Analysis of the Unsuccessful Efforts to Design & Construct Invasive Mechanical COVID-19 Ventilators in Mexico: Did the Current BME Curricula at Mexican Universities Contribute to the Failure?

Mexico was caught unprepared to deal with the current COVID-19 pandemic. One of the most egregious failures was the incapability to provide an additional 10,000 ventilators in order to cope with the excess demand. The Mexican government proposed a program for funding the development of these devices and over 100 designs were submitted but were of below standard quality and performance. Only three designs have been approved up to date.This work analyzes the failures from the point of view of the incapability to design, develop and test locally made ventilator designs, and asks whether the national university system, after a history of 48 years of producing thousands of Biomedical Engineering students in over 60 institutions has become incapable of delivering a design of a medical device of medium complexity.

Updating the Biomedical Engineering Curriculum in Latin America: Moving from management and maintenance to Design and Development of Medical Devices.

Biomedical Engineering as an undergraduate degree in Latin America is not new. However, most programs have the objective to produce professionals dedicated to the management and maintenance of health care technology. We believe that there is an important area of opportunity in the education of engineers who are competent in the design and development of medical devices. Among the 100 programs in the region there could be a few which could stand out as providers of such professionals. This work proposes a curricular structure to fulfill these aims.

Improved Outcomes in Hemodialysis/Hemodiafiltration Treatments Applying Exercise and Physiological Monitoring Techniques: Preliminary Results.

End-stage renal disease affects millions of people worldwide, and the only definitive solutions are renal transplants that are not widely available. Temporary solutions are renal replacement therapies such as peritoneal dialysis, hemodialysis and hemodiafiltration. These therapies as they are applied today are just partial measures and have many drawbacks and complications such as high mortality rates and high costs due to the use of supplemental drugs and emergency room visits. Many enhancements to the therapies have been published, but they are not applied consistently in real world practice. Our work presents the results from the systematic application of several techniques to provide individualized therapies that can minimize the drawbacks and improve patient outcomes. This approach is based on the use of exercise, analysis of cardiovascular parameters, such as heart-rate variability, body composition and dry weight measurements through the use of bioimpedance and real-time monitoring of energy expenditure and nutrition intradialytically in order to provide individualized and dynamically variable therapies. Results show that patients can lead long, productive lives while maintaining a quality of life equivalent to that of a renal transplant.

Critical assessment and outlook for the 50 biomedical engineering undergraduate programs in Mexico.

Biomedical Engineering (BME) has been taught in Mexico at the undergraduate level for over forty years. The rationale for the introduction of this profession was to help manage and maintain the growing technological infrastructure in the health care system during the seventies. Owing to this, it is not surprising that early versions of the BME curricula were oriented towards clinical engineering and medical instrumentation. In the last decade the number of programs has grown from three in the seventies and eighties to fifty at present. This work is the result of the analysis of the BME programs in all the institutions that offer this degree in Mexico. Three main issues were studied: the curricula, the sub-disciplines that were emphasized in the programs and the job market. Results have shown a striking resemblance in most of the programs, which are mostly dedicated to teaching aspects of medical instrumentation and clinical engineering. These results reflect an agreement with the requirements of the job market, but since most job offerings are for low-paying positions in sales, service and hospital maintenance, we question the wisdom of stressing these sub-specialties at research universities, where faculties and research labs offer a wide variety of options. An analysis of work at these centers shows that most of the results are publications, so the need to emphasize translational research and partnerships with industry are suggested.

Biomedical Engineering curriculum at UAM-I: a critical review.

The Biomedical Engineering (BME) curriculum at Universidad Autónoma Metropolitana (UAM) has undergone at least four major transformations since the founding of the BME undergraduate program in 1974. This work is a critical assessment of the curriculum from the point of view of its results as derived from an analysis of, among other resources, institutional databases on students, graduates and their academic performance. The results of the evaluation can help us define admission policies as well as reasonable limits on the maximum duration of undergraduate studies. Other results linked to the faculty composition and the social environment can be used to define a methodology for the evaluation of teaching and the implementation of mentoring and tutoring programs. Changes resulting from this evaluation may be the only way to assure and maintain leadership and recognition from the BME community.

Managing new directions for a 38 year old undergraduate BME program.

The Biomedical Engineering curricula in general must reflect the state of the art in the technology related to medicine and health care, as students who graduate from these programs are directly related to the well-being of the patients, either through new devices and technologies being invented or through the application of their technical knowledge in the service industry. At present, there are more than 25 BME undergraduate programs in Mexico. Most of them are oriented towards the instrumentation and clinical engineering branches of the field, while a few others have strong components in signal analysis. The program at Universidad Autónoma Metropolitana (UAM) is one of the oldest and has been used as a reference by most other programs. Since UAM is one of the top three research universities in the country, it is well poised to incorporate its research directions into a more modern curriculum. This paper deals with the efforts that have been carried out in order to minimize the excessive influence of the electrical engineering subjects in the BME undergraduate curriculum and the approaches to reach consensus-based decisions to explore new directions related to emerging disciplines in medical technology and health care. After analysis of the current state, a discussion on future directions is presented.

VO2 and VCO2 variabilities through indirect calorimetry instrumentation.

The aim of this paper is to understand how to measure the VO2 and VCO2 variabilities in indirect calorimetry (IC) since we believe they can explain the high variation in the resting energy expenditure (REE) estimation. We propose that variabilities should be separately measured from the VO2 and VCO2 averages to understand technological differences among metabolic monitors when they estimate the REE. To prove this hypothesis the mixing chamber (MC) and the breath-by-breath (BbB) techniques measured the VO2 and VCO2 averages and their variabilities. Variances and power spectrum energies in the 0-0.5 Hertz band were measured to establish technique differences in steady and non-steady state. A hybrid calorimeter with both IC techniques studied a population of 15 volunteers that underwent the clino-orthostatic maneuver in order to produce the two physiological stages. The results showed that inter-individual VO2 and VCO2 variabilities measured as variances were negligible using the MC while variabilities measured as spectral energies using the BbB underwent 71 and 56% (p < 0.05), increase respectively. Additionally, the energy analysis showed an unexpected cyclic rhythm at 0.025 Hertz only during the orthostatic stage, which is new physiological information, not reported previusly. The VO2 and VCO2 inter-individual averages increased to 63 and 39% by the MC (p < 0.05) and 32 and 40% using the BbB (p < 0.1), respectively, without noticeable statistical differences among techniques. The conclusions are: (a) metabolic monitors should simultaneously include the MC and the BbB techniques to correctly interpret the steady or non-steady state variabilities effect in the REE estimation, (b) the MC is the appropriate technique to compute averages since it behaves as a low-pass filter that minimizes variances, (c) the BbB is the ideal technique to measure the variabilities since it can work as a high-pass filter to generate discrete time series able to accomplish spectral analysis, and (d) the new physiological information in the VO2 and VCO2 variabilities can help to understand why metabolic monitors with dissimilar IC techniques give different results in the REE estimation.

Analysis of the impact of medical technology assessment subjects on BME curricula.

This paper presents and analyzes the factors that have arisen on the implementation of the medical technology assessment and management courses, and the academic methodologies used to deal with them. Five courses that cover topics as Technology Management, Health Economics, Quality Assessment, Innovation and Entrepreneurship were designed as electives for BME curriculum and have been taught for the last two years. The activities carried out within the courses are described and their impact on the comprehension of the course contents are presented. Also, several elements and factors pertaining to the teaching-learning process are discussed. Future perspectives for the students that follow this sub-specialty branch of the BME curriculum are presented.

Imaging facilities for basic medical units: a case in the state of Guerrero, Mexico.

This work presents the methodology to design a small imaging unit in a small regional hospital that takes into account the real imaging needs in the region regardless of current administrative guidelines. The situation of the imaging facilities in Mexico's states is studied and compared with other countries, and a project plan is designed for the specific state (Guerrero) where the clinic is to be located. The proposal includes the acquisition of a basic suite of modalities that include an ultrasound system, a mammography unit, and a conventional X-ray system in addition to a CT system that is not available anywhere within the state. The system should be primarily digital and should incorporate a simple picture archiving and communications system that can be the basis of a future telemedicine unit. The conclusion of this study also proposes changes in the segmented and pyramidal structure of the Mexican health system in order to provide higher quality care at the lower level, to reduce bottlenecks, and to provide higher quality health care near the patient's home.

Updating the biomedical engineering curriculum: Inclusion of Health Technology Assessment subjects.

This paper describes the work being carried out at Metropolitan Autonomous University (UAM) in Mexico City with regard to the continuous evaluation and updating of the Biomedical Engineering (BME) curriculum. In particular the courses regarded as part of the BME basic branch are reduced and new sets of elective subjects are proposed in order to bring closer the research work at UAM with the subjects in the BME curriculum. Special emphasis is placed on subjects dealing with Health Technology Assessment (HTA) and Health economics, as this branch of the BME discipline is quite promising in Mexico, but there are very few professionals in the field with adequate qualifications.

A digital programmable telemetric system for recording extracellular action potentials.

This article describes the design and preliminary evaluation of a small-sized and low energy consumption wearable wireless telemetry system for the recording of extracellular neuronal activity, with the possibility of selecting one of four channels. The system comprises four radio frequency (RF) transceivers, three microcontrollers, and a digital amplifier and filter. This constitutes an innovative distributed processing approach. Gain, cutoff frequencies, and channel selection are remotely adjusted. Digital data transmission is used for both the bioelectrical signals and the control commands. This feature offers superior immunity to external RF interference. Real-time viewing of the acquired data allows the researcher to select only relevant data for storage. Simultaneous recordings of neuronal activity from the striatum of a freely moving rat, both with the wireless device and with a wired data acquisition system, are shown.

Analysis of the medical imaging services at three hospitals of the Mexican National Health System.

We present a study on the quality of operation and the characteristics of the medical imaging equipment in three specialty hospitals of the Mexican Health System. Six month residencies were carried out in order to better understand the problems and internal functioning of the three imaging departments. The kinds of equipment, the types of equipment failures and the internal operation of these services were analyzed. The results allow us to identify four factors that are linked to faults in the quality of the health care delivered to patients. The first factor is equipment obsolescence; the second is related to deficient preventive maintenance procedures and problems associated the supervising of external service providers. The third factor is derived from the equipment's (over) workload, which is indirectly tied to the age of the imaging modalities and the fourth factor is misuse of the equipment. The solutions to these problems include the modernization of the equipment and a better supervision by the clinical engineering department of all the processes involving the medical imaging services in each hospital. In addition to this, a special effort of the continuing education of personnel associated with medical imaging at all levels should be carried out.

New continuing education programs for hospital and clinical engineering.

This paper describes the new continuing education efforts that are being made to offer degrees more in tune with the career path for clinical engineering or for engineers working at different hospitals. Following an analysis of the issues regarding the field of hospital engineering in Mexico, and the type pf professionals that provide this service, we have implemented a series of programs in order to provide a full spectrum of educational opportunities in biomedical engineering. Since the conventional research-oriented graduate program is doing well, and the number of faculty that is interested in clinical engineering is growing, we now offer professional development track for engineers working inside the hospital environment.

The effects of body position, controlled breathing and exercise on the heart rate variability parameters in healthy subjects

Durante la realización de cinco maniobras se determinó el comportamiento de parámetros temporales y espectrales de la variabilidad de la frecuencia cardiaca para caracterizar los niveles de actividad simpático-vagal. Se comparó la capacidad discriminativa de dos formas de obtención de los parámetros espectrales y se evaluó la influencia respiratoria. Fueron analizados 110 archivos de frecuencia cardiaca instantánea y amplitud respiratoriia, obtenidos de 22 sujetos sanos durante 5 maniobras: acostado, respiración controlada, parado, ejercicio y recuperación. Se encontró un comportamiento característico y discriminativo entre las maniobras para los parámetros temporales de dispersión y los componentes de baja parcial e intermedia. Se observó un comportamiento semejante para los componentes espectrales en sus dos formas de integración normalización, resultado que hace independiente la interpretación funcional del procedimiento seleccionado. I a partición del componente de baja en dos, hizo que éstos tuvieran una mayor capacidad discriminativa. La respiración ejerció una influencia importante durante la respiración controlada y moderada en el resto de las maniobras. En conclusión las maniobras determinaron un comportamiento tipico en los parámetros de dispersión y espectrales (componentes de baja parcial e intermedia), los cuales indicaron en forma adecuada niveles distintivos en la actividad simpático-vagal para cada una de ellas