BIOMEDICAL ENGINEERING: A HISTORICAL PERSPECTIVE Evolution of the Modern Health Care System 1. Hippocrates 2. Galen 3. Galileo 4.

William Harvey 5. Henry VIII 6. Florence Nightingale- forced to medical attention to focus on the care of the patient, which is NURSING The modern medical practice actually began at the turn of 20th century. Before 1900 medicine had little to offer. 1903 William Einthoven devised the first Electrocardiogram Machine and measured the electrical changes that occurred during the beating of the heart Various Transplantation Possibilities Human Genome Project: Pharmaceuticals Agriculture Forensics Anthropology Biomedication Industrial Processes Biofuels What is Biomedical Engineering? Involves applying the concepts, knowledge, and approaches of virtually all engineering discipline (e.g. electrical, electronics, mechanical and chemical engineering) to solve specific health care related problems, the opportunities for interaction between engineers and health care professionals are many and varied. Branches: Biomechanics Prosthetic Devices & Artificial Organs Medical Imaginf Biomaterials Biotechnology Tissue Engineering Neural Engineering Biomedical Instrumentation Bionano technology Physiological Modeling Rehabilitation Engineering Medical & Biological Analysis

2. Biomedical design engineer for industry 3. The research scientist Professional Status of Biomedical Engineering Biomedical Engineers are professionals. Professional have been defined as an aggregate of people finding identity in sharing values and skills absorbed during a common course of intensive training. Professionals generally accept scientific standards in their work, restrict their work activities to areas in which they are technically competent, avoid emotional involvement, cultivate objectivity in their work, and put their clients interests before their own. The concept of profession that is involved in the design, development, and management of medical technology encompasses three primary occupational models: science, business, and profession. One can determine the status of Professionalization by noting the occurrence of six crucial events: 1. The first training school 2. The first university school 3. The first local professional association 4. The first national professional association 5. The first state license law 6. The first formal code of ethics MORAL AND ETHICAL ISSUES The term ethics (Greek) ethos, meaning custom. The Latin word for custom is mos and its plural, mores, is the equivalent of the Greek ethos and the root words moral and morality. Philosophers Define ethics as a particular kind of study and use morality to refer to its subject matter. It represents the philosophical view of morals, and, therefore, is often referred to as moral philosophy.

Consider the following 3 questions: 1. Should badly deformed infants be kept alive? 2. Should treatment be stopped to a terminally ill patient to die? 3. Should humans be used in experiment? 4. Are these questions of morality or ethics? Philosophers argue that all moral judgments are considered to be normative judgments, which can be recognized simply by their characteristic evaluative terms such as good, bad, right, or wrong. Organizations developed and formalize the Code of Ethics for Medical Practitioners: Geneva Convention Code of Medical Ethics in 1949 World Medical Association Principles of Medical Ethics in 1980 and revised in June 2001 American Medical Association Two Moral Norms 1. Beneficence the provision of benefits 2. Non-maleficence the avoidance of doing harm. A fundamental medical ethical norm by at least some ancient physicians was accepted. 1. To help 2. At least, to do no harm Redefining Death- There is no doubt that the use of medical technology has in many instances warded off the coming of the grim reaper. Ex. In the US today, the average life expectancy for males is 74.3 years and for females 76 years, whereas in 1900 the average life expectancy for both sexes was only 47 years.

Roles played: Biomedical engineering involves training essentially three types of individuals 1. Clinical Engineer in health care

Terminally ill patient no hope to live due to chronic illnesses. Euthanasia mercy killing

Because of religious belief: Thou shall not kill Exodus 20:13, euthanasia reduced Taking Control Medical care decisions can be tremendously difficult. HOW to decide? In an attempt to assist individuals to make these decisions, it is often helpful to follow the pathway outline here: 1. Obtain all the facts (i.e., clarify the medical facts of the situation) 2. Understand all options and their consequences 3. Place a value on each of the options based on your own set of personal values. WHOs to decide? Consider the 4 concentric circles of consent: 1. The 1st, and primary, circle is the patient. 2. The 2nd circle is the use of advance directives, that is, choosing in advance through the use of such documents as the living will. 3. The 3rd circle is others deciding for the patient (the move from personal control to surrogate control) 4. The 4th and final circle is the courts and bureaucrats. Thermoregulation & Ventilation Technique- Premature infant medical care NICU- equipment helps sustain the life of the child e.g. Incubator- molded see-through plastic used to stabilize the body temperature of the infant. Apnea- breathing pattern is either aperiodic or irregular. Jarvic 7- 1985s artificial heart, first patient is Barney Clark Basic Principles: Biomedical research involving human subjects must conform to generally accept scientific principles and should be based on adequately performed laboratory and animal experimentation and on a thorough knowledge of the scientific literature. The design and performance of each experimental procedure involving human subjects should be clearly formulated in an experiment protocol, which should be transmitted to a specially appointed independent committee for consideration, comment, and guidance. Biomedical research involving human subjects should be conducted only by scientifically qualified persons and under the supervision of a clinically competent medical person. The responsibility for the human subject must always rest with a medically qualified person and never rest on the subjects of the research, even though the subject has given his or her consent. Engr. Every biomedical research project involving human subjects should be preceded by careful assessment of predictable risks in comparison with foreseeable benefits to the subject or to others. Concern for the interests of the subject must always prevail over the interests of science and society. The right of the research subject to safeguard his or her integrity must always be respected. Every precaution should be taken to respect the privacy of the subject and to minimize the impact of the study on the subjects physical and mental integrity and on the personality of the subject. Doctors should abstain from engaging in research projects involving human subjects unless they are satisfied that the hazards involved are believed to be predictable. Doctors should cease any investigation if the hazards are found to outweigh the potential benefits. In publication of the results of his or her research, the doctor is obliged to preserve the accuracy of the results. Reports of experimentation not in accordance with the principles laid down in this Declaration should not be accepted for publication. In any research on human beings, each potential subject must be adequately informed of the aims, methods, anticipated benefits, and potential hazards of the study and the discomfort it may entail. He or she should be informed that he or she is at liberty to abstain from participation in the study and that he or she is free to withdraw his or her consent to participation at any time. The doctor should then obtain the subjects freely given informed consent, preferably in writing. When obtaining informed consent for the research project, the doctor should be particularly cautious if the subject is in a dependent relationship to him or her or may consent under duress. In that case, the informed consent should be obtained by a doctor who is not engaged in the investigation and who is completely independent of this official relationship.

In the case of legal incompetence, informed consent should be obtained from the legal guardian in accordance with national legislation. Where physical or mental incapacity makes it impossible to obtain informed consent, or when the subject is a minor, permission from the responsible relative replaces that of the subject in accordance with national legislation. The research protocol should always contain a statement of the ethical considerations involved and should indicate that the principles enunciated in the present Declaration are complied with. Medical Research Combined with Professional Care (Clinical Research) In the treatment of the sick person, the doctor must be free to use a new diagnostic and therapeutic measure, if in his or her judgment it offers hope of saving life, re-establishing health, or alleviating suffering. The potential benefits, hazards, and discomfort of a new method should be weighed against the advantages of the best current diagnostic and therapeutic methods. In any medical study, every patientincluding those of a control group, if any should be assured of the best-proven diagnostic and therapeutic method. The refusal of the patient to participate in a study must never interfere with the doctorpatient relationship. If the doctor considers it essential not to obtain informed consent, the specific reasons for this proposal should be stated in the experimental protocol for transmission to the independent committee. The doctor can combine medical research with professional care, the objective being the acquisition of new medical knowledge, only to the extent that medical research is justified by its potential diagnostic or therapeutic value for the patient. Nontherapeutic Biomedical Research Involving Human Subjects (Nonclinical Biomedical Research) In the purely scientific application of medical research carried out on a human being, it is the duty of the doctor to remain the protector of the life and health of that person on whom biomedical research is being carried out. The subjects should be volunteers (i.e., either healthy persons or patients for whom the experimental design is not related to the patients illness). The investigator or the investigating team should discontinue the research if in his/her or their judgment it may, if continued, be harmful to the individual. In research on humans, the interest of science and society should never take precedence over considerations related to the well-being of the subject. Medical/Biomedical Research with Voluntary Consent It represents legal authorization to proceed. The subject cannot later claim assault and battery. It usually gives legal authorization to use the data obtained for professional or research purposes. Invasion of privacy cannot later be claimed. It eliminates any claims in the event that the subject fails to benefit from the procedure. It is defence against any claim of any injury when the risk of the procedure is understood and consented to. It protects the investigator against any claim of an injury resulting from the subjects failure to follow safety instructions if the orders were well explained and reasonable. Regulation of Medical Device Innovation USA Food and Drug Administration (FDA) 1. Center for Biologics Evaluation and Research 2. Center for Drug Evaluation and Research 3. Center for Food Safety and Applied Nutrition 4. Center for Veterinary Medicine 5. Center for Devices and Radiological Health Philippines Department of Health 1. BFAD Regulation of Medical Device Innovation The purpose of the regulatory process is to conduct product reviews to: (1) Assure device safety and effectiveness, (2) Assure quality of design,

(3) Provide surveillance to monitor device quality. Therefore, thereview process results in verification and validation of the medical device. Medical Marketing Devices in USA 4 principal routes of marketing: 1. Pre-Market Approval (PMA) Issued by FDA (if the medical device is safe and effective). 2. Investigational Device Exemption (IDE)- Is an approved regulatory mechanism that permits manufactures to receive an exemption for those devices solely intended for investigational use a human subjects (clinical evaluation). 3. Product Development Protocol (PDP) - Is a mechanism allowing a sponsor to come to early agreement with the FDA as to what steps are necessary to demonstrate the safety and effectiveness of a new device. 4. 510(k) Notification /Pre-Market Notification- Is the section in the Food Drug Certificate of Approval. The Role of the Biomedical Engineer in the FDA Process Safe Medical Devices Act of 1990 (Public Law 101-629) on November 28, 1991. Biomedical engineers need to be aware of FDA regulations and the process for FDA approval of the use of medical devices and systems. These regulatory policies are, in effect, societys mechanism for controlling the improper use of these devices ANATOMY AND PHYSIOLOGY Biomedical engineering is aninterdisciplinary field based in both engineering and the life sciences, it is important for biomedical engineers to have knowledge about and be able to communication in both areas. Cellular Organization The cell theory states that: 1. All organisms are composed of one or more cell, 2. The cell is the smallest units of life, and 3. All cells come from previously existing cells

Normal human male shows the 22 pairs of Autosome chromosomes in descending order based on size, as well as the X and Y sex chromosomes. Tissues- Groups of cells and surrounding substances that function together to perform one or more specialized activities. Pacemaker cells in the sinoatrial node (SA node) depolarize first and send an action wavefront through the atria. The propagating action potential slows down as it passes through the atrioventricular node (AV node), then moves through the Bundle of His and Purkenji systemvery rapidly until it reaches the cells the cells of the ventricles -90mV (charges) 20mV (depolarized) Sodium & potassium ECG output is an electrical measure of the sumof these ionic changes within the heart. The P wave represents the depolarization of the atria and QRS represents the depolarization of the ventricles. Ventricular depolarization shows up as the T wave and atrial repolarization is masked by ventricular depolarization. Changes in the amplitude and duration of the different parts of the ECG provide diagnostic information for physicians. Circulatory Systems Blood pressure can be measured directly or indirectly (noninvasively) 1. Direct blood pressure measurements are made by introducing a catheter or needle that is coupled to a pressure transducer into a vein or artery. 2. Indirect methods include sphygmomanometry, in which a cuff is used to apply sufficient pressure to an artery, usually in the arm, to prevent the flow of blood through the artery, and a stethoscope is used to listen to the change in sounds as the cuff is slowly deflated. NORMAL Systolic: 110 - 140mmHg Diastolic: 70 - 90 mmHg Respiratory Systems- is moves air to and from the gas exchange surfaces in the body where diffusion can occur between air and the circulating blood. Nervous system, which is responsible for the integration and control of all the bodys functions, has two major divisions: the central nervous system and the peripheral nervous system The brain is a large soft mass or nervous tissue and has 3 major parts: 1. Cerebrum 2. Diencephalon 3. Brain stem and cerebellum Skeletal Systems- 206 (Adult Bones) Synovial joints, such as the knee, are the most complex and varied and have fluid-filled joint cavities, cartilage that covers the articulating bones, and ligaments that help hold the joints together. Diseased or damage hip (a) and knee (b) joints that are nonfunctional or extremely painful can be replaced by prostheses. Muscular system is composed of 600 700 skeletal muscles. Depending on the muscle in use, the location of the load and the location of the fulcrum, the Humerus can act a class 1 lever, a class 2 lever, or a class 3 lever. The 3 types of muscle tissue: 1. Cardiac 2. Skeletal 3. Smooth- Share 4 important characteristics: 1. Contractility, the ability to shorten; 2. Excitability, the capacity to receive and respond to a stimulus; 3. Extensibility, the availability to the stretched; 4. Elasticity, the ability to return to the original shape after being stretched or contracted.

Homeostasis Organ systems work together to maintain a constant internal environment within the body. The process by which physical and chemical conditions within the internal environment of the body are maintained within tolerable ranges even when the external environment changes. REHABILITATION ENGINEERING AND ASSISTIVE TECHNOLOGY Since the late 1970s, there has been major growth in the application of technology to ameliorate the problems face by people with disabilities. Various terms have been used to describe this sphere of activity, including: 1. Prosthetics /orthotics 2. Rehabilitation engineering 3. Assistive technology 4. Assistive device design 5. Rehabilitation technology, and even 6. Biomedical engineering applied to disability.

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Careful and thorough consideration of available of available technology for meeting the users needs must be carried out to avoid overlooking potentially useful solutions. The users preference and choice must be considered in the selection of the assistive technology device. The assistive technology device must be customized and installed in the location and setting where it primarily will be used. Not only must the user be trained to use the assistive device, but also the attendants or family members must be made aware of the devices intended purpose, benefits, and limitations. Follow-up, readjustment, and reassessment of the users usage patterns and needs are necessary at periodic intervals.

Key elements of the design process involve the following sequential steps: 1. Analysis 2. Synthesis 3. Evaluation 4. Decision 5. Implementation Key Engineering Principles Wide variety of design tasks including: 1. Worst case design 2. Computer simulation, 3. Temperature effects, 4. Reliability, and 5. Product safety Key Ergonomic Principles Principle of Proper Positioning Principle of the Anatomical Control Site Principle of Simplicity and Intuitive Operation Principle of Display Suitability Principle of Allowance for Recovery for Errors Principle of Adaptability and Flexibility Principle of Mental and Chronological Age Appropriateness Career Opportunities In the early 1980s, the value of rehabilitation engineers and assistive technologist was unappreciated and thus required significant educational efforts for over 2 decades. Currently, this profession can be found in hospital based rehabilitation centres, public schools, vocational rehabilitation agencies, manufacturers, and community-based rehabilitation technology suppliers; opportunities also exist as independent contractors. BIOMATERIALS Materials in Medicine: From Prosthetics to Regeneration

Principles of Assistive Technology Assessment Misconceptions: 1. Assistive technology can solve all the problems. 2. Persons with the sane disability need the same assistive devices. 3. Assistive technology is necessarily complicated and expensive. 4. Assistive technology prescription are always accurate and optimal. 5. Assistive technology will always be used. Principles: 1. The users goal, needs, and tasks must be clearly defined, listed, and incorporated as early as possible in th intervention process. 2. Involvement of rehabilitation professionals with differing skills and know-how will maximize the probability for a successful outcome. 3. The users preferences, cognitive and physical abilities and limitations, living situation, tolerance for technology, and probable changes in the future must be thoroughly assessed, analysed, and quantified.

Biomaterials: Properties, Types and Applications Mechanical Properties and Mechanical Testing: The common way to determine mechanical properties is to pull a specimen apart and measure the force and deformation.

 Materials are also tested by crushing them in compression or by bending them. The terminology is essentially the same in either case only the mathematics are different. Standardized test protocols have been developed to facilitate comparison of data generated from different laboratories Metals Metals used as biomaterials have high strength and resistance to fracture and are designed to resist corrosion. Ceramics and Glasses The advantages of the class of materials known as ceramics are that they are very biocompatible (particularly with bone), are inert, have low wear rates, are resistant to microbial attack, and are strong in compression. Some disadvantages include brittleness, the potential to fail catastrophically, and being difficult to machine. Polymers are well suited for biomedical applications because of their diverse properties. Example, polymers can be flexible or rigid, can be low strength or high strength, are resistant to protein attachment or can be modified to encourage protein attachment, can be biodegradable or permanent, and can be fabricated into complex shapes by many methods.

integration with the surrounding extracellular matrix. Surface Topography (2-D) Surface topography of a biomaterial has been shown to provide cues to cells that elicit, a large range of cellular responses, including control of adhesion, cell morphology, apoptosis, and gene regulation. Scaffolds (3-D) Tissue repair of large defect is best accomplished by filling the defect space with a scaffold material that can simulate the microenvironment provided by the embryonic extracellular matrix Application-Specific Strategies for the Design and Selection of Biomaterials Musculoskeletal Repair The design and selection of the biomaterials components for an implant should be based on restoring the biological function of the damaged or diseased tissue. The principal function of musculoskeletal tissues is to provide a framework to support the organs and to provide a means of locomotion. Group of Musculoskeletal Tissues: 1. Bone 3. Tendons 5. Muscles 2. Cartilage 4. Ligaments Cardiovascular Devices The primary requirements for biomaterials used for blood-contacting circulatory applications such as heart valves and blood vessel replacements or stents are resistance to platelet and thrombus deposition, biomechanical strength and durability, and biocompatibility and nontoxicity. Drug Delivery The goal of drug delivery research is to prepare formulations that will result in sustained active drug level in the body, leading to improved drug efficacy. Controlled-release formulations accomplish this by various techniques that involve conjugation of the drug to a biomaterial.

Some disadvantages of polymers are that they to have lower strengths than metals or ceramics, deform with time, may deteriorate during sterilization and may degrade in the body catastrophically or by release of toxic by-products.

Natural Materials Are synthesized by an organism or plant and are typically more chemically and structurally complicated than synthetic materials. Composites Materials consist of two or more distinct parts. Are made by mixing two components and molding, compacting, or chemically reacting them together. Tissue-Biomaterial Interactions Interactions with Blood and Proteins The implantation of a biomaterial often creates a wound, and bleeding generally ensues. Blood and proteins The Wound Healing Response after Biomaterial Implantation Metallic corrosions Biomaterial Degradation and Restoration Biomaterials may be permanent or degradable. The degradation process may be chemically driven or accomplished by cells. Immunogenicity is the tendency for an object to stimulate the immune response. Guiding Tissue Repair with Bio- Inspired Biomaterials Surface Chemistry Modifications (1-D) The interaction of cells and tissues with biomaterial surfaces is critically important to promote new tissue deposition and for healthy