CIMIT blog

Video "Screen"

Lynn Osborn passed THIS ARTICLE along from the Economist. I figure since the last opinion piece was on video games and game play for the real world I should follow it up with another that reaches into different territory.

The article brings up good ideas as to how we can use video games to simulate disaster and response; something Ryan Bardsley has made a name for himself with at CIMIT in RIPS and COMETS. While I think there is no doubt this type of “play” simulation is of incredible use and its value now clear, I have to ask myself what we really gain? Do we stop to ask ourselves if we are measuring experiments that perhaps can’t be measured?

What I mean is… Do humans really do what computers think they do? And do we tell the computers the correct things about our behavior when we practice simulation? Is it all far too unique to program? Or in the case of a real person being in control of each simulated character, as in an MMO, do the controllers actually do as they would in real life?

The thing I have found myself wondering from this article is: Why can we train for reality through fantasy, but not measure reality through fantasy?

Fundamentally it rests in one question: Are people willing to admit their own shortcomings? If you are in control of an animated character do you have the same instinct and response? The answer in my mind is, no. As the article points out we may value our simulated characters lives as extensions of ourselves, but do we value the responsibilities the same? Do we have computer simulated children and spouses? Bills to pay? Jobs and personal lives to balance? Friends and feelings? Tempers and jealousy?

Many people don’t join the military because they do not wish to be killed or seriously injured. But many of those same people would probably play military oriented MMO’s. I think it is impossible to entirely divorce ourselves from the euphoria of invincibility and consequence free decision making in a simulator.

Most of us don’t run into the burning building because we have family we would leave behind if killed or we fear for our own safety. But we all like to think that we would run into the burning building. However, we can train ourselves to run into that building as fire fighters do. But why is there a separation of reality and fantasy here? Why can’t we measure the reality of instinct through simulators?

The one common element of simulation is “The Screen.” We view all of our new media, TV, film, video games and simulations through a screen. This screen may be an LCD, plasma, head display or old tube, but in one way or another they are all screens. These screens are barriers that physically separate us from our real life decision-making. We have been conditioned to suspend our disbelief and can easily bring about a life of fantasy when positioned in front of a screen. We see images and have feelings about them differently than we would in real life. But the edge of the screen, that spot where an image disappears, is where that fantasy/reality meet.

And so when it comes to simulators of real life we have a balance between fantasy and reality, which function simultaneously in a simulator. We have to balance what we would do with what we wish we could do and I simply don’t know if we can.

The military has been putting their recruits through boot camp for hundreds of years. The idea is not to teach the recruit of actual war, but give them concrete actions to reflexively perform once in the breach. The hope is that repetition of action will be enough to survive in situations where our natural reactions are lacking.

This is the real strength of a simulator. We cannot begin to expect true reality of instinct from a simulator. What a simulator can do is provide people with reflex training. Actions that become repetitive and replace instinct. Actions that we perform when faced with situations we’ve seen on a screen many times.

What this article hopes for falsely is that we can study honest human behavior and reaction from MMO’s or simulators. I don’t see this being possible at this time or with the style simulator anyone currently produces. This would take a fundamental change of doctrine.

No soldier goes into battle because it is his or her instinct to do so. They go because they have been trained to. So to study a plague through The World of Warcraft probably won’t get us far because the people behind the controls of each character don’t have to be responsible to their real feelings. They feel pressure to be heroic or courageous when in real life they may simply walk away. It is the difference between hitting the walk-off homerun and saying you would have when the real player strikes out.

However, I do not enjoy being so negative about any new technology, a technology which is sure to give us great advances in medicine so…

Here’s to looking forward.

Quest for a Wearable Kidney: Will Nanotechnology Make a Difference?

Nearly 400,000 patients in the U.S. have end stage kidney disease requiring dialysis or transplantation. Currently, the number on dialysis or with an allograft number is approximately 1,300,000 worldwide, a number much smaller than the prevalence of end stage renal disease because of the amount of resources required for maintenance dialysis and the scarcity of organs. Even for those on dialysis there is reason to believe that more frequent dialysis would be beneficial. Wearable dialysis machines have been discussed for at least 40 years and yet little progress has been made. Some of the design challenges include:
removal of fluid that has been taken in by the patient, clearing the blood of urea, creatinine, potassium, acids and metabolic waste products among other things maintaining serum electrolytes and pH in a normal range having no significant adverse effect on blood pressure.

Under normal circumstances, an individual's kidneys can filter 150-180 liters a day of blood and reabsorb approximately 98-99% of that filtrate while excreting the appropriate waste products and finely regulation volume status and electrolyte status of the individual. The normal kidney is also an endocrine organ providing, for example, the erythropoietin, that then acts on the bone marrow to increase red blood cell production. Thus there are many challenges for an artificial kidney which must replace many of these functions.

Joseph Bonventre, MD, PhD, Robert Ebert Professor of Medicine and Health Sciences and Technology, Harvard Medical School; Director, Renal Division, Brigham and Women's Hospital; CIMIT Site Miner, BWH, joseph_bonventre@hms.harvard.edu

Continuously Functioning Artificial Nephron: The Promise of Nanotechnology
Theodore I. Steinman, MD, Clinical Professor of Medicine, Harvard Medical School; Beth Israel Deaconess Medical Center, tsteinma@bidmc.harvard.edu

Nanotechnology is being translated into nanomedicine. Our current dialysis delivery system is cumbersome, time consuming and associated with a high morbidity and mortality. With nanotechnology we are at the verge of developing a human nephron filter that mimics the function of the human glomerulus and tubule. Compared to current technology, the newest nano-membranes will be two to three times greater in efficiency than current dialyzers, be much more compact, and light weight so as to be adaptable for wearing. No dialysis solutions will be needed with the newest devices. The goal for the future is to make this device implantable.

Joseph Bonventre; Theodore Steinman; Greg Erman, MBA, Serial Entrepreneur and former President & CEO, Renalworks Medical Corporation, ermangreg@comcast.net; and Jeffrey Borenstein, PhD, Director, Biomedical Engineering Center; Distinguished Member of the Technical Staff, Charles Stark Draper Laboratory; Program Leader for Biomaterials and Tissue Engineering and Draper Laboratory Site Miner, CIMIT, jborenstein@draper.com

For more information on the Forums including how you can attend (Always open to the public) please visit CIMIT Education

CIMIT Education Team

Nasa investigates virtual space

The BBC has an article (CLICK HERE) describing NASA's new plans for a "Second Life" style MMO. Of course game technology is on the forefront of medicine right now and so I thought this article could be useful. In addition, as John Abele points out this style of gaming solution could be of interest to all companies who are looking to recruit young and bright employees.

I think Second Life has certainly run its course and is going in the way of extinction, but what we are left with is an interesting archive of learning. I think where Second Life has failed we are taught something not only about gaming, but about simulation. How do we get physicians to use such tools regularly? How do we overcome the stumbling blocks? I think one major block will be boredom and interest level. A simulation cannot simply capture initial interest; it must provide prolonged learning to be of real value and to do that it must be adaptive. The Sims is a great example of this. The Sims is most popular within a video game market that historically, and by the numbers, has little interest in gaming: Women. And what’s more is that it runs the age range with spectacular success from the very young to the very old.

All great video games, especially MMO’s (with a few exceptions) have a point where interest levels drop. This is commonly caused by new games, advancements in graphics or more interesting concepts. When this happens all of the time and energy put into building the game infrastructure is… lost. This is why many game companies build all their games off of only one engine. The games look different, the settings are varied, but the brain is the same. This saves video game company’s time and money in development, as the engine is the most difficult to produce. But if the game essentially thinks the same underneath the images, are we really gaining anything? Or simply exploring what has already been explored? This may pass in a consumer game world, but in institutionalized medicine one major failure of interest in a simulator could set back adoption of the concept.

If NASA’s new simulator is built off an old engine I see interest in this dropping away quickly. On the other hand, if they take a lesson from America’s Army, they could be set for the same level of success.

For example, the book “Generation Kill” describes how the majority of Marine’s in the initial Iraq invasion cited one specific commercial as the reason for joining. That particular commercial depicted a Marine climbing a mountain and wearing a suit of medieval armor to defeat a dragon. The Marine then morphs into a modern day Marine defending his country. Similarly, many in the Army today cite the America’s Army video game as the catalyst for their joining. So, it’s clear that with just one successful game-like recruitment program (be it a game-like commercial or an actual game) you can reach hundreds of thousands of young and NASA has joined in that hunt.

In addition, I think key to the success of a program such as this by NASA will be the interest level of young women. And to do this they should look at what EA has done with The Sims. Of course, with time, The Sims has fallen off as well. However, the game play behind the Sims is very different than what typically entertains a male. NASA may have to choose if they are more interested in recruiting males or females as it seems difficult for one video game to attract both in similar numbers.

So, what does this tell us about the adoption of medical simulation? How will we have to tailor simulators to the interest levels of either males or females? Or will it make no difference at all?

Regardless, this is certainly a positive step forward for all forms of simulation. No matter the level of success with such a program we will at least be left with an archive of learning as we have been with Second Life.

CIMIT Education Team

Wii Head Tracking Link

Obviously the Nintendo Wii has made waves in almost ever inch of... Well, everything. And in medicine it's no different. Over here we are constantly using these little boxes of wonder to learn more about the way people work and possible advances in medical simulation.

This video has been making its rounds lately and HERE it is. Or see below for the embedded video.

It shows in crystal clarity how to turn the Wii into a piece of three-dimensional… art, I think would be the least geeky way of putting it.

CIMIT Team

Medical tech event reveals hot devices

To read the whole article click HERE

Hello,

 

Click HERE for a news piece on the CIMIT Innovation Congress 2007. It comes from the Indus Business Journal, a Waltham-based newspaper that circulates nationally with about 40,000 readers - most with ties to India.

It is an informative view of our Congress. It references other CIMIT leaders such as Janice Crosby and Bev Brown, as well as CIMIT friends including John Abele and John Cullinane. I think you will find it interesting.

Dyke C. Hendrickson

Communications Manager
CIMIT
(Center for Integration of Medicine and Innovative Technology)
dhendrickson@partners.org
617-643-3847

Click HERE for article in full.

The Future of Global Health - January 08, 2008 Forum Video

Unprecedented efforts are being directed at overcoming the challenges of delivering healthcare in low income countries globally. Previous, though well-intentioned, attempts to implement technologies to improve healthcare have largely failed. “Known, effective, and cheap” are necessary but insufficient criteria for successful Global Health technologies. However, much has been learned. The CIMIT Global Health Initiative Forum on January 8th seeks to highlight some of the challenges and opportunities in this field. Two CIMIT funded researchers will highlight their current work in the realm of diagnostic testing utilizing microfluidic technology directed at conditions ranging from Avian Flu through HIV. Microfluidics holds significant promise to allow rapid, accurate, and inexpensive diagnostic testing in settings without supportive laboratory infrastructure or personnel. Please come and join in the discussion!

Moderator: Kristian Olson, MD, MPH, Clinical Educator Svc, Department of Medicine, Massachusetts General Hospital; CIMIT Global Health Initiative Leader; MGH Center for Global Health Senior Advisor; Instructor, Harvard Medical School, krolson@partners.org

Disposable Molecular Diagnostics: Microfluidic Laboratories for the Field
Catherine Klapperich, PhD, Assistant Professor of Manufacturing and Biomedical Engineering, Boston University, catherin@bu.edu

The impact of infectious disease on resource poor areas of the world is devastating. It is unlikely that the financial climate surrounding drug development for diseases prevalent in third world countries will soon change. Our best approach at dealing with some of these diseases will be prevention efforts assisted by the widespread availability of inexpensive and accurate diagnostics. Probes to amplify and identify microbial or viral nucleic acids are available for almost every well known disease vector. Assays for serum antibodies to many organisms are also well documented. Dedicated engineering of test protocols (patient
sample preparation, dilutions, washing, blocking, and detection) and devices is required to move these technologies out of the research laboratory and into the field where they can have a more immediate impact on world health. Catherine Klapperich’s team is focused on designing and prototyping disposable microfluidic platforms to enable molecular diagnostic testing using patient samples in locations far from a full service laboratory. Device design goals are low production costs, long shelf lives and relative ease of use. This talk will cover the formulation, fabrication and testing of microfluidic solid phase extraction columns based on polymer monoliths impregnated with nanoparticulate inclusions for protein and nucleic acid isolation from patient samples. Mammalian and bacterial cell lysis in microfluidic chips will be covered in addition to a discussion of strategies for micro and nanoscale enzyme linked immunosorbent assays. Practical concerns about the direct use of patient samples (blood, urine, saliva, and stool) will also be addressed.

Disposable, Point-of-care Microchips for CD4 Counts in Resource Limited Settings
Utkan Demirci, PhD, Instructor of Medicine and Health Sciences and Technology, Harvard Medical School, Brigham & Women's Hospital, Harvard-MIT Health Sciences and Technology
Bio-Acoustic-MEMS in Medicine: BAMM Labs, udemirci@rics.bwh.harvard.edu

More than 35 million HIV-infected people live in the developing world, yet it is estimated that only one in ten persons infected with HIV has been tested and knows his/her HIV status. The U.S National Intelligence Council (NIC) predicted that the number of HIV-infected individuals in the developing world would rise to 80 million by 2010[1]. Effective antiretroviral therapy (ART) for HIV has been available in developed countries for more than a decade. However, worldwide, less than 10% (1.3 million) of all the infected individuals are currently receiving treatment, since most affected persons live in developing countries. Part of the problem associated with existing ART delivery systems are the limitations of conventional methods to diagnose and monitor infected individuals living in rural poor communities. In order to increase access to HIV care and to improve treatment outcomes requires an urgent development of low-cost diagnostic tools for developing countries[2-5].

Utkan Demirci’s team’s objective is to develop novel point-of-care low cost diagnostics to bridge emerging engineering nano- and micro-scale solutions to HIV infected patients at resource limited. This laboratory at the interface of Harvard and MIT specializes in applying micro- and nano-scale techniques to problems in medicine. The Lab’s target is a point-of-care, low-cost (<$1), disposable, microfluidic device which uses a fingerstick blood sample (<10 µl) and produces a CD4 count rapidly (<1 min) with on-chip sample handling and will greatly accelerate CD4 counting in resource-limited settings.

Scar-free surgery

The Boston Globe today ran a major story on NOTES. The article quotes Dr. David Rattner and is very informative. Writer Mary Carmichael learned about NOTES at the CIMIT Innovation Congress 2007. She might write a story for Newsweek as well.

Here is the LINK

String Duck

We ran across this out standing video which explains string theory in less than 2 minutes. It has inspired us begin brainstorming a series of short films for presenters, moderators and participants at forums. If you have any ideas for SmartCrowds be sure to let us know.

Here is the LINK to the video or see below for the embedded video

And of course for more great presentations see TED