Litrature review

Literature Review

Project Diabetes

Introduction:

As per World health organization 180 million diabetics in world and the number is about to reach 230 million by 2030. Out of these more than 30% diabetics are from India and China. The known diabetics count in India has reached 32 million and more than 50% of them reside in rural sector. There is a real need to understand the fact of the rapid growth in the number of diabetics and work towards coming out with possible design interventions in the community benefit. This requires extensive research about the field and need to understand the healthcare system which supports in managing chronic diseases like this. If we see the broader picture most of the diabetics lack in managing their regular blood sugar levels because of several reasons such as lack of knowledge, poor resources, poverty, and mismanagement etc. the increasing growth in rural diabetics is an good example of lack of resources. The rural diabetic can’t manage his BGL because he in capable to afford the cost involved with the disease and no proper channels through which he can take benefit. Where as half of the diabetics suffer with lack in early diagnose and most of them die identified. On the other hand an urban diabetic is busy in his daily activities, which makes him difficult to find time to regulate his BGL. The fast urban life has developed irregular food habits and fast food culture, where a diabetic really can’t keep a record of every day food management. Hence this develops a need of support product service system where the rural diabetic can get benefited with low cost services, education and product support and the urban diabetic gets a service where he can manage his daily data and gets regular feedback. The overall dialogue is suggesting that an effective product service system can stand efficient to help the diabetic to manage their condition.

Visualizing the service

The term “Product service system” has been defined as a marketable set of products and services capable of jointly fulfilling a user’s need. The product and service ratio in this set can vary, either in terms of function fulfillment or economic value” in case of diabetes home care model the service will be looking at the both the perspective but in different user needs as the rural sector needs the economic value where as the urban sector needs functional fulfillment and both carry equal weightage. The service is apparently works in conjunction with different stakeholders. There are various approaches and trends are outlined towards the development of product service system (PSS) are outlined as

• Sale the use of product rather than product itself

• The change to leasing society

• A repair society rather than throw away society

• Change in user’s mentality from sales to service orientation.

The challenge new approach lies in system solutions, where bits and pieces fits together, integrated to a support care system which will the diabetic to self manage his/her conditions to a satisfactory level. Such system based solutions should facilitate the shift from other healthcare systems, in which products, services, supporting infrastructure and necessary networks are designed, so that to provide a certain quality of life to the diabetic and same time reduces the environmental impact of the system.

For a diabetic, this service means a shift from buying expensive products and spending time and money on doctor’s visits to buying a service which has potential to provide vital data through web based interface and the required product support

For the service provider, the service means higher degree of responsibility for the products full life cycle, early involvement of diabetic in the design of service and design of a close loop system.

Why this service?

The home care model concept has the potential to bring about such changes which can accelerate the healthcare industry to shift towards more sustainable practices and societies. According to some authors, the concept might be promising for commercial companies, government, and customers

Understanding this system will provide an opportunity to bring a better lifestyle for diabetic. The current health care practice in India is not very well organized. The cost of healthcare is unbearable by a common man and the government services are so chaotic and unhygienic. They are not really managed; the service they provide is not really dependable. So by supporting such kind of private healthcare institutes government can assure a clean and hygienic health care practice. The concept of a product service system facilitates innovation at a more than incremental level and has potential to bring financial benefits.

This service can be an extension for some healthcare companies for their existing offers for the patients. Others can see it as a new business opportunity.

Usually such companies are forerunners and see the opportunity of being first on the market as a basis for survival.

There are different benefits for product manufacturing companies, heath workers and health practitioners by getting associated with the service.

Product component

Attach addition value to product.

Simplify the usage of the product so as to understand by the common user.

Make the product economically viable and easily in reach of user.

Service component

Health workers can locate the area and take charge. Visit the diabetic at regular interval. The job of health worker is clearly defined, and that is to guide the diabetic to self manage his BGL. Explain the benefits regular exercise and diet control. Keep a track of their BGL readings and forward it to the concern heath practitioner. If serious symptoms observed she can suggest the diabetic to visit the concern health practitioner.

The role of health practitioner is to monitor the diabetic condition and prescribe the required mediation. He will be involved in educating the rural sector in conjunction with health workers and attend regular camps.

The overall set up will be organized and by the healthcare team and will be connected through a web based interface.

Government and society component

Understanding diabetes home care model (DHM) can therefore help to formulate policies that promotes sustainable pattern of consumption and sustainable lifestyle. DHM have the potential to offer a new way of understanding and influencing all the stakeholder relationships and viewing product networks, which again may facilitate development of more efficient policies (Mont.o.k)

At the same time, it is expected that the promotion of added services or substitute of products and alternative schemes of product-service use can assist in the creation of new job.

Benefits

Diabetics can be benefited by this service because they receive product support and prospect for schemes to for variety of products. It will not be mandatory to go for the same product as their will be a greater diversity of choices in the market for those who can afford.

The service components, being flexible by nature the, induces new combination of products and services, better able to respond to changing needs and conditions. The products given to the diabetics are can be under the ownership of the producer and so the user will not have to worry about its servicing part.

The service system changes the price cost systems of the present economy because “the cost of production are only a very small part of the costs involved in making a product available to customer.” Diabetics pay not for material goods but for intangible services. This can amplify the technical development of dematerialization, which is already an ongoing process.

As products are essential part of this service, successful development of a product service system requires that manufacturers and service providers extend their involvement and responsibility to phases in the life cycle, which are usually outside the traditional buyer-seller relationship, such as take back, recovery, reuse and remanufacturing. Usual responsibilities for products are extended through the additional or deepened responsibility for service, including the responsibility for proper organization of take back arrangements and systems for reuse, remanufacturing and recycling and for educating consumers about efficient product use. The reduced technology and material requires a stronger co-operation with suppliers and expertise of the field.

The relationship between the healthcare team and the diabetic plays key role if the product service system are to be designed effectively. Some healthcare institutions have already started working in the area of diabetes and building up close relationship with the diabetics.

The organization who wants to adopt this service will need to change its traditional structure. The extended involvement of the organization with other stakeholders and actors in the service chain may create a demand for intermediates. A web based service can act as the binding element or will act as a common thread. A new network may need to establish in order to develop the system. This can be research network which will investigate through qualitative and quantitative method the actual number of diabetics in the sector, regional and sectoral network can help locating diabetics which are unidentified, through the means of health camps, advertisement and campaigns.

Design particularities

There are few existing examples of design projects, where entire product service system is being designed. The design methodologies of the entire DHM probably differ from the regular product design method.

• Designing DHM requires close interaction of all actors with in the life cycle of a product service. Through interaction between the service and the product manufacturer, is more likely to permit the clear transmission of the economic incentives, allowing service activities to drive manufacturing or design changes.

• The servicing and maintenance part of product should be well designed

• Alternative scenarios of service considering different aspects and possibilities to be priorly thought of.

• The scenarios to be shown to the user of the service, providing information on economic and environmental offers.

• Health workers are to be trained regarding the topic of self management, diabetic care and other required knowledge.

Barriers

The concept of PSS is still in the development phase, but it has already been suggested all possible scenarios of moving towards more sustainable production and consumption system. Hence it’s therefore important to examine all convincible barriers to its development, application and continuous betterment.

• As the service is dealing designing both the product and service system it’s difficult to develop the scenarios of alternative product use.

• As we have an identified sector to work on the risk of acceptance of the service and convincing the service to the society reduces to an extent.

• The designing of service with product support considering the environmental and sustainable issues can be lengthening and can create dilemmas

• The user of the service might not be very enthusiastic about the ownerless service, or the target area might not turn beneficial.

• Product testing should be done before implementing the service as product failure can also lead to the failure of service.

• All components of the service need to be intact and well designed as the success /failure of service is the responsibility of each and every stakeholder.

Conclusion

There are many examples of service design can be found in various fields like eco design, product customization, recycling , healthcare, public services etc. but we can find very few complete examples which are successful in completing the loop. Hence service has to be design carefully considering each stake holders responsibilities and viabilities. Even we should have to think of the uncertainties which can fall into place time to time. Need to project future scenarios and work on those lines which will help in presuming the threat lying ahead. Readiness to accept the service by the user should be estimated by a participatory research to evaluate a competitiveness of the service and its profitability for the user. Research should be carried out in all various aspects; parallel model can be studied if required. Result of research and gather information will govern the future design directions.

Bibliography.

Social research methods, Lawrence Newman.

How to do research project. Colin Robinson.

M. Bhaskara Rao, Manja Prasek, Zeljko metelko, organization of diabetes health care in Indian rural areas, 2002

Mike Graves and Naresh Kumar Reddy, Electronic Support for Rural Health-care Worker.

WHO Technical Report Series 646, 1980. WHO Expert committee on diabetes mellitus: second report

Liam fennessy, Soumitri Varadarajan, Helen McLean, Working with communities: a case study of design for diabetes, 2007

Mont o.k, clarifying the concept of product-service system, Lund University.

Stahel WR, the limits to certainty: Facing risk in the new service economy, kluwer academic publishers, Dordrecht, 1989

Goedkoop MJ, van halen cjg, te riele hrm, rommens pjm, product service systems, ecological and economical basis, 1999

Rao Pv., http://diabetes-india.com

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For Melbourne in Melbourne with Melbourne

For Melbourne in Melbourne with Melbourne

I am not very good at writing. Even if its IELTS Exam or literature reviews, I have always struggled with my writing skills and wonder how people can write so much and so beautiful.

So here I am sharing my experience in Melbourne and with Melbourne since last 4 months. I have tried to maintain the order of occurrence as and when they happened.

So this is how it started…

One fine morning Praveen (our coordinator) called me in his cabin saying he has selected me for the exchange program with the German university. Wow!! That was great news however it didn’t last for long as prerequisite was the passport details. So that how this chapter got over for me. Opportunity got shifted to one of my colleague. However Praveen called me and said that there is another opportunity waiting ahead for me. Opportunity to be associated with RMIT University Melbourne, this is how my journey for RMIT started.

Three of us from our class and total 18 from NID got selected for exchange. After a long struggle I managed to get my passport also. Everyday meeting with Catherine (International Program Coordinator, NID), mailing to Liam regarding the clarification and preparing for IELTS exam was the routine. We all faced too many uncertainties before reaching Melbourne. From IELTS, medical to VISA everything was uncertain. Visa also got delayed, but some how managed to get it before a day prior to the journey. So finally out of 18, 15 managed to get ourselves through this tough time.

7^th July 2008 was our flight for Melbourne. Everything was set. My parents came to drop me till Pune station from where I took a bus to Mumbai. The fortnight halt was at Shweta’s sister’s place. Next morning we left to Chatrapati Shivaji terminus, we were doubtful about the road network and traffic jams but still managed to reach in time.

Finally after 3hours with all the security check-up and adieu to all friends and relatives, 11 AM we sat in the Singapore airlines flight.

This was my first International flying experience. As I always loved to see places I was very excited about this journey. The whole journey I kept looking at beautiful view out side the window into the indefinite blue with couple of glasses of wine.

Around 5.30 we landed Singapore Changi Airport. I was stunned to see the structure; architecture of Changi Airport is really amazing. We spent around three hours there on the airport, waiting for our next flight to Melbourne.

9.00 pm we boarded for Melbourne. The flight was full as compared to the previous flight. This time I couldn’t help sleeping through out the journey because it was dark outside.

8^th July, morning 7.30 four of us landed Tullamarine Airport Melbourne. After a long security checkup, it took us more than 2 hours to come out of airport. Soumitri and Liam were there to pick us up.

I had met Liam in NID before coming to Melbourne, so it was easy to locate him in that crowd. However it was our first encounter with Soumitri; we had our formal introduction with him. At the first glance, I found him serious However it all went in vein when we had a real comfortable talk on the way to Nunnery. Soumitri dropped me and lalit to Nunnery, introduced us with the place and people and left as he was in a hurry.

‘Nunnery” guest house is located on Nicholson Street. The 150 year old building was a great experience for living. It was quite expensive for our standards but nicely maintained place, surely value for money. I really thank Liam for booking our stay in nunnery at first go, because that was our first impression about Melbourne and we all were very delighted to have such a wonderful welcome.

We were chilled and thrilled, hungry till afternoon receptionist suggested us to go to Bambi’s pizza. This was our first encounter with Melbourne food and was quite disappointing at first go, but sooner we managed to find some quite nice joints to satisfy our tastes.

Nunneries stay lasted for two weeks; meanwhile we were looking for different guesthouses, backpacker’s hostel and apartments. As nunnery was little expensive deal, we finally managed to find an affordable deal at Victoria hall accommodation a recently renovated guest hose. During these days I enjoyed self and group cooking experience, carrying differences but still together.

Liam has always supported us and helped us out in many things. From opening account in bank to the access card he was always there to guide us. I always had a close interaction with Liam regarding Mekhala’s case and trust me he had done best possible, what he can do for it. That was the time when I realized that he is not just a good guide but a very nice human being as well.

We were getting acquainted with the place, started knowing people around there culture and living style. It was quite fascinating to see what we use to hear about foreign countries and I found it convincing. The discipline and management is just in the blood of these people.

A day at Soumitri’s home was an unforgettable experience with in this span. It was Sunday when Soumitri called us for lunch at Chauvel Street. We took Sunday special met card which is of 2$ 80, an amazing deal to see Melbourne zone1 and 2.

Walking through the lanes of beautiful bungalows with sloping roofs, it gave me a feeling of my dream place. I always wanted to have my own house in exactly similar neighborhood. Home made food, adrak ki chai, besan ke laddu and cricket with Iyan made our day.

Work itself started on 21^st July. Soumitri showed some of his work and gave us a brief idea about his project. I got introduced to ben for the first time here. Benjamin creek second year student of Industrial design and my project partner in diabetes project and now one of my good friends in Melbourne. Over the time I got to know more and more about ben. He is a disciplined, well organized guy. He was very helpful and supportive through out the tenure.

When Soumitri introduced me to the project, I was quite relaxed to see that the brief was not drastically different to what I had been expecting. I had previous experience of working on service design, which helped me to understand the depth of the subject. Soumitri has introduced many different ways of research techniques, information collection and paper prototyping, which I never used before. In this way it was a great learning experience.

Through out the period, I really enjoyed working on the project, developing service, visualizing scenarios and making prototypes. I think more than research class I enjoyed the major project.

Confusions were always there in mind. About the work I am doing, which books to read, where to collect the information, whom to talk and discuss. The background from which I came, we were taught in a different manner. The way to look at things as problem solving slowly got washed out with rigorous discussion with Soumitri.

Social Innovation was a new term for me. Even though I was very much aware ofthe meaning of it, but was unaware of its implication in terms of design. After looking at Soumitri’s work I understood the depth of it but still I am not sure whether I am working on those lines or not .I is still struggling to understand the essence of the subject. Hoping the end results will be the quit satisfying and up to the expectations.

Thursday research class is something which always goes above my head. Methodologies, reading books, discussing writers my god this is not my cup of tea. After finishing the class we used to get so zapped, that people use to say “oh today is Thursday”. I have always been confused in research class through out the semester.

Exploring Melbourne is quite an exciting task. Melbourne museum, Federation Square, Eureka Sky Deck and lot more places to see. Saint Kilda beach and Brighton beach were accomplished, and still a long way to go.

Working late night or most of the time full night; I really enjoyed building 87. Sometimes we all feel that there is an attachment with endeavor room now. I think am really going to miss this experience for sure.

I celebrated Ramadan here in Melbourne, one more exciting event. Working full night and then having bread and jam in the morning 4 am for fasting and then after Namaz going to sleep for rest of the day till evening became routine that time. I and lalit use to sleep full day and up full night, so lalit also did fasting with me in way. Garlic bread was introduced by Nayab and Prachi within these days only. Now garlic bread and French onion dip is our breakfast, lunch and sometimes dinner as well. Ramadan prayer was another awesome experience. We offered it in the jail court. Then we all went to shweta’s place where Shweta cooked very nice breakfast for us with shahi tukada (I just love it) then we saw movie ijaazat one my favorite movies, we also had very nice lunch together. Shweta is really amazing cook one should admit.

Initially I was very excited to see that RMIT has provided Muslim prayer rooms but felt very terrible to see that now those rooms are banned for praying. So every Friday prayer we offered in the open space near main building. I wish soon this matter will get resolved.

I never imagined last year that I will celebrate my next birthday in Melbourne. Every body was up till twelve to wish me then we celebrated it by cutting cake and saw movie the Wednesday online. That day we went to see Eureka sky deck 330mtr high residential building. It is World’s tallest residential building. An extraordinary experience again, the edge of 3 meters cantilevered glass floor was thrilling. It felt like we were flying in the air. Standing 280mtr high in air is such an extraordinary experience. In the evening I gave a small treat in Bismi again. Overall we enjoyed a lot that day. Similarly we celebrated Shweta, Nayab and Khshitish birthday with in this span.

Along with good experiences I came across some strange experiences as well. However I believe experiences only teaches a person understand the way of living. The importance of home one can understands only when you are away. We all missed home food. Now sub way burger and Bismi’s biryani has become quite a torture.

I will never forget the one week we spent in global backpackers. One of the worst experiences we had in Melbourne. The typical pungent smell, unpainted walls and the clumsy room, it was a horrible experience that led us to extensive search for an apartment. This was the time when we six got divided into two groups. Shweta and Anindita got a sharing accommodation and we went back to Victoria.

This was the time when I was going through a little bad phase and faced tough time.

Before coming to Melbourne we planned that we will work part time so that we can save good amount of money. But it didn’t work out. Some dreams remained incomplete only. 5000$ scholarship is sufficient enough to survive with bare minimum facilities in Melbourne. One would need approx 1200$ per month if he is staying in a dormitory. And for four months 5000$ is sufficient. But if u want to roam around, drink and enjoy then you definitely need to do part time job and getting a part-time job is again a stressful thing.

The thing we used the most is the internet facility by RMIT. I wonder after going back to NID, how we are going to survive? Internet has become a bare necessity some how. Everyday on NID mail we see student facing problems with slow internet speed, ban on video downloading and limited access to internet. Internet has become a bare necessity some how.

There are many things I liked about the place. Many times the culture reminds me of Goa in India. The people here, their eating and drinking habits are almost similar. I am very much impressed with neighborhood planning and the public services. Everything falls in right place, every activity happens on right time. If u walk around at morning 4 to 5 u will see the road cleaning vehicle running down the road. I really wonder why India lacks in all such kind of services. The superb road and transportation network, traffic disciplines, tram service, free tram service, disciplined and energetic people, clean and neat roads, I think I am going to miss all this back home.

Project Diabetes is now on the verge of finishing as per schedule but for me it’s still yet in the developing phase, we have developed a service for diabetics which is essentially an web based service which works in conjunction with health careers and health practitioners. Essential product support is provided for different class of patients as per their need. Very interesting aspect of this project is that rural sector can be benefited by low cost products support at subsidized rate. Soumitri has cleared lot of doubts and showed me right path every time.

I was always nervous about the project; but still I am happy to be a part of it and hopefully will keep on working ahead on the similar lines. Scenario building and paper prototyping is something really new I learned here. And I am very much convinced that, it’s a very good process to adopt for product development. It really gives justice to the produced work.

Meeting with Pam (health care practitioner) was an informative part of this project which helped me to understand the service part in more elaborate manner. Soumitri has taken regular efforts to arrange meeting with all the possible stake holders understanding my need and requirement of project. That was the best part I liked about him. Right now I am working on the product part of project, me and ben working together on the cad models of glucometer and kiosk. We both are running behind schedule and really need to gear up. My cad skills are very weak so I am under confident about that part, but still trying to learn. it is an important and necessary skill which we would need to learn to survive in the industry.

Once Soumitri said dream the service, this reminds me of a very nice statement of Paulo Coelho from his book Alchemist “Before a dream is realized, the soul of the world tests everything that was learned along the way, it does this not because it is evil, but so that we can, in addition to realizing our dreams, master the lesson we have learned as we have moved toward the dream”.

And this is the time when most of us give up, and I don’t want to do that.

So still the journey is continued, lot more to do, lot more things to dream and make them tangible, bring them to reality.

Vazir

Blood Glucose

All about blood glucose and how it affects your diabetes management

Blood glucose (blood sugar) is a form of sugar produced when the body digests carbohydrates (sugars and starches). Blood glucose is the body’s major fuel for the energy it needs. When insulin is absent or ineffective, the blood glucose level increases. High blood glucose levels can lead to both short and long-term diabetes complications.

The goal in living with diabetes is to keep your blood glucose level as close to normal as possible, as often as possible. That means maintaining a healthy glucose average—and also preventing blood glucose swings that are too high or too low. Keeping in “good control” helps you feel better and reduces the risk of developing diabetes-related complications. “Poor control,” on the other hand, means falling far outside the healthy range for blood glucose. Poor control affects your health in the present, and puts you at higher risk for the long-term complications of diabetes, such as heart disease, eye, kidney and nerve diseases and even death.

The exact glucose target level can vary by person. A person without diabetes generally has an average blood glucose level of around 100 mg/dL. Good control for a person with diabetes before a meal is 90-130 mg/dL. But a number of circumstances can affect your ability to hit even that average. Your physician will give you guidance as to what average would define “good control” for you.

Each day you make choices for your health about what and when to eat, how active to be and so on. Blood glucose testing can be an important part of diabetes management because it can show you how well your choices are working. The results from your blood glucose meter provide immediate feedback, which can help you understand how different factors are impacting your blood glucose levels.

But testing is not just about getting a test result. It’s also about knowing how to interpret each result and how to take action. Your goal should be to keep your blood glucose in the target range recommended by your health care team, and avoid going either too high, which can lead to hyperglycemia, or too low, which can result in hypoglycemia. Once you know your blood glucose level, you can use the information to adjust your food, exercise or diabetes medication, so that you can feel your best. Keeping your blood glucose level as close to normal as possible is one of the best ways to stay healthy and reduces your risk of diabetes complications.

Did you know?
Blood glucose monitoring can be done at any time of the day. But it’s often best to plan on testing at specific times, and perhaps at the same times each day. By tracking your blood glucose results, you can learn a lot about yourself—and if necessary, you can make immediate changes to your diabetes care routine.

A fructosamine test reflects your average blood glucose levels of the last two weeks. An A1c test reflects your average blood glucose for the past 2-to-3 months. Combined, these tests provide valuable feedback for you and your health care team, so you can stay on target.

Stay in range! You’ll feel better and can lower the risk of diabetes complications.

insulin pump

Custom Mini Lead Screw Critical to Insulin Pump from Kerk Motion Products, Inc.

products

The full kit

wiki discription

Artificial pancreas – Wikipedia, the free encyclopedia

an insulin pump with feedback from a continuous blood glucose sensor.

Day one

22nd July’ 08

Today was our first session. We started with the formal introduction of everyone. I was the first one to start with it. There are total 14 students working in campaign projects.

Benjamin Creek student of RMIT is going to work with me on project External Pancreas.

Soumitri introduced himself and made a small presentation of his work.

He explained briefly on issues like sustainability and social innovation, with the examples of paddle cycle intervention and restoration of Austin car.

To make us familiar with the campaign project, he showed a small introductory movie on campaign projects. Further he explained about each project, which is going to happen within this semester.

There are total three project first is Icarus, which deals car sharing, second is Locavore project and third is External Pancreas which deals with product development for diabetics.

Then we were told to go through the brief of the project and decide a tangible timeline for the project. Soumitri also gave us some sheets for self assessment. After this we dispersed for project discussion in individual groups.

I introduced myself to Ben and told him about my college, work experience and vice e versa. Ben is a second year student of product design in RMIT, but he has already done diploma in product designing before. I found him sincere and very well organized in the course of discussion. We shared our thoughts about the project; we worked out the time line and decided how we are going about the project.

Ben is going to study the Australian context and I am supposed to study the Indian context. Same time we are supposed to do the market analysis for parallel products and available products in market. Case studies of patients, doctors and home nurses are also to be arranged by Soumitri.

Meanwhile Soumitri also briefed about the project to us, he explained about the types of diabetes. The cause, effect and the need of the product design intervention in the area of diabetes. He gave us some products and showed some nice journals done by the previous students.

To end up the session, Soumitri showed us the way to set up a blog and the best use of You tube and flickr.