17 Late in the 1960's, the technology had progressed to the point where a new industry for local analyses of ECG's came to life. More than 500,000 people have had their records screened automatically, thus establishing a new benchmark in the early identification and treatment of heart disease. 18, 19 This thrust toward automatic analysis of health records has been strongly supported by NASA's research on normal individuals, research that involved both the development of instrumentation and methods for total medical information management. 20 Maintaining Adequate Health Improving physiological measurements is essential for long-term advances in the quality and quantity of medical care, and it is here that NASAsupported research has made a significant contribution. Better measurement, however, translates into more advanced equipment and larger systems of data and research management. As the Nation's current, large-scale attack on major health problems intensi Tools for prediction and prevention are needed for health maintenance. fies, tools for performing tests faster and more accurately must be developed; new testing methods and instruments will be required; and, finally, the capability to interpret and act on the information generated must be improved. Activities to maintain adequate health are supported internationally by organizations such as the United Nation's World Health Organization and UNICEF, private organizations such as CARE, and through numerous bilateral and multilateral government aid programs. Within the United States, the Public Health Service, the National Institutes of Health and other agencies within the Department of Health, Education and Welfare are involved across the whole spectrum of maintaining adequate health, from nutrition and health education to diagnostic screening programs; in addition, the Department of Agriculture has had a long-term major role in the revolutionary increases in productivity of American agriculture. In the production of food, new technology has played a fundamental role. Fertilizers, pesticides, and "miracle" strains of wheat and corn have increased production potential many-fold in the last few decades. Now satellites and aircraft are coming into use to identify crop diseases, discover new arable land, and improve weather forecasts used in planning for planting and harvesting. 21, 22 Food preservation techniques, so Remote sensing and contamination control tools help improve food production and distribution. essential for good nutrition, also have been improved significantly in recent 23 years. The food processing industry, in developing foods to NASA requirements for use on long-term space missions, has generated much new information on food processing, preservation, and nutritional value which is being used for consumer products. To sharply reduce the chances of food-borne infection on space flights, for example, firms that have produced foods for NASA have established special controls and procedures in food production. such control is the use of "clean rooms," isolated areas where contamination is minimized, to prepare food. Clean room technology has been One significantly advanced by NASA, the Department of Defense and the Atomic Energy Commission. The use of a contamination free environment could lead to elimination or reduction in the need for thermal processing, which often destroys nutritional value, flavor, and color; it could also lead tion in the incidence of food-borne diseases, which is still a public health problem. Other NASA work on food technology which has general applicability includes identification of dietary requirements to avoid bone demineralization (a problem with bed-ridden patients), contributions to the use of radiation for food preservation, and a low cost method of determining the vitamin content of food. Adequate health is maintained not only by proper nutrition, but also by frequent diagnosis. In the past decade, automated and computer-created health screening centers have been organized, particularly in support of Multiphasic health screening is demonstrated. paid health maintenance programs and large medical institutions. For instance, the Kaiser "Multiphasic Health Checkup" was screening 25,000 patients annually in 1965 at a cost of about $35 per patient. The screening provides an instantaneous computer summary of more than 40 medical measurements obtained during a 2-1/2 hour examination. NASA was an early contributor to the technology of automated health screening. At the Manned Spacecraft Center in Houston, for example, a program for multiphasic analysis of clinical patients has been operated since the Center was established in 1961.25 Some 5,700 people have been screened routinely during the decade. This work also has affected medical procedures by standardizing results, reproducing tests, defining normals, and developing computer software for records management and data analysis. Among other things, an operational, computerized medicalrecord system called MEDATA emerged from this work. 26 A technique developed at the Goddard Space Flight Center to detect life on other planets is being adopted by researchers at Johns Hopkins University Hospital in Baltimore to help identify urinary tract infection, & malady affecting 1,000 Americans. 27 The first step, nearly complete, has New developments can make many tests routine. been to establish the reliability and repeatability of the technique by comparing its results with those obtained through the standard technique in which cultures are prepared from urine specimens. Results, the second step, also nearly concluded, involves the construction of an automatic apparatus that completes the test in 20 minutes as opposed to the 3 to 5 days involved in the standard test. This apparatus literally makes a diagnostic test routine that formerly was undertaken only after other symptoms of infection indicated the advisability of specific confirmation. The Whittaker Space Sciences Division of the Whittaker Corporation has used diagnostic and optical instrumentation technology it developed under a NASA contract to build a new instrument for screening potential lead Social problems relate to health problems. poisoning victims. 28 Lead poisoning is particularly problematic in inner city areas where lead-based paints still take a terrible social and economic toll by causing brain damage in young children. Whittaker has introduced a portable instrument that can rapidly and economically detect the presence of lead in the blood. At Baltimore City Hospital, the Whittaker unit was used during the past two years to screen approximately 1,000 children; 12 percent were found to have abnormally high levels of lead in their blood. 29 Children with a reading above 60 micrograms of lead per 100 grams of blood are placed in convalescent facilities; those above 80 micrograms are placed in intensive care. Use of the machine at Charleston, South Carolina and at Harrisburg, Pennsylvania showed that the tests could be performed rapidly and with few personnel, and that costs were reduced to about $1.00 per fficient equipment developnents can meet specific needs. test from the $15.00 per test using the usual atomic absorption method. It has been suggested that 12 percent of all ghetto children have a reading of 50 micrograms or greater. After a person's level reaches 60, it can rise very rapidly and cause irreparable harm to the central nervous system. In St. Louis, a demonstration model of the Whittaker instrument was used on about 200 children; 11 percent had a high level of lead indicated, while another 15 percent showed positive readings without lead indicating other serious problems such as sickle cell anemia, poor nutrition, etc.30 Use of the unit is faster than conventional methods and greatly reduces testing trauma. The technologies of power supply, fiber optics, photo-detection, and miniaturization were combined with the laboratory fluorimeter's capabilities to provide this valuable diagnostic tool. Sanders Associates in Nashua, New Hampshire is marketing a medical data management system that embodies technology developed from the Saturn V prelaunch checkout system. 31 The medical data system has been tailored to link all map parts of hospital information networks, including laboratories, treatment rooms, admissions, accounting, and dietary kitchens. 32 The Kaiser Memorial Hospital in San Francisco uses this system in its pediatric center where 24 cathode ray tube displays provide interactive Data management systems link hospital units. data links. The Mayo Clinic in Rochester, Minnesota installed the system about two years ago in its Admissions and Records Department where 130,000 line items per day are processed. These examples illustrate the technological basis behind improvements in measurement and data management affecting large numbers of people. Population screening is a trend in health care delivery that is clearly in its infancy. Screening will continue to grow as a force in health care because it is much less expensive--socially and economically-to correct potential problems than to treat major disabilities. Correcting Health Problems The impact of technology in health care is perhaps most graphically demonstrated in the treatment and rehabilitation phases of a patient's recovery. Open heart surgery, organ transplants, and cancer therapy, to Serious medical equipment shortages exist. cite just three examples, require ad- such expensive equipment sometimes overshadows the fact that less costly instruments, equipment, and appliances that can play such an important role in health care are not generally available. About four years ago, the National Academy of Engineering recognized that a clear discrepancy existed between the problems in health care delivery and the number of devices available to meet these problems.33 The Academy established the Committee on the Interplay of Engineering with Biology and Medicine to determine why the discrepancy existed and The National Academy of Engineering recently studied this problem. what could be done to correct it. The committee learned that one of the factors behind the discrepancy was the fact that certain devices, while highly desirable, need only be manufactured in small quantities; for other devices, the markets are fragmented, isolated, and difficult to predict, with the result that no manufacturing activity occurs. The committee suggested that one way to close the gap might be to create an agency with primary responsibility to develop and stimulate deployment of biomedical engineering technology. The NAE committee's recommendation gives an appropriate perspective for viewing the operation of NASA's Biomedical Application Program. 34 Three teams, comprised of engineers and scientists and operating from NASA BATeams help develop needed devices. nonprofit research institutes, attempt to match technology generated through space-oriented research and development with patient needs identified in medical research or field practice. Some 77 medical facilities across the country currently participate in this program. In addition to providing information, the application teams oftentimes oversee the development of prototype devices for field evaluation. An example of a recent collaborative effort between the National Cancer Institute (NCI) and the three Biomedical Application teams illustrates the problem definition and solution process. 35 Dr. Edward S. Henderson, head of NCI's Leukemia Service, asked the Biomedical Application Team at the Research Triangle Institute (RTI) in North Carolina to assist in a NCI and NASA are testing a new device for early detection of shock. search for a new way to detect the onset tional methods for detecting initial drops in blood pressure were either unsuitable or unduly disturbing for critically ill patients. A promising solution to the problem was discovered recently when an RTI team member visited NASA's Ames Research Center. An Ames engineer proposed the use of an ear oximeter that measures the oxygen content and pressure level of blood by employing an infrared absorption technique. Impressed with the oximeter's potential, Dr. Henderson and his staff are working with the NASA Application Team to adapt the instrument for shock measurement use. NASA's research in planetary quarantine, the life sciences, materials, and instrumentation has produced a number of contributions to treatment and rehabilitation technology. Areas of NASA concern for space missions such as contamination-free environments, miniaturized instrumentation, remote sensing of physiological processes, and closed-cycle life support systems are directly related to basic problems in the medical community ospitals are beginning to use ontamination control techiques originally applied by EC and NASA. and, as a result, have been particularly Clean rooms that practically eliminate airborne bacteria from a room in minutes embody contamination control technology originally developed for the assembly of delicate instruments used in aerospace and atomic energy. To reduce the risk of infection, at least 25 hospitals in the U. S. now apply such technology both in operating rooms and in facilities reserved for patients undergoing radiation and cancer chemotherapy or who have received organ transplants. 37 In the field of biomedical instrumentation, several NASA developments have found medical application. Biotelemetry units developed to monitor the physical condition of astronauts in flight have been adapted and incorporated for use in patient monitoring systems that simultaneously monitor several patients from one nurses' station. Devices originally developed at Ames Research Center and Manned Spacecraft Center allow telemetering of blood pressure, temperature, electrocardiograms, and electroencephalograms without encumbering the patient with lead wires. lany NASA-developed instruments tre finding medical appliation. A NASA-developed sensor for monitoring the breathing of animals now performs the same task for infants suffering respiratory difficulties. The sensor monitors the pace and intensity of the baby's breathing. Information is telemetered to a nursing station where any unacceptable change in the child's breathing sets off an alarm. Engineers at NASA's Lewis Research Center have designed a control system for an experimental artificial heart operated by the Cleveland Clinic; they also have designed a small, inexpensive analog computer to monitor heart patients' blood pressure and cardiac output at St. Vincent's Charity Hospital in Cleveland. Space materials technology also has found medical application. Carbon composites developed originally for rocket nozzles are being used by researchers as implantable splints, heart valves, and other devices. The carbon material appears to be more compatible with the human body than any other known material and can easily be fabricated into complex shapes. 38 Several major medical centers, such as Rancho Los Amigos and 'arious materials first used in space vehicles are applied in several different medical Creas. the University of California in Los Angeles, are involved in developing applications for the material. Lightweight epoxy composite materials are being tested for use in a variety of prosthetic devices and appear to hold promise of significant reductions in the weight and bulkiness of such items. Foam material, originally developed for advanced airline passenger seats to counteract crew discomfort on long flights, is being used experimentally as a decubitus ulcer prevention aid in bed pads, as lining materials for prostheses, and as padding material for burn victims. |