Conner Calzone, Tiffany Pang

1. If you are the Chief of Police for Afghanistan, what solution would you develop to pay the cops that are actually working, reduce corruption, and boost their morale?

Solution 1: Have policemen supervised and their progress monitored – if they fall below the standard, threaten to lower their salaries until they reach the expectations set for them, and if they still refuse to work efficiently, fire them

• • This is a measure of regulation in systems thinking, since it focuses on feedback to lead to the desired outcome of the system, in this case being the performance of the police.
  • This will help everyone work together for the cause of the country, and for themselves
  • This can also be seen as leverage, since their salaries are being threatened, and potentially their jobs.

Solution 2: Offer incentives such as bonuses or extra days off for high performance working cops

• • This could be seen as a leverage point, as the incentive will lead to a shift in the individual policemen, affecting the overall safety of the community due to a better police force.
  • However, we must also understand that more incentives or bribing can hurt the poor when resources are going to increasing incentives for the policemen

Solution 3: Create new policy-sustainable improvement on how the government should deliver services by endorsing sensible rules and practices that ensure change

• • Similarly to enforcing stricter surveillance and supervision on policemen as a regulation, it is possible to gradually integrate new policies that force the policemen to make the guidelines in order to receive certain benefits in an abstract fashion

Solution 4: Keeping the citizens engaged on what is happening at the local, national, interaction and global levels to promote engagement

• • Through holism, changing the communities’ and people’s behavior by teaching them the relevant information/tools to push engagement and participation in their government by identifying priorities, problems and looking for solutions; this allows the power of the people to occur
  • This idea helps indirectly solve the problem at hand, yet it is effective
  • It’s not the best option as it could lead to riots and a mass rebellion with those of extremely high positions versus the people, but corruption is not easy to change 
    • Some real life examples of protests are Hong Kong, Thailand, and BLM protests around the world

 

2. If you are the entrepreneur, what multi-final solution will you develop so that you succeed, your venture succeeds (takes water hyacinth off the lake), and the people living along the lakeshore also walk away happy. Please be specific on how your solution might function and precisely whom you would work with. For example, refrain from including vague stakeholders like entire communities.

Solution 1: The fisherman already knows the hyacinth is affecting their fishing business which is also decreasing the overall amount of food resources available for the community. The fisherman, the people in this village knows this and if this continues, they may lose the most efficient/effective way of getting food

• Therefore, the entrepreneur should publicize what she is trying to do. I believe that poster billboards with very explicit images will help the people of the village and the fishermans understand what is going on. I believe that their lack of understanding, is making them unhappy, and causing them to be subjected to think the entrepreneur is only doing this for the money
• In a way, she is also educating the public about the situation and how dire it is to fix and get rid of the hyacinth, before it’s too late, where the plants will start to affect the economic state and lifestyle of the people
• This is Multifinality where resource optimization is happening in this case, thus the fisherman most likely saw the entrepreneur as a competitor since she was earning money. However, if the fisherman saw it like this where the entrepreneur fixes the hyacinth problem earns some money, then the fisherman will be able to earn their money from fishing more now since the hyacinth is gone and then the consumers of the fish being sold at the market will be able to bring home food for their families to eat

 

Solution 2: The entrepreneur can show that she is not competing against the fisherman for who gets the best business and instead her goal is to support and aid their community that is being supported by fishing. She would have to explain and describe that, in order to help the fisherman, she must earn some money to sustain this hyacinth-ridding system she has created. 

• This shows interdependence as they are helping each other rather than competing against each other, hoping to create a symbiotic relationship
• This defines equifinality where the end goal of getting rid of the hyacinth is what both parties want. Both want to earn money to sustain their business, but they have competitive advantages based on each other. If the entrepreneur succeeds in clearing all the hyacinth and restoring these bodies of water, then the fisherman can earn more money by catching more fish and the compost produced from the crushed hyacinth can help families potentially to fertilize their own small gardens or to be used as firewood.

World Hope International

1. 1. WHI is a multi-national non-profit dedicated to alleviating global poverty and improving global health, has been instrumental in providing access to resources and facilitating networking opportunities within Sierra Leone during our team’s developmental phase.
   2. They are actively stationed in countries including Liberia, Haiti and other Sub-Saharan African countries.
   3. Following integration into large hospitals, WHI has interests aligned with our goal to develop education and screening programs for Peripheral Health Units (PHUs) in peri-urban and rural areas
   4. Responsible for developing Community Health Worker (CHW) systems in the Bombali, Tonkolili, and Kareneh districts of Sierra Leone and have excellent ground network to integrate sickle cell education and testing into PHUs and these CHWs work with

We would like to work with WHI to leverage their social capital and their political capital. They have allowed us to access their office space and other practical resources within Sierra Leone. They split the risks with us to help us advance our venture forward. In return, as a symbiotic relationship, we provide passionate goals to innovate impact and implementation of our device, while at the same time, having the ability to conduct in-field research with evidence based approaches. Since WHI will serve as a significant partner to help establish our venture after launch, we must strengthen this partnership by connecting with someone internally within the organization, to have larger discussions about what needs to be done in order to have the device implemented successfully.

 

Sickle Cell Careers Awareness Network (SCCAN)

1. 1. SCCAN is an organization that aims to raise awareness about SCD, treatment and prevention while also offering practical support for those with SCD.
   2. Our team aims to collaborate with SCCAN through SCD treatment efforts. We could reimburse the profits of our product into SCCAN for penicillin prophylaxis and hydroxyurea supplements.
   3. We are part of a coalition working together towards a common goal

With SCCAN we have a symbiotic relationship as they provide the legal cover for our ventures in the country since they are legal organizations as a nonprofit and we can serve as their partners. We bring specific areas of expertise that the organization may not have and possibly additional revenues to be used for SCD treatment. Overall, we have the ability to go out and innovate with evidence based approaches. The team currently doesn’t have close collaboration with someone who is a part of this organization, so in order to strengthen that, we must find contact with someone internally to keep constant contact with in order to see how they can offer support to our venture.

 

Dr. Cheedy Jaja

1. 1. Interests aligns with our goals: currently is researching sickle cell disease (SCD), pharmacogenetics and health care disparities.
   2. Has built excellent relationships with relevant stakeholders in Sierra Leone and created partnerships with SCD patient advocacy groups to organize and conduct community advocacy campaigns to increase SCD education and awareness.
   3. Is a PI for the Sierra Leone Sickle Cell Disease Data Collection Project with an approved IRB surveillance and support from the US Department Fulbright Scholar.
   4. Is an expert SCD consultant on the Sierra Leone Ministry of Health and Sanitation Sickle Cell Disease Technical Working Group. The group is currently developing guidelines for clinical management of SCD in Sierra Leone. He represents Sierra Leone on the African Newborn Screening and Early Intervention Consortium.
   5. He has assembled a multidisciplinary team with expertise in multiple areas (nursing science, hematology, implementation science, public health, qualitative methods, and epidemiology) pertinent for successful execution of our proposed study
   6. Our team has been in contact with Dr. Cheedy Jaja and we have developed a plan to begin alpha testing using his patient’s blood under his IRB approval. Our team and Dr. Jaja have similar goals and can use each other’s partnership beneficially.

With Dr. Cheedy Jaja, it is a symbiotic partnership where working with him will expand his connections and relationships with our team and possibly lead up to connecting us with key partners he has established (being the link to other sources). We have been keeping close contact with Dr. Cheedy Jaja, but what could strengthen our relationship is that we can continue to update him with our venture’s plan and where we stand right now, so he could offer advice or suggestions.

 

Dr. Ranju Gupta

1. 1. A local hematologist who works with sickle cell patients at Lehigh Valley Health Network (LVHN) for laboratory testing of sickle cell blood samples to determine the device’s accuracy in the current developmental phase. 
   2. Also, looking to receive HbS blood samples from LVHN in the near future

We have a symbiotic relationship with Dr. Ranju Gupta, who provides the validation of our device’s stage for early clinical trials and brings credibility to our device, while we help to expand his connections and participation in SCD-related projects like ours. We can strengthen our with Dr. Ranju Gupta by constantly checking up on him through email and asking about what is the current outlook on SCD patients he’s had so far.

 

Local Blood Bank in Bethlehem

1. 1. Providing us with purified blood samples
      1. Currently we are only approved to accept healthy (HbA) blood samples from the bank, but we aim to accept SCD (HbS) blood from them as well
      2. This relationship is not necessarily symbiotic as we do not provide much value to them, but we do not ask much for them and they generously help us

The local blood banks in a way, provided us validation of our device during the clinical trials stage as we need to test our device with real blood to see if it is functioning as planned. Although the relationship is not symbiotic, as a team we could establish a stronger partnership with them by letting them know what the blood samples are being used for and when we run low on stock, we could become one of their recipients on their database that commonly requests for blood samples.

1.

1. All the individuals on the team are focusing more on being able to complete the main lab procedures independently
2. Personally, I have been taking on more responsibility the longer I have been on the team. Currently, our lead senior in the lab, Maria Lancia, is certifying me to teach the procedures to others on the team, so cumulatively, we can be more efficient in the lab.
3. Additionally, I have become much more adept at working as a team since joining the Sickle Cell Group. Collaborating on presentations and grant papers have allowed me to adapt these skills. 
4. I have always been a keen listener to others ideas, but I have realized to trust my own ideas more as well.
5. I have become more effective in problem solving and problem framing as well. Finding a way towards approaching and solving complex problems is a key skill in the lab, while making presentations and more.
6. Each member of the team has been assigned to present about what the project is about, lab protocols, purpose of our project, and/or protocols to external systems we use like ImageJ. We do this in our weekly meeting with Professor Cheng and our senior member Maria to ensure that everyone is on the same page and absorbing this information.
7. All of our subgroups have to be on the same page to efficiently deliver results. For example, analyzing test line intensities, we need to make a lab schedule, go to the lab and run the experiment while following protocols, then send them to the ImageJ team for analysis.
8. I have realized the importance of having background cultural knowledge. In high school, I modified a “Hippo Roller” to create electricity while being rolled to purify the water inside. I did not take the cultural aspects when prototyping the implementation of this device.
9. Additionally, I have realized that to understand the true scope of our project, we need not only read previous articles from our team, but also previous articles regarding Sickle Cell Anemia and Lateral Flow Devices.
10. I have also improved on my procrastination since joining the group. Many of my team members like to work ahead of schedule, so they have helped me be accountable for completing my work earlier.

 

2. 

Roles:

Our team’s role is to successfully develop and administer a lateral flow immunoassay test strip in order to diagnose sickle cell disease (SCD) in Sierra Leone. The organizations and individuals (listed in “Relationships” below) identified the absolute need for a low-cost, screening device and have shown interest in what our solution proposes.

 

Relationships:

The project has gone through multiple stages of prototype designs to the design we have today with our PI, Professor Cheng, and GSIF coordinator, Khanjan Mehta. The team has also validated this device and has received feedback through the connections we have established with World Hope International, Sickle Cell Care Awareness Network (SCCAN) and Dr. Ranju Gupta together with partnerships within Sierra Leone including Masanga Hospital and Dr. Cheedy Jaja. We would also like to acknowledge Lehigh Global Social Impact Fellowship (GSIF), Lehigh Technical Entrepreneurship, Lehigh Valley Health Network and VentureWell E-team for bringing us this far along our work.

 

Procedures/Work in Progress as of Now:

So far, the team has a successful diagnostic test strip established. The novel device schematics, the “E-junction”, is capable of running on only a single drop of blood without a dilution step. The process is efficient and only takes 15 minutes to run. Currently, the diagnostic device is being tested using purified HbA and HbS, and also HbA blood samples from a local blood bank in Bethlehem. Our team has been awarded the Stage 1 grant of $5,000 offered by VentureWell E Team, the Davis Foundation’s Peace Prize, been selected as finalists for the Global Health track in the John Hopkins Healthcare Design Competition, invited to publish our year’s IEEE article onto a special issue indexed by SCOPUS called Multidisciplinary Sciences and Engineering organized by Advances in Science, Technology and Engineering Systems Journal (ASTESJ), received acceptance for this year’s IEEE GHTC Conference, and received acceptance for BMES 2020 Conference. We are currently under review for the NIH Tech Accelerator Challenge (NTAC) and DEBUT by VentureWell.

In the lab, we are currently running optimization tests to maximize the test line intensities. ImageJ software is used to quantify the test line intensities from these direct binding tests. Variations of the test line position on the test strip, as well as the location of one test line with respect to another test line, are being studied. Three test lines were printed with the HbA antibody on to the test strip at different locations relative to the absorbance pad. By doing this, we are seeing if there are possible indicators that inhibit or decrease the test line intensities. Test line intensities are conducted for the current prototype in order to measure for accuracy analysis with ImageJ software.

 

Current Goals and Milestones:

As our lateral flow device is improved and developed over time, our team plans to write publications. To do so, we are looking into journals to understand what our targeted audience wants to see from our research. For instance, in-depth concepts about our diagnostic device’s design, outcome, specificity, and sensitivity. Our experiments will be planned based on our target journal and two main focuses discussed in our publication will be design versus clinical tests versus field considerations. Some publications the team is considering as of right now are Lab on the Chip, and the Journal of Hematology. 

Another goal the team is looking at is quality control. As a team, we must figure out the shelf-life and storage of the test strips (by itself or with the blood sample + running buffer + antibody). Possible storage we are looking into is the development of a casing. Other aspects to consider are also the effects of humidity, temperature and other possible constraints (dehydration). 

After establishing quality control, we are currently working on optimizing the production of test strips. An automated repetitive system for the printing mechanism has been slowly developed alongside the diagnostic device. The system will consist of a conveyor belt and functionality programmed by an Arduino with Matlab. The goal is to create a motor-driven belt in which it could transport the strips of Nitrocellulose membranes down the conveyor. The Nitrocellulose membrane strips will reach a point, where it will trigger a light sensor (Photocell or Light Dependent Resistor Sensor), causing a chain reaction to enable an attached syringe press (propped up by a 3D printed stand) to pump the antibody solution onto the strip.

 

Next Steps and Larger Goals:

We aim to return to Sierra Leone in August of 2021 in order to conduct the alpha testing phase of the diagnostic device. To conduct this testing, we aim to collaborate with Dr. Jaja who has IRB approval to run studies on current SCD screening devices, SickleSCAN®. As we work under his guidance, an estimate of 10-20 devices will be tested to validate its usability. 

We are planning to launch our product in Sierra Leone in Summer 2023. By cross-referencing a population density map and a map of all the public hospitals in Sierra Leone, we have constructed an ordered list of hospitals where we will introduce our device. One year after launch, we expect to be implemented in 10 densely populated hospitals encompassing many areas of the country. Two years after launch, we expect to be in 25 hospitals, and three years after launch, we expect to be in at least 50 hospitals diagnosing 75% of the newborns. 

The device will be implemented into the standard operating procedures (SOP) of care in target hospitals where the hospital staff will issue the single-step test for SCD and Sickle Cell Trait (SCT) when a child is born. 

Five years from launch, the venture will be sustainable and autonomous from our input as we will shift our focus to look at the intellectual side: strategic gaps, false positives/negatives. The project will be absorbed into the Sierra Leone Ministry of Health which will continue screening for SCD/SCT for newborns because they have the authority and funds to sustain our venture.