Something old, something new: harnessing technology of the future.
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Biomedical Technology↗
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A review of cardiac imaging modalities.
Cardiac catheterization has been the "gold standard" to evaluate cardiac anatomy and severity of physiological dysfunction. However, this procedure is limited by its invasive nature. Recent technological advances have provided noninvasive cardiac imaging methods that delineate cardiac structures and assess myocardial perfusion, function, and metabolism. Echocardiography is used in the assessment of left ventricular (LV) hypertrophy, LV dilatation, LV wall motion, and the cardiac valves. Radioisotope imaging methods are used to evaluate myocardial perfusion while blood pool scintigraphy is used to assess myocardial function. The purpose of this article is to describe current noninvasive and invasive imaging technologies available for the diagnosis and evaluation of cardiac disorders including the chest radiograph, echocardiography, radioisotope imaging methods, blood pool scintigraphy, and cardiac catheterization. Future technologies (positron emission tomography, magnetic resonance imaging, and ultrafast cardiac computed tomography) are also discussed.
Diagnostic Imaging↗
Capabilities of compact analyzers for decentralized testing of lipids and lipoproteins.
Advances in compact analyzer technology have provided the capability to move laboratory testing to the patient, the bedside, the physician office, wellness sites and even into the home. The future has arrived in the sense that lipid testing can be performed in a simple manner similar to blood pressure testing with results immediately available to facilitate treatment decisions. The realities of access and utilization as well as the rate of future technology developments will be determined to a large degree by government regulatory and reimbursement decisions.
Blood Chemical Analysis↗
A short history of the Foley catheter: from handmade instrument to infection-prevention device.
Although it is one of the most frequently utilized devices in the hospitalized patient, the Foley catheter has often been taken for granted. This lack of attention is unfortunate, as the Foley catheter remains one of the primary sources of hospital-acquired infections, which increase morbidity, mortality, and the financial burden on the healthcare system. Although education on the appropriate techniques, proper use, and early removal of Foley catheters is important, such measures unfortunately result in transient benefits. Current technologic advancements have moved the coating technology to a state where bacterial adhesion and migration can be limited and the frequency of catheter-associated urinary tract infections can be reduced. Future technological advances in the Foley catheter will help provide better care and comfort for the catheterized patient.
Biofilms↗
Taking arrays from the lab to the field: trying to make sense of the unknown.
With the rapid pace of nucleic acid microarray technology development and a renewed national emphasis on detecting and characterizing microorganisms in environmental samples, there is a rush to operationalize existing microarray technologies and apply them to uncharacterized environmental backgrounds. The purpose of this article is to pause and ask a basic question: what do microarray data actually mean in the face of uncharacterized sample backgrounds? In attempting to answer this question, we draw a clear distinction between hypothesis-driven fundamental science and operational uses of microarray technology; assess microarray technology assumptions in the face of uncharacterized environments; offer an environmental microbiologist's perspective on technology needs and requirements for quantitatively analyzing microbial communities; and hopefully stimulate a scientific and technical dialogue around the concept of analytical environmental microbiology and future technology development.
Bacteria↗
Future of bradyarrhythmia therapy systems: automaticity.
Since the first fixed-rate ventricular pacemaker was introduced in the late 1950s, pacing systems have evolved rapidly. Current developments focus on making devices more sophisticated and less complex--a challenging combination. Automaticity features such as beat-by-beat capture verification, sensitivity threshold adaptation, and algorithms to govern dynamically the maximum sensor rate have either recently been introduced or are likely to be introduced in the near future. Technologic advances are likely to allow meaningful improvements in current drain, battery performance, memory capacity, signal processing, telemetry, and programmer interface. Bradyarrhythmia therapy devices of the future promise to go beyond the pacemaker. Ultimately, pacing systems will become part of integrated cardiac rhythm management systems.
Bradycardia↗
Intravascular stents in the last and the next 10 years.
The first balloon-expandable coronary stent was approved "for the prevention of restenosis" in 1994, the same year that the Journal of Endovascular Therapy was inaugurated. Since then, the development of the stent has paralleled the evolution of endovascular intervention as a new specialty. Innovators have pushed to explore new and varied stent applications outside the coronary arteries. Carotid stenting, transjugular intrahepatic portocaval shunts, and covered stents are a few of these new applications that have now become commonplace. Dozens of stent designs and several new materials have been tested to solve the problem of in-stent restenosis, but it is the drug-eluting stent (DES) that has emerged as the most promising, at least in the coronary arteries. However, the benefits of DES technology are not likely to be effective in the more pervasive forms of in-stent restenosis, such as encountered in the femoropopliteal segment. In the future, technologies aimed at stimulating rather than inhibiting tissue response to an implant may be part of the next wave of developments, as we take aim against the poor and/or slow tissue incorporation that manifests as leaks and dislodgement. In the superficial femoral artery, for example, mechanical stresses that cause fractures and dislocations may be addressed by using a very flexible endovascular device with a tissue-friendly inner surface that promotes rapid stent endothelialization to counter the biological effects of motion and microtrauma. The rapidly developing fields of nanotechnology, microelectronics, and advanced materials technology will enable the surface engineer to design molecular-specific surfaces for a new generation of vascular devices. Interactive implantable or injectable microdevices aimed at providing specific information upon demand from an external source will revolutionize disease prevention, as emphasis shifts toward monitoring cardiovascular risk exposure. There is no doubt that during the next 10 years, we will witness impressive technological progress in the field of cardiovascular implantable devices.
Femoral Artery↗
Instrumentation problems for physicians.
The physician has, for whatever reasons, diminished his or her level of involvement on the team dedicated to developing, refining, and evaluating medical technology. As a result, the challenge confronting the physician and the technology development team today is to orchestrate a team structure that will ensure the greatest input and commitment from physicians and other professionals during current and future technology development. The charges of cost escalation and dehumanization in our system of health care delivery will also be discussed, as will the lack of, or confusion about, access to data concerning cost of a given instrument, and fuzzy semantics and perspectives on technology and instrumentation. The author suggests answers to, or means to ameliorate, the problems.
Decision Making↗
Robotic orthoses for body weight-supported treadmill training.
BWSTT has become an accepted standard of care in gait rehabilitation methods. This type of locomotor training has many functional benefits, but the physical labor costs are considerable. To reduce therapist effort and improve the repeatability of locomotor training, three groups have developed commercially available robotic devices for assisted stepping. The purpose of these robotic devices is to augment locomotor rehabilitation by decreasing therapist manual assistance, increasing the amount of stepping practice, while decreasing therapist effort. Current clinical studies have yielded positive and promising results in locomotor rehabilitation inpatients with neurologic impairments of stroke or SCI. The potential benefits from robotic technology are significant for clinical use and research. As further research is conducted, rehabilitation therapists and patient outcomes will be able to contribute to the development of current and future technologies.
Body Weight↗
Gonadal tissue cryopreservation in boys with paediatric cancers.
In considering gonadal tissue cryopreservation in children about to undergo chemotherapy or radiotherapy for cancer, numerous issues need to be confronted. This relates firstly to a dearth of information available on the subject of children's gonads coupled to ill-defined fertility preservation procedures, technologies and perhaps less well-publicized regulatory, ethical and legal controls. There may be benefits in considering gonadal tissue preservation for children prior to chemotherapy or radiotherapy, in the hope that future technologies can utilize their immature gametes. Whether or not freezing of gonadal tissue is encouraged prior to cancer therapy, there is a growing demand from parents and clinicians for more information to be made available. This paper reviews our current knowledge of children's gonads in terms of physiology and of fertility experience gained after childhood cancer treatment. It further examines the various issues and concerns regarding children's gonadal tissue storage, its potential use, the present law and the demands and pressures under which clinicians find themselves with patients and parents. This information is important for both the counselling process and decision-making when presented with potential fertility issues in paediatric oncology patients.
Child↗
Issues of social policy and ethics in gene technology.
Technical developments in the last ten years have made possible mapping and sequencing of the entire human genome, along with the possibility of treating genetic disorders by manipulating DNA. A variety of issues regarding potential uses and abuses of these technologies have become apparent. They relate to both genetic screening and gene therapy. Problems facing individuals and their families mostly revolve around rights of self-determination and of confidentiality. Health care professionals will need to design optimal systems to provide genetic counseling and to protect confidentiality of DNA data bases. Society and social institutions will need to develop policies and laws that protect the privacy of individuals whose DNA is stored in data banks. Patenting of the results of gene research remains controversial internationally. Moreover, there is concern in many quarters about society's potential abuse of gene technology for eugenic purposes. Gene therapy is now a reality. There is little disagreement on the use of gene therapy to treat genetic diseases in individuals by somatic cell therapy. There is much controversy, however, over the use of germ-line cell therapy. Gene technology has contributed to the growth among a small group of influential people of the Post-Modern Movement, which is strongly antiscience and antitechnology. This movement may pose a long-term threat to future technological advances and should not be ignored. There is much outside of the laboratory that scientists, particularly molecular biologists, can do to assure a secure place for science and technology in our culture.
Ethics, Medical↗
Human genome sequence variation and the search for genes influencing stroke.
BACKGROUND: Technological progress spurred by the Human Genome Project is accelerating the pace of genetic studies of common diseases, including stroke. Stroke clinicians will soon need to interpret increasingly complex genetic studies. SUMMARY OF REVIEW: Linkage analysis and epidemiological association are 2 fundamental methods of identifying gene variants affecting common diseases such as stroke. Combining these methods with advanced molecular genetic techniques, 3 recently published studies have made important contributions to the genetics of common vascular diseases: identification of the location of a gene for stroke on chromosome 5q12 and identification of gene variants that may increase risk of myocardial infarction. Driven by genomic technology, future studies will be increasingly comprehensive and systematic in their assessment of the contribution of genetics to the clinical course of stroke. The scale and complexity of such studies will require large-scale collaboration among stroke physicians, geneticists, and biostatisticians. CONCLUSIONS: Rapid improvements in technology and study design are likely to elucidate the role of inherited genetic variation in complex diseases such as stroke. Understanding the methods of population-based genetic investigation and the patterns of human genome variation will enable stroke physicians to follow these future developments.
Genetic Linkage↗
Physics and engineering of transcatheter cardiac tissue ablation.
Ablation of arrhythmogenic cardiac tissues has emerged as one of the most important advances in cardiac electrophysiology. With the introduction of transcatheter ablation, the treatment of ventricular tachycardia, Wolff-Parkinson-White syndrome and other cardiac arrhythmias has progressed from an expensive and painful surgical therapy accompanied by a long recovery period to the less expensive, less traumatic transcatheter approach. The feasibility of cardiac ablation, along with the increasing number of physicians using the technique, requires understanding of the anatomic and electrophysiologic bases of transcatheter ablation as well as the different technologies, their limitations and complications. This report provides an overview of the physical, scientific and technical aspects of cardiac ablation performed with the methods currently available and a summary of the limitations of each method and expected future technologic developments in this growing field. Emphasis is placed on radiofrequency and direct current energies, the primary methods now used. Methods such as cryoablation and laser, and microwave and chemical ablation are discussed with less detail because the method of delivering energy for these ablative procedures has not been fully developed.
Animals↗
Dental biomaterials: where are we and where are we going?
This article reviews the current state of the art for restorative biomaterials by examining the roles of 1) truly biological biomaterials, with respect to the "near-future" of five to ten years, 2) traditional synthetic biomaterials, and 3) performance outcomes for biomaterials. Biological biomaterials are discussed in terms of tissue engineering and stem cell research, self-assembling system opportunities, and nanotechniques or technologies. Future developments for major areas of synthetic biomaterials are considered for bonding systems, composites, VLC curing, ceramics, and cements. Performance outcomes are discussed for all biomaterials in terms of safety, efficacy, and longevity of materials.
Biocompatible Materials↗
Engineering concepts for food processing in bioregenerative life support systems.
Long-duration manned missions, such as Mars exploration, will require development of new and cost-effective food production and delivery systems. Requirements for both carry-on preserved food and food processed from on-board crops exceed the capabilities of existing food processing and preservation technologies. For the transit phase, new food products, preservation methods, and processing technologies for ground-based food processing are required. The bioregenerative surface phase requires methods for processing of in situ-grown crops, treatment of food wastes, preparation of daily meals, and design of nutritious and appealing plant-based menus, all within severe cost and labor constraints. In design of the food supply for a long-term mission, the designers must select and apply both the packaged food and in situ processing technologies most appropriate for the specific mission requirements. This study aims to evaluate the strengths and weaknesses of different food system strategies in the context of different types of mission, and to point out the most important areas for future technology development.
Diet↗
Methods currently used for the control of one-host ticks: their validity and proposals for future control strategies.
Available methods for the control of one-host ticks as well as their possible applications in control programmes are reviewed. The advantages and disadvantages of current methods (dipping vats, spray races, hand sprays) are compared to other chemical control methods (ear-tags, pour-ons, systemics, slow-release devices). Their integrated application with other technologies based on immunological, genetic or biological approaches is discussed. Because of the great diversity of geographic, climatic, infrastructural and scientific-technological developments in vast areas of the world, the author concludes that there is no universal method of application. What really matters is to be able to develop control programmes based on local ecological, socio-economic and political facts, integrating the best of available technology. Future tick control prospects are discussed with reference to the need for standardization of criteria on requirements and the legal basis for acaricide registration, introduction of new evaluation techniques for acaricide efficacy and development of faster techniques to recognize resistance. Special emphasis is laid on the need to establish control programmes integrating diagnosis, research and production of vaccines against one-host ticks and their haemoparasites.
Animals↗
Technology and human vulnerability. A conversation with MIT's Sherry Turkle.
For most of the last 50 years, technology knew its place. Yes, we all spent a lot of time with it, but even five years ago, few people would seriously claim that technology had taken over their lives. It's very different today. Technology is not only ubiquitous but has become highly intrusive as well. On the Internet, people invent imaginary identities in virtual chat rooms, playing out the lives they wish they really lived. Children are growing up with interactive toy animals that respond to them like real pets. Indeed, some critics claim that technology has not just entered our private lives but started to define them. If we want to be sure we'll like who we've become in 50 years, we need to take a closer look at the psychological effects of current and future technologies. The smartest people in technology have already started. Universities like MIT and Caltech have been pouring millions of dollars into researching what happens when technology and humanity meet. To learn more about this research, HBR senior editor Diane L. Coutu spoke with one of the field's most distinguished scholars: Sherry Turkle, MIT's Abby Rockefeller Mauzé Professor in the Program in Science, Technology, and Society and the author of Life on the Screen, which explores how the internet is changing the way we define ourselves. In a conversation with Coutu, Turkle discusses the psychological dynamics that can develop between people and their high-tech toys, describes ways in which machines might substitute for managers, and explains how technology is redefining what it means to be human. She warns that relatively small differences in technology design can have disproportionate effects on how humans relate to technology, to one another, and to themselves.
Computers↗
Skin replacements.
There is much progress to be made to optimize the development of laboratory-grown temporary and permanent skin replacements. Replacement of both epidermal and dermal layers is important for achieving optimal take of cultured grafts and for optimizing the quality of wound healing. Although the use of retained cadaver allodermis on the wound bed may improve the performance of cultured epithelium, the development of successful, complete dermal-epidermal skin replacements (composite grafts) would greatly simplify burn management. In the future, handling and stability of the cultured grafts should be improved, and clinical outcomes should be expected to be superior. Unfortunately, funding for this type of applied research has not achieved high priority from the federal government granting agencies, despite the great clinical need for improved technology. Future progress depends largely upon commercial support.
Biological Dressings↗