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CHAPTER 1
INTRODUCTION
Max E. Valentinuzzi
What is first goes first, what is last goes last, and often there is something in between ... as a sandwich.
Abstract
Bioengineering has evolved steadily and increasingly over the last two or three decades, but especially when it crossed the centuries dividing line, as if the millennium transition meant a unique omen leap. In the beginning, it was a simple mixture of a few ingredients, and people talked of Medical Electronics (ME) as a multidiscipline. Step by step, the link became more intimate, and it was called an interdiscipline, because there was free crossing from one area into the other. Nowadays, new disciplines show up, reminding of transgenic organisms, where the very deoxyribonucleic acid (DNA) is modified. Thus, we should speak of transdiscipline. Far off is the naïve 1950s idea of putting together in a room a bunch of engineers, biologists, and physicians to produce ME!
1.1The Seven Lamps of Bioengineering
They sure enlighten its road, as a rainbow
It is said that Saint Mathesis, patron of mathematics, used to be surrounded by seven lamps eternally lit: lampas utilitatis (usefulness), lampas imaginationis (imagination), lampas poesis (creativity), lampas infinitatis (infinite), lampas decoris (beauty), lampas mysterii (mystery), and lampas religionis (religion). Bioengineering, strongly supported by mathematics, searches the quantification of the biomedical sciences. No doubt, these lamps also illuminate its course because this interdiscipline is certainly useful, for it applies directly or indirectly to the human being. It requires tremendous imagination and creativity and extends unlimited in all directions branching off here and there. It is as beautiful as an enchanted fairy while it shines with some degree of mystery when penetrating the darkness of the unknown, so spurring curiosity, and shows also even mystical and mythical1 edges when human, ethical, and religious aspects are touched on (Smith, 1947; Valentinuzzi, 2004, 2010).
1.2Current Definition of Bioengineering
Oh, definitions ... are they really necessary? Some people become obsessed with them!
This book refers to the use and application of principles, laws, techniques, and general knowledge, taken from the physical and engineering sciences, to the better understanding and solution of biological and medical problems at large. No one argues this anymore. We just realize how wide and ambitious the intent is. Of the several terms that have danced around for a long time, Bioengineering and Biomedical Engineering seem to stay with us, showing no differences between the two, the former being shorter than the latter, if a hard eye looks for one. Clinical Engineering though, the newest of those words, is clearly linked to Health Care Systems since it deals with problems found in hospitals and emergency services, and works side by side with medicine. It shows a well-defined personality with publications of its own. Bioengineering has become more biological in some respects and more engineer-like in others, quite medical on occasions and very technological in many specific areas, such as ophthalmology or anesthesiology, or when getting into agricultural or ecological problems, which in the end support life on Earth. Boundaries are not well delimited, nor they need be, and information and activities must flow freely from one disciplinary compartment to another in a constant exchange if results are to be fruitful. Interestingly enough, the two biggest international organizations do not officially use either of the two current terms, preferring longer combinations of words: The Institute of Electrical and Electronics Engineers/Engineering in Medicine and Biology Society (IEEE/EMBS) and the International Federation for Medical and Biological Engineering (IFMBE). However, Bioengineering or Biomedical Engineering, and their much more bounded sub-discipline Clinical Engineering, constitutes common language terms in their respective publications and meetings as well.
Definitions are always controversial and, in this particular case, perhaps more than ever for there is still a state of development and evolution of concepts, making terms obsolete in a relatively short time. Thus, a flexible and open mind becomes mandatory (quite an attractive characteristic of Bioengineering, indeed!). Definitions are not absolute, they are secondary; they can and should be changed as required. They are simply convenient. Look with a serious frown at those people who stick stubbornly to definitions (and even worse, to standards!). Imagine what it would be like had we fastened ourselves to the definitions (and the concepts supporting them) of the Middle Age or, without going as far back, of the more recent last two centuries.
1.3Multidiscipline, Interdiscipline and Transdiscipline
Discipline, among other meanings, for us is a field of study
Engineers and physicists measure, they measure to describe magnitudes in terms of numbers attaching them to units, too, so that they better know about a given event; they measure to design and adjust, to quantify, as the case is, for example, with the amount of cement and number of bricks to build a wall. Physicians also measure, parameters such as body temperature, body weight, blood pressure, and other physiological events. Nutritionists have a similar stand with meals and their caloric content. What should we eat and how much? Dietetics, strongly based on nutrition concepts had to draw upon physics and physiology.
Bioengineering, as meals, developed first as a simple mixture of biological and technological ingredients (a salad). Early in its modern life, say during the 1950s, it barely was electronic instrumentation used in biology and medicine. Not much was the knowledge of the intervening engineers and physicians about the other guy’s area. The book by Donaldson (1958, 1959) stands as an almost bibliographic relic, to be highly cherished and kept by those who still hold a copy, for its content well offers a clear description of those instruments and their conceptual philosophy. That kind of bioengineering was, yes, a simple mixture, with little or no interaction of the parts, but nicely set the route of the biological stimulators and amplifiers plus other more or less successful gadgets. At one point, Biological and Medical Electronics popped shyly up as a multidiscipline, including some physics and math, too, but not much, for it took considerable time to add more elaborated methods (Valentinuzzi, 2014; Valentinuzzi and Kohen, 2013). No doubt, much water has run under the bridge, as wisely stated by an old motto.
Slowly but steadily, the relationship became wider and deeper, as a kind of integrative cooking action (Fig. 1.1). The informational content increased and the concept of interdiscipline came up, because there is free information transfer from one discipline to the other, and as in dancing parties, girls and boys integration takes place, or as in stews, each ingredient during the cooking process delivers its own set of components, with a deeper effect than in the simple former mixture.
Foods, meals, and their associated numerical caloric values recognize equipment, procedures, theoretical and experimental models, observations, in both animals and clinical tests, involved in obtaining the values that a dietician or nutritionist needs to recommend a given diet within safety margins. The dietician may not realize, but this is Bioengineering, too, in the end.
Figure 1.1: Bioengineer, as a cook, mixes and combines several ingredients to come out with a potent product, as a goulash to face a hard Nordic winter night. Drawn by Gustavo Idemi.
New disciplines are being generated because interactions get deeper and stronger so that transdiscipline appeared as another word, in an evolving phenomenon somewhat similar to the transgenic organisms (transgenic rats, transgenic seeds), holding in their germinal line an exogenous deoxyribonucleic acid (DNA) experimentally introduced. Thus, several bioengineering areas are now on the scene, such as nanoscience, neuroengineering, biorobotics, and biomechatronics, the latter attempting to reach human biology with the idea of assisting or even replacing members, senses, or injured organs caused by trauma, disease, or congenital defects. Closer we get to the science fictional Bionic Man or Woman leaving quite behind the modest XIXth Century Frankenstein Monster. And all this transgenic science, or transgenic engineering, is transdiscipline! How much of such turmoil will remain ... we do not know, but exciting it is, no doubt.
The word above — transdiscipline — brings us to the prefix trans- or tran-, from Latin, which means across, beyond, or crossing, according to the Collins English Dictionary (2009). Hence, the act of translating refers usually to rendering from one language into another, as a kind of transformation. Its adjective — translational — qualifies a given activity or discipline, as translational research. The latter, for example, and getting now closer to our area, helps to make findings from basic science useful for practical applications that enhance human health and well-being. It is practiced in the medical, behavioral, and social sciences. In medicine, it is used to “translate” findings in basic research quickly into medical practice and meaningful health outcomes. Applying knowledge from basic science often is a major stumbling block. Translational research is another term for translative research and translational science, while translational medicine is research that aims at moving “from bench to bedside” or from laboratory experiments through clinical trials to point-of-care patient applications (i.e., near the site of patient’s care). Following this trend of new terms, there is a journal — the Journal of Translational Engineering in Health and Medicine (JTEHM) — launched by IEEE/EMBS, which supports the movement of biotechnological innovations from idea to clinical trials and ultimately to commercialization; it also fosters global conversation and interdisciplinary collaborations on translational research. It intends to bridge the clinical and engineering worlds, along with a variety of interactive contents, all aimed at a better global healthcare, and dealing with Medical Devices, Nano-biosensors and Biosystems, Medical Imaging, Cardiovascular, Neurovascular and Rehabilitation Devices, Surgical and Interventional Devices, Bio and Surgical Robotics, Wearable Sensors and Health Monitoring, Wireless and Communication Technologies for Bio-Information, Electronic Medical Records, Global Health, Harsh Environments, Social Determinants of Health, Law, Ethics and Policy, all appealing emerging areas, indeed. How many out of this list will survive? How many even newer will appear? We do not know, and it is not easy to foresee, perhaps in a way resembling a kind of survival of the fittest and of natural selection, as introduced in biology by Charles Darwin in the XIX century (Darwin, 1859) after his long and famous voyage (1831–1836) on board of His/Her Majesty Ship HMS Beagle, under the orders of Vice-Admiral Robert FitzRoy (1805–1865).
1.4Frames of Reference and Humor
Two women meet at the supermarket. One looks cheerful, the other depressed. The former said: “What’s eating you? Nothing’s eating me. Death in the family? No, God forbid! Worried about money? No ... no ... Trouble with the kids? Well, sort of, it’s my little Jimmy. What’s wrong with him? Nothing really, his teacher advised me to see a psychiatrist. PAUSE. Well ... what’s wrong with that? Nothing ... just the psychiatrist says he’s got an Oedipus complex. ANOTHER PAUSE. Well ... Oedipus, Shmoedipus, what the heck, I wouldn’t worry so long as he’s a good boy and loves his momma”
In the days of the Austro-Hungarian Empire, a dashing but penniless young officer tried to obtain the favors of a beautiful courtesan during a dance in the romantic Vienna palace, both caressed by an orchestra’s charming waltz. To shake off this unwanted suitor, she coldly said that her heart was not free. Recovering from the unexpected shock, the chap replied politely: “Mademoiselle, I never aimed as high as that”. Both stories from Koestler (1964).
The creative act of the humorist consists in bringing about a momentary fusion between two habitually incompatible matrices. In the little first story above, the cheerful woman’s statement is ruled by the logic of common sense: if Jimmy is a good boy and loves his momma, there cannot be much wrong. But in the context of Freudian psychiatry, the relationship to the mother carries entirely different associations (Fig. 1.2). The second story does not require an explanation for...
