Thursday, November 13, 2008

Going Beyond a Multinational

"Connecting those who need it most" is the goal of a new innovative firm called Inveneo. Inveneo is a pioneer in a new breed of organizations which utilize their technical superiority to widen the reaches of computer technology and take it to rural areas around the world. On November 11, Jeff Wishnie, the Chief Technology Officer of Inveneo, delivered a stimulating lecture highlighting the pathbreaking achievements of Inveneo within just a few years of formation.

"The mission is to get the tools of ICT-Information and Communication Technology to the people and organizations who need them the most, those in remote and rural communities in the developing world," Jeff said. The non-profit organization believes that ICTs are the premier solutions in offering rural healthcare and relief, better finance and market opportunities and more well rounded education. Inveneo has been successful in employing ICTs in the predominantly rural areas of the world, including Rwanda, Uganda, Sierra Leone and Nigeria.

Over the years, Duke students have been actively connected with Inveneo. Duke Smart Home and Engineers Without Borders (EWB) students installed Inveneo systems and computers at the RASD (Rural Agency for Sustainable Development) resource center in Nkokonjeru, Uganda. "It was so gratifying to see people – many of whom had never been on the internet before - at the computers," said Will Patrick of EWB. "We trained RASD volunteers how to maintain it, and in its first month, the cafĂ© brought in more than 200,000 shillings. It's not much, but it was twice as much as the bills to the phone company."

Jeff said that the task of installing computers and the Internet, which appears to be really simple in a country like the USA, involves a complex procedure in the underdeveloped areas. This is due to the extreme social, infrastructural and technological challenges posed in these places. "Even government healthcare hospitals do not have generators. If they do have them, most don't work or don't have fuel", Jeff said, recounting his first-hand experiences working in such harsh conditions. "Thus,"he adds, "there needs to be a major focus on building a sustainable design, which should be usable, affordable, supportable, resistant, resilient and low power consuming." The engineers and software designers at Inveneo have incorporated all these design considerations into their systems, which has enabled them to live up to their mission of "Connecting those who need it the most."

Music to your ears... and your brain

Every day on the bus I see kids plugged into their iPods, heads bobbing to unheard music. This synchronization with the beat, according to author and neurologist Oliver Sacks, is “a uniquely human experience.”

With the exception of the penguins from “Happy Feet,” other animals just don’t seem to appreciate music the way we humans do. We dance and sing to it, sometimes to the chagrin of those around us.

“There are quite a number of people who are severely tone deaf-- but just don’t know it,” Sacks said, to chuckles from the overflow crowd in Duke's Page Auditorium Wednesday night.

Sacks, who provided the kickoff to a day-long Thursday symposium on Music and the Brain, then explained the peculiar case of a woman who thought music was completely unintelligible. She had been to concerts, but found them excruciating. Her idea of music was dropping pots and pans on the kitchen floor. Finally, doctors were able to diagnose her with congenital immusia-- the inability to perceive music in a normal way.

Sacks shared a story about another immusiac who was suddenly inspired by music -- after he was struck by lightning. The man, while talking on a cellphone outside during a storm, was hit by lighting and sent into cardiac arrest. When he recovered, he was shocked to discover a love of music, and now is a fairly well-known composer. What are the odds of that?

Next Sacks shared a story about a man who seemed to be an immusiac by all appearances. After being ridiculed as a child for his inability to sing, the man avoided music for 30 years. Finally, he decided to conduct an experiment on himself. He took singing lessons for a year, and had an MRI done before and after. Not only did he love the lessons, but the before and after MRIs revealed that his rediscovery of music had actually changed his brain.

“There is something special about the ability to play music,” Sacks said.

According to Sacks, musical memory can endure when sometimes nothing else does. After a stroke, a formerly musical man had only a 7-second memory. From minute to minute, he could not remember where he was or what he was doing. And yet, when guided to the stage, he could conduct an orchestra with all of his professional ability.

Sacks also discussed his experiences at Beth Abraham Hospital, which he chronicled in his book, “Awakenings.” There he encountered several patients who were frozen, transfixed by a sleeping sickness called encephalitis lethargica. Music made a difference, he discovered, but “it had to have rhythm, had to have a beat.” When they heard music, the formerly frozen patients were able to move.

“Music will act as a sort of vehicle, will carry memory and emotion with it, as it does for all of us,” Sacks said.

Sacks went on to describe his experiences with Alzheimer’s and Parkinson’s patients, and with those suffering from schizophrenia and depression. He spoke about an event that happened to novelist William Styron, Duke alumnus and author of a memoir about depression, “Darkness Visible.” According to Sacks, Styron suffered from depression for many years. One night, he stayed up late to watch a movie by himself. At one point during the film, a character sang a single, clear contralto note, and it “pierced his heart like a dagger.” All at once came an outpouring of happy memories, of his wife, his children, and his work.

“This opening-up power of music can’t be predicted, but when it works, it can be astounding,” Sacks said.

Monday, November 10, 2008

Shortcomings of Medical Donations

Studies show that 80 percent of the medical equipment reaching developing nations' hospitals is donated but 70 percent of those donations don't work. Such shortcomings could explain why the world's medical communities' failed in their goals to deliver health care everywhere by the 21st century, said Robert Malkin, a Duke professor for the practice of biomedical engineering who also directs a voluntary program called Engineering World Health.

Malkin analyzed why nearly 3,000 pieces of such technology failed to work correctly during a Nov. 7 talk at a Duke conference on Bioengineering Applications to Address Global Health. Some widely-touted reasons, such as a lack of spare parts or an inability to train local staff to use the equipment, appear to actually be off the mark, he said.

One of the biggest real problems is hospitals' inability to replace disposable items connected the technology in places where the per-patient outlays for such "consumables" cannot exceed 34 cents, he said. Spare parts may be less of an issue than access to the right tools, he added. And staffs that might appear confused in training may really need access to manuals in the right language.

Malkin's own Engineering World Health (EWH) project sends volunteer engineers to work alongside hospital administrators to evaluate equipment needs. Those needs are then met with donated equipment.

After that, engineering and science students from Duke and other universities visit those hospitals after undergoing language and technical training in Costa Rica or Tanzania. Once on location, the students work on equipment repair and installation. And the voluntary engineers also make followup visits to make sure everything is working properly.

Between 2003 and 2007 EWH has put 1,623 pieces of equipment --- $3 milllion worth -- into service, Malkin said.

Giving Women Control Against HIV

HIV, the AIDS virus, "targets women with Darwinian ferocity," says Patrick Kiser, an assistant biomedical engineering professor at the University of Utah who got his Ph.D. at Duke. In Africa, the HIV infection rate among young women can be three times higher than men.

That's in part because females are at the "receiving end" of HIV-infected semen and partly because of their vulnerable societal status, Kiser said Nov. 6 at a Duke conference on Bioengineering Applications to Address Global Health. So while male use of condoms can prevent transmission, that requires far-from-certain negotiating between sexual partners.

Kiser's lab is working on techniques that would shift control to women by introducing agents called "microbiocides" to stop the virus cold in the vagina. But early experiments by others have not been promising, he said.

While one candidate gel preparation seemed to block the virus in laboratory culture, for example, the salt content of semen interfered with the agent's effectiveness. Also, women did not always follow instructions that called for applications before each sex act.

His group's tactic is to combine advanced microbiocides more attuned to bodily chemistries with better drug delivery techniques. As one example, it is developing flexible plastic intravaginal rings that can be made for pennies and deliver a constant amount of microbiocide for 30 days.

One gel method of action he described would trigger the release of anti-HIV drug when normally acidic vaginal fluids undergo a pH change upon intercourse (sperm is basic rather than acidic). At the same time, the normally free-flowing gel would chemically crosslink into a semi-solid to stop viral particles from reaching vulnerable white blood cells of the immune system.

Kiser is also collaborating with a Duke group headed by biomedical engineering professor David Katz.