The Speculum Finally Gets a Modern Redesign

It was afternoon in the San Francisco headquarters of Frog, the design firm best known for its hand in creating the iconic look of products like Apple's original Macintosh computers. Hailey Stewart, one of Frog's industrial designers, had scattered an array of prototypes on a table. On one end, you could see cylinders of foam that looked almost like skinny vibrators, with handles that stuck out at different angles and sketches of levers and screw mechanisms. And on the other, the common speculum—the device used in routine gynecological exams to inspect the cervix. Stewart picked one up and cranked it open. "You're literally in the stirrups with that sound"—the device made a loud, painful sounding click—"and it's like, excuse my language, but what the fuck?"

Most of the designers in the room had never seen a speculum before. Some (the men) had never considered the contents of a pelvic examination—stripping off your clothes, laying on an examination table, and strapping your feet into stirrups, while a doctor pries you open with a cold, metal gadget. But Stewart hadn't gathered her colleagues just to explain what happens to women at their annual exams. She had a greater goal in mind.

For the past several months, mostly during down time and on weekends, Stewart and interaction designer Sahana Kumar had been studying this device. They'd wrenched it open and closed, studied the curve of the bills, read endlessly about its history. And now, she told the rest of the designers at Frog, they had taken on what was turning into a particularly ambitious project: redesigning the speculum for the 21st century.

The current design of the speculum, fashioned by American physician James Marion Sims, dates back to the 1840s. The device had two pewter blades to separate the vaginal walls, and hinged open and closed with a screw mechanism. Sims, sometimes called the "father of modern gynecology," used the speculum to pioneer treatments for fistula and other complications from childbirth. But his experiments were often conducted on slave women, without the use of anesthesia. So to say that the speculum was not designed with patient comfort in mind would be an egregious understatement.

And yet, the speculum today looks almost identical to the one Sims used more than 150 years ago. The most noticeable difference between the original Sims device and the one you can find in gynecological offices today is that instead of pewter, modern specula are made of stainless steel or plastic.

That the speculum is old is not, on its face, a problem. It's that the design is neither optimal for patients nor physicians. Doctors have to stretch the speculum's bills wide in order to see as far back as the cervix, and even then, it's not always possible to get a good look inside. (Some specula come with built-in lights, but the problem has more to do with tissue falling in than the darkness of the vaginal canal.) All of that pressure causes discomfort; one review of the medical literature found that some women even avoid the gynecologist because of the dreaded device.

Mercy Asiedu

In 2014, the American College of Physicians went so far as to recommend against pelvic exams, citing the "harms, fear, anxiety, embarrassment, pain, and discomfort" associated with speculum examinations. Those side effects impact gynecologists, too. "The more comfortable a patient is, the faster they can do their job, the more patients they can see," says Stewart. "There's actual monetary value to [patient] comfort."

It’s not that nobody’s tried to change things. In 2005, a San Francisco-based company patented the design for an inflatable speculum called FemSpec. The device was made out of polyurethane, the same material used to make condoms; a physician could insert it like a tampon and inflate it like a tiny balloon. It debuted to some fanfare, but ultimately flopped. As an article in The Chicago Times pointed out, most women never even got to experience the new speculum "because it is so new on the market that most doctors aren't using it."

"With a speculum, you just shove it in and expand it as wide as you want to get the visualization you want. With this, you have to put it in and gently move it around, kind of like a joystick." — Biomedical engineer Mercy Asiedu

Other do-overs have focused on more modest improvements. A prototype called the Lotus, created by a student at the Pratt Institute, kept the bill shape but curved it slightly for a more ergonomic insertion. The design also included a rotating handle to open the speculum bills vertically, and a hidden lever mechanism to prevent pinching. It seemed promising, but after appearing in a student showcase last year, it never turned into anything real.

In Oregon, a group called Ceek Women's Health has begun clinical trials for a series of new devices—including a sleeve, a speculum with narrower bills, and a speculum that patients can self-insert. Their goal is to create a variety of specula to serve a variety of patients, rather than recreating another one-size-fits-all tool. "For women who have a lot of tissue, women who have had more than two vaginal births or a high BMI, for women with a history of trauma or rape, for post-menopausal women who have vaginal atrophy—there isn't any product to address their needs," says Fahti Khosrow, Ceek's co-founder and CEO. Give physicians a whole new toolkit, she says, and they can better serve their patients.

Perhaps the most promising new design comes from Duke University, where researchers are testing a device that could circumvent the speculum altogether. Mercy Asiedu, a doctoral candidate in biomedical engineering at Duke, designed a tampon-sized device with a 2 megapixel camera attached to the end. "The speculum was originally designed for a physician to view the cervix from outside the body," Asiedu says, "but with current technology, you can easily view the cervix from inside the body."

Asiedu tested her prototype in a pilot study with 15 volunteers this year, the results of which were published in the journal PLOS One in May. Every single patient said the smaller device provided a better experience than the speculum.

The Duke study looked at patient satisfaction, and Asiedu acknowledges that physicians may offer more criticism of the device. The design emphasized comfort, modesty, and patient empowerment, not necessarily ease of use for physicians. "With a speculum, you just shove it in and expand it as wide as you want to get the visualization you want," Asiedu says. "With this, you have to put it in and gently move it around, kind of like a joystick."

When Stewart and her team set off to redesign the speculum, they knew what they were up against. Plus, Stewart says, "I hadn't even seen a speculum."

So before they started researching or sketching ideas out, Stewart and Kumar listed the things that had bothered them in gynecological exams. There was the noise (like a can opener), the temperature (freezing cold), the feeling inside (as if someone was stretching your insides like a rubber band). When they acquired a set of specula, one plastic and one metal, they realized they needed to change the aesthetics too. These things looked like medieval torture devices.

First, Stewart explored how to silence that ratcheting sound. She and Fran Wang, a mechanical engineer at Frog, investigated new types of opening mechanisms. No concept was too bizarre. What if, like a pufferfish, they used saline to inflate the device from the inside? Or what if they used air, blowing it up like an air mattress? They looked for inspiration in nature (cobra hoods), in machining (milling chucks), and in everyday objects (bicycle pumps); they studied how a tripod clamps open and shut, how ski bindings clip in and out, searching for ideas that might replace the old-fashioned screw mechanism.

Frog

Next, they considered new materials. Instead of constructing the device out of plastic or metal, they decided to cover the whole thing in autoclavable silicone—a material that wouldn't feel cold, could be easily sterilized, and would make insertion more comfortable. "On the metal speculum, there are pokey bits," says Wang. "Those shouldn't go near your delicate body parts! Having all of that covered in silicon, it prevents tissue from getting damaged. And also when you look at it, it's nicer."

They experimented with using three prongs instead of two, opening the device into a triangle shape. They tried shrinking the device to the size of a tampon, or borrowing design language from the vibrator industry. They put the device's handle at different angles, ranging from 90 degrees to 120 degrees, to find most ergonomic position for physicians. And then they 3-D printed a few different prototypes and put them in the hands of OB/GYNs and medical providers.

"The one they were really excited about was the one that opened up using three bills, rather than just two," says Stewart. The triangle-shaped opening gave physicians the same field of view without having to open the bills as wide, making the process less "stretchy" for patients. OB/GYNs also liked the device's handle at 110 degrees, which enough extra space between the physician's hand and the patient's body to eliminate the "last scooch" down the examination table. The silicon covering was a big hit, too. A button unlocks or locks the speculum with one hand, freeing up the other hand; a push handle eliminates the need for screws. Even more comforting, the speculum was totally silent.

Conferring with OB/GYNs made one thing very clear, though: The project wouldn't succeed with redesigned hardware alone. Stewart wondered why she felt more comfortable getting a bikini wax than she did seeing the gynecologist once a year, and the answer boiled down to the environment. One felt cold, clinical, and scary; the other, relaxing and personal, even if it was more physically painful. If they wanted to redesign the speculum, they had to redesign the entire experience.

Half a year later, the project has turned into something of a coup d'état on the modern pelvic exam. There's the speculum itself, still in development with the insight from several OB/GYNs who have signed on to help. There's a list of guidelines for physicians, which include simple but meaningful tips like giving patients somewhere to hang their clothes and explaining the components of the exam. "It's never going to be perfect," says Kumar. "So how do we at least prepare people emotionally for how it's going to be, and make them feel like they got some value out of it at the end?"

There's also a mock-up of an app, which would let patients fill out forms, ask questions, or follow a guided meditation before the exam. Kumar invented a gear kit—a stress ball, socks to cover your feet in the stirrups—to improve patient comfort, alongside the new speculum. The team also added Rachel Hobart, a visual designer at Frog, to help brand the experience. The result is called Yona.

For now, the Yona project is still an early-stage design concept. Stewart and Wang are still hashing out new speculum prototypes, while Kumar and Hobart refine the app and experience. They're working with their board of physicians to fine-tune the idea, to negotiate what's feasible and what isn't. And collectively, they're searching for partners who may have similar goals, like the tech-savvy healthcare service One Medical, who can bring Yona from concept into reality.

The trickiest part, it seems, is developing something that physicians will actually adopt. It's not lost on the Frog designers that other prototypes have failed after physicians bristled at the idea of investing in something new, either financially (the cost of purchasing a new device) or mentally (the time it takes to learn how to use a new device). Gynecologists have been using the speculum for over a century, and so far, it's worked. Why change now? "You could create the most beautiful, most unique, most user-friendly device, but if a doctor doesn't want to learn how to use it, your patient's never going to see it," Stewart says.

But Wang says that's mostly a matter of getting the product out there, showing physicians how great it can be for them and for their patients. She knows the traditional speculum works fine for most gynecologists. "It passes, but it's not great," says Wang. "But we're working on making it better. When you give [physicians] the option to choose a better one or a worse one, then they're going to choose the better one. But they might not know that until they get that option."

Read more: https://www.wired.com/story/the-speculum-finally-gets-a-modern-redesign/

StackCommerce buys Joyus to focus on video and expand into fashion, shopping and beauty

StackCommerce, which sells articles sponsored by brands and published on websites, has acquired the online video marketing company Joyus in an all cash transaction to expand its advertising footprint in media targeting women and work more with online video.

The media market for fashion, women’s health, and shopping is a new one for StackCommerce which has worked closely with websites like Mashable, Engadget and others. The company’s service is similar to Wirecutter, offering brands a chance to sell their gear on websites with sponsored reviews.

Now, with Joyus, which started life as an online Home Shopping Network and pivoted into providing video reviews for websites like Aol (which is owned by Oath, which also owns me and my words) or Refinery29, StackCommerce can go after publishers that focus on health, fashion, beauty, and design.

While Joyus had raised $67 million in financing from investors including Accel Partners, Marker, Steamboat Ventures, InterWest Partners, and TimeWarner Investments, StackCommerce took a much more capital efficient approach to its growth.

The Los Angeles-based startup had raised a minuscule $800,000 in seed funding back in 2012 (it was the company’s only outside investment). Backers in that round included 500 Startups, Amplify.LA, Draper Associates, EchoVC Partners, Paige Craig, Tim Draper, and Wavemaker Partners.

Terms of the acquisition were undisclosed, but a person familiar with the transaction said it was less than $50 million.

As a result of the acquisition, Joyus’ team is getting cut, according to a person with knowledge of the deal. Select team members will be joining StackCommerce in specific roles that have yet to be determined the person said.

While this is StackCommerce’s first acquisition, it likely won’t be the company’s last. The company, which is working with over 750 publishers today, will likely want to expand its suite of monetization tools to include data targeting and personalization and subscription-based services.

From its humble beginnings in Los Angeles, StackCommerce has grown to employ 65 people form its headquarters in Venice. The company rolled out two new offerings earlier this year including a  Brand Studio product that lets publishers make on-demand advertising copy using the company’s editorial and video resources, and a feature called Momentum which distributes the company’s white-labeled reviews and advertisements across different social media properties.

Read more: https://techcrunch.com/2017/09/29/stackcommerce-buys-joyus-to-focus-on-video-and-expand-into-fashion-shopping-and-beauty/

The White House and Equifax Agree: Social Security Numbers Should Go

The Trump administration is exploring ways to replace the use of Social Security numbers as the main method of assuring people’s identities in the wake of consumer credit agency Equifax Inc.’s massive data breach.

The administration has called on federal departments and agencies to look into the vulnerabilities of employing the identifier tied to retirement benefits, as well as how to replace the existing system, according to Rob Joyce, special assistant to the president and White House cybersecurity coordinator.

“I feel very strongly that the Social Security number has outlived its usefulness,” Joyce said Tuesday at a cyber conference in Washington organized by the Washington Post. “Every time we use the Social Security number, you put it at risk.”

Joyce’s comments came as former Equifax CEO Richard Smith testified before the House Energy and Commerce Committee, the first of four hearings this week on Capitol Hill. Lawmakers from both parties expressed outrage over the size of the breach as well as the company’s response and grilled Smith on the timeline of the incident, including when top executives learned about it.

Smith said the rising number of hacks involving Social Security numbers have eroded its security value.

“The concept of a Social Security number in this environment being private and secure — I think it’s time as a country to think beyond that,” Smith said. “What is a better way to identify consumers in our country in a very secure way? I think that way is something different than an SSN, a date of birth and a name.”

Joyce said officials are looking into “what would be a better system” that utilizes the latest technologies, including a “modern cryptographic identifier,” such as public and private keys.

Read more: Five Data-Security Ideas Brought Up During the Equifax Hearing

‘Flawed System’

“It’s a flawed system that we can’t roll back that risk after we know we’ve had a compromise,” he said. “I personally know my Social Security number has been compromised at least four times in my lifetime. That’s just untenable.”

Joseph Lorenzo Hall, chief technologist at the Center for Democracy and Technology in Washington, said one possibility could be giving individuals a private key, essentially a long cryptographic number that’s embedded in a “physical token” that then requires users to verify that the number belongs to them. It could work like the chip in a credit card that requires the owner to enter a pin allowing use. He pointed to Estonia where they have deployed such cards that people use to validate their identity.

“Your pin unlocks your ability to use that big number,” he said. The challenge is how to create the identifiers and how to distribute the keys. “It’s very promising” and “it’s possible to technically design something like this” but it could be expensive to design and disseminate such material to each American, he said. “This is a pretty big endeavor.”

The administration is also participating in discussions Congress is having about the requirements of protecting personal data and breach notifications for companies.

Avoiding Balkanization

“It’s really clear, there needs to be a change, but we’ll have to look at the details of what’s being proposed,” Joyce said. In the response to the Equifax hack, though, he said, “we need to be careful of Balkanizing the regulations. It’s really hard on companies today” facing local, state and federal regulators as well as international rules, he added.

The U.S. government began issuing Social Security numbers in 1936. Nearly 454 million different numbers have been issued, according to the Social Security Administration. Supplanting such an ingrained apparatus would not happen over night. The original intent was to track U.S. workers’ earning to determine their Social Security benefits. But the rise of computers, government agencies and companies found new uses for the number, which gradually grew into a national identifier.

Over the decades, the Social Security number became valuable for what could be gained by stealing it, said Bruce Schneier, a fellow at Harvard’s Kennedy School of Government. It was the only number available to identify a person and became the standard used for everything from confirming someone at the doctor’s office to school.

Akin to Infrastructure

“They appeared at an age when we didn’t have other numbers,” Schneier said in an interview. “Think of this as part of our aging infrastructure” from roads and bridges to communications. “Sooner or later we as a society need to fix our aging infrastructure.” 

He pointed to India’s wide-scale rollout of the Aadhaar card, a unique number provided to citizens after collecting their biometric information — fingerprints and an iris scan — along with demographic details, to almost 1.2 billion people. In the U.S., a more secure system could be designed, “but magic math costs money,” he said.

Making any changes to the current system, including replacing numbers entirely or restricting who can use them, would likely require an act of Congress, according to Marc Rotenberg, executive director of the Electronic Privacy Information Center in Washington, which advocates for limiting the use of Social Security numbers. 

Rewriting Laws

“You’d need to change a lot of existing public law," Rotenberg said. “There would need to be extensive hearings and study about the consequences. It’s a complicated issue." 

The government’s own record of protecting Social Security numbers has its blemishes. Medicare, the federal health-care program for senior citizens, has long used the numbers on identification cards recipients must carry. After years of criticism by the agency’s inspector general for the risks that creates, new cards with different numbers are currently being rolled out.

The failure of the Social Security number is that there’s only one for each person, “once it’s compromised one time, you’re done,” Bob Stasio, a fellow at the Truman National Security Project and former chief of operations at the National Security Agency’s Cyber Operations Center.

Public and private keys — long strings of code — could help validate identities. For instance, the government could issue each person a public key and private key. If people were to open a bank account, for instance, they could provide their public key — instead of a Social Security number — and the bank would send a message that could only be decrypted using their private key. If the private key gets compromised, the government could easily issue another one.

Saved by Math

Stasio also cited emerging blockchain technology as another potential tool. It could create a kind of digital DNA fingerprint that’s “mathematically impossible” to duplicate. In place of a Social Security number, each person could receive a blockchain hash — a kind of algorithm unique to an individual — that is stamped on every digital transaction or action.

That type of technology “could be used as a much more efficient and mathematically sound method of transaction, identification and validation,” Stasio said.

While lawmakers were unanimous in criticizing Equifax’s response to a breach that compromised information on 145.5 million U.S. consumers, they were divided on how to fix the underlying issue. Democrats on the panel have reintroduced legislation imposing requirements for when companies have to report data breaches, while Oregon Republican Greg Walden noted the company’s human errors, saying “you can’t fix stupid.”

Smith said the Equifax employee responsible for communicating that the vulnerable software needed to be patched didn’t do so. That failure was compounded when a scan of the company’s systems didn’t find that the vulnerability still existed, the former CEO said.

Joyce’s comments helped take some of the focus off Equifax’s blunders, analysts at Cowen Inc. said in a note Tuesday.

The “White House may be indirectly coming to Equifax’s rescue,” they wrote. “This reduces the risk of business-model-busting legislation such as a requirement that consumers opt-in to a credit bureau collecting their data.”

    Read more: http://www.bloomberg.com/news/articles/2017-10-03/white-house-and-equifax-agree-social-security-numbers-should-go

    This ‘tree’ has the environmental benefits of a forest

    (CNN)Air pollution is one of the world’s invisible killers.

    It causes seven million premature deaths a year, making it the largest single environmental health risk, according to the World Health Organization.
    In urban areas, air quality is particularly problematic. More than 80% of people living in areas where pollution is monitored are exposed to air quality levels that exceed WHO limits. And given that by 2050 two thirds of the global population will be urban, cleaning up our cities’ air is a matter of urgency.
      One well-established way to reduce air pollutants is to plant trees, as their leaves catch and absorb harmful particulates.
      But planting new trees is not always a viable option.
      That’s why the “CityTree”, a mobile installation which removes pollutants from the air, has been popping up in cities around the world, including Oslo, Paris, Brussels and Hong Kong.

      Moss is in the air

      Each CityTree is just under 4 meters tall, nearly 3 meters wide and 2.19 meters deep, available in two versions: with or without a bench. A display is included for information or advertising.
      Berlin-based Green City Solutions claims its invention has the environmental benefit of up to 275 actual trees.
      But the CityTree isn’t, in fact, a tree at all — it’s a moss culture.
      “Moss cultures have a much larger leaf surface area than any other plant. That means we can capture more pollutants,” said Zhengliang Wu, co-founder of Green City Solutions.
      The huge surfaces of moss installed in each tree can remove dust, nitrogen dioxide and ozone gases from the air. The installation is autonomous and requires very little maintenance: solar panels provide electricity, while rainwater is collected into a reservoir and then pumped into the soil.
      To monitor the health of the moss, the CityTree has sensors which measure soil humidity, temperature and water quality.
      “We also have pollution sensors inside the installation, which help monitor the local air quality and tell us how efficient the tree is.” Wu said.
      Its creators say that each CityTree is able to absorb around 250 grams of particulate matter a day and contributes to the capture of greenhouse gases by removing 240 metric tons of CO2 a year.

      A tale of four friends

      The story of the CityTree dates back 11 years.
      While studying at Dresden University of Technology, Wu met Victor Splittgerber, a mechanical engineer, and Dnes Honus, an architect. After graduating, they ran a workshop at the university on sustainable urban design focusing on new ways to tackle environmental problems in cities.
      Four years ago, the trio met Peter Snger, a graduate in production management for horticulture, and the idea for the CityTree project was born.
      Today, bureaucratic obstacles are the main challenge.
      “We were installing them (the CityTrees) in Modena, Italy, and everything was planned and arranged, but now the city is hesitant about the places we can install because of security reasons,” Wu said.
      The team also has plans to introduce the “CityTree” to cities in lower-income countries such as India, which tend to have elevated levels of pollutants.
      So far, around 20 CityTrees have been successfully installed, with each costing about $25,000.

      Can this really fight pollution?

      Gary Fuller, an expert on air pollution at King’s College London, thinks that the concept of an urban air purifier might be too ambitious.
      “Even if you had a perfect air cleaner, getting the ambient air in contact with it is really hard,” he told CNN. Pollution from a car exhaust, for example, gets dispersed vertically a few kilometers into the air.
      “Efforts would be better put into stopping the pollution from forming in the first place, maybe cleaning up a city’s bus fleet,” he added.
      The CityTree inventors say that they are aware of this and choose the location of each CityTree carefully.
      “We intentionally pick spots where pollution is heavy due to traffic and air flow is limited. We are also testing a ventilation system to create our own air flow that gets the pollution to the tree.”
      Wu also argued that the CityTree is just one piece of a larger puzzle.
      “Our ultimate goal is to incorporate technology from the CityTree into existing buildings,” he said.
      “We dream of creating a climate infrastructure so we can regulate what kind of air and also what kind of temperature we have in a city.”

      Read more: http://www.cnn.com/2017/06/07/world/citytree-urban-pollution/index.html