you come back we later there's no power
00:39:57
because the people who live there have taken down the tower script all the cop or decide to
00:40:02
make cooking pots out of the you know the fibre and whatever is just not there
00:40:06
so the reason people in africa have these kinds of phones is they want
00:40:11
the lowest cost solution to understanding where their crops can be sort of
00:40:14
the highest price they all have g. too but they're probably not going up more than that for quite a long time that's interesting but
00:40:23
what's more interesting is i in the people can do this concert they make that kind of thing
00:40:27
is easily is as we could more easily why don't they
00:40:33
and the answer of course is the glories of capitalism and the answers if you're making a ten dollar device how much profit
00:40:40
can you make right and or device and answers not a lot so you don't make it and all the lights
00:40:46
so this will get fixed eventually like to comes to rubble comedy very low cost commodity i don't know how long it's going to take
00:40:53
but there's another really interesting point and that is this question of modification and read here
00:41:01
if you go to many countries there are developing and you say wouldn't it be
00:41:07
nice wooden sure medical sorry improved if you had a high end equipment
00:41:13
and the people say from here to show you something i take you over to wall in
00:41:18
the open closet and the clauses stack bottom to top with high and biomedical devices
00:41:24
and so quietly using them the answer is they did they plug the man there was a two cables version the
00:41:30
power line it took the mother board and fried it and no one will come to that country to repair
00:41:36
so that idea i mean just as this kind of device
00:41:40
i think as essentially no use in the developing world
00:41:45
this on the other hand the sort of device has two advantages the first is that it's battery run
00:41:51
so you find batteries everywhere and little solar collectors but there no power
00:41:56
surges you so it should run pick a number i don't know
00:42:00
ten thousand devices test or something of that kind but somebody will eventually drop out well how to repair any answers
00:42:07
that that price you don't we parrot you throw it away you open the box and you do another one
00:42:13
so it completely change the paradigm for how you maintain equipment
00:42:17
which is you don't maintain it you use it you
00:42:19
make it robust and you discarded wins broke but i think this is the correct way of doing things
00:42:26
now i just want to talk about two systems here for the sake of one for the sake of
00:42:33
interest in the second for the sake of amusement this is a lighter fluid leaks and breast sensors
00:42:40
lighter fluid leaks if the for those we were can us you know that
00:42:44
if you take paper you'd like to make an electrical line on it
00:42:48
it's actually not trivial to do for the reason that if you
00:42:52
use a printed organic can doctor it wicks these are
00:42:56
usually suspensions and water you put them on the weekend capillary
00:43:00
fashion and so there are which use however however
00:43:05
if you simply form a line using exactly the same technology we've
00:43:10
discuss of hydra philip material in the paper then you print on
00:43:15
that and it's constraint according to the shape it should print
00:43:20
so it's very straightforward and to print a shape and you put on whatever you want
00:43:25
in terms of a electrically conducting organic and you get to print electronics is way
00:43:30
what's more interesting is that if you take that line and then you reprint it with a
00:43:36
wax harder phobic wax the wax spontaneously spreads
00:43:40
on the printed conductor and insulate spontaneously
00:43:45
so what you end up with then is the interesting thing about
00:43:48
harder feel like channel containing wires which are cellulose fibre
00:43:55
with an organic conductor and with an organic insulator all form spontaneously
00:44:01
and it allows you to do a lecture chemistry and all sorts of interesting things
00:44:06
remarkably simply then this i think will prove to be quite useful stuff
00:44:11
and this is just what paper looks like by itself and coded with p. r.
00:44:15
which is a good doctor and then coded with that carton attitudes which
00:44:19
is another conductor and then you put other stuff on top and it's all
00:44:22
fine so you can see his remain open channels as those people
00:44:28
now the um respiration monitor
00:44:33
we ration i got into this because we were interested in sleep that out actually
00:44:37
that's i'm building lily i'll show you why we originally got into it
00:44:41
um okay but it's also in principle interested pulmonary disease the
00:44:45
way you major one where issues of breath sensor
00:44:49
the way you measure breast now largely clinic is you set the patient down
00:44:54
used immersed opposite the patient and the nurses there was a watch and
00:44:59
watches the patient breeze but since that's an interaction which disturbs the measurement
00:45:04
the breast out that you get is who knows what it means
00:45:08
people don't like doing this so there are a bunch of
00:45:11
interesting problems you can do in measuring breathing with though
00:45:15
oh pulmonary disease exercise physiology and other stuff and what i want to talk about is dreaming
00:45:22
and you think could have inside you know from anything like this to
00:45:25
that and not show it so here's how we make stuff
00:45:31
the most straightforward thing you can imagine you're spread carbon ink on paper and you make
00:45:36
to interview detailed electrodes on paper and what you see when you make them
00:45:41
is that here's the paper electrodes are here if you
00:45:45
have any digital electrodes you change the humidity the
00:45:50
me teach current between the two electrodes varies and actually varies by
00:45:54
quite a margin out the number zero one two three four
00:45:58
for some magnitude over change from twenty percent to eighty percent relative humidity
00:46:03
so strange did this and they came to me proudly with this sort of well the draft
00:46:07
and they say look this is or or h. well if you know the the nature
00:46:11
and i said because i am a decent person and a supportive research
00:46:16
director i said kindly i've never seen anything more useless light
00:46:21
and so they went away and i did you know come back into this or something was well do it
00:46:27
and they came back originally with the idea of sleep at now and the ideas of what we would
00:46:33
do is to take this thing and put it on the inside of a a procedure mass
00:46:39
this kind and if you do that what you have is the inner ditch stated sensor as the patient
00:46:47
breeze and they breathe here from whatever the relative in that it is outside when they breathe
00:46:52
out they breathe out here at a hundred percent relative not it and you don't care
00:46:57
what the role even it is outside which is almost certainly going to be different from inside
00:47:02
unless you're an smarter or someplace like that whether arch can be a hundred percent
00:47:07
so what you see as the patient breathes is just this in our corresponding to
00:47:14
um the difference between an exhalation at a hundred percent and insulation had done
00:47:20
well the thing that and this can be very easily hooked up of either by having a little bit of apparatus here
00:47:26
or something else to something which is a blue tooth transmitter which converts it into a signal of that so
00:47:32
here's what the data actually look like you don't actually care about
00:47:36
the draft in the background because you're only majoring this signal
00:47:40
and if you really wanted to be easier easy to make sure you do the first derivative of this
00:47:44
but here is a case where this is normal breathing there's a deep breath here and you can see that was
00:47:51
there's more normal breathing here someone stops breathing for a while and you can see the human go
00:47:57
down and then they go back to random breathing within initially breath and all the crews straightforwardly
00:48:04
so you say alright you say you were interested in sleep at yeah um what about sleep up yeah
00:48:11
it's interesting medical problem when you get different majors about important is
00:48:15
depending upon what we talk to but basically if you're majoring
00:48:21
sleeper happy and measuring breathing patterns you where various kinds of electronics
00:48:25
often you wear something looks like a seat that mask
00:48:29
and people don't like doing this it's uncomfortable they have landed back it's really a problem
00:48:34
so the kind of thing that i showed you is straightforward and you say is an
00:48:39
important problem and the number that as a catalyst catches the attention is that
00:48:44
this red cost over here goes to about somewhere between five and six billion dollars a year
00:48:51
so there's enough there to drive things this is just the measurement park with the other stuff comes into
00:48:57
so you can use this for beijing breathing in that
00:49:01
circumstance in a way that's much more acceptable patience
00:49:05
you could also do things like exercise physiology so for example in
00:49:11
this particular case although it i'm i sort of worry that it wasn't covered under the i. r. b.
00:49:18
somebody was sitting one the graduate students was sitting at their desks and really and
00:49:22
then they were forced to run up three or four flights of stairs
00:49:27
and so the breathing goes up and then changes what sort of interesting if you look at subject one and subject to
00:49:34
in subject one when they were doing exercise they breathe a lot
00:49:38
more rapidly so big issue actually breeze a lot more slowly
00:49:43
so these issues of how you build us into a model of physiology is actually pretty interesting one
00:49:49
but this is really what i wanna show you this is a
00:49:52
measurement of breathing over night in these sorts of bombs probably
00:49:57
occurred when somebody roll over in their sleep but i want to look at this region here in this region here
00:50:03
and you say i can't see anything any answers what you do is go to this
00:50:09
where we blow these things up in this nation this is our case this is
00:50:16
a circumstance in which the person who's been measured is in phase forcefully
00:50:22
so you're in deep sleep and apparently in deep sleep you are its own imagine no
00:50:28
it just does this there's no control you're just set for some frequency
00:50:35
and when you're in face chew which is dreamy which you can follow by the fact that
00:50:42
your eyes are tracking whatever you're dreaming about you see something that looks like this
00:50:49
and if you talk to sleep physiologist at least some of the will say this is random and this is regular
00:50:56
but when i was much younger i was trained to do an m. r. spectroscopy and the thing
00:51:02
that you learn from that if nothing else is how to do fourier transforms in your head
00:51:07
and so you do a fourier transform of this in your head and this this comes out as a single sharply
00:51:14
this amazingly i still don't understand it it doesn't happen really reproduce ugly but it happens with
00:51:20
different patients you get the same p. here but now you got another p. here
00:51:26
so what apparently is happening is that the brain turns on another matter now
00:51:31
now why is that and i don't have any clue but the ability to look it breathing
00:51:37
non invasive lead lead you into a whole series of things such as in a gene
00:51:43
patterns of dreaming change in various kinds of your physiological problems patterns of breathing change so
00:51:50
all of a sudden you can do this in a way you can measure
00:51:53
things having to do with breathing and analysts them by pretty straightforward but
00:51:57
still sophisticated pattern recognition methods to find out what's going on
00:52:02
the reason for going through the story is a is a canister i love the idea that one can go from something it's idiots simple
00:52:08
to a window into brie into dreaming which i just like it is a concept
00:52:13
but i think more generally what this does is the indicate that are
00:52:16
than simple technologies can come capabilities that are actually quite interesting new
00:52:24
now let me turn to the last part of the talk push
00:52:28
you recognise for its deep technical significance by this image
00:52:33
and what i wanna talk about is what really is the limiting factor in
00:52:38
we have lots of technology or show you only a small fraction it works it works pretty well however
00:52:46
however it's still not mark why not and the answers this problem
00:52:52
what i want you to do is to think of this three layers and which as this is the developed world
00:52:58
this is the developing world and the question is what we do here if you're in the developed world
00:53:04
in most circumstances you don't really need low cost agnostics four point of care
00:53:11
in the nursing home stands for point of care the sense of
00:53:14
reservations an inner city clinics and things that's what you do with the majority of
00:53:20
clinical diagnostics will be done by roche an avid inquest and so on
00:53:24
so what you have in the developed world yes lots of smart people
00:53:31
lots of capital but the markets are complicated because among other things if you start doing something that
00:53:37
actually threatens motion habit they will do very effectively
00:53:42
everything they can't actually that's the business incorporation
00:53:46
so this introducing this kind of thing and us i think is going to be problematic
00:53:52
and i think for some of the technologies referred to day you're going to have that kind of problem you notice all that somehow
00:53:58
what about the third world the developing world in the developing world
00:54:03
you see exactly the opposite there's no question that needs we get request literally
00:54:09
every day from people say i run a clinic in guyana and
00:54:12
i have this problem or that problem and would you send me five hundred of your test so we can test
00:54:19
which is fine but the problem is they don't have any money
00:54:23
and by money i don't mean that they won't pay for the wheel although come to what they will pay in a moment
00:54:29
but what they don't have is a culture that understands the to develop new technology for in the you
00:54:36
have to invest in that technology up front in order to get the product in manufactured for
00:54:43
i mean the just the process by which one goes from a new idea to a product is not familiar
00:54:49
so in the developed world there's money and people but no real commercial me no market
00:54:55
in the developing world there's need but not much money and another welcoming
00:55:01
culture so this again no mark can't get the technology developed
00:55:06
so i'm sorry what what's the answer the answer that we have a
00:55:10
hypothesis is that what you do is go in between the two
00:55:15
which is caught in the trade the berkeley world were break he stands for
00:55:20
brazil india china russia and high is indonesia or something you know
00:55:27
it varies with who you're talking with with all those are countries that have lots of money have lots of need and have lots of smart people
00:55:34
but they haven't yet gotten to this probable they will in due course but not yet
00:55:39
so there is very appealing and they in fact are quite interested in this for historical reasons
00:55:45
we've been working mostly in india so i've been through this and we skip this
00:55:53
we're not sure something's a mirror top that we for a little bit
00:55:58
earlier and there there are important numbers to sort of reinforce
00:56:03
when you look at the cost of research and development and prototyping and market development
00:56:08
the broad rule of thumb is the research scales these stages scales
00:56:13
one for research to channel for prototyping a hundred to a product thousand a marketable
00:56:21
you say how could that possibly be a and the answer is that when you start setting up a market
00:56:25
you have to have a distribution system you have to have salesman you have to
00:56:28
have people who do training you have to maintain equipment maybe whatever it is
00:56:33
so what we tend to do is to say we do this we universities
00:56:38
and start ups we do this maybe we do some of this but we have real problems when we get to this part of things
00:56:45
i agree with the number we've heard any new technology including must of course a hundred to two hundred million dollars
00:56:51
we heard it in the context to buy markers but here we're talking about devices and it takes a
00:56:56
minimum of ten to twenty years did all those are almost universal rules for everything outside of software
00:57:03
and so the final thing is that in goldman sachs style capitalism
00:57:08
which is increasingly the way the world one's social return that is
00:57:12
doing something for the developing world is a sign negative that
00:57:17
and the argument here is that in most corporations particular big corporations um
00:57:24
the money the any money that's spent on research and development is up and expense not
00:57:32
an investment that means you spend it on research and it never comes back
00:57:37
if you ever invest but you would expect to get something back but goldman
00:57:42
sachs does not expect big corporations to make any money from research involved
00:57:48
so the only thing the big companies do now is to buy revenue streams
00:57:52
this is an important part because their revenue stream you have to market and so it all
00:57:57
comes back to the mark i mean the technology is a way of getting market though
00:58:03
and i wish i didn't believe all of that but i do
00:58:06
here's the last thing i wanna say and this is of this sort is really sort of interesting
00:58:11
how much are these things going to cost and what can you do with the money and there's a neat problem
00:58:17
here and that is i don't know actually how the cost per test scales as the number of tasks
00:58:23
but the number in much of chemistry is that scales is the zero point seven hour of the
00:58:28
number of channels that is the more test the last call the lower the cost purchase
00:58:34
so if we make ten thousand of these tests which we've done the cost is high
00:58:39
you're paying the technician your pain for h. d. c. and insurance
00:58:44
and all the rest that stuff and just expensive to do
00:58:48
you make a million it by cost realistically ten dollars per test for
00:58:52
use paper based test for a hundred million it's about a
00:58:55
dollar if you multiply cassette it could be you know anywhere from
00:59:00
um ten cents to one cent for these kinds of things
00:59:06
yeah we've looked at market sizes in india and people in india for let's say the lever function
00:59:12
test will pay between one two dollars per test and they seem perfectly happy with that
00:59:19
what we would like to do is to where what we've done is to set up
00:59:22
a corporation in india which union company which is for profit by indians in india
00:59:28
and we would like them to sell a lot of these things and pay us royalties which we will use
00:59:34
to develop more test because we're basically in a not for profit mo so let's say it
00:59:40
cost us ten cents did actually make one of these things somewhere in this region
00:59:45
and so that we might make is much is ten or
00:59:49
twenty cents of it of profit something like that return
00:59:55
how much money do we have to make suppose we get ten cents per test out of a dollar sales price
01:00:02
what ten cents per test on a million tests and or whatever your ten cents per
01:00:07
test on a billion tests is in the order of one hundred thousand dollars
01:00:14
a p. h. d. in united states fully loaded is two hundred fifty thousand dollars
01:00:19
so
01:00:21
if you sell a million tests and a dollar a test you pay for half of the u. s. p. h. d.
01:00:28
which means you can't do much research which means you can't imagine making this really work
01:00:34
this business model will not work into you sell about a hundred billion tests
01:00:40
and this is for all you were interested in developing world stuff you guys think about
01:00:44
this kind of crude calculation to figure out whether it makes sense or not
01:00:49
now from our point of view this is not truly crazy because a hundred million people doesn't actually
01:00:55
mean that you have to have a hundred million separate people because some will require multiple testing
01:01:01
moreover that number is five percent of the combined population african indian
01:01:06
all you have to do and i put all in your quotes is that you have
01:01:10
to become a standard of care in the african indian developing world 'cause that's
01:01:17
sounds easy like we'll figure out how to do the good sign in this is that
01:01:22
one of the companies that we work with john a care is introducing a
01:01:27
basically an apple glucose testing which is not a new test
01:01:32
biochemical but it's a nice happen it shows you your
01:01:35
generally but could cause they don't worry that much about privacy and it has little sure
01:01:40
people words that encourage you to lower your blood glucose or whatever it might be
01:01:44
but they think that they're ready we only get to something like a million tests
01:01:49
him somewhere between the end of your one of the end of your too
01:01:53
and that's you know going from zero to a millionaire is taking advantage of what's already
01:01:58
there but i think that their business models based on this kind of idea
01:02:03
that is that you need you should for tens of millions of tests and you probably need to do
01:02:08
it by taking advantage of existing technology that are actually pretty encourage so i'm comfortable with that
01:02:16
so where do we go from here
01:02:19
and actually the last thing that i think that is not straightforward and this
01:02:24
is how do you achieve on so how do you pay for it
01:02:28
and i you know discuss these kinds of things but you know the issue in
01:02:32
the emerging role is that you've got to find places where their markets
01:02:37
and i think a health maintenance pregnancy pediatrics
01:02:41
chronic non infectious disease free screening which
01:02:44
is the way their function will be used all those represent interesting ideas
01:02:49
also there's a very important will issue an emerging world which
01:02:53
is that much of the medical system there is socialist
01:02:57
so that you can actually do something you can't do in united states in europe which is to sell
01:03:02
on the basis of societal cost as opposed to
01:03:05
individual cost and that raises an interesting opportunities
01:03:10
developed world although i haven't talked about it in detail you can see how they're going to
01:03:14
be applications for that in point of care in nursing homes in emergency rooms in
01:03:20
places where the ability to do a chest of some kind is time limited
01:03:26
because what these things bring is not high accuracy but you really need to
01:03:29
get them done rapidly just pulled off the shelf and use it
01:03:33
and i think there are number of operating shop opportunities there and then we'll resource limited settings
01:03:38
even in the developed world for very rural areas and for some help with good things
01:03:44
the hard ass a problem is an interesting one and for example
01:03:47
we for about t. v. multiple drivers the t. v.
01:03:52
and the problem with this is actually not doing the nucleic acid
01:03:56
work the problem is getting the spectrum from the patient
01:03:59
and getting the cells licensed souls broken without harming healthcare worker
01:04:04
and it's a very dim programmable sample preparation problem
01:04:08
so that this is the reason why the gene expert is not made a lot of headway because it's very good system but
01:04:14
it's expensive and it solves this but in the difficult way but these other things are interesting as well
01:04:20
and then there are other possibilities which were very interested in because they provide in principle
01:04:27
low volume but high margin when you can use the high margin to sell
01:04:32
you know to improve develop things that could be used as well it's
01:04:37
and this is actually although it looks an interesting it's actually important slide
01:04:44
what is the organisation that we've had to develop to do this
01:04:49
we in my research group develop stuff we were invention group so we make stuff
01:04:55
and we probably size it through publications and the tech community and straightforward stuff
01:05:01
we
01:05:03
when we develop something harbour pass it and the reason for panning is not to make money
01:05:08
but rather than no one is going to go the effort of developing
01:05:12
a new technology which is expensive unless they have intellectual property protection
01:05:17
then we have something which is called diagnostics for all which is a
01:05:21
not for profit it's called a five oh one c. three
01:05:24
the objective of this is not to make money for us at any rate but rather
01:05:28
to develop technology that will be used for ethical reasons in the developing world
01:05:33
so our ultimate motivation does is ethical we want to share
01:05:37
technology with countries that don't have the independent keeper with buildings up and certainly
01:05:44
none of us will working on this project intended making money for
01:05:48
this is an engineering company this is research company this is now a for profit engineering company
01:05:54
which is in between these which takes this technology does engineering and transfers that
01:06:00
to india and when we get some problem straightened out to china and poland
01:06:06
and there may be other applications intern but the point
01:06:10
of all this is to go from a development
01:06:13
idea generation enterprise through the planning process into something
01:06:18
which manages has the objective of keeping the
01:06:20
cost down with developing do things and then into developing market requires this combination of
01:06:28
you know science at the beginning but the for profit business at the
01:06:33
end because in india you got to make a living got kids
01:06:36
to pay could because to them pay for their schooling and you've got to buy dinner and do all the rest of that stuff
01:06:43
so that i think is successful enterprise in this has to go
01:06:48
from straight capitalism over here to something else that's over here
01:06:53
and it makes it a little bit more complicated but if you're in a start up if
01:06:57
you're somewhere in this little you need to think about both of those parts of it
01:07:02
and the summary than is here papers to grade six yes this
01:07:07
is work very well i think there's lots of technology
01:07:10
the electronic and web connection is going to be a critical we're one we all agree with
01:07:15
that and it may or may not be have based the basis one issue with apps
01:07:20
which is the nice thing is they can be downloaded over the web the not nice thing is that the phone system will not
01:07:27
let you i'll download anything unless you can prove that it actually
01:07:30
doesn't screw up their telephone system is a fairly important
01:07:34
capital and then capitals limiting when the this rule of some of a hundred million dollars to
01:07:40
buy anything is about why we probably spend five million on the liver function tests
01:07:45
close to fifty million dollars overall in developing this technology we have
01:07:51
actually this is wrong we have type one device clearance which means the ability to factors on human patients
01:07:57
from you have to be that that then that's what you can do for actually making diagnosis
01:08:03
markets you knew to choose the market correctly and the did brick
01:08:08
countries are one thing areas like delay probably does liver injury
01:08:13
they're actually very interested in us and that could be a much higher margin kind of area
01:08:17
and then point of current there ah sticks you for one more about this today
01:08:22
volume is an absolutely key issue and for this kind of market
01:08:27
we're gonna have to get the numbers that are under one two hundred billion tests to make sense of it
01:08:32
and customers generally even delay will pay for product with they absolutely
01:08:38
will not pay to develop or we just don't you
01:08:42
so where we are and there's an overall in this kind of thing with
01:08:45
sky somewhere between twenty five and fifty million dollars on this project
01:08:49
and if you take the hundred million dollar were roughly on track i think we're about halfway there
01:08:56
and then i would make one final point this is the last one
01:09:02
if you look at the people who've list are listed over your some of these are absolutely fabulous collins um
01:09:08
are we talking about vincent linder get some very good things
01:09:12
a. j. crew markings you're right fantastic running is
01:09:16
own field trials and you can on the er sandia and some of the others are wonderful but
01:09:23
one of the things it's interesting they come from all over so these multiple points of view are
01:09:28
very important in running this kind of operation but equally important is you look at this
01:09:35
and what's very interesting for those of you are in the european system
01:09:40
or in the in the american systems we have money for
01:09:45
um we're really as we have money for the gates
01:09:47
foundation began reagan bits of stuff from other places
01:09:52
but both the money is actually come from durban daughter worked with the department of defence
01:09:58
the company here is the paid nothing nothing and then the convention healthcare industries
01:10:04
or agencies that is an i. h. n. n. is that absolutely will not support that's
01:10:09
and so for those of you who are interested in developing technology
01:10:14
it maybe a little bit different different in the you
01:10:17
this kind of thing false intermediate between fashionable diseases
01:10:22
like cancer and cardiovascular and important diseases like the
01:10:26
chronic non infectious diseases in the developing world
01:10:31
and trying to figure out how to pay for these development costs is a really interesting problem
01:10:36
so this is to make this work what you need is something which is a
01:10:42
little bit broader then either the usual academic or start up kind of notion
01:10:48
big companies will be involved only when you have a new revenue streams you can't find conventional
01:10:54
convention supported the beginning and adventure world is actually not
01:10:58
terribly enthusiastic about this for a variety of reasons
01:11:02
so it's a really interesting in really important problem the technology will work
01:11:06
the biology is hard and the financing is the hardest and so figuring out of my
01:11:11
could go is is based on your scale in solving those three problems backwards first
01:11:18
so thank you very much for the invitation to be here it's been very instructive day and i've learned an enormous now thank
01:11:37
yeah
01:11:44
huh
01:11:47
oh
01:11:48
oh
01:12:05
one reason for using paperwork is the really is pretty much
01:12:09
universally available that just every place has paper or
01:12:13
you know newspapers and every country has comic books and the reason i did this for comic book reasons
01:12:20
you say is it is this critically dependent on the quality of the paper
01:12:25
and one of the things that we found very interesting is that if you look at newsprint even by newsprint by the time
01:12:31
but even when you buy a very high quality of filter paper you know stuff that is very clean
01:12:37
the cost in quantities that are on imaginable large for me doesn't come in the calculation
01:12:45
yeah
01:12:47
oh i'm sorry maybe i misunderstood what you mean by regions i'm sorry i misunderstood the really it's almost all relations
01:12:55
so even even in small quantities the antibodies are much more expensive than the paper
01:13:00
or the stuff that goes into yep i i misunderstood your question i thought
01:13:12
thank you you spoke about patenting in about a breach countries
01:13:17
what is you strategy of patenting you do you patent everywhere or it's
01:13:22
more specifically in bree countries no actually very pen is primarily an
01:13:28
the non wreck countries unless we have a specific interest so new technology developed in india by the
01:13:35
indian subsidiary will probably be candid in yeah but you know as you know pending is expensive
01:13:41
and particularly in switzerland fattening is expensive to maintain so that what we have done is to
01:13:48
set up things so that we pan in europe and the combined pam convention in united
01:13:53
states in a couple of other places where the technologies available to develop and manufacture
01:14:00
but the idea is that we would develop a manufacturer where we can best and then transfer the technology and in
01:14:06
the freezer objective in this is to pay for it not to make money for if you understand the distinction
01:14:12
so somebody in china or india steals this and goes often makes
01:14:18
it work that's actually fine from my point of view
01:14:22
but or senses that we're going to have to have some level than production
01:14:25
at the beginning so we do do pending in the most developed countries
01:14:31
okay thank you
01:14:42
so
01:14:43
very hungry or thirsty yes
01:14:48
yeah
01:14:51
if if he you know
01:14:55
oh you are so
01:15:00
uh oh
01:15:02
yeah as a a you know
01:15:09
do i
01:15:10
something else if you sell your question is a ah
01:15:19
oh hi or a slow
01:15:25
you know they didn't know that implantable devices are already being used in diabetes yeah i'm not so optimistic about
01:15:33
other things in the immediate future and the quality that you need minute the number that
01:15:38
is sort of bandied about does it for patient it ha the patient in remission
01:15:43
p. e. it about one strand of ornate for five millimetres so you
01:15:49
need sort of that order of magnitude but you needed repeatedly
01:15:53
and i think you relax saying when a the typical patient luna looking for that one signal
01:16:04
oh yeah

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Conference program

Welcome Note
Gaëtan Cherix, Director - School of Engineering
26 Oct. 2017 · 10:08 a.m.
Welcome Note
Marc E. Pfeifer, Symposium Chair
26 Oct. 2017 · 10:15 a.m.
Point-of-care Diagnostics: what are the real needs of general practioners?
Nicolas Senn, PMU, UNIL
26 Oct. 2017 · 10:19 a.m.
Recent developments in microtechnologies for point-of-care testing
Philippe Renaud, EPFL
26 Oct. 2017 · 10:47 a.m.
GenePOC, a breakthrough solution in molecular point-of-care testing
Patrice Allibert, GenePOC
26 Oct. 2017 · 11:19 a.m.
Reglementary aspects ruling the reimbursement of laboratory analyses in the context of the compulsory health insurance
Michèle A. Fleury-Siegenthaler, Federal Office of Public Health
26 Oct. 2017 · 2:12 p.m.
Recent advances in non-invasive diagnostics
Samantha Paoletti, CSEM
26 Oct. 2017 · 3:53 p.m.
How nanofluidics bring diagnostics closer to the patient
Fabien Rebeaud, Abionic
26 Oct. 2017 · 4:17 p.m.
Keynote Session introduction
Marc E. Pfeifer, Symposium Chair
26 Oct. 2017 · 5:07 p.m.
Keynote session: Accessible Bioanalysis for the Developing World and the Point of Care
George M. Whitesides, Harvard University, Cambridge - USA
26 Oct. 2017 · 5:09 p.m.
Conclusions
Marc E. Pfeifer, Symposium Chair
26 Oct. 2017 · 6:25 p.m.

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