IEEE ENGINEERING IN
MEDICINE AND BIOLOGY Magazine VOLUME 25 • NUMBER 3 ■ http://EMB-Magazine.bme.uconn.edu ■ MAY/JUNE 2006
IEEE ENGINEERING IN VOLUME 25 • NUMBER 3 MAY/JUNE 2006 http://EMB-Magazine.bme.uconn.edu
MEDICINE AND BIOLOGY Magazine
Engineering Humanity
Themes 16
The Humanitarian Efforts of Biomedical Engineers Robert Malkin
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Science, Engineering, and Humanity Richard R. Ernst
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The Science of Volunteering Peter Creane
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International Aid's Medical Equipment Training Program Billy Teninty
BACKGROUND IMAGE© DIGITAL VISION, LTD., INSET PHOTOS, L. TO R., TOP ROW: VSO/FIDAL GO, 2ND ROW: VSO/LIBA TAYLOR, 3RD ROW: CAROLINA HILLER, VSO/LIBA TAYLOR, 4TH ROW: VSO PIETERNELLA PIETERSE, VSO/JOHN SPAULL.
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Senior Design for Persons with Disabilities John D. Enderle
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Prescription for Success Greg Russell
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Engineers Without Borders and Their Role in Humanitarian Relief Claes I Helgesson
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A Low-Cost Solution to Rural Water Disinfection Charles Taflin
Features 38
The Evolution of Pacemakers Sandro A.P. Haddad, Richard P.M. Houben, and Wouter A. Serdijn
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Locomotion Techniques for Robotic Colonoscopy Irwan Kassim, Louis Phee, Wan S. Ng, Feng Gong, Paolo Dario, and Charles A. Mosse
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Noncontact Measurement of Breathing Function Ramya Murthy and Ioannis Pavlidis
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Study of Facial Skin and Aural Temperature Eddie Y.K. Ng, Wiryani Muljo, and B. Stephen Wong
IEEE ENGINEERING IN MEDICINE AND BIOLOGY MAGAZINE
MAY/JUNE 2006
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Departments 4 From the Editor The Bright Future of BME
6 Society News New Chapters, New Members
7 Student's Corner EMBS Students Surf More Than the Web
9 Book Reviews 12 BME Company Profiles CleveMed,Orbital Research, and Their Spinoffs
75 COMAR Report of COMAR Activities 2005–2006
76 Patents The U.S. Patent That Reached Around the World
77 Emerging Technologies Healthcare Applications of RF Identification
84 Engineering in Genomics Melatonin Administration Does Not Affect Isoproterenol-Induced LVH
88 Retrospectroscope Did Wheatstone Build a Bridge?
91 Cellular/Tissue Engineering Tissue Engineering and Eucomed News in Brief
92 GOLD EMBS Goes for the GOLD!
93 Conference Calendar
Mission Statement The Engineering in Medicine and Biology Society of the IEEE advances the application of engineering sciences and technology to medicine and biology, promotes the profession, and provides global leadership for the benefit of its members and humanity by disseminating knowledge, setting standards, fostering professional development, and recognizing excellence.
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NOTES FOR CONTRIBUTORS IEEE Engineering in Medicine and Biology Magazine is a theme-article publication that covers the full range of fields within biomedical engineering (BME), with each issue covering one theme. Articles are written for technically knowledgeable readers who are not necessarily specialists in the theme topic. A sample list of theme topics of interest includes: biochemical engineering, biocontrols, bioinformatics, biomems, biomaterials, biomechanics, biosignal processing, biotechnology, cellular and tissue engineering, clinical engineering, imaging and image processing, information technology, instrumentation, sensors and measurements, micro- and nanotechnolgy, neural systems and engineering, physiological systems modeling, proteomics, radiology, rehabilitation engineerNOTES FORinCONTRIBUTORS ing, robotics surgery, and telemedicine. In addition to the theme articles, which are invited contributions, the magazine also publishes unsolicited features Coming Attractions that areissues of interest a broad segment IEEE Engineering in Medicine and Future of thetomagazine will haveofthe themes of Teaching Engineering Biology Magazine readers. Tissue Engineering, Biotechnology, and Wearable in Medicine and Biology. IEEE Engineering Medicine andonBiology also publishes 20 Sensors/Systems and in Their Impact BME. Magazine Contributions on themeover topics regularly scheduled columnsarticles for readers interested in industry, academia, and are invited. Other technical and feature stories of interest to biomedgovernment. are peer reviewed andare written by experts in the field. ical engineersAll arearticles also welcome. All articles submitted anonymously for On the magazine comprehensive, in-depth tutorial, peeroccasion, review. Letters to the publishes editor, notes, commentaries, and review, other pieces of and survey articles. Letters to the editor, notes, other related pieces personal opinion will be published as such. Wecommentaries, also seek pressand releases of personal in opinion will be published as such. We also seek press releases to activities your company, organization, or school. related to activities your company, school. Manuscripts areinONLY accepted organization, in electronic or format through Manuscript Manuscripts aresite ONLY accepted in electronic format through Manuscript Central at the Web http://embs-ieee.manuscriptcentral.com. Instructions for Central Web and site how http://embs-ieee.manuscriptcentral.com. Instructions for creatingatanthe account to electronically submit a manuscript are available creating an account to original electronically submit aormanuscript available at at the Web site. Doand nothow send submissions revisions are directly to the the Web site. Do Ifnot send or revisions directly to the editorEditor-in-Chief. you areoriginal unable submissions to submit your contribution electronically or in-chief. If you are to submit yourplease contribution or have queshave questions onunable manuscripts style, contactelectronically the Editor-in-Chief: Dr. tions on Enderle, manuscripts style, please contact the editor-in-chief: D. Enderle, John D. Biomedical Engineering Director, UniversityJohn of Connecticut, Program DirectorRoad, for Biomedical Connecticut, 260 Glenbrook Storrs, CTEngineering, 06269-2247.University Voice: +1of860 486 5521.Room Fax: 217, 260486 Glenbrook Road, Storrs, CT 06269-2247 USA. Voice: +1 860 486 5521. +1 860 2500. E-mail:
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From the Editor the bright future of BME John Enderle
he months of May and June are a time of graduation, a time of new beginnings. I wish all of the graduates the best of fortune and a bright future. This issue focuses on humanitarian efforts by biomedical engineers around the world. The guest editor is Dr. Robert Malkin. He is the director of Engineering World Health and a professor of the practice of biomedical engineering (BME) at Duke University in Durham, North Carolina. I know that you will be amazed by the achievements of the biomedical engineers described in this issue. The future for U.S. BME graduates at all levels appears to be bright. At the American Institute for Medical and Biological Engineering (AIMBE)
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Academic Council on 3 March 2006, Dr. Steven Schreiner presented data on the 2004–2005 placement statistics. A total of 1,343 graduates were part of the survey, separated by level: B.S., M.S., Ph.D., M.D./Ph.D., and postdoctoral. There were 42 BME programs out of 88 programs providing data. Placement for all was above 90%, with B.S. graduates at 90%, M.S. graduates at 96%, and doctoral graduates at 97%. Of the B.S. graduates, 34% continued their education in graduate school, 21% went into medical school, 35% obtained jobs, and 10% were still seeking employment. Of the M.S. graduates, 43% continued their education in graduate school, 53% obtained jobs, and 4% were still seeking employment. Of
IEEE ENGINEERING IN MEDICINE AND BIOLOGY MAGAZINE Editor-in-Chief John Enderle University of Connecticut Editorial Board Hojjat Adeli The Ohio State University Howard I. Bassen Food and Drug Administration Krzysztof J. Cios Univ. of Colorado at Denver and Health Sciences Center Pouran Faghri University of Connecticut Limin Luo Southeast University, Nanjing Jasjit Suri Biomedical Technologies Inc. Eugene Veklerov Lawrence Berkeley Laboratory Associate Editors A Look At Jean-Louis Coatrieux University of Rennes, France Book Reviews Paul King Vanderbilt University
Cellular & Tissue Engineering Maria Papadaki P&G Italian Research Center, Italy Clinical Engineering Stephen L. Grimes GENTECH COMAR Dennis Blick Independent Consultant Emerging Technologies Dorin Panescu St. Jude Medical Faces and Places Andrew Szeto San Diego State University Genomics Harold (Skip) Garner University of Texas Southwestern Medical Ctr. Government Affairs Luis Kun National Defense University Industry Affairs Semahat Demir National Science Foundation Issues in Ethics John Fielder Villanova University
International News John Webster University of Wisconsin, Madison Patents Maurice M. Klee Fairfield, CT Point of View Gail Baura CardioDynamics San Diego, CA Regulatory Issues Robert Munzner DoctorDevice.com Grace Bartoo Instrumentation for Science and Medicine Retrospectroscope L.A. Geddes Purdue University Senior Design Jay Goldberg Marquette University Society News Jorge Monzon Universidad Nacional del Nordeste Student Activities Jennifer Flexman University of Washington
the Ph.D. graduates, 50% continued their education, 47% obtained jobs, and 3% were still seeking employment. The average starting salary for the B.S. graduate was US$50,400. I would like to encourage IEEE Engineering in Medicine and Biology Society members outside of the United States to share their data on placement of BME graduates. I will post the data as it is received. The AIMBE meeting had a number of interesting themes: Keeping America Competitive, Advancing Women Bioengineers, Fostering Innovation and Accelerating the Commercialization of Inventions, and Biomarkers. While all of the topics were interesting, the one that captured my attention was the role of measure-
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Editorial Correspondence: Address to John D. Enderle, Program Director for Biomedical Engineering, University of Connecticut, Room 223 B, 260 Glenbrook Road, U-2157, Storrs, CT 06269-2157 USA. Voice: +1 860 486 5521. Fax: +1 860 486 2500. E-mail:
[email protected]. Indexed in: Current Contents (Clinical Practice), Engineering Index (Bioengineering Abstracts), Inspec, Excerpta Medica, Index Medicus, MEDLINE, RECAL Information Services, and listed in Citation Index. All materials in this publication represent the views of the authors only and not those of the EMBS or IEEE.
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MAY/JUNE 2006
ment technologies (biomarkers, imaging, diagnostics, etc.) in advancing human health. What are the most important measurement technologies and how will they be developed and adopted, including factors and policies that will promote or impede them? Dr. Peter Katona, president of the Whitaker Foundation, gave the Earl Bakken Keynote address, and was the recipient of the Pierre Galletti Award. A remembrance for Swamy Laxminarayan was held during the meeting, with many of Swamy’s family members participating. For more information on the annual AIMBE event, see http://www.aimbe.org/ aimbe/default.jsf.
STEVENS
Institute of Technology
Until the next time, John Enderle
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MAY/JUNE 2006
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Society News new chapters, new members Jorge E. Monzon
n this column I would like to mention some issues that illustrate the growth of our Society. Quite frequently, our magazine presents local and regional events organized by our chapters. Local biomedical engineering activities through IEEE Engineering in Medicine and Biology Society (IEEE-EMBS) chapters seem to be a “perpetum mobile,” and we celebrate such continuity as we also welcome the creation of new chapters, which for the last months have arisen in different regions of the world, showing the proactivity of EMBS members everywhere. Hosted by Prof. Jan Bergmans of the Technical University in Eindhoven, the Netherlands, a one-day kick-off meeting of the new IEEE-EMBS Benelux Chapter took place. Bart Vanrumste (Katholieke Universiteit Leuven, Belgium) and Peter Veltink, from the University of Twente (Enschede, the Netherlands) were the organizers of the event. Dr. T.V. Ananthapadmanabha chairs the new EMBS chapter of the Bangalore Section in India. Dr. Nezamoddin N. Kachouie formed a new chapter of the Kitchener Waterloo Section in Canada. A joint chapter— EMBS and the Control Systems Society—has been established in the IEEE Central Coast Section, under the leadership of Dr. Cesar C. Palerm. Another joint chapter—EMBS and Engineering Management—was created by Tom Jobe and colleagues in Oklahoma City, Oklahoma. Our editor-in-chief, Prof. John D. Enderle, and 35 of his students formalized an EMBS student branch chapter at the University of Connecticut. Another student chapter, organized by Hemal Dalai, was created at the Watumull Institute of Electrical Engineering and Computer Technology, in Bombay, India. We also look forward to the success
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of those initiatives by Benjamin Mak and Stephen Davies to form a chapter in Toronto, Canada, and by Jan Vrba, who committed himself to start a chapter in the Czech and Slovak Republics. We also welcome the intention of Alexey L’vov to create a chapter in Saratov, Russia. There are some movements in Japan to establish new chapters in Fukuoka and in Sendai under the coordination of Dr. Kenji Sunagawa. Dr. Balakrishnan Santhanaraj, from the city of Kodakara in India, plans to found another EMBS chapter in his country.
Our Society has the highest membership elevated to senior grade. The EMBS Ad Hoc Committee for Chapter Development was created to identify areas that could support EMBS chapter activities and assist local members in the process for creating chapters by providing tools and information that can expedite chapter creation. This committee will be, for 2006, in the hands of Nathalie Gosset (Buenaventura Chapter) and Joaquin Azpiroz Leehan (Mexico Chapter). Among membership development best practices, each year the IEEE promotes its Senior Membership Program. The EMBS Senior Member Initiative was brilliantly coordinated by Barbara Oakley and chapter chairs around the world. Their hard work was highly successful. Sending e-mails to hundreds of potential candidates, distributing forms, contacting references, and answering more than 500 e-mail questions from
people who had received requests or recommendations led to a total of 76 EMBS Senior Member elevations in one quarter. This number places our Society as the one with the highest percentage of its membership elevated to senior grade and quite above all the other Societies. In terms of absolute number of new senior members, EMBS is one of the three most successful IEEE Societies for this program. The other two are • Communications (80 new senior members) • Computer (122 new senior members). This is definitely something to brag about! Just remember that there are 11 IEEE Societies with membership— i.e., potential Senior Members—larger than ours. Although new EMBS senior members belong to all regions, Europe and Asia were the best at growing their senior member base (15 new senior members each), whose loyalty to the Society translates into a higher retention rate. Membership figures (although provisional at the time of this writing) illustrate a positive trend. While a number of other IEEE Societies are losing members, at the end of 2005 our Society had 8,049 members, representing a 2.6% increase from 2004. For the same period, EMBS student membership increased by 11.5%. It must be pointed how, however, that a significant number of members chose to renew IEEE membership but, sadly, did not feel it was valuable to renew their EMBS membership. This suggests that we assess the effectiveness of the advertising campaign for new members and that we reconsider all the services offered to satisfy our members’ needs and as a way of retaining them in EMBS. Our Society continues to grow, as evidenced by those latest reports. No doubt that we all will do our best to keep it that way. MAY/JUNE 2006
Student’s Corner EMBS students surf more than the Web Jennifer Flexman
ou may notice changes to the student Web site—there’s more than just new colors and a new layout. I hope you will find this Web site easy to navigate and useful both for you personally and for your club or chapter. The IEEE Engineering in Medicine and Biology Society (EMBS) student network is growing every day, and we can use this Web site to share ideas, collaborate, and grow professionally. New features on the EMBS Student Web (http://embstudents.org) include: ➤ an online form to submit petitions for establishing student clubs and chapters, and annual renewals ➤ quick links on the home page to take you where you need to go for funding, conference information, summer schools, and more ➤ profiles of events put on by your fellow clubs and chapters to give you new ideas and helpful tips and suggestions ➤ a revamped job site, with links to company databases and resource material
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➤ and much, much more!
Please direct any feedback and suggestions to me. Get Ready for EMBC 2006!
Hopefully everyone has submitted their abstracts and is planning to attend the 28th Annual Conference of the EMBS in New York City. Information soon will be provided regarding shared accommodations for students; we will help to organize roommates. In addition, a special session is planned for students: “Students: The Movers and Shakers of EMBS.” Here, you will be able to meet student leaders within EMBS. This session will be a forum for you to ask questions about starting and running a student club or chapter, how to be a leader and motivate others, and what EMBS can do for you to help you plan and fund activities. We want to hear about your experiences, so come ready to share in the conversation. Look for this session in your conference program.
The California Lutheran University EMBS Student Club Mixes Surfing with Tissue Engineering
Thanks to Abigail Corrin for submittng the following to let us know what the California Lutheran University EMBS Student Club has been up to! Our newly established IEEE-EMBS Student Club at California Lutheran University is unlike anything that has ever been held on our campus. The goal of our club is to bring awareness and opportunities to all the science departments on our campus. The group has roots in the Bioengineering Department, but there are also biology, biochemistry, physics, and computer science majors involved. We are networking with the Buenaventura Chapter of the IEEEEMBS to provide mentors and internship opportunities for our students. This club offers a chance for students in the engineering and natural sciences to collaborate with each other about classes, attend conferences, and discuss frustrations and elations regarding undergraduate research. Other than educational excursions, we also attempt to create a close-knit community within our club by doing various activities: having dinner after a conference, taking surfing trips to the beach, and planning an upcoming weekend camping trip. The IEEE-EMBS Student Club brings unique opportunities to California Lutheran University. If you want to share an update about your student club or chapter, please send a description, including pictures, to me (
[email protected]). Share Your Opinion
California Lutheran University EMBS students bring biomedical engineering to the beach near Thousand Oaks, California: (back row) Daniel Perkins and mentor Dr. Mike Shawfront; (front row) Abigail Corrin, Erica Freeman, and Mohnish Charan.
IEEE ENGINEERING IN MEDICINE AND BIOLOGY MAGAZINE
In each “Student’s Corner” column of IEEE Engineering in Medicine and Biology Magazine, I will pose a question, and I want you to respond with your opinion. By encouraging dialogue within our community, I hope to foster MAY/JUNE 2006
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ing, and in the United Kingdom you can attain Chartered Engineer status. The process varies in other countries. The question is: Do you think that as biomedical engineers we should attain postgraduate licensing for professional designation? What are the advantages/disadvantages of becoming licensed? What kind of licensing exists in your country? Contact me at
[email protected] with your responses and comments!
The EMBS student club attends a meeting of the Los Angeles Tissue Engineering Initiative (from left): Erica Freeman, Candace Bragg, Dr. Bill Tawil, Abigail Corrin, Cassandra Hernandez, and mentor Dr. Mike Shaw.
discussion on the broader impact of our field and how it should grow. Being a student is a perfect time to start thinking about these issues because you are the future of the profession. In other types of engineering, where there is frequent interaction with the public, getting the Professional Engineer (PE) designation is commonplace. Being licensed in civil engineering allows you to sign and seal engineering plans and drawings, so it is an essential step in your career. In the United States, getting the PE designation involves writing a general “Fundamentals of Engineering” exam as you
near completing your undergraduate degree, and full licensing is generally granted with four years of acceptable work experience and a pass on the subject-specific “Principles and Practice” exam. However, there is no “Principles and Practice” exam on the subject of biomedical engineering, so students of this discipline can only become licensed in a related field (such as chemical, agricultural, or mechanical engineering) or generally licensed in some states. In Canada, the process is similar, but you can become a Professional Engineer in the discipline of biomedical engineer-
Here are some helpful links: • The National Society of Professional Engineers (USA): http://www. nspe.org/ • The National Council of Examiners for Engineering and Surveying (USA): http://www.ncees.org/ • The Canadian Council of Professional Engineers: http://www.ccpe.ca/ • Engineering Council (United Kingdom): http://www.engc.org.uk/ Jennifer Flexman is currently studying at the University of Washington, Department of Bioengineering (Image Computing and Systems Laboratory/ Neuroimaging and Biotechnology Laboratory) towards a Ph.D. in bioengineering. She graduated with a B.Eng. in electrical engineering from McGill University in 2000 and worked as a wireless test engineer for two years.
Book Reviews
Paul King
Biomedical Imaging Principles and Applications in Engineering Series
Karen M. Mudry, Robert Plonsey, Joseph D. Bronzino (Editors), CRC Press, 2003. ISBN: 0-8493-1810-6, 360 pages, US$109.95. This textbook is a compilation of 16 chapters written by individuals or teams of experts in the fields of medicine, medical instrumentation, and engineering. The chapters were selected from the most relevant sections of the second edition of The Biomedical Engineering Handbook (1999), which was also published by CRC Press. The book is intended for readers with some technical proficiency in engineering and physiology, although it is not geared as a pedagogical textbook for undergraduate or graduate courses. In particular, the chapters neither contain example problems within the text nor homework/thought questions at the end. Nonetheless, most subsections contain a list of defining terms that aid the reader in focusing on the critical features of the topic. The book is subdivided into two sections, the first being devoted to physiologic systems and the second to medical imaging itself. The “Physiologic Systems” section comprises seven chapters covering the primary human systems: cardiovascular, endocrine, nervous, vision, auditory, gastrointestinal (G-I), and respiratory. Although one would not turn typically to a medical imaging book to reference the background material on these systems, these seven chapters do offer a sufficient overview of each system. The “Respiratory System” chapter is the only one in this section that contains several fundamental mathematical models (for gas partial pressures and pulmonary mechanics). The chapter on the “Gastrointestinal System” IEEE ENGINEERING IN MEDICINE AND BIOLOGY MAGAZINE
provides a thorough examination of the control mechanisms and response activity in the G-I tract with specifics about the electrogastrogram (EGG). On the whole, however, this physiology section does not enhance the material presented in the imaging section and could have been omitted entirely from the book. The “Imaging” section contains a chapter on each of the standard imaging modalities—X ray, computed tomography (CT), magnetic resonance (MR) imaging, nuclear medicine (including SPECT), positron emission tomography (PET), and ultrasound as well as several specialty chapters on MR microscopy, electrical impedance tomography, and virtual reality technology. Each of these chapters offers a solid explanation of the components needed for signal/source generation, image detection, and computer processing. Nearly half of the “X-ray” chapter is devoted to the topic of mammography, with many physiological examples related to the image output. Similarly, about half of the “MR Imaging” chapter contains two special-topics subsections on functional MRI and chemical shift imaging. The chapter on CT includes an historical account of the data-acquisition geometries of CT scanners and many good figures illustrating the hardware of the system; several of these figures lack dimensions needed for clarification of size. The chapter closes with an overview of image reconstruction principles. The “Nuclear Medicine” chapter likewise covers system design and image reconstruction techniques. An extensive table of radionuclides used in biomedicine is included in the chapter on PET. The “Ultrasound” chapter opens with a discussion of transducer design and follows with imaging principles. This
part of the text does contain two computational examples on Doppler flow. A summary of the medical applications of virtual reality technology is offered in the final chapter, including coverage of image fusion, surgical training and planning, and telemedicine. Lastly, most of the imaging sections delve into the areas of image resolution and clinical applications. Although published in 2003, almost all of the imaging chapters contain references that are dated no later than 1994, but the developments in each modality are very thoroughly investigated. Because most of the chapters were written by multiple authors, some of the material occasionally is repeated, and thus the structure of the book is not cohesive. Overall, this book would serve best as a reference tool for medical professionals to offer a basic foundation in biomedical imaging systems. —Diane Muratore Testa Western New England College Creative 3-D Display and Interaction Interfaces
B.G. Blundell and A.J. Schwarz, Wiley Interscience, 2006. ISBN: 0471482714, US$94.95. This textbook provides an historical and technical overview of three-dimensional (3-D) display techniques. To a lesser extent, interaction devices are covered. It can serve as a resource for students and others interested in the technology from these perspectives. The text consists of nine chapters. Each consists of the chapter “body,” followed by a discussion/overview of the chapter, and an “investigations” section, which consists typically of six or so semi-homework questions related to the chapter material. A bibliography and reference section is reserved for the end of the text, so reference-chasing means flipping to the end each time. MAY/JUNE 2006
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Book Reviews (continued)
Chapter 1 in this construct outlines the remainder of the text and gives a 10,000-ft overview of the field of visualization. To further prepare one for the remainder of the text (and a career in the field), chapter 2 consists of an exquisitely well-done chapter covering the human perception of space (vision); chapter 3 covers haptics and the human sensory system. A historical discussion of 3-D visualization, including the use of a vanishing point and horizon in drawing and painting as well as the construction and use of the camera obscura and lucida, are all covered in the next section. Chapter 5 reminds us of traditional interaction mechanisms used in imaging, such as the lightpen, joystick, and mouse as well as the lesser-known implement the grafacon. The Fitts’ model (law) of the human motor system is introduced and described well in this chapter. Chapters 6–8 comprise the “meat” of this text, describing depiction and interaction opportunities (including stereo pairs to virtual reality devices), Haptic devices (used for medical training, prototyping and design and chemistry), and use of the visual channel (an overview of methods for displays of information, including Pepper’s Ghost.) The final chapter, “Adopting a Creative Approach,” primarily discusses the use and usefulness of devices that might allow a two-handed interaction with the data (image) on display. The text concludes with a brief mention of the Chimenti Drawings, an early circa 1850 stereoscopic image pair, and a discussion of holographic images (appendixes 1 and 2.) This text is interesting and comprehensive. It could use a CD insert for many of the images presented; the gray-scale images in the text are generally too small and of too low a quality to be useful for teaching or study. —Paul H. King Vanderbilt University Misadventures in Health Care— Inside Stories
Marilyn Sue Bogner (Editor), Lawrence Erlbaum Associates, 2004. 10 IEEE ENGINEERING IN MEDICINE AND BIOLOGY MAGAZINE
ISBN: 0-8058-3378-1, 264 pages, US$59.95. Misadventures in Health Care, Dr. Bogner’s first book since Error In Medicine (1994), is an excellent first volume in a new book series on patient safety published by Lawrence Erlbaum Associates. The book presents a series of independent case studies of episodes of care that involve medical error. The case studies can be read in any order but generally proceed through the continuum of healthcare and include episodes involving the blood bank (i.e., blood transfusion), shock trauma, surgery, intensive care, and anesthesiology, concluding with episodes involving the hospital discharge process and home care. The episodes highlight errors and near misses caused by failures in human-human interaction (e.g., team communication), overreliance on technology (e.g., electronic alarms and alerts), poorly designed human-technology interfaces (e.g., not designed with the human user in mind), and complexity (e.g., too much technology and data overload). Bogner effectively uses the case study approach to provide readers with rare insight into the complexities of the healthcare system from the perspectives of the care providers. Each chapter or case study concludes with a discussion by the authors about the human factors and circumstances that contributed to the error during the episode of care. The authors are experts in patient safety research, and many are practicing clinicians. This is the greatest strength of the book because it provides the case studies with balance of clinical and technical content. The book has been written to facilitate analysis and discussion, so the authors do not propose solutions to the problems identified in each episode. The book succeeds in making the case that the healthcare system is incredibly complex, often for unacceptable reasons, and that the errors and adverse events patients occasionally experience during their interaction with the system seldom result from simple human error. Misadventures in
Healthcare is highly recommended reading for students and professionals in healthcare, human factors engineering, safety and risk engineering, and anyone interested in learning more about safety in healthcare. —Dan France, Ph.D., MPH Design and Development of Medical Electronic Instrumentation
David Prutchi and Michael Norris, 2004. ISBN: 0-471-67623-3, 461 pages, US$126.50. I know these guys. I mean, not personally, but I understand who they are, and I think I have a pretty good idea as to why they wrote this book. They are two veterans of the medical device industry who have dealt with the pressures of creating devices that work in the real world. I expect they wrote the book because they were tired of dealing with young engineers just out of engineering school who understand the theory of electronic instruments but have no idea how to actually build something that works. Having had encounters with student designs using 1- resistors and 1-F capacitors, I can feel their pain. Clearly they set about creating a book in which they attempt to give the reader real-world examples with realworld components. The book is part textbook, part grimoire, and part technical biography of problems they have solved. As such, it is chock-a-block with component names, values, vendors, and even pin numbers of circuits. And therein lies the trap. In providing such specificity, the authors tie themselves to a particular technological age, a particular style of design, and a particular audience. And in rushing to provide specifics, they miss the opportunity to explain the general. For example, as early as page 9, they show a buffer circuit with a negative-signal guard ring. The part number of the buffer they would use is listed, the pin numbers of the connections are provided, even the jumper connections on a standard input buffer board are provided, but there is no mention of why you MAY/JUNE 2006
want a negative-driven guard ring or even what a guard ring is. There is actually a lot to like about this book. Any book which has major legal warnings about the danger of the circuits or techniques described every ten pages or so holds a certain appeal. They have flyback power supplies, Jacob’s ladders, and toxic chemicals in here! In addition, there are moments, such as in their switched capacitor discussion, where I said, “Oh so that’s why.” The problem is, I have a hard time identifying any sort of sizable audience for it. Its strength is its specificity, which reduces the applicability for a general audience. There are also some strangely dated references. Their A/D system runs through a parallel port, something which is beginning to vanish from modern computers, their code is in QuickBasic—hardly the standard at most universities now—and there are several references to the original Star Trek, which will completely elude the under-45-year-old crowd. I also expect that the modern student won’t understand an analog graphic equalizer, hex addressing for LPT1, or state machine programming. For the right application, I can see this book being invaluable, and the authors are to be congratulated for staking their explanations to reality. However, at US$128 list price and given the small scientific area covered, I can’t see this as being a general medical instrumentation textbook. Final comments to the publisher: If you are going to agree to print a textbook (especially one that you list at US$128), then you should pay some attention to the production values. The figures in the book look they were printed on a dot-matrix printer; Figure 1.3 is a composite of three figures with different font sizes, font types, and line thicknesses. Figure 1.12 looks like it was printed on a plotter. In figures 1.23 through 1.25 “Biopotential amplifier,” “Oscilloscope,” “Input 1,” and “Input 2” are different font types and sizes. If the argument is “that’s how the authors provided them,” then I would hope the IEEE ENGINEERING IN MEDICINE AND BIOLOGY MAGAZINE
authors are getting the lion’s share of the profits. Lastly, the subtitle of this book is A Practical Perspective of the Design, Construction and Test of Medical Devices. As an engineer, I am hardly one to comment on grammar but shouldn’t that be: and Testing of Medical Devices? R.L. Galloway Virtual Reconstruction: A Primer on Computer-Assisted Paleontology and Biomedicine
Christoph P. Zollikofer and Marcia S. Ponce de León, Wiley, 2005. ISBN: 0471-20207-9, US$89.95. If you are interested in, and need some understandable text to comprehend, the three-dimensional (3-D) reconstruction of past and present human and other anatomy, this is the text for you! This is a very well referenced and structured text, covering the fundamentals of image collection and reconstruction in a number of areas related to paleontology and biomedicine. The text does this through a standard chapter format, with a well-conceived set of case studies sprinkled throughout the text, with several appendixes covering standard linear algebra techniques (and others) related to image manipulation, and with suggested readings and references. A companion Web reference site is available for use with the text. The main text consists of eight chapters, each titled according to the main thrust of the section. Chapter 1 is titled “Virtual Reconstruction” and covers the general topic of scanning real objects (fossils to living humans) in order to create an image that is a virtual reality manipulative of the original object. The end goals of this visualization are typically the generation noninvasive reverse-engineered representation of the original. “Data Representation” is the title of the next chapter, which is truly a primer on data structures, image formats, and vision. Chapter 3, “Data Acquisition,” covers the basics of vision versus cameras, transfer func-
tions, various modalities of CT scanning and the basics of MRI as well as surface scanning techniques. Chapter 4, “Image Data Processing,” is a nice overview of the overall process of image formation and analysis. Special emphasis is placed on various imaging techniques, including windowing, filtering, and various boundary extraction methods. Chapter 5 gives an overview of visualization and interaction and covers shading techniques, image movement and rotation, volume rendering, and the use(s) of trackballs, mice, and the like. “Virtual Fossil Reconstruction” (chapter 6) is a good discussion of physical versus virtual reconstruction. Several great examples (fossilized alligator, Neanderthal skull, etc.) give good visualization and instruction into techniques for reconstruction. Virtual surgery for the reconstruction of someone’s face (post bear attack) and custom implant design show a useful application to medicine. Chapter 7, “From Virtual Reality to Real Virtuality,” covers the basics of several rapid-prototyping techniques and gives examples of its use in fossil reconstruction, surgical planning, and implant developments. The final chapter, “Morphometric Analysis,” discusses the use of mathematical tools in the study and analysis of form(s) and change of form(s) over years of evolution and between similar species. An interesting sidelight is a discussion of the commonality of several cave drawings and analyses of shape changes (for example skull shape) as a function of age. For biomedical engineers interested in a practical and understandable text covering the application of virtual reconstruction techniques to problems in medicine, this is an enlightening textbook. It could well comprise a large part of an upper-level medical imaging course. Reading the text is sure to increase one’s vocabulary and likely also make a minor difference (positive) to one’s IQ! —Paul H. King, Vanderbilt University MAY/JUNE 2006
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BME Company Profiles CleveMed, Orbital Resesarch, and their spin-offs Semahat S. Demir
n this column I am featuring Cleveland Medical Devices Inc. (CleveMed), Orbital Research, iACTIV, Flocel, CleveMed Neuro Wave, and ComSense Technology by presenting an electronic interview I had recently with Robert Schmidt, chairman and founder of these companies.
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S.S. Demir: Would you please introduce CleveMed and your other companies to us and also the engineering and biosciences that your companies are involved in? Please give us a short history of the companies and how you founded them all. Our readers would be interested in knowing whom your companies employ and what kind of engineers. R. Schmidt: I started Cleveland Medical Devices Inc. (CleveMed) and Orbital Research Inc. in December 1990 and incorporated them the next spring. The intent was to make Robert Schmidt medical devices through CleveMed and aerospace devices and controls through Orbital Research. However, what I found once I started the corporations is that they are more than just a legal person; they develop their own personality and grow into their own entity, despite what the founder initially envisions. As the chief executive officer, you can force the company to follow a predetermined business plan path, but you will stunt its growth by not letting it flourish as the market allows. Consequently, CleveMed is now working for the military developing new wireless systems, and Orbital Research is developing new medical devices. The other companies are spin-offs of these two “mother” companies. 12 IEEE ENGINEERING IN MEDICINE AND BIOLOGY MAGAZINE
S.S. Demir: What are your annual sales? Are your companies publicly traded? If yes, what are the annual net incomes? What is your market capitalization? R. Schmidt: Our annual sales of all the companies are about US$10 million. The companies are not publicly traded. They are owned by their employees. S.S. Demir: Where are your companies’ efforts concentrated in bioengineering and biosciences? R. Schmidt: CleveMed’s primary mission is to develop, manufacture, and market wireless monitors and rehabilitation devices to lower total healthcare costs and allow patients to leave the hospital sooner. Our four major focus areas are: emergency brain monitoring, sleep disorders, pressure ulcer management, and movement disorders. Our initial major products are wireless electrophysiology monitors, which are primarily focused on the brain, looking at things like sleep and seizures. Orbital Research has developed a microelectromechanical systems (MEMS) microvalve. These tiny silicon valves are being used to make a Braille array (a computer monitor for the blind). This technology has been licensed to a spin-off, iACTIV Corp. The microvalves can also be used to actuate the microflow effectors on aircraft and missiles. Another MEMS device that we have developed and patented is the Dry Electrode. These micromachined electrodes are used for patient monitoring, and they eliminate the need for pastes or gels, which can dry out over time. S.S. Demir: You founded seven companies: Cleveland Medical Devices Inc. (CleveMed), Orbital, iACTIV,
Flocel, CleveMed NeuroWave, RadioStorm, and ComSense Technology. Please inform us of the entrepreneurship that you have had and the translational activities that your companies had to go through. R. Schmidt: Starting a business from scratch is extremely difficult, particularly without a large source of external funding. When I teach entrepreneurship, I always tell people “never quit a good job to start a company.” I went from a six-figure income to a four-figure income, and that has a drastic effect on your lifestyle. For the first four years, I hardly received any pay, and for the next four years, it wasn’t much better. Most students and professors work very hard for a number of years to get a lab prototype. If they carry their project further, they get to the engineering prototype stage, where their device has the form, fit, and function of the actual product. That means it is the right size and operates pretty much like the final device. Those inventors usually have no concept of the fact that once they have that engineering prototype, they are at best 5% of the way toward commercialization. The next step, and this is a step usually best done by small businesses, is to develop a manufacturing prototype. Now the device has an industrial design that is ready to be made and have customer acceptance; its case and electronics don’t break if you drop it; the software has been tested, not only by in-house engineers but by an actual customer; and it can be made on a production line, without needing individual tweaking. It passes the “ility” tests: reproducibility, reliability, manufacturability, maintainability, reparability, as well as safety tests, and is ready to go through regulatory MAY/JUNE 2006
Fig. 1. The CleveLabs Kit with the BioRadio 150.
Fig. 2. A typical CleveLabs screen shot from the Gait Lab session.
testing. Then you are 10% of the way to a commercial product. In the medical field, the next step is getting your Food and Drug Administration (FDA) approval to market, usually a 510(k) for most devices. That testing and the approval process will get you to about the 25% mark. After that is getting your CMS (Center for Medicare and Medicaid Services) approval for reimbursement. That can be very expensive, and sometimes insurmountable, for new medical devices. Once you have finished that, your new medical device may be half way to commercialization. That last 50% is the market entry piece. It requires getting at least one medical champion and preferably several. These M.D.s are critical. The training of physicians usually takes very smart, creative people and then spends about a decade making sure they stay within the box of “standard of care.” Physicians are trained that if they go outside those bounds, they will put both the hospital and their medical practice at risk. Thus, it takes a brave doctor to perform the medical research and then publish a new way of practicing medicine. From the company’s standpoint, they need not only a brave physician but one who is recognized as a leader in the field. Nothing can be more discouraging than having the data showing that you IEEE ENGINEERING IN MEDICINE AND BIOLOGY MAGAZINE
in fact have a “better mousetrap” but no one cares. Getting people to care not only takes intellectual horsepower but also the funding to get the story out so that other physicians have the opportunity to listen. The model we use is the Thomas Edison Invention Factory model. We have funded a large part of our research using the SBIR program. However, SBIR does not pay for marketing. Since the marketing costs are significantly larger than the development cost, we have to determine how we will fund the marketing of the new product. If we can do it internally, we do so as that gives our current owners the greatest return. However, some products need more funding. We have formed a number of spin-off companies that have raised, or will be raising, money to commercialize the technologies developed by the mother companies. One such example is ComSense Technology Inc. A pressure sensor was initially created at Case Western Reserve University and then further developed by Orbital Research. This pressure sensor has been spun off into a new company called ComSense Technology Inc. This high-temperature pressure sensor is being tested on diesel engines and has the potential for saving up to 5% of transportation fuels, potentially saving up to a bil-
lion barrels of fuel a year worldwide (an amount equal to about 2.5 times the production from Alaskan oil fields). ComSense Technology is in the process of raising additional funding to finalize the product and to start selling it. CleveMed is also in the process of spinning off some of its technologies through emerging companies: CleveMed NeuroWave and RadioStorm. It is intended to license anesthesia neuromonitoring technology and possibly various sleep evaluation and ADHD (attention deficit hyperactivity disorder) diagnosis algorithms to CleveMed NeuroWave and missile tracking and shipboard wireless system evaluation technologies developed for the military to RadioStorm Inc. Flocel is marketing an in vitro blood brain barrier test, a technology we licensed from the Cleveland Clinic Foundation. S.S. Demir: Would you please comment on your companies’ partnerships, collaborations, and alliances? R. Schmidt: We are working with a number of companies in different technology areas; however, most of them are not ready for public release yet. We have started a joint venture in India called Medadim to do sleep testing, initially in Calcutta. MAY/JUNE 2006
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BME Company Profiles (continued)
S.S. Demir: Would you like to specifically talk about the products of your companies?
Toronto, Arizona State University, Case Western Reserve University, and as far away as Waikato University in New Zealand. We are starting to sell CleveLabs into countries like China, Malaysia, and the Philippines, and the
R. Schmidt: Our Crystal Monitor Model 20-S was designed for the sleep apnea market to provide a deck-ofcards-sized device that allows the patient to be untethered. It is convenient, portable, and FDA approved to market, allowing sleep labs to be set up anywhere: in empty hospital beds, hotels, nursing homes, firehouses, or wherever the user wants to study sleep on a patient. Because it is wireless, an attended study can be performed and the technician can be several rooms away, without the need of running wiring. Another version of the device is the Crystal Monitor 20-E, which is designed for the emergency department (ED) to diagnose nonconvulsive seizures. Our initial testing in an ED, along with other studies, has shown that there are 2–5 million people in the United States that are having nonconvulsive seizures that never get diagnosed. Failure to diagnose and treat nonconvulsive seizures can lead to loss of memory, mental processing problems, and other neurological issues. The Crystal Monitor also has a research and teaching version called the BioRadio 150. It is used for both animal and human research monitorFig. 3. The Crystal Monitor 20-S sleep ing. Uses are as diverse as studying apnea monitor. elderly in their homes by Catholic University in Washington, D.C., to monitoring elephants in Thailand and orcas and dolphins in Siberia. The BioRadio is combined with a laboratory course and is sold around the world as CleveLabs. Because it is used to teach engineering basics, basic electrophysiology, advanced electrophysiology, and clinical applications, it has rapidly become the standard to teach electrophysiology. It has been adopted by universities like the University of Southern California, University of Fig. 4. The Flocel blood brain barrier tester. 14 IEEE ENGINEERING IN MEDICINE AND BIOLOGY MAGAZINE
course has also been translated into Spanish. We have also developed a high school course for secondary schools to provide an advantage to their technically minded students. A much smaller version of the BioRadio is sold as the RatPaak. It is approximately the size of a U.S. quarter dollar and is worn in a backpack by small animals to monitor their physiological status. CleveMed has also developed other devices and algorithms. They include: the ParkinSense to monitor Parkinson’s symptoms, Pressore Step to monitor walking and standing of diabetic patients, a Heart Patch and arrhythmia detector for cardiac monitoring, and a number of other devices. Orbital Research is developing a number of flight control technologies. It has shown in wind tunnel tests up to Mach 3.0 that it can control a missile with small micro flow effector devices on the nose cones and tails of missiles. This technology has the potential to reduce the size of missile fins that cause drag, enhancing range and payload and also possibly allowing them to hit targets behind the plane (rear hemisphere engagement) and to provide last-second corrections to be able to more effectively hit moving vehicles. Other flow control technology actively diverts flow through wings and fins using our Reconfigurable Porosity technology. We have also been working closely with the University of Notre Dame to develop a Plasma Wing technology. This Plasma Wing technology is as close to a flying saucer that most people will ever see and can be controlled without any moving parts. Orbital Research has also developed a number of advanced control techniques. One such technique utilizes the neural net of a cockroach’s escape mechanism to provide either collision avoidance or target seeking for missiles, micro-aircraft, sea vehicles, trucks, automobiles, and the like. MAY/JUNE 2006
Valve 1 Valve 2 Valve 3 Valve 7
Valve 4 Valve 5 Valve 6 Valve 8
Card Edge Connector Fig. 5. iACTIV’s MEMS microvalve modules for microfluidics.
Other guidance and control algorithms are developed in near real time using genetic algorithms. This path planning technique randomly selects alternate paths and scores each one based on a set of predetermined criteria such as safety, fuel consumption, or other criteria that may be important to the trip. These algorithms may be used for purposes as varied as planning the flight of a missile or for reprovisioning a ship at sea. A number of other advanced control techniques have also been developed to provide adaptive predictive control and to control underactuated systems (those that are normally thought to be uncontrollable using standard techniques). Both the aerodynamic control devices and the control algorithms have been combined to form a new generation of micro air vehicles. We consider that all of these new controls and vehicles are forming a new industry; we call it aerionics. Orbital Research also works as the distributor of a new heat treating technology that provides an extremely fast quench to provide hardness and toughness to any steel, resulting in properties
IEEE ENGINEERING IN MEDICINE AND BIOLOGY MAGAZINE
significantly better than by using current state-of-the-art processes. S.S. Demir: Can you give us an overview of the new areas that your companies will expand into in the near future? R. Schmidt: Our plates are pretty full at the moment. However, the industries we are trying to grow in northern Ohio are neuro, MEMS, and aerionics (our name for our new miniature aviation control systems). Most of our efforts will focus in these three new areas. All three of them are at the bottom of their S curves, so there is lots of room for growth. S.S. Demir: Many of our readers will be interested in hearing about the career and/or job opportunities at your companies. Would you please summarize the career and/or job opportunities? R. Schmidt: CleveMed’s staff is 70% engineers. Most are electrical engineers, including analog, digital, and radio frequency engineers. Software and firmware engineers make up the next
biggest percentage, tied with biomedical engineers, who lead our design teams to develop products that meet human needs. Mechanical engineers and technicians round out the design teams. What we are looking for are more seizure detection engineers that have had electroencephalogram (EEG) experience. At Orbital Research, 75% of our employees are engineers. Most of the Orbital Research engineers are aero/mechanical engineers or materials engineers. We also hire control systems, electrical, and software engineers. S.S. Demir: Please let us know of the Web site from where our readers can get further information about your companies. R. Schmidt: They can see more at: • http://www.CleveMed.com • http://www.Orbitalresearch.com • http://www.iACTIVCorp.com • http://www.ComSenseTech.com • http://www.Flocel.com Two other nonprofits that we support to help grow our industries are: • http://www.NEOBio.org • http://www.OhioMEMS.org.
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BIOMEDICAL ENGINEERING HUMANITARIANISM
The Humanitarian Efforts of Biomedical Engineers An Overview from the Guest Editor BACKGROUND IMAGE© DIGITAL VISION, TLD., INSET PHOTOS, L. TO R., TOP ROW: VSO/FIDAL GRO, 2ND ROW: VSO/LIBA TAYLOR, 3RD ROW: CAROLINA HILLER, VSO/LIBA TAYLOR, 4TH ROW: VSO PIETERNELLA PIETERSE, VSO/JOHN SPAULL.
BY ROBERT MALKIN
fter the tsunami hit Southeast Asia, homes, factories, schools, hospitals, and universities were wiped away with the force of thousands of kilograms of rushing water. Immediately, organizations around the world mobilized to help those whose lives were destroyed. Relief organizations sent supplies, professional organizations sent experts, and professional societies (including engineering professional societies) organized relief drives and sponsored their members’ trips to the ravaged area. Some of my colleagues expressed their disappointment that biomedical engineers were seemingly absent in the response to the tsunami, when, arguably, healthcare and healthcare infrastructure were among the most critical needs in the aftermath of the disaster. Taking this one incident as an example of a broad trend, some argue that biomedical engineers are not contributing their share to humanitarian efforts. One of the goals of this special issue is to dispel this myth. Perhaps biomedical engineering (BME) professional societies are not assuming their natural leadership role in delivering humanitarian efforts, but it is simply not true that biomedical engineers are not dedicating a part of their careers towards helping the less advantaged. This special issue of IEEE Engineering in Medicine and Biology Magazine is meant to illustrate by numerous examples the ways in which biomedical engineers are improving conditions throughout the world. Not only do I hope that this series of articles will dispel the myth that BME is not doing its share, but I hope the articles will also inspire an even stronger commitment to humanitarian efforts. And indeed, as scientists and engineers, we have an obligation to commit ourselves to humanitarian work, as Richard Ernst argues in the opening article of this issue. Dr. Ernst won the Nobel Prize in 1991 for his work in the development of magnetic resonance spectroscopy, the cornerstone of modern magnetic resonance imaging (MRI). Like many Nobel Laureates, Dr. Ernst has used his notoriety, in part, to further the cause of humanity, highlighting ways in which we should and must commit ourselves to this cause. There are many ways to fulfill that commitment as a biomedical engineer. Organizations like Engineering World Health (EWH), Volunteer Services Overseas (VSO), and International Aid (IA) describe their need for university faculty
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to volunteer their time to teach engineering, science, or math in the developing world. In the case of EWH and IA, this can mean volunteering for as little as few weeks. VSO offers opportunities for up to two years of sustained contribution by a faculty member as an educator in a disadvantaged community. For students of biomedical engineering, there are numerous opportunities to get involved. Senior design projects that focus on the developing world and the domestically disadvantaged are described by Dr. John Enderle, editor-in-chief of this magazine. In some sense, these projects are doubly powerful. They directly contribute to their target audience, but they also can put young biomedical engineers on the path to dedicating a part of their professional lives to humanitarian efforts. Gregory Russell describes a summer program that places students in developing world hospitals, living with developing world families. EWH and Engineers Without Borders (EWB) offer opportunities for engineering students to get involved with designing solutions to problems affecting communities throughout the world. Contaminated water is one the leading causes of death in Africa. Not only students but professionals can get involved in issues such as water purification (such as the project described by Charles Taflin). In these projects, an experienced designer can affect millions with their efforts. If you are interested in volunteering for one of the organizations mentioned here, feel free to contact the authors directly. They look forward to hearing from you. No series of short articles could possibly be a comprehensive list of opportunities for biomedical engineers to carry out humanitarian efforts. But information about BME-specific opportunities is scattered and difficult to find. If you know of an opportunity or an organization that is looking specifically for biomedical engineers and the skills they possess to make a unique contribution to help humanity, please let me know (robert.malkin@ duke.edu). I will accumulate your suggestions and add them to a list that will soon be published. Finally, I hope that these articles will inspire you to consider what you can do to help people suffering from natural disasters, the ravages of war, economic pressures, or other disadvantages. Every biomedical engineer can contribute— including you. (continued on page 19) 0739-5175/06/$20.00©2006IEEE
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28th Annual International Conference of the IEEE Engineering in Medicine and Biology Society: Engineering Revolution in BioMedicine Marriott Marquis Times Square, New York City, New York, USA 30 August – 3 September 2006 Pre-Conference Workshops: 29 – 30 August 2006 Conference Chair Atam P. Dhawan, Ph.D. New Jersey Institute of Technology Conference Co-Chair Metin Akay, Ph.D. Arizona State University Program Chair Andrew F. Laine, Ph.D. Columbia University Program Co-Chair Ki H.Chon, Ph.D. State University of New York, Stony Brook Finance Chair Laura Wolf IEEE-EMBS Publication Chair Andreas Hielscher, Ph.D. Columbia University Local Arrangement Chair Helen Lu, Ph.D. Columbia University Student Activities Chair Jorge Monzon, Ph.D. Universidad Nacional del Nordeste, Argentina Important Dates Four Page Paper Submission: 24 April 2006 Notification of Acceptance: 15 June 2006 Final Program Available: 1 July 2006 Exhibition Booth Reservation: 31 May 2006 Early Conference Registration: 15 July 2006 Hotel Reservation: 1 August 2006
Program Themes Biomedical Signal Processing Biomedical Imaging and Image Processing Bioinformatics and Computational Biology Micro- and Nano- Biotechnologies Bio-sensors, Bio-instrumentation & Wearable Technologies Cellular and Functional Tissue Engineering Pharmaceutical Studies, Drug Delivery and Gene Therapy Biomechanics, Bio-Robotics, and Surgical Planning Cardiovascular and Respiratory Systems Neural and Rehabilitation Engineering, and Neuromuscular Systems Clinical Engineering and Healthcare Information Systems
The 28th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBS) will be held 30 August to 3 September 2006 at the Marriott Marquis Times Square in New York City, USA. The general theme of EMBC 2006 is "Engineering Revolution in BioMedicine" covering the broad spectrum of the medical physics, biological and biomedical sciences, and biomedical and clinical engineering. Specific themes include Molecular Imaging, Neural Engineering, Nano-Technologies for Biomedical Applications, Computational Biology and Bio-Informatics, Technical Innovations in the Pharmaceutical Industry, and BioCounterterrorism and Bio-Defense Technologies. Special symposiums and workshops will be conducted with leaders in the respective fields providing an overview as well as in-depth description of the cutting-edge research technologies. Special emphasis has been given to student activities including opportunities to meet and talk with leaders and pioneers in the biomedical engineering and biological sciences with discussions on exploring career paths. Keynote Speaker: Nora D. Volkow, M.D. Director, National Institute of Drug Abuse (NIDA) August 31, 2006, 8.00 AM-9.00 AM "Imaging the Addicted Human Brain: From Molecules to Behavior" Plenary Speakers: Molecular Imaging: Michael Phelps, Ph.D., Chair, Dept of Molecular & Medical Pharmacology, Director, Crump Institute of Molecular Imaging, UCLA Neural Engineering: John Donoghue, Ph.D., Henry Merritt Wriston Professor and Chairman, Department of Neuroscience, Brown University Nano-Technologies for Biomedical Applications: Jennifer L. West, Ph.D. Isabel C. Cameron Professor and Director, Institute of Biosciences & Bioengineering, Rice University Computational Biology and Bio-Informatics: Joseph M. Jasinski, PhD, Program Director, Life Sciences, IBM Innovations in Pharmaceutical Industry: David Goldenberg, Sc.D., M.D., Chairman, Immunomedics, Inc. Bio-Counterterrorism Technologies: Ernest T. Takafuji, M.D., MPH, Director, Office of Biodefense Research, NIAID, National Institutes of Health Biomechanics: Van Mow, Ph.D., Stanley Dicker Professor of Biomedical Engineering and Orthopedic Bioengineering, Director, Liu Ping Laboratory for Functional Tissue Engineering, Chair, BME, Columbia University Student Paper Competition and Student Design Competition Special Mini-Symposiums on BME Careers, Research Funding, Proposal Writing and Industry-Academia Interactions 18 Technical Workshops and Special Mini-Symposiums
Please visit the EMBC’06 website for further details http://embc2006.njit.edu
BIOMEDICAL ENGINEERING HUMANITARIANISM
Science, Engineering, and Humanity Our Contribution to the Future BACKGROUND IMAGE© DIGITAL VISION, TLD., INSET PHOTOS, L. TO R., TOP ROW: VSO/FIDAL GRO, 2ND ROW: VSO/LIBA TAYLOR, 3RD ROW: CAROLINA HILLER, VSO/LIBA TAYLOR, 4TH ROW: VSO PIETERNELLA PIETERSE, VSO/JOHN SPAULL.
BY RICHARD R. ERNST
cience, engineering, and humanity. The relationships between these three terms appear to be so obvious that writing about them seems superfluous. We scientists and engineers are convinced that we comprise the primary source of societal prosperity. Innovation is the only path to future happiness! But, is this all that must be said? What about our current trend of destroying the future by exhausting our natural resources, poisoning fertile agricultural soil, and contributing to global warming? What about ruthless economic competition steamrolling weaker cultures, leading to a uniform way of life that leaves behind little deserving of the term culture. Today, cultural diversity is being extinguished as much as biodiversity. And what about our obsession with the development of even more powerful and more inhumane killing devices based on “advanced” scientific principles? Is it really true that we are living in the Robot Age, as was claimed at EXPO 2005 in Aichi, Japan, where the much publicized Robot Project featured floor cleaning robots, garbage collection robots, security robots, guide robots, childcare robots (!!), and next-generation wheelchair robots (http://www-2.expo2005.or.jp/en/robot/ index.html)? Even the opening ceremony was dominated by robots! Why should we have childcare robots when human fertility is decreasing more rapidly than ever before in the so-called civilized countries? The poorer overpopulated countries cannot afford these devices anyway. Perhaps, in the end, all we need are childcare robots that decide, by themselves, when to administer Ritalin to children that become ill-behaved in the hands of other heartless robots! The Swiss producer of Ritalin, Novartis, would be grateful. I hope that these controversial remarks illustrate today’s dilemma. There are many good reasons why we scientists and engineers should be concerned. We the clever inventors of possibly useless devices are also responsible for educating future generations of leaders in politics and economy; they will determine the fate of our offspring. We should implant the proper germs of ideas in their brains. However, we cannot possibly satisfy this vital function by concentrating exclusively on our fascinating research inter-
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ests, disregarding the developments in the greater world. We must, at least occasionally, come out of our deep and dark research shafts to appreciate the real problems of today’s world and those that will possibly emerge in the future. Universities are not designed to be just educational institutions for the specialized training of industrial and academic functionaries. Their broader obligations can only be satisfied if they act as radiating cultural centers, directly inspiring and vitalizing the cultural development of our society. Universities should develop innovative and sustainable models for the future development of the global society. We need more interdepartmental discourse at universities and also between science and the humanities for appreciating the most relevant problems of our time and for finding, hopefully, lasting solutions. All members of academic institutions can contribute fruitfully to this discourse. Often, students add the freshest and most unbiased inspirations. Today, as the gaps between societies, cultures, religions, and races widen and deepen at a frightful rate—enhanced by shortsighted and fundamentalist politicians—it is our obligation to actively foster intercultural contacts. Occasions for intercultural encounters are abundant in academia. Let us make lasting contributions to this essential discourse! I can understand why adolescents, full of energy and idealism, decide not to devote their entire lives to the specialized sciences as they are being taught today at traditional universities. Why should an energetic young person work day and night on a particular molecule, elementary particle, or a particular step of a biological mechanism? Research could be much more inspiring when performed in a lively university atmosphere where discussions on humanitarian problem solving are daily activities. Of course, it would not always be possible for research activities and general concerns to coincide. But, sometimes, cross-fertilization might happen, guiding the research in a direction it would not have taken without the lively transdisciplinary discussions of societal issues. François Rabelais (1483–1553) said 500 years ago: “Science sans conscience n’est que ruine de l’âme (Science without conscience is nothing but the ruin of the 0739-5175/06/$20.00©2006IEEE
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As the gaps between societies, cultures, religions, and races widen and deepen at a frightful rate, it is our obligation to actively foster intercultural contacts.
soul).” Indeed, much responsibility rests on the shoulders of academia; it is a long-term responsibility, which political and economic leaders cannot bear because they must solve today’s problems without considering adverse longterm effects. Even dishonesty is accepted, sometimes, from politicians or from profit-oriented managers when their endeavors lead to rapid success. In the academic realm, on the other hand, unconditional honesty forms the very first basic law that should not be violated under any conditions without grave consequences. Our world, sometimes, might appear to be in a hopeless disarray that increases day by day. Nevertheless, we are asked to follow the advice of the great philosopher of science, Karl Popper (1902–1994), who proclaimed in 1993 in Berlin: “Optimism is our duty! We all are responsible for what will come.” Richard R. Ernst was born in Winterthur, Switzerland, in 1933. He enrolled at the Swiss Federal Institute of
Technology in Zurich (ETH-Z), where he received his undergraduate degree in chemical engineering in 1956 and his Ph.D. in 1962, working on high-resolution nuclear magnetic resonance, a field in its infancy at the time. In 1968, Ernst returned to ETH-Z, where he became professor of physical chemistry, from which he retired, reaching the age limit in 1998. His research has dealt with multidimensional nuclear magnetic resonance (NMR) and its practical applications, especially in the medical field. It was for his contribution to NMR spectroscopy that he was awarded the Nobel Prize in Chemistry in 1991. Address for Correspondence: Richard R. Ernst, Laboratorium für Physikalische Chemie, ETH Hönggerberg HCI, 8093 Zürich, Switzerland. Phone: +41 44 632 4368. Fax: +41 44 632 1257. E-mail:
[email protected].
Guest Editor (continued from page 16) Robert Malkin is the director of Engineering World Health and a professor of biomedical engineering at Duke University in Durham, North Carolina. Previously, he was the Herbert Herff Professor of Biomedical Engineering at the University of Memphis in Memphis, Tennessee, and the University of Tennessee. Before moving to Tennessee, Malkin was a professor of electrical engineering at the City College of New York and a member of the graduate faculty at the City University of New York and a research associate at Columbia University. Malkin received the B.S. degree in electrical engineering from the University of Michigan in
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1984, and he received his M.S. and Ph.D. in electrical engineering from Duke University in 1993. Before attending graduate school, he taught English in Thailand, and he worked for EM Microelectronics designing integrated circuits, Cordis Corporation designing pacemakers, and Sarns Inc. designing heart lung machines. He has received numerous awards, including service awards from the Republic of Nicaragua, IEEE-Memphis, EM Microelectronics, and Cordis Corporation; an Outstanding Faculty Research Award from the College of Engineering; an Established Investigator Award from the American Heart Association; and an award for Innovation and Excellence in Undergraduate Education from The President of The City College of New York.
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BIOMEDICAL ENGINEERING HUMANITARIANISM
The Science of Volunteering A Big Break for Your Career BACKGROUND IMAGE© DIGITAL VISION, TLD., INSET PHOTOS, L. TO R., TOP ROW: VSO/FIDAL GRO, 2ND ROW: VSO/LIBA TAYLOR, 3RD ROW: CAROLINA HILLER, VSO/LIBA TAYLOR, 4TH ROW: VSO PIETERNELLA PIETERSE, VSO/JOHN SPAULL.
BY PETER CREANE
or many people, taking a sabbatical means time off from their careers. Yet for many others, the thought of taking time off to volunteer overseas is appealing for altruistic reasons, as something they’d like to do as a way of giving back. In recent years there has been an increase in demand from developing countries for skilled professional volunteers. This shift in the delivery of development has led to a fresh look at the personal and professional benefits of volunteering overseas.
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What Is VSO?
VSO (Voluntary Service Overseas) is an international development charity that works through volunteers. Volunteers live and work with local communities, sharing their skills and knowledge. Since 1958, VSO has sent over 30,000 volunteers to work in Africa, Asia, the Caribbean, and Pacific regions in response to requests from overseas partners, many of them requiring a background in either biology or biomedical engineering. “Opportunities are available for people with specific biology or biomedical engineering skills for medical, technical, and teaching posts around the world. These are highly diverse positions and at any one time we may be looking for a biomedical engineer, laboratory technician, or a biology lecturer,” says Abigail Fulbrook, a placement co-coordinator at VSO. “We look for applicants who can be flexible and can adapt their skills to the needs of their placement. This is important because many jobs involve an element of training or community work, which wouldn’t normally be part of their regular jobs at home.”
There are also personal gains to be had from a career break. Many people want to learn about themselves as much as learn new skills. Responding to new professional challenges in a very different environment is a revitalizing and rewarding experience and can reveal capabilities you never knew you had (see Figures 1–5). At the end of their time away, many volunteers return saying they have learned more than they have passed on. Professionals wishing to volunteer with VSO should be prepared to give two years of their time. This may seem like a long time, but VSO believes that working and sharing skills with colleagues is the most sustainable way to manage development. This type of cross-cultural teamwork takes time to develop. Volunteers need time to test their ideas and to adapt them to different circumstances and demands, and things can move very slowly in developing countries. Many volunteers reflect that they only began to have a real impact during their second year overseas, once they had established themselves as respected and valued members of the community. One in five volunteers chooses to stay longer than the initial two years. A comprehensive package is provided to volunteers, including training before departure and after their arrival in-country. Volunteers also receive a modest living allowance, return flights, accommodations provided by the local employer, medical and travel insurance, national insurance (or equivalent) pension contributions, visas and work permits, and grants before, during, and after the placement, with a guaranteed minimum of three weeks of vacation per year. Case Studies
What’s in It for Me?
The view of employers towards career breaks has changed, especially in recent years with more and more people recognizing that sabbaticals can be a part of career development. Research also shows that career breaks are good for developing skills. A 2001 survey by Demos, an independent U.K. think tank, showed that professional volunteering directly enhanced and developed skills such as adaptability, interpersonal skills, problem solving, strategic thinking, handling responsibility, stress management, and self-assurance, all much sought after qualities in the workplace. 20 IEEE ENGINEERING IN MEDICINE AND BIOLOGY MAGAZINE
Nigeria: Louise Cuff
In 2002, Louise Cuff, 32, took up a VSO placement as a biomedical engineer at the National Eye Hospital in Nigeria. My role at the hospital was to work with the Instruments Engineering Department. The role of the department was to carry out routine maintenance and repairs on all the medical equipment throughout the hospital. When I first arrived, there didn’t really seem like that much work was going on. There wasn’t any routine maintenance, and repairs would be made, if possible, as and when the equipment failed. No 0739-5175/06/$20.00©2006IEEE
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This shift in the delivery of development has led to a fresh look at the benefits of volunteering overseas.
VSO/FIDAL GO
attempt had been made to repair any of the faulty equipment, whose numbers were growing. The reasons behind these problems became clear when I realized that there were no spares, no training, no test equipment, and no information about the equipment. One of the first things I set about doing with my new team was to try and collect as much information as possible about the existing equipment, much of which did not have service manuals and, where those did exist, they were in German. The level of service we had from suppliers was generally very poor. Very few were interested in helping us. One exception was Carl Zeiss, which was excellent and sent us a whole package of documents, including manuals and drawings of various types of equipment. But, overall, it was very disappointing—considering that when the hospital was commissioned, enough state-of-the-art equipment was purchased from European and American companies to fit seven operating theaters, seven diagnostic clinics, five wards, and a pathology unit, which must have equated to several million British pounds worth of business. We had the same problem locating spares for damaged equipment. Much time was spent on the Internet tracking down the suppliers who invariably didn’t respond to our e-mails for quotations for spares. Eventually, the only way to obtain any was when I returned to the [United Kingdom] for a midterm break and contacted the suppliers directly. Once this was done, they were much more responsive than to my e-mails from Nigeria. Despite these initial frustrations, I loved working at the hospital and am really proud of the things I managed to
Fig 1. David Bevan, science curriculum advisor, showing some students how to use a microscope with the only available regular source of light in Zanzabar, Tanzania— the sun!
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VSO/LIBA TAYLOR
VSO/PIETERNELLA PIETERSE
Fig 2. Bill Thomas, a volunteer electronics instructor, with medical instrumentation students in Sri Lanka.
Fig. 3. Sarah Ingleby at the Discare Wheelchair Centre in Zambia.
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Many volunteers reflect that they only began to have a real impact during their second year overseas.
electrical equipment from a very unstable power supply. When I arrived, we had very little, but by the time I left and one of my colleagues took over, we had managed to establish a technical library, set up a well-furbished workshop, and helped the department to gain access training, vital resources, and new skills. The people I worked with were so enthusiastic. They really wanted to learn all they could from me, which in itself was a very motivating and rewarding factor. People seemed so happy despite so many hardships. It really was a quite humbling experience.
VSO/LIBA TAYLOR
Uganda: Eric Bridgeland
VSO/JON SPAULL
Fig. 4. Elenor Clomby, a volunteer Physics Teacher, making new friends in Ethiopia.
Fig. 5. VSO shares skills with local colleagues in India, like this woman.
achieve. When I first arrived, the department didn’t even have its own computer. I managed to secure a grant from VSO, which I used to purchase equipment: a computer, a good soldering iron, RCD switches, and a large number of voltage regulators, which are essential in Nigeria to protect
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After more than three years working in Uganda as a science lecturer at the National Teachers College in Kabale, Eric Bridgeland, 64, can agree with Louise Cuff. I was surprised at how quickly I settled in. Within a month it felt like home, the people were so welcoming and warm. I’d considered volunteering when I was a research student, but I ended up getting married and having kids so it wasn’t really realistic. After 30 years lecturing in biology at Huddersfield University, I was coming up to retirement and felt I needed a change. I still felt I had a lot to offer so I thought I’d try and work in a developing country. I’d never traveled before and, to be quite honest, wasn’t sure what to expect when I arrived. My classes were small at the college, and we had very little resources, but the students were enthusiastic; I always felt my work was really valued and very appreciated. I’ve just accepted a second posting to Ghana and will be leaving in September! Conclusions
Taking a different direction in your life does not have to mean taking time out from your career. Working with VSO may not be a holiday, but it is an experience which will challenge and reward all those involved with memories and experiences that will last a lifetime. To find out more visit http://www.vso.org.uk. Address for Correspondence: Peter Creane, 317 Putney Bridge Road, London, SW15 2PN, United Kingdom. E-mail:
[email protected]. Peter Creane is the placement coordinator for health at Voluntary Service Overseas.
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BACKGROUND IMAGE© DIGITAL VISION, TLD., INSET PHOTOS, L. TO R., TOP ROW: VSO/FIDAL GRO, 2ND ROW: VSO/LIBA TAYLOR, 3RD ROW: CAROLINA HILLER, VSO/LIBA TAYLOR, 4TH ROW: VSO PIETERNELLA PIETERSE, VSO/JOHN SPAULL.
Enabling Health-Focused Relief and Development
BY BILLY TENINTY
he World Health Organization (WHO) estimates that in some developing countries, up to 50% of the medical equipment is unusable at any given time. In some hospitals, up to 80% of their medical equipment is inoperative and is stored in hallways or patient rooms. This situation results in the neglect of patients and an increased risk of harm to them and to health workers. In addition, time and resources are wasted on the purchase of sophisticated and duplicate biomedical technology equipment, which is underutilized or never used due to the lack of operator training and a qualified maintenance staff. The inexperience of operators and the lack of repair and maintenance capabilities drastically reduce the functioning life of equipment, limiting access to life-saving care for the most vulnerable segments of society. International Aid (IA), a health-focused relief and development organization, has been addressing this problem by training biomedical technicians in developing countries since 1998. Through their medical equipment training (MET) program, 337 trainees in 15 countries have received at least four weeks of training in electronics, general education, and medical equipment troubleshooting. As of 1 June 2005, 162 trainees have completed 24 weeks of training through the MET program with two classes, one in Ghana and another in Honduras, scheduled to graduate in July and August. The training includes three tracks: electronics, general maintenance education, and equipment troubleshooting. Courses are often taught by volunteer electrical engineers and biomedical engineers. Until his retirement, Phil Marcotte, the first Ghana MET volunteer instructor, taught electronics at Ferris State University (Big Rapids, Michigan). Instructors have come from other universities, such as Ohio State Technical College and Purdue University (Fort Wayne, Indiana). However, the MET program has had volunteers from companies such as Siemens and the local expertise of volunteers from the Hospital Maintenance Systems in Davao City, Philippines, and the National Institute of Mental Health and Neuro Sciences in Bangalore, India. When someone volunteers to teach a course for IA, the organization covers the roundtrip airfare and in-country expenses. IA maintains training centers throughout the world. In Ghana, West Africa, IA’s first and most successful international training site, students have come from many countries,
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BIOMEDICAL ENGINEERING HUMANITARIANISM
International Aid’s Medical Equipment Training Program
including the Democratic Republic of Congo, Ethiopia, Ghana, Kenya, Liberia, and others (see Figures 1 and 2). The Honduras MET program began during summer 2001. Three classes have graduated from the Honduras MET, and a class of 18 students is currently enrolled. In order to perpetuate the program, the Honduras program will be turned over to the host school, Universidad Cristiana Evangelica Nuevo Milenio, in 2006. The Kosovo MET program began in 2001. Graduates are maintaining the medical equipment at the University Clinical Center of Kosovo and the regional hospitals in
Fig. 1. Volunteer Don Slattery teaching Ghana MET students to troubleshoot and repair electrosurgical units.
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Time and resources are wasted on equipment that is underutilized or never used due to the lack of operator training and a qualified maintenance staff.
Fig. 2. Ghana MET students completing repairs on an x-ray machine.
Gjakova, Gjilan, Mitrovica, Peje, and Prizren. Over 100 trainees have entered the Philippine’s MET program. In response to the 26 December 2004 earthquake and tsunami in the Indian Ocean, IA is working with the Aceh Provinical Health Office to set up a medical equipment service (MESC) center in Banda Aceh. The MESC will be staffed by volunteer biomedical engineers working side-by-side with Indonesian electromedical technicians. The first task was to conduct an inventory and assessment of the medical equipment in the province, which will serve as a baseline for MESC. The inventory and assessment of medical equipment was completed in June 2005 and covered 28 hospitals in Aceh Province. An Indonesia MET program will begin in 2008. The MET program has had a tremendous impact. “Our medical equipment technician, Ernest Magbitang, who was
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a laboratory assistant at the time he was sent by the foundation for training on medical equipment, started to attend the MET course on 19 November 2001. After finishing the first module, he can already do minor repair works on our microscopes and suction machines,” says Dr. Raquel M. So-Sayo, medical director of Felimon D. Tanchoco Medical Foundation Hospital, a 220-bed tertiary hospital located in the heart of Caloocan City, Philippines. “With the knowledge gained and skills acquired on the succeeding Modules 2–5, he is now able to help the hospital as well as the college with regard to medical equipment maintenance management. With the technical support of our ME technician, the hospital is able to save on expenditures on repair and maintenance of medical equipment.” International Aid’s MET program has made great contributions to the hospitals in the developing world thanks to the volunteer efforts of biomedical engineers. Instructors are needed for courses in general electronics and specific biomedical areas such as clinical laboratory, cardiac, dental, eye, surgical, ultrasound, and x-ray equipment. Billy Teninty has worked with hospitals in developing countries since 1979. He was trained as a biomedical equipment technician in the United States Air Force and received Association for the Advancement of Medical Instrumentation (AAMI) Certified Biomedical Equipment Technician (CBET) certification in 1980. The medical equipment training (MET) program began in 1998 and has provided tools, test equipment, and training to 372 students in 15 countries. Address for Correspondence: Billy Teninty, International Aid, 17011 W. Hickory Street, Spring Lake, MI 49456 USA. Phone: +1 616 846 7490. Fax: +1 616 846 3842. E-mail:
[email protected].
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Senior Design for Persons with Disabilities Student Projects That Improve Quality of Life BACKGROUND IMAGE© DIGITAL VISION, TLD., INSET PHOTOS, L. TO R., TOP ROW: VSO/FIDAL GRO, 2ND ROW: VSO/LIBA TAYLOR, 3RD ROW: CAROLINA HILLER, VSO/LIBA TAYLOR, 4TH ROW: VSO PIETERNELLA PIETERSE, VSO/JOHN SPAULL.
BY JOHN D. ENDERLE
his article provides an overview of senior design in the United States and its impact around the world. Within the United States, the National Science Foundation (NSF) Senior Design Projects to Aid Persons with Disabilities program has provided funding since 1988 to thousands of senior design projects that have been completed by students for persons with disabilities. This program combines the academic requirement of a design experience with enhanced educational opportunities for students, and it improves the quality of life for disabled individuals. Also described are two national design competitions hosted by the Rehabilitation Research’s Rehabilitation Engineering Research Center (RERC) on Accessible Medical Instrumentation (AMI) and the National Collegiate Inventors and Innovators Alliance (NCIIA). In addition, there are a number of biomedical engineering (BME) programs in the United States that provide an opportunity for students to design and construct projects for individuals in developing countries.
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Introduction
As part of the accreditation process for university engineering programs in the United States, students are required to successfully complete a senior design course during their senior year [1]. Many call this the capstone design course. Senior design in biomedical engineering outside the United States is typically not a part of the undergraduate curriculum. This appears to be due to the three-year duration of many B.S. degree BME programs and the research focus of most BME departments. In Europe, for instance, most BME B.S. degree programs are oriented around a three-year program without a capstone course, followed by a two-year M.S. degree program. There are exceptions, such as the Ecole Polytechnique Fédérale de Lausanne, Switzerland, which requires a two-semester design project, and at the National University of Singapore’s bioengineering four-year program, a two-semester design and research project is required in the senior year. Engineering design is a course or series of courses that brings together concepts and principles that students learn in their field of study—it involves the integration and extension of material learned in their major toward a specific project. Most often, the student is exposed to systemwide synthesis IEEE ENGINEERING IN MEDICINE AND BIOLOGY MAGAZINE
and analysis, critique, and evaluation for the first time. Design is the creative process of identifying needs and then devising a product to fill those needs. It is an iterative, decision-making process in which the student deals with compromise and optimally applies previously learned material to meet a stated objective. It is an approach to problem solving for large-scale, complex, and sometimes illdefined systems. Design is different than research. Design considers alternative solutions and ends by selecting the optimal solution with a fixed goal or specifications in mind. Design often results in a commercial product being developed. Research has an open-ended goal and is exploratory, with no set specifications in mind, and does not necessarily result in a product or a service. It has been reported that over 35 million people in the United States have disabling conditions. More than 9 million Americans have significant mental or physical conditions that prevent them from being able to carry out the major activity of their age group (that is, play, attend school, work, or maintain a household). These numbers are rapidly increasing due to advances in medicine that extend life expectancy. Today, the average American spends approximately 12 years of his or her life as a person with disabilities. Besides the enormous suffering experienced by the disabled community, disability imposes an enormous cost to the United States, totaling more than 6.5% of the gross national product (greater than US$170 billion). Aside from the economic cost to the United States due to disabilities, there is the vitally important consequence of the disability to the individual. Every American has either a disability or direct contact with a person with disabilities (that is, a family member or close friend). Disability ranks as America’s greatest health problem in terms of the number of individuals affected and the economic impact. Devices and software to aid persons with disabilities often need custom modification, are prohibitively expensive, or are nonexistent. Much of the disabled community does not have access to custom modification of available devices and other benefits of current technology. Moreover, when available, engineering and support salaries make the cost of any custom modifications beyond the reach of a person with disabilities. 0739-5175/06/$20.00©2006IEEE
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This article describes three activities meant to improve the lives of persons with disabilities. The first is the NSF program started in 1988 to build senior design projects for persons with disabilities. The second is the creation of two national senior design competitions initiated by the Rehabilitation Research’s Rehabilitation Engineering Research Center on Accessible
Fig. 1. This dressing chair was designed by Sarah Park and Ronald Lee (Duke University, 2002) for a little girl named Janie. Janie has cerebral palsy. The chair helps her get dressed for school independently.
Fig. 2. This shoulder-steered tricycle was designed by Derek Juang and Irene Tseng (Duke University BME, 2003) for a boy named David. David has thrombocytopenia-absent radius (TAR) syndrome.
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Medical Instrumentation and the BME idea sponsored by the NCIIA. The third is by senior design students from U.S. institutions who are building projects for disadvantaged people in developing countries. National Science Foundation Research to Aid Persons with Disabilities
In 1988, the NSF began a program to provide funds for student engineers at universities throughout the United States to construct custom-designed devices and software for disabled individuals [2]. Through the Bioengineering and Research to Aid the Disabled (BRAD) program of the Emerging Engineering Technologies Division of NSF, funds were awarded competitively to 16 universities in 1988 to pay for supplies, equipment, and fabrication costs for the design projects. (In January 1994, the Directorate for Engineering was restructured. This program is now in the Division of Bioengineering and Environmental Systems, Biomedical Engineering & Research Aiding Persons with Disabilities Program.) Funding for this program has continued each year since, with the goal of this NSF program to enhance the educational opportunities for students and improve the quality of life for persons with disabilities. Approximately 15 universities have been involved with this program on a yearly basis since its start. Students and university faculty provide—through their senior design classes—engineering time to design and build the device or software, and the NSF provides funds for supplies, equipment, and fabrication costs for the design projects. Previously completed projects since 1988 are described at http://nsf-pad.bme.uconn.edu. Figures 1 and 2 show projects completed at Duke University. The purpose of the NSF program is threefold. The first purpose is to provide an opportunity for practical and creative problem solving in addressing a well-defined problem to students for meeting the required design component of their study. An outcome of this involvement is that an individual with a disability receives a device that provides a significant improvement in the quality of his or her life at no cost to the disabled individual due to NSF funding of the projects. In many cases, the development of devices and/or software for an individual may lead to applications for others with similar disabilities. Students are also exposed to a unique body of applied information on current technology in the area of rehabilitation design. The second purpose is to motivate students, graduate engineers, and other healthcare professionals to work more actively in rehabilitation, towards an increased technology and knowledge base, to effectively address the needs of the disabled. This goal assumes greater importance with the implementation of the Americans with Disabilities Act of 1990 (ADA). The third purpose is to allow universities an opportunity for a unique service to the local community. The students participating in this program have been singularly rewarded through their activity with persons with disabilities and have justly experienced a unique sense of purpose and pride in their accomplishments. Many of the projects carried out in this program have been highlighted on national radio, local television news programs, CNN and in conference publications, local newspapers, and the ASEE Engineering Education Magazine. MAY/JUNE 2006
Disability ranks as America’s greatest health problem in terms of the number of individuals affected and the economic impact.
Under faculty supervision in the senior design class, students developed specific projects to address the identified needs of particular disabled individuals. Local school districts and hospitals have participated in this effort by referring interested individuals to the program. A single student or a team of students designs each project for a specific disabled person or a group of disabled individuals with a similar need. A positive outcome of this involvement is that the person with disabilities receives a device that provides a significant improvement in quality of life and independence at no cost to him or her. Students are provided an opportunity for practical and real creative problem solving in addressing a well-defined problem; the person with the disability receives the product of that process. There is no financial cost incurred by the recipients participating in the program and, upon completion, the finished project becomes the property of the individual for whom it was designed. Some of the projects are custom modifications of existing devices, modifications that would be prohibitively expensive to the disabled individual were it not for the student engineer and this NSF program. Other projects are unique one-ofa-kind devices wholly designed and constructed by the student for the disabled individual. University of Connecticut and Ohio University
In the University of Connecticut’s (UConn) BME program, senior design provides an opportunity for practical and creative problem solving. Particular focus in the design experience is placed on the creation of a “commercial product.” As an outreach program, many of the projects built by UConn students are done for persons with disabilities that reside in an economically depressed Appalachian region of southeast Ohio. The goal is to have students from one of the most prosperous states in the United States building projects that make a difference for some of the poorest in the United States. This experience is comprehensive, reflecting all aspects of the engineering design process and industry practice. Students use the Web to describe and report progress on their project. The senior design homepage is located at: http://www.bme.uconn. edu/bme/ugrad/bmesdi-ii.htm. BME senior design at UConn consists of two required courses, BME Design I and II. Design I is a three-credithour course in which students are introduced to a variety of subjects. These include: working on teams, design process, planning and scheduling (timelines), technical report writing, proposal writing, oral presentations, ethics in design, safety, liability, impact of economic constraints, environmental considerations, FDA, patents, manufacturing, and marketing. Design II is a three-credit-hour course following Design I. This course requires students to implement IEEE ENGINEERING IN MEDICINE AND BIOLOGY MAGAZINE
their design by completing a working model of the final product. Prototype testing of the paper design typically requires modification to meet specifications. Ohio University (OU) is well suited to serve as a partner with the UConn senior design project experiences, not only because the two faculty (Dr. Enderle and Dr. Brooke Hallowell) working on the project have complementary areas of expertise but also because of OU’s facilities and clinical affiliations. The College of Health and Human Services at Ohio University houses six health-related professional schools. The college has, in addition to its own on-campus communication disorders and physical therapy clinics, 22 active off-campus clinical contracts serving people of all ages with a wide variety of disabilities, such that contacts with persons with disabilities in the surrounding Appalachian region are numerous. OU also houses its own college of medicine, with active clinical components in geriatric, family, and specialty medicine, providing additional possible sources for the identification of specific needs of individuals in the region. Once the projects are completed at UConn, they are sent to OU for delivery to the clients. To facilitate working with sponsors, a Web-based approach is used for reporting the progress on projects. The student provides a weekly report on the course homepage. The report structure includes: project identity, work completed during the past week, future work, and status review [3] The global marketplace is one in which engineering and professional teams are working on projects simultaneously at distant sites. It is vitally important that students be exposed to working in local teams and global teams at distant sites before working in industry [4]. Part of this experience has included video conferencing, telephone, e-mail, and the use of the Web in communicating project progress between the sponsor, the student team, and the faculty. For the most part, this has worked well. At first, the use of video conferencing was thought to be the best way to communicate. But the difficulty of arranging video conferencing and the cost of video conferencing has limited its usefulness. Telephone, e-mail, and the Web have been the most successful methods of communication. Each year, the NSF has published a book describing each of the successfully completed projects (for example, see [5]). The overall goal for this publication is that it serves as a catalyst and a source of information for future design projects to aid disabled persons. An indirect goal of the publication is to motivate other biomedical engineering programs to work more actively in rehabilitation design and provide service to their local communities. These books are available online at http://nsf-pad.bme.uconn.edu. MAY/JUNE 2006
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Students are also exposed to a unique body of applied information on current technology in the area of rehabilitation design.
RERC–AMI Annual Student Design Competition: Universal Design for Accessible Medical Instrumentation
An annual design competition has been sponsored by the RERC on AMI for the past two years based on input from focus groups and interaction with participating universities. The goal of this initiative is to bring attention to accessible medical instrumentation. Student teams accepted into the competition received reimbursements up to US$2,000 for their projects. The first year was a test of concept with only a few projects funded while setting up the judging process. In 2004–2005, the second year of the competition, three design competitions were carried out in the following areas: accessible weight scale, accessible syringe dosing, and an accessible ergometer. These projects were designed for a fictitious group of clients with a variety of disabilities, including paralysis, fragility and weakness, multiple sclerosis, diabetes, poor eyesight and blindness, limited limb function due to stroke, Parkinson’s disease, and hearing impairment. For the competition, each team created a Web site to evaluate the design and to help select the winners of the competition. At a minimum, each Web site contained a final report, detailed photos, and a digital video clip of the project in action. The final report also contained a full description of the project (including detailed drawings and photographs, full engineering analysis of optimal design, and at least one alternative design), the consideration of accessible design principles and how the design addressed the needs of the hypothetical clients, and all expenses to build the prototype and the projected cost to create a manufactured product. For full credit, the project was tested with representative intended users, with feedback used to improve the project. The use of appropriate terminology was stressed when dealing with disability and assistive technologies (see http://www.lsi.ku.edu/lsi/internal/guidelines. html). The Web sites followed Web accessibility guidelines (http://www.w3.org/WAI/). Nineteen teams from 16 universities submitted entries into the competition. The projects were evaluated at the end of the spring 2005 semester by 11 judges from government, industry, and academia. At least four judges evaluated each entry. Six teams received awards in the competition for first, second and third places. The results were posted on the RERC Web site (http://www.rerc-ami.org/rcw-sandbox/projects/ d/2/2/year2/). Prizes for first, second, and third place were awarded at US$1,000, US$750, and US$500, respectively. In addition, each team in the competition was given US$2,000 for fabrication costs, parts, and supplies. For the 2005–2006 academic year, three competitions are being offered based on input from the focus groups: blood glucose monitor, accessible medication dispensing device, and a patient positioning aid. As before, these projects were 28 IEEE ENGINEERING IN MEDICINE AND BIOLOGY MAGAZINE
designed for a fictitious group of clients with a variety of disabilities. The structure of the competition will remain the same as before for this competition. BME Idea
The BME idea is a national design competition sponsored by the NCIIA. NCIIA supports design through grants and a national design competition focused on invention, innovation, and entrepreneurship to supplement the educational programs at universities across the United States. The goal is to improve traditional classroom instruction by encouraging the development of new technologies that benefit humans and the environment. The design competition does not restrict the type of project, like the RERC on AMI, but does not automatically provide funds to support fabrication costs, parts, and supplies. A ten-page project description is required to enter the competition, which includes: problem objective statement, final report, working prototype, patents search, regulatory issues, manufacturing costs, market analysis, and business plan. The evaluation criteria include technical, economic, and regulatory feasibility. The first, second, and third prizes are US$10,000, US$2,500, and US$1,000, respectively. Additional details are provided at http://www.nciia.org. Design in Developing Countries
This article has thus far described senior design and opportunities in the United States. While there are a few required BME senior design courses in programs outside the United States, there are a number of BME programs in the United States that provide an opportunity for their students to design projects for individuals outside the United States. (This section is based on a presentation by Dr. Matthew Glucksberg at the BME Educational Summit II held in Virginia in March 2005; visit http://www.whitaker.org/academic/wrapup.html.) In the developing world, healthcare needs are quite different; needs often have simpler solutions than those in the United States, and they also have a huge impact. There are a number of diseases significantly impacting the developing world’s population (e.g., HIV/AIDS in Africa, high infant mortality, effects of landmines, environmental hazards, war, nutrition, etc.). In the developing world, resources available are limited: healthcare spending is low, community services such as transportation, electricity, and communications (telephone, cell phone, Internet, etc.) are not available, local and well-equipped hospitals are located only in the largest cities, and skilled workers and industry do not exist. In addition, expectations are significantly different in developing countries regarding healthcare delivery, education, government, religion, etc. Several BME programs in the United States have exported some of their senior design projects to developing countries, focusing on projects that are easy to use, inexpensive, and MAY/JUNE 2006
maintenance free. At Le Tourneau University, Dr. Roger Gonzalez’s students work on extremity prosthetic devices for amputees in Africa. Dr. Lars Olsen from Marquette University had a team of senior design students working on an airway function tester for garment factory workers in Central America. Dr. Matthew Glucksberg’s senior design students working at the Center for International Rehabilitation with a focus on Africa. Dr. Robert Malkin has an extensive program at Duke University (it is described in the article “Prescription for Success” in this issue [6]). All of these programs serve as a model for how other BME programs can make a difference. Conclusions
This article provides an overview of senior design projects in biomedical engineering programs. The NSF Senior Design Projects to Aid Persons with Disabilities program, started in 1988, provides funding for students in their normal ABET course on senior design and provides funding to create and build projects for persons with disabilities. All projects built in this program have been compiled into an annual publication funded by the NSF. The ultimate goal of the annual publications and projects that were built under this initiative is to assist individuals with disabilities in reaching their maximum potential for enjoyable and productive lives. The program at UConn illustrates how senior design can be moved to other sites with profound needs. Two national design competitions in the United States support invention and innovation in senior design projects. The RERC on AMI hosts three design competitions each year, with projects specially described to support a group of fictitious clients. The projects are selected by focus groups identified by the RERC on AMI that highlights accessibility. The BME idea senior design competition is supported by NCIIA, with a focus on promoting innovation and entrepreneurship. The last area described in this article is the novel use of senior design students to build projects for individuals in developing countries. The projects built in these initiatives are typically easy to use, inexpensive, and maintenance free due to the lack of infrastructure in the client’s home country. All of the projects described here have a huge impact on persons with disabilities, especially those who do not have the resources to pay for these projects.
dinator for biomedical engineering at North Dakota State University (NDSU), Fargo. Enderle joined the National Science Foundation (NSF) as program director for the Biomedical Engineering & Research Aiding Persons with Disabilities Program from January 1994–June 1995. In January 1995, he joined the faculty of the University of Connecticut (UConn) as a professor and the head of the Electrical and Systems Engineering Department. In June 1997, he became the director for the Biomedical Engineering Program at UConn. Enderle is a Fellow of the IEEE, the current editor-inchief of IEEE Engineering in Medicine and Biology Magazine, the 2004 EMBS Service Award Recipient, pastpresident of the IEEE Engineering in Medicine and Biology Society (EMBS), EMBS Conference chair for the 22nd Annual International Conference of the IEEE EMBS and World Congress on Medical Physics and Biomedical Engineering in 2000, a past EMBS vice president for Publications and Technical Activities and vice president for Member and Student Activities, fellow of the American Institute for Medical and Biological Engineering (AIMBE), an ABET program evaluator for bioengineering programs, a member of the Engineering Accreditation Commission, a member of the American Society for Engineering Education and Biomedical Engineering Division Chair for 2005, and a fellow of the Biomedical Engineering Society. Enderle was elected as a member of the Connecticut Academy of Science and Engineering in 2003; its membership is limited to 200 persons. He has also been a teaching fellow at the University of Connecticut since 1998. Enderle is also involved with research to aid persons with disabilities. He is editor of the NSF Book Series NSF Engineering Senior Design Projects to Aid Persons with Disabilities, published annually since 1989. These books described almost 2,000 projects that have been constructed and given to persons with disabilities throughout the United States (see http://nsf-pad.bme.uconn.edu). He is also an author of the book Introduction to Biomedical Engineering, published by Elsevier in 2000 (first edition) and 2005 (second edition). Enderle’s current research interest involves characterizing the neurosensory control of the human visual and auditory system.
Acknowledgments
The work described in this article is funded by the National Science Foundation under grants 0302351 and 0454456 and the U.S. Department of Education’s National Institute on Disability and Rehabilitation Research’s Rehabilitation Engineering Research Center (RERC) on Accessible Medical Instrumentation. National Institutes on Disability and Rehabilitation Research, U.S. Department of Education Grant H133E020729. John D. Enderle received the B.S., M.E., and Ph.D. degrees in biomedical engineering and the M.E. degree in electrical engineering from Rensselaer Polytechnic Institute, Troy, New York, in 1975, 1977, 1980, and 1978, respectively. After completing his Ph.D. studies, he was a senior staff member at PAR Technology Corporation, Rome, New York, from 1979–1981. From 1981–1994, he was a faculty member in the Department of Electrical Engineering and coorIEEE ENGINEERING IN MEDICINE AND BIOLOGY MAGAZINE
Address for Correspondence: John Enderle, University of Connecticut, 260 Glenbrook Road, Storrs, CT 06269-2247 USA. Phone: +1 860 486 5521. Fax: +1 860 486 2500. Email:
[email protected]. References [1] J.D. Enderle, J. Gassert, S.M. Blanchard, P. King, D. Beasley, P. Hale Jr., and D. Aldridge, “The ABCs of preparing for ABET,” IEEE Eng. Med. Biol. Mag., vol. 22, no. 4, pp. 122–132, 2003. [2] J.D. Enderle, “An overview on the national science foundation program on senior design projects to aid persons with disabilities,” Int. J. Eng. Educ., vol. 15, no. 4, pp. 288–297, 1999. [3] J.D. Enderle, A.F. Browne, and B. Hallowell, “A WEB based approach in biomedical engineering design education.” Biomed. Sci. Instrumentation, vol. 34, pp. 281–286, 1998. [4] J.D. Enderle, W. Pruehsner, J. Macione, and B. Hallowell, “Distance learning in senior design,” in Proc. 26th IEEE EMBS Annu. Int. Conf., July 2000, THBa204, pp. 23–26. [5] J.D. Enderle and B. Hallowell, Eds., National Science Foundation 2003 Engineering Senior Design Projects to Aid Persons with Disabilities, Mansfield Center, CT: Creative Learning Press 2005, p. 405 [Online]. Available: http://nsfpad.bme.uconn.edu [6] G. Russell, “Prescription for success,” IEEE Eng. Med. Biol. Mag., vol. 25, no. 3, pp. 30–31, 2006.
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Prescription for Success
BACKGROUND IMAGE© DIGITAL VISION, TLD., INSET PHOTOS, L. TO R., TOP ROW: VSO/FIDAL GRO, 2ND ROW: VSO/LIBA TAYLOR, 3RD ROW: CAROLINA HILLER, VSO/LIBA TAYLOR, 4TH ROW: VSO PIETERNELLA PIETERSE, VSO/JOHN SPAULL.
One Program Corrects the Problems of Hospitals in the Developing World
BY GREG RUSSELL
he first sign that something might be awry at the Children’s Hospital in Managua, Nicaragua, are the sheep grazing in the medical equipment repair area. A better clue, though, would be the fire that unexpectedly erupts above a patient on an operating room table. “A lot of people would be shocked if they saw some of the things that go on in this and other hospitals in third world countries,” Duke University professor Dr. Robert Malkin says. “Some of the occurrences are totally unbelievable.” Malkin was so appalled by such conditions that he created a new institute that focuses on correcting problems at hospitals in economically depressed countries. The program, Engineering World Health (EWH), sends biomedical engineering students to hospitals in underdeveloped countries to repair and install donated medical equipment (Figures 1 and 2). The result has been better care facilities and, in some instances, saved lives. “When we see the people come from the EWH, we are happy because we know improvements are on the way for our hospital,” says Dr. Enrique Alvarado, director of the
Children’s Hospital (Hospital Infantil Manuel de Jesus Rivera) in Managua. “Their work makes our hospital function better and in the process, has helped play a role in saving lives.” Children whose existence relied heavily on antiquated or nonworking medical equipment now have a new life because of support monitors and other equipment installed and repaired by EWH students. Surgeons are better able to operate on patients because of upgraded medical equipment supplied by the Duke-EWH Summer Institute. Malkin says the program is already showing results. He says that Jessica, a two-year-old patient at the Children’s Hospital in Managua, might not be alive today if not for Engineering World Health. Suffering from totally anomalous pulmonary venous drainage, a congenital disorder that is fatal if left untreated, Jessica was completely dependent on the program’s donated, refurbished equipment during her stay at the hospital. “Thanks to our efforts, every station in the intensive care unit of the Children’s Hospital now has a monitoring station,” says Malkin. The program doesn’t just benefit patients either. Those who go through the summer institute receive a unique, hands-on educational experience. “The students get extensive clinical experience, language, and technical training,” says Malkin. “The opportunity to spend a month in a foreign country—especially a third world country—can be a life-changing experience.” The institute is open to engineering, physics, and chemistry majors from any university. “This is an opportunity for me to apply my technical engineering background in an environment that benefits underprivileged children,” says Fig. 1. Students in the Duke-EWH summer program 2005 in Central America about to student Nicolle Kramer. “It makes me embark on a team-building exercise swinging through the trees of the rain forest on aware of the importance of things that zip-lines. After their training, these students worked in poor hospitals in Nicaragua and I would otherwise take for granted.” El Salvador. Malkin says a major problem at many
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Malkin was so appalled by such conditions, he created a new institute that focuses on correcting problems at hospitals in economically depressed countries.
third world hospitals is not fixing a broken part but having the ability to pay for a part. “One government donated an intensive care unit to the hospital in Managua, and another country donated ventilators to be used in the unit,” Malkin says. “But the hospital was lacking one simple piece needed to make the ventilator work, so the facility was totally empty and not being used. The piece that was missing costs only five dollars, but to the Nicaraguans, that is a lot of money. They just can’t afford it,” he says. “Our students arrive with the needed part, and it has a huge impact even though it is a relatively small amount of money,” Malkin says. “Now the facility can be used.” Lightbulbs are another example. “There is a certain type of lightbulb needed for surgery, but they can’t afford it, so they use regular light bulbs,” Malkin says. “These bulbs can give off too much heat, sometimes resulting in a fire. The nurses have to quickly cover the patient until the fire is extinguished.” Malkin points out that the students in the program fix a wide range of problems. “We try to provide things as simple as lightbulbs or as complex as monitoring stations,” Malkin points out. “On campus, the Duke students meet each week to work on broken equipment. We fix it, recalibrate it, and get it working. It is then shipped down to the developing world where it is installed.” Some Duke students are also taking a new class, Design for the Developing World, where they are designing new equipment to meet the special needs of the developing world. Malkin first became interested in setting up the program when biomedical engineering students approached him “wanting to make a difference” in the world. Malkin says that it is easy for anyone to become involved. Because of a lack of money in the depressed areas, he says that monetary and equipment donations are important to Engineering World Health. Information on donating can be obtained at the Web site (http://www.ewh.org) or by contacting Robert Malkin at
[email protected] “The goal of every teacher is to offer a class that is so insightful and exciting that it can change a student’s life,” says Malkin, who holds degrees from the University of Michigan and Duke University. “This educational experience has that potential. It can open students up to an understanding of the real world and their place in that world,” he says.
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Fig. 2. Santhi Elayaperumal (University of Minnesota, a senior majoring in biomedical engineering) working on an ECG machine. A few hours later it was in use at a patient’s bedside.
“I am convinced we can make a major impact,” he says. “The best thing about it is that it not only provides a great educational experience, it helps serve people who are in need.” For questions about the Engineering World Health program, correspondence should be sent to Dr. Robert Malkin (
[email protected]). Greg Russell is editor of the Creative Services Office in the Division of Marketing and Communications at the University of Memphis, a position he has held since November 2000. Before that, he was a writer in the Creative Services Office from 1991–2000. He received a B.A. in journalism from the University of Memphis, Tennessee, in 1985. Address for Correspondence: Greg Russell, 303 Administration Building, University of Memphis, Memphis, TN 38152 USA. Phone: +1 901 678 3811. E-mail:
[email protected].
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BIOMEDICAL ENGINEERING HUMANITARIANISM
Engineers Without Borders and Their Role in Humanitarian Relief Contributing to a Sustainable World BACKGROUND IMAGE© DIGITAL VISION, TLD., INSET PHOTOS, L. TO R., TOP ROW: VSO/FIDAL GRO, 2ND ROW: VSO/LIBA TAYLOR, 3RD ROW: CAROLINA HILLER, VSO/LIBA TAYLOR, 4TH ROW: VSO PIETERNELLA PIETERSE, VSO/JOHN SPAULL.
BY CLAES I HELGESSON
he first national Engineers Without Borders (EWB) organization, or Ingénieurs San Frontières (ISF), was founded in France in 1982. The vision of ISF-France was to “promote the implementation of sustainable development through the critical practice of engineering by integrating volunteer engineering students in programs managed by professional nongovernmental organizations (NGOs) in Africa, Latin America, and Africa.” ISF also planned to participate in lobbying and information activities in France on issues like fair trade, international trade rules, water and energy supply, etc. Finally, ISF-France engaged, and still engages, ISF groups in the promotion of ethics among engineering students and of critical debates on ethical issues between professionals. Since the foundation of ISF-France, EWB-affiliated, national organizations have been formed in many countries around the world. As of September 2005, EWB-affiliated organizations are registered in more than 50 countries, many of them in the third world. The total number of individual members now exceeds 50,000. Most of the national EWBs are organized with a central, national administration and local, active chapters at universities around the country. The majority of EWB members are engineering students, although in most of the EWB-affiliated organizations, professional engineers also are members. While there has been limited cooperation between EWBaffiliated organizations in different countries so far, an international network organization, EWB-International, was founded in 2002 (http://www.ewb-international.org). Although it is currently based in the United States in Colorado, an international registration has been filed. A discussion has also been initiated to organize regional cooperation platforms in Asia and Europe. In January 2005, EWB-International created “The Humanitarian Engineers Corps Database” as an answer to the direct need to help communities affected by the December 2004 tsunami in Asia (http://www.ewb-international.org/VolunteerDatabase.htm). The database provides a link between those in need and those who can provide services, technologies, and solutions to eradicate poverty in communities around the world. It will also be used for reconstruction and humanitarian projects around the
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world. The database is free and open to individuals interested in registering their skills for the benefit of others on the one hand and to organizations involved in poverty reduction on the other. Database members include professionals (active and retired), students, NGOs, humanitarian organizations, etc. All EWB-affiliated organizations share the same vision: a world where all people have access to basic resources and knowledge to meet their self-identified engineering and economic development needs. EWB members want to contribute to new and ongoing development projects around the world in an effective way and at the same time promote new dimensions of experience for engineering students and practicing engineers. It is our belief that this is a primary path to achieving a sustainable world, without suffering the consequences of engineering projects that are socially, culturally, or economically inappropriate. Many national EWBs also participate in lobbying and information activities on sustainability, international and ethics issues like fair trade, international trade rules, water and energy supply, etc. Many EWBs also lobby for changes in the curricula of universities’ engineering programs to include courses on sustainability, fair trade, ethics, etc. Many EWBs also offer their members courses on issues related to project work in developing countries. Why do we just now find such a large interest in EWB and its activities? Many engineering students (and other students for that matter) and professional engineers are frustrated at being tied up with solving problems connected to people in the wealthy part of the world when, at the same time, they are becoming increasingly aware of the poverty that characterizes a majority of the inhabitants in the third world. Many feel that they want to spend some time and effort utilizing their knowledge and experience to bridge the prosperity gap in the world. For a long time, they have had no way to do this, but when the growing, worldwide EWB organization offers a way to spend some time for this cause without jeopardizing their professional careers, the possibility is welcomed. The mission of all EWB-affiliated organizations is to support disadvantaged communities in improving their living standard, welfare, livelihood, and quality of life through 0739-5175/06/$20.00©2006IEEE
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Many engineering students and professional engineers are frustrated at being tied up with solving problems connected to people in the wealthy part of the world.
EWB Projects
the implementation of environmentally and economically sustainable engineering projects, while developing internationally responsible engineering students and professionals. EWB members believe in change that can contribute positively to the communities in which they work, in common action to provide new solutions, and in working to interrupt the cycle of poverty that contributes to terrorism and the rejection of democracy. EWB-affiliated organizations believe that the people in host communities must define their own development project goals and contribute to the accomplishment of projects that can solve their problems, thereby building new skills. EWB members believe in environmentally sustainable projects that are symbiotic with the environment, society, and culture. EWB-affiliated organizations also believe in a university education that will develop a new generation of engineers who will benefit from seeing the many facets of engineering solutions to problems in developing communities and not just the technical skills obtained in their basic education. They also believe in the education of host-community partners. EWB members believe in ethics that require the highest level of integrity. Finally, they believe in partnerships with a broad cadre of institutional, academic, development, and engineering professionals who are willing to assist in capacity building towards a more equitable and sustainable world.
Fig. 1. A three-stone oven is the most common oven used in most third world countries. The smoke permeates the hut, causing lung irritation, asthma, and even lung cancer; the stove is also very energy inefficient. Orongo, Ethiopia.
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CAROLINA HILLER
CAROLINA HILLER
EWB projects are carried out by five to ten students and one or more professional engineers. The group spends some weeks, or even months, on location implementing their projects. In some cases, students can receive college credit for their EWB project. Critical issues when carrying through EWB projects are the local contacts and infrastructure on site. Cooperation with local NGOs—or international NGOs who have a history of activities in the country in question—and local authorities is vital. One important way to build relationships with the local people is by regular visits by EWB groups, where one group continues where the earlier group left off. Another important goal is to cooperate with local vocational schools and universities. We are talking with Rotary International to get support from local Rotary clubs in the form of contacts and introductions to local industry and authorities as well as moral support of different types. Most of the projects carried through by EWBs and their members have a direct or indirect healthcare significance.
Fig. 2. A “solar-furnace” developed by students of Chalmers University of Technology, Gothenburg, Sweden, and tested on site in Orongo, Ethiopia.
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Many EWB projects around the world have been devoted to building water pipes and drilling wells.
Most of the EWB projects have components related to water supply and renewable energy; both are important issues for health. For example, women in most countries in the third world spend a large part of their day collecting firewood to cook the evening meal. The most common stove is a three-stone oven, i.e., a pot standing on three stones heated by an open fire. The smoke from the fire fills the entire hut, which causes lung irritation, asthma, and, in some cases, lung cancer (Figure 1). Many EWB projects have tried to address this serious healthcare issue. One example is the development of a “sun oven,” which consists of foldable reflector plates (Figure 2). By preheating the food before the final cooking, the use of the open firewood could be minimized. Another example is a fan-powered stove that uses solar cells for power, resulting in a lean combustion with a minimum of smoke (Figure 3). Carrying water containers with fresh water for long distances is a daily burden for many young girls in the devel-
Fig. 3. A fan-powered firewood stove developed by the Foundation for Sustainable Tecnologies, FoST, Kathmandu, Nepal (http://www.fost.home-page.org), and implemented in villages around Nepal. The fan can be driven by a small, rechargeable battery charged by solar cells. The fan makes the stove very energy efficient.
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COURTESY OF EWB-USA
CLAES I HELGESSON
oping world. The time spent on water transport could be used for other purposes, such as education. Furthermore, infected water is hazardous, not only when used for drinking or preparing of food but also when used for cleaning dishes and for personal hygiene. When there is a “surplus” of fresh water available, the use of infected water for any purpose will, hopefully, decrease. Many EWB projects around the world have been devoted to building water pipes and drilling wells. Powering water pumps with solar cells offers an interesting and sustainable solution (Figure 4). A combination of modern, efficient solar cells and energy-efficient water pumps has opened the possibility to implement reliable and maintenance-free water pump installations also on remote sites in the third world.
Fig. 4. Sun-powered water pump, Mauritania. The picture shows the installation work in an existing well engineered by a group from EWB-USA.
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It is expected that EWB members worldwide will be responsible for a large part of the international aid work in the coming years.
Making EWB Projects Work
All EWB members offer their time and effort to EWB projects without remuneration, although they are reimbursed for their direct costs. The funds to cover the direct project costs are raised through donations from individuals, organizations, and corporations. In many cases, EWB receives grants from governments or international aid organizations. But why do students and professionals offer their time and efforts without remuneration? Many students feel, after having studied for many years, that they want to be able to apply what they have learned to support development in the less privileged parts of the world. Most of the students also believe in the importance of a sustainable world and want to make a contribution towards this goal. Experience shows that engineers who refer to project work under difficult circumstances such as an EWB project in their curriculum vitaes have a competitive advantage when applying for a job. For some students, the EWB project is part of their master’s thesis project. My personal view is that the number of students carrying out EWB projects as an integral part of their education will increase in the near future. This would, however, require changes in the attitude to such projects from the university administration—and teachers. Conclusions
National organizations of EWB and their projects with international healthcare implications are here to stay. It is expected that EWB members worldwide will be responsible for a large part of the international aid work in the coming years, mostly in the areas of water supply and renewable energy. A deeper cooperation between the national EWBs within the framework of EWB-International will also be valuable for students wanting to participate in projects in the third world. This international cooperation could consist of an exchange of experience, allowing project team
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members from other countries and support to students from other countries wanting to utilize infrastructure and local contacts at a specific site developed by a national EWB organization. Claes I Helgesson received his M.Sc. in chemical engineering at Chalmers University of Technology, Gothenburg, Sweden, in 1959. During his employment as a researcher at the Research Institute for the Swedish National Defense, he earned his Ph.D. in silicate chemistry (ceramic materials) from Chalmers in 1970. During the late 1970s and 1980s, Helgesson was mainly active in implementing results from scientific research into industry. In the 1990s, Helgesson was appointed director (rector) first of the Swedish School of Mining and Metallurgy, Filipstad, and then of the University of Kristianstad, Sweden. Since retirement, Helgesson has been active as consultant professor to Chalmers University of Technology, the University of Gothenburg, and the University of Boras in mainly environmental issues, among others, in research and education. He has been responsible for the development of an International Master’s program on “Implementation of Sustainable Technology to SMEs” (financed by the European Union’s EuropeAid Program, Asia-Link) with students from many parts of the world, including developing countries. In 2001, Helgesson founded EWB-Sweden (http://www.inug.nu), and in 2002, he cofounded EWB-International.
Address for Correspondence: Claes I Helgesson, Lotsgatan 10, SE-414 58 Goteborg, Sweden. Fax: +46 31 775 38 41. Email:
[email protected].
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BIOMEDICAL ENGINEERING HUMANITARIANISM
A Low-Cost Solution to Rural Water Disinfection
BACKGROUND IMAGE© DIGITAL VISION, TLD., INSET PHOTOS, L. TO R., TOP ROW: VSO/FIDAL GRO, 2ND ROW: VSO/LIBA TAYLOR, 3RD ROW: CAROLINA HILLER, VSO/LIBA TAYLOR, 4TH ROW: VSO PIETERNELLA PIETERSE, VSO/JOHN SPAULL.
The Development of an Effective Chlorinator
BY CHARLES TAFLIN
orbidity and mortality statistics show that childhood diarrhea is a major cause of sickness and death in children five years old and younger in developing countries. Other water-borne diseases such as cholera claim the lives of people of all ages in these areas. Providing safe drinking water benefits these populations more than any other single measure. However, providing safe drinking water presents significant biomedical engineering problems. Simple filtration systems that can reduce water-borne pathogen populations by more than 90% are common in many rural areas, but to be truly effective, they should be supplemented by removing or deactivating biological agents (disinfection). Chlorine, an oxidizing agent, is the disinfectant of choice in most water treatment systems because it is widely available and highly effective. Chlorine can also provide a residual disinfectant that will continue to provide protection against contamination throughout the distribution system. For example, in rural Nicaragua there are hundreds of simple water systems serving rural communities with populations of 200 or more. Most of these systems are gravity fed and commonly consist of a spring capture, plastic piping, and one or more small concrete reservoirs. Disinfection, where practiced, usually consists of chlorine bleach, or another oxidizing agent, dripped into the reservoir through plastic tubing. Yet, many problems with this type of chlorine treatment remain, including poor stability of the chlorine and inconsistent drip rates. In 1998, Taller de Salud Campesina (TASCA) reported systems, such as those described for Nicaragua, consistently test positive for coliform bacteria.
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➤ It should handle water flow rates between 2–10 gallons per
minute (gal/min) and should deliver a consistent dose of chlorine regardless of water flow rate. CTI selected solid tablets of calcium hypochlorite as the source of the oxidizing agent. After two years of development, the chlorinator design was ready. It is called the CTI 8—because it was the eighth design tested—and is constructed of 3- and 4-in diameter polyvinyl chloride (PVC) water pipe and fittings (see Figure 1). In operation, the incoming flow is directed by an influent baffle toward a slotted tube containing a stack of chlorine tablets, which dissolve in the flow. As the lower tablets
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Given the poor success rates with chlorination in the developing world, Compatible Technology International (CTI) decided to tackle this engineering problem. An initial assessment demonstrated that none of the disinfection systems commercially available at that time were economically or technically suited to the task. CTI began the design of a chlorinator more appropriate for the target populations. Our design criteria were as follows: ➤ The unit should be simple, nonelectrical, field-constructible, and suitable for village-level operation and maintenance. 36 IEEE ENGINEERING IN MEDICINE AND BIOLOGY MAGAZINE
no
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Development of the CTI Chlorinator
low
Cutaway View
Fig. 1. The CTI 8 low-cost water chlorination system is constructed of 3-in and 4-in diameter polyvinyl chloride (PVC) water pipe and fittings. The incoming flow is directed by an influent baffle toward a slotted tube containing a stack of chlorine tablets, which dissolve in the flow.
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Community acceptance is absolutely essential to the ultimate success of this project.
dissolve, new tablets drop into the flow. A flow-related dose is achieved by an effluent weir plate, which controls the water level in the body of the chlorinator (the higher the flow the deeper the water and the more tablets are exposed to the flow). The chlorinator is installed on a bypass line with valves to control the proportion of the total flow passing through the chlorinator. Field Testing
The initial laboratory testing indicated that the device was ready for field testing. In cooperation with the Operation and Maintenance Division (UNOM) of the Nicaraguan Health Ministry, CTI selected a test site and conducted training sessions on the use of the new disinfection technique. During the three months of the initial field test, the village water committee checked the chlorine residual in three locations each day. The initial field results were very promising, leading to the installation of 30 more chlorinators in Nicaragua and two in Guatemala (see Figure 2). CTI has been very sensitive to community acceptance of their new device. Community acceptance is absolutely essential to the ultimate success of this project. For this project, the villagers build, maintain, and operate their own water systems, increasing their investment in the project. The villagers pay a monthly fee, assessed by their own water committee, to support the system and purchase necessary supplies, including chlorine. Technical support and oversight come from the local offices of the government ministries of water and health. The community measures the success of the devices by the palatability of the water they drink and through observing that their children have fewer incidents of diarrhea. Results and Conclusions
While obtaining high-quality chlorine tablets has been a problem, the program has been very well received by the communities, as evidenced by the fact that UNOM cannot keep up with the requests for the units. Laboratory results show that the village water systems with the chlorinators are free of coliform bacteria. Record keeping in these villages is almost nonexistent. However, anecdotal information indicates that infantile diarrhea is reduced when the chlorinator is installed. In approaching a problem like this, there are several factors that will determine the success or failure of the project. The most important has already been mentioned—community acceptance and involvement. Feedback and follow-up are also important; information from the field will not only help you to
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Fig. 2. A CTI 8 chlorinator being installed in rural Guatemala.
refine the design but will also show the community that you have a continuing interest in the project. Finally, a truly critical factor is appropriate technology. The device, whatever it is, needs to be engineered for compatiblity with the technological level of the intended users. It may be considerably more difficult to engineer a simple device than a complex one, and the designer must be willing to spend the extra time and effort to “keep it simple.” Charles Taflin’s career spans 50 years, devoted almost entirely to the field of drinking water supply and treatment. His principal employer was the City of Minneapolis Water Works; his last position was as superintendent of plant operations. He also has done water system engineering and treatment plant design for several engineering firms in the Minneapolis-St. Paul area. He has taught courses in water supply and treatment plant design at the University of Minnesota and is one of the contributing authors of the Handbook of Public Water Systems, Second Edition. Address for Correspondence: Charles Taflin, Hamline University, Box 109, 1536 Hewitt Avenue, St. Paul, MN 55104 USA. E-mail:
[email protected].
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The Evolution of Pacemakers
BY SANDRO A.P. HADDAD, RICHARD P.M. HOUBEN, AND WOUTER A. SERDIJN
round 40% of all human deaths are attributed to cardiovascular diseases. Cardiac pacing has become a therapeutic tool used worldwide with more than 250,000 pacemaker implants every year. The purpose of this article is to detail the significant advances in cardiac pacing systems. Our focus is on the evolution of circuit designs applied in pacemakers. Future pacemaker features and further improvements are also pointed out. Since the first artificial pacemaker was introduced in 1932, much has changed and will continue to change in the future [1]–[3]. The complexity and reliability in modern pacemakers has increased significantly, mainly due to developments in integrated circuit (IC) design. Early pacemakers merely paced the ventricles asynchronously, not having the capability of electrogram sensing. Later devices, called demand mode pacemakers, included a sense amplifier that measured cardiac activity by avoiding competition between paced and intrinsic rhythms. By the introduction of demand pacemakers, the longevity increased since pacing stimuli were only delivered when needed. In 1963, pacemakers were introduced having the capability to synchronize ventricular stimuli to atrial activation. Since that time, clinical, surgical, and technological developments have proceeded at a remarkable rate, providing the highly reliable, extensive therapeutic and diagnostic devices that we know today. Modern pacemaker topologies are extremely sophisticated and include an analog part (comprising the sense amplifier and a pacing output stage) as well as a digital part (consisting of a microcontroller and some memory), implementing diagnostic analysis of sensed electrograms, adaptive rate response, and device programmability. Pacemakers have become smaller and lighter over the years. Early devices weighed more than 180 g, whereas today, devices are available weighing no more than 25 g [4]. This weight reduction has occurred partly due to the development of high-energy-density batteries. Finally, there have been remarkable advances in cardiac lead technology. Novel electrode tip materials and configurations have provided extremely low stimulation thresholds and low polarization properties [5]. In this article, we will concentrate on the evolution of analog circuit designs applied in cardiac pacemakers. First, the electrical operation of the heart is described. The following section treats the history and development of cardiac pacing systems as well as their circuit descriptions. Then, some new features in modern pacemakers are discussed. Finally, the conclusions are presented.
A An Electronics Perspective, from the Hand Crank to Advanced Wavelet Analysis
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Cardiac pacing has become a therapeutic tool used worldwide.
The Heart Excitation and Conduction System
The heart is composed of atrial and ventricle muscle that make up the myocardium and specialized fibers that can be subdivided into excitation and conduction fibers. Once electrical activation is initiated, contraction of the muscle follows. An orderly sequence of activation of the cardiac muscle in a regularly timed manner is critical for the optimal functioning of the heart. The excitation and conduction system, responsible for the control of the regular pumping of the heart is presented in Figure 1. It consists of the sinoatrial (SA) node, internodal tracks, Bachmann’s bundle, the atrioventricular (AV) node, the bundle of His, bundle branches, and Purkinje fibers. Cardiac cells are able to depolarize at a rate specific for the cell type. The intrinsic rate of AV-nodal cells is about 50 beats per minute (bpm), whereas Purkinje fibers depolarize at a rate of no more then 40 bpm. During normal sinus rhythm, the heart is controlled by the SA node having the highest intrinsic rate of 60–100 bpm, depending on the hemodynamic demand. The right atrial internodal tracks and Bachmann’s bundle conduct the SA-nodal activation throughout the atria, initiating a coordinated contraction of the atrial walls. Meanwhile, the impulse reaches the AV node, which is the only electrical connection between atria and ventricles. The AV node introduces an effective delay, allowing the contraction of the atria to complete before ventricular contraction is initiated. Due to this delay, an optimal ventricular filling is achieved. Subsequently, the electrical impulse is conducted at a high velocity by the HisPurkinje system comprising the bundle of His, bundle branches, and Purkinje fibers. Once the bundle of His is activated, the impulse splits into the right bundle branch, which leads to the right ventricle and the left bundle branch serving the left ventricle. Both bundle branches terminate in Purkinje fibers. The Purkinje fibers are responsible for spreading the excitation throughout the two ventricles, enabling a coordinated and massive contraction [6].
waves depends on the amount of tissue activated per unit of time as well as the relative speed and direction of cardiac activation. Therefore, the physiological pacemaker potentials, i.e. the SA-nodal potentials, generated by a relative small myocardial mass are not observed on the ECG. The first ECG wave within the cardiac cycle is the P-wave, reflecting atrial depolarization. Conduction of the cardiac impulse proceeds from the atria through a series of specialized cardiac structures (the AV node and the His-Purkinje system) to the ventricles. There is a short relatively isoelectric segment following the P-wave. This is the PQ interval, which is related to the propagation delay (0.2 s) induced by the AV node (Figure 1). Once the large muscle mass of the ventricles is excited, a rapid and large deflection is observed on the surface ECG. Depolarization of the ventricles is represented by the QRS complex or R-wave (Figure 2). Following the QRS complex,
Internodal Tracks
Bundle Branch
SA Node AV Node Bundle of His
Purkinje Fibers
Fig. 1. The cardiac conduction system.
R
Cardiac Signals Surface Electrocardiogram
The electrocardiogram (ECG) is a recording from the body surface of the electrical activity generated by the heart. The ECG was originally observed by Waller in 1899 [7]. In 1903, Einthoven introduced electrophysiological concepts still in use today, including the labeling of the waves characterizing the ECG. He assigned the letters P through U to the waves avoiding conflicts with other physiologic waves studied at that time [7]. Figure 2 depicts a typical ECG signal. ECG signals are typically in the range of ±2 mV and occupy a bandwidth of 0.05–150 Hz. The morphology of the ECG IEEE ENGINEERING IN MEDICINE AND BIOLOGY MAGAZINE
Bachmann's Bundle
QRS Complex or R Wave: Ventricular Depolarization
P Wave: Atrial Depolarization
ST Segment T
P
P
Q S
PR Interval 0.2 s
T Wave: Ventricular Repolarization
Fig. 2. Typical electrocardiogram.
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another isoelectric segment, the ST interval, is observed. The ST interval represents the duration of depolarization after all ventricular cells have been activated, normally between 0.25 s and 0.35 s. After completion of the ST segment, the ventricular cells return to their electrical and mechanical resting state, completing the repolarization phase observed as a lowfrequency signal known as the T-wave. In some individuals, a small peak occurs at the end or after the T-wave and is called the U-wave. Its origin has never been fully established, but it is believed to be a repolarization potential [8]. Intracardiac ECG
An intracardiac ECG (IECG) is a recording of changes in electric potentials of specific cardiac locations measured by electrodes placed within or onto the heart by using cardiac catheters. The IECG can be recorded between one electrode and an indifferent electrode, usually more then 10 cm apart (unipolar electrogram) or between two more proximate electrodes (100 bpm) or decrease (bradycardia:
