STENEX could be used to insert word The early version of the talking steno- Become Obsolete?, IEEE Trans.
Become Obsolete?, IEEE Trans. Syst., Man,
equivalents of speech at the foot of televi-
sion displays-on the fly-so that the hard-
of-hearing could enjoy television enter-
tainment. The legally deaf could also use
this facility.
Lastly, because of its economy and light
weight, STENEX may be of use to sighted
students and others for taking verbatim
notes.
Acknowledgments
The patient help of many blind users with
talking aids and the cooperation from
CNIB are acknowledged; special thanks
are due to CNIBs Howard Riddell. Erol
Hembroff and wife Sylvia (both blind) are
active in their advice and support. Advice
was given by Maggy Dodd on teaching the
stenograph art. Lastly, students Simon KO
and Michael Lau of the Electrical Engineer-
ing Department of the University of British
Columbia and IASTE exchange student
Gerard Hoffmann from Luxemburg con-
tributed much to the project.
Control Engineering and Therapeutic
Drug Delivery
This article presents a short introduction to
the control aspects of therapeutic drug delivery
[11-[31.
There are several intrinsic feedback control
mechanisms in most therapeutic situations that
cover a wide range from the acute to the
chronic. First, the physician prescribes a
therapy to the patient. This therapy can include
several drugs that can be administered orally
or intravenously. For instance, if certain drugs
are to be given orally, the physician can also
include other instructions, like special dietary
considerations, exercise, or physiotherapy.
Feedback Control
This therapy has measurable and
unmeasurable effects on the patient. The
measurable factors can be heart rate, blood
pressure, and blood or urine levels of certain
Selim S. Hacisalihzade is a visiting scholar in the
School of Optometry at the University of
California, Berkeley, CA 94720, on leave from
the Swiss Federal Institute of Technology. He
is also a National Research Council Associate
at NASA Ames Research Center.
44
graph [3] gained the interest of National
Research Council (Canada) consultant
Victor Huczek and linguists at the Univer-
sity of Victoria. Mr. Huczek is now Manag-
ing Director of Boswell, Inc., which is
committed to making stenograph machines
called BOSWELL. Commercial backing is
from Rockspan Resources Ltd. of Van-
couver.
Financial support for the research came
from the National Science and Engineering
Research Council of Canada and the Mr.
and Mrs. P. A. Woodward Foundation.
The performance of blind and sighted
people with STENEX has been monitored
in informal tests. We hope, shortly, to be
funded for a definitive training/evaluation
program for STENEX. This would include
possible applications.
References
[ 11 D. Gopher and D. Raij, Typing with a Two-
Hand Chord Keyboard-Will the QWERTY
Selim S. Hacisalihzade
substances. The unmeasurable factors can be
pain, changes or reactions in skin color,
mood, etc. The physician can adjust the
therapy based on the measured information.
This is the first feedback loop.
Often, there is a controller, which deter-
mines the therapy based on the measurable
and unmeasurable attributes of the patient.
This controller can, for instance, adjust the
speed of a pump to deliver a drug with a cer-
tain rate based on the time history of the
variable that is to be controlled. The con-
troller can also be an abstract rule like allow-
ing the patient to take a second dose of an
analgesic if the pain is not relieved after the
initial dose. In this generalized sense, the con-
troller can even be a nurse or a paramedic who
can administer drugs according to a rigid
scheme based on their assessments of measur-
able and unmeasurable factors. This is the
second feedback loop.
In the general case, the controller is also
privy to the therapy the patient receives. Since
the controller may include a model of the pa-
tient (this model can vary from the most crude
to the very sophisticated), it can compare the
Cybern.,July/Aug. 1988.
21 D. A. Norman and D. Fisher, Why Alphabet
Keyboards Are Not Easy to Use: Keyboard
Layout Doesnt Much Matter, Human Fac-
tors, vol. 24, pp. 509-519, 1984.
31 M. P. Beddoes Design Features of a C-
based Talking Aid for the Blind and Handi-
capped Called SPEECHEX, IEEE Trans.
Bwmed Eng., vol. BME-33, pp. 463-467,
1986.
[4] M. P. Beddoes and S. M. KO,A Talking Aid
for the Blind, Research Rept. 1987,Univ. of
British Columbia, Canada.
[SI anon., Stenograph Theory for Court Report-
ing, STENOGRAPH, IL.
161 H. S. Elovitz, R. Johnson, A. McHugh, and J.
E. Shore, Letter to Sound Rules for Auto-
matic Translation of English Text to Phonet-
ics, IEEE Trans. Acoust., Speech, Signal
Process., vol. ASSP-24, pp. 446-459, 1976.
[7] J. L. Flanagan, Talking with Computers:
Synthesis and Recognition of Speech by
Machines, IEEE Trans. Bwmed. Eng., vol.
BME-29, pp. 223-232, 1982.
measured outcome of the therapy with the
predicted one. This comparison can modify
the controller itself (if it has adaptive features
built into it), or the result of the comparison
can be communicated to the physicians who
can then modify the controller. At any rate,
the output of the controller is utilized by the
physician to adjust the therapy. This con-
stitutes the main feedback loop.
At times, certain aspects of this complex
loop system may be missing. When a physi-
cian tells a patient on the phone to take two
aspirins (therapy) and call me back in the
morning if your headache persists (feedback
of the unmeasurable factors), he is basically
hoping to have an open-loop control case.
On the other hand, when a controller regulates
the mixture of various gases that the patient
inhales (therapy) to maintain a prescribed level
of anesthesia based on the relaxation level of
the patients muscles (measurable factors), it
is a simple feedback controller. There are
applications in which the controller includes
a model of how the patient should react to
anesthesia. This model (especially the
parameters of the model) can constantly be
IEEE Control Systems Magazine
modified according to a preset scheme based
on the individual properties of the patient like
weight, age, actual anesthetic situation, and the
delivered drugs. In that case, we are dealing
with an adaptive controller. It is possible to
have a further level of adaptation. This is the
case where the anesthetist switches from one
adaptation scheme to another based on some
information (like the color of the lips), which
the controller does not have access to.
Of course, it is possible for the physician to
learn more about the therapeutic situation at
hand from outside sources, which might in-
fluence the way to map all the available
information into a therapy. Also, there are ex-
ternal variables (like modeling errors, failure
to comply with the physicians prescription of
drugs and diet), which might effect the patients
C are not yet available, the best solutions today
i rely on individually programmable pocket size
a controller
Fig. I . Therapeutic situations involve several
feedback loops: (a) therapy, (b) measurable
effects of therapy, (e) controllers communica-
tion to physician, (d) physician modifier con-
troller, (e) nonmeasurable effects of therapy,
U) direct treatment of patient by controller,
(g)physicians continuing education, (h) uncon-
trollable effects acting on patient.
response to the therapy in an unpredictable
fashion. Note that all the subsystems involved
in the general therapeutic situation can be
nonlinear and time-varying.
1989 Conference on Neural Networks
The IEEE Control Systems Society and the
IEEE Systems, Man, and Cybernetics Society
are among the cosponsors of the third lEEE
International Conference on Neural Net-
works. The conference will be held in
Washington, D.C., at the Washington Shera-
ton Hotel on June 19-22, 1989. The confer-
ence will include exhibits of the latest neuro-
computers, neural network software, and
applications presented by some 40 companies
and organizations. Papers of eight pages or
June 1985
Mathematical Model
It was not until about a quarter of a cen-
tury ago that the mathematical closeness of
drug delivery and control engineering pro-
blems were discovered. Different applications
with varying degrees of complexity and
sophistication have since been in use. By far,
the most common application of control
engineering methods is in the field of open-
loop drug delivery, in which mathematical
models of the dose-effect relationship of the
used drugs, with parameters identified from
population statistics, are utilized. This field
employs mostly oral or rectal administration,
which are rather insensitive to inaccuracies in
dosage or timing of administration. However,
the problem of subcutaneous delivery of
insulin for the purpose of blood glucose level
control in patients with diabetes is the single
application that has received the greatest
attention. It would be best, of course, if the
insulin administration could be made a func-
tion of the actual blood glucose level (closed-
loop), but since miniaturized glucose sensors
insulin pumps, which can deliver insulin
according to a preset time-history.
Necessarily more complicated are closed-
loop controllers, which do regulate the
amount of insulin to be administered based
on the measured blood glucose levels (arti-
ficial pancreas). The use of such devices,
however, is indicated in cases of stationary
patients. Inherently, even more complex are
adaptive controllers used during surgery for
anesthesia. Much research has gone into
different types of adaptation schemes like
gain scheduling or model reference adapta-
tion after it became clear that, due to special
characteristics of the dose-effect relationship,
simple proportional controllers can become
less are solicited on the following areas: opti-
cal and electronic neurocomputers, combina-
tional optimization, network architectures,
neural network theory, neurobiological con-
nections, knowledge processing, learning
algorithms, and novel applications including
vision, robotics, self-organization, communi-
cations, control, and speech recognition and
synthesis.
The Conference Chair is Shun-Ichi Amari,
the International Chair is Rolf Eckmiller, and
unstable under certain circumstances.
Another technique employed here is the use
of Smith predictors, which is indicated by the
presence of pure delays in the dose-effect rela-
tionship of the used anesthetics.
Recently, the idea of intelligent controllers,
using knowledge-based control laws relying on
previous actions of experts, are finding applica-
tions in fields like anesthesia and fluid reten-
tion control. These controllers are waiting to
be applied to other fields of drug delivery. The
very nature of drug delivery problems, with
its difficulties in measurment and assessment
of pharmacological effects and awkward
simplifications in the modeling process, as well
as the difficulty in transforming physicians
decisions to simple input-output relationships,
makes this field an excellent candidate for fur-
ther applications of intelligent controllers.
Obviously, a pressing concern during the
use of computer controlled drug delivery
devices is safety. It can be argued that once
industry standards have been set for safety
features and related subjects, the use of
automatically controlled drug delivery devices
will increase dramatically.
References
[l] S. Vozeh, J. L. Steimer, Feedback Con-
trol Methods for Drug Dosage Optimiza-
tion, Clinical Pharmacokinetics, vol. 10,
1985.
[2] P. G . Katona, Closed-loop Control of
Physiological Variables, Proc. of the
1st IFAC Symp. Modeling and Contr.
Biomedical Sysf., Venice, Italy, April,
1988.
[3] D. A. Linkens, S. S. Hacisalihzade, Com-
puter Control Systems in Pharamacological
Drug Administration: A Survey, to appear
in J. Medical Engineering and Technology,
1989.
the Program Committee Chair is Robert
Hecht-Nielsen. The Organizing Committee
Chairs are Wesley Snyder and Allen
Stubberud.
For further details, call or write:
Nomi Feldman
ICNN-89 Conference Coordinator
3770 Tansy Street
San Diego, CA 92 12 1 USA
Phone: (619) 453-6222
45