C. Donald Combs

Startling technologies promise to transform medicine

Many writers have dared to look into the future and, far more boldly, commit their vision to print. Readers, especially those graced with hindsight, can then assess the forecast and observe the inevitable inaccuracies. I have been asked to join those ranks and cheerfully accept the challenge of forecasting some startling new technologies that will change the practice of medicine. I will focus on existing technologies that are in various stages of development and on extensions of those technologies. The five areas of technological innovation that I think will change medicine in startling ways are molecular medicine and biometrics, nanotechnology, wave technology, fabricators, and robotics and simulation (box 1). These technologies already have had individual and collective effects on some aspects of medicine and their influence is increasing.1 Alvin Toffler was correct when he said, “Technology feeds on itself. Technology makes more technology possible.”2 Four brief scenarios illustrate the types of changes I envisage. #### Box 1 Categories of startling technologies John, who is 25 lb overweight, walks through a device that looks like an airport x ray scanner. When he emerges, about 5 lb of fat tissue has been “fried” by a laser.3 Through the normal purging processes, the fat will be gone from his body in about three days. He repeats the process every two weeks until all the extra weight is gone. No side effects are seen apart from the resizing of his wardrobe. Jane, who has hypertension and diabetes, has a barely visible radio frequency chip implanted just below the skin on her upper arm. This chip simultaneously monitors and transmits data on her heart rate, respiratory rate, blood pressure, and concentrations of blood sugar. The data are received in two places—a remote monitoring station in her general practitioners …

Do we need a national research agenda for modeling and simulation

The National Modeling and Simulation Coalition (NMSC) is interested in a national research agenda that enables the convergence of domain specific modeling and simulation (M&S) approaches towards a common discipline to foster reuse and dissemination of research results. This panel evaluates the various views on such an effort from experts in the domains of science, engineering, and applications.

The Digital Patient: Advancing Healthcare, Research, and Education

The healthcare industry’s emphasis is shifting from merely reacting to disease to preventing disease and promoting wellness. Addressing one of the more hopeful Big Data undertakings, The Digital Patient: Advancing Healthcare, Research, and Education presents a timely resource on the construction and deployment of the Digital Patient and its effects on healthcare, research, and education. The Digital Patient will not be constructed based solely on new information from all the “omics” fields; it also includes systems analysis, Big Data, and the various efforts to model the human physiome and represent it virtually. The Digital Patient will be realized through the purposeful collaboration of patients as well as scientific, clinical, and policy researchers.

Medical Simulators: Current Status and Future Needs

The transformation of a knowledgeable individual into an elite performer occurs through “deliberate practice”. Given the grave risk associated with using human subjects in skills training, the concept of high-fidelity simulators is increasingly being introduced into medical and health professions education. Within the past few years, there has been substantial research and development of innovative medical simulators that allow learners to refine their clinical skills in a controlled environment that precedes live patient interaction and therefore improves patient safety.

Data analytics, the digital patient and simulation in healthcare

A ultrasensitive amperometric immunosensor for the detection of cancer biomarker, α-fetoprotein (AFP), was fabricated using Au/chitosan modified glassy carbon electrode (GCE) and antibody-functionalized dumbbell-like Au-Fe3O4 heterostructures as sensing platform and immuno-labels, respectively. To fabricate the labels, nano-Au NPs were first epitaxially grown onto Fe3O4 surface to form the dumbbell-like Au-Fe3O4 followed by conjugation of secondary antibody onto Au surface (Au-Fe3O4-Ab2). Results showed that the GCE modified with chitosan produced high electrochemical response by conjugation of more Au-Ab1 and the dumbbell-like Au-Fe3O4 served as a dual-probe to immobilize Ab2 onto Au as well as to reduce H2O2 by Fe3O4, resulting in the enhancement of signal amplification. The prepared Au-Fe3O4/Ab2/AFP/Ab1/Au/chitosan/GCE immunosensors exhibited a good analytical performance in the presence of 10 mM H2O2 with wide dynamic range of 4 orders of magnitude (0.01–40 ng mL-1) and low detection limit of 2.3 pg mL-1. In addition, the dumbbell-like Pt-Fe3O4 nanoparticles have been used to fabricate the amperometric biosensors for detection of dopamine. The Pt-Fe3O4-based electrode is linearly dependence on dopamine concentration in the range of 10-850 μM with the detection limits of 0.13-7.22 μM. Results obtained in this study clearly demonstrate that the dumbbell-like metal-magnetite biosensor is a promising biosensing platform for highly sensitive detection of tumor makers and neurotransmitters.

Thoughts about the Future of Modeling and Simulation in Healthcare and Higher Education

The U.S. healthcare and higher education systems face long-standing challenges concerning effectiveness and costeffectiveness that could be addressed by modeling and simulation. This will require the modeling and simulation industry to adapt through diversification, experimentation and the engagement of the leaders of these systems in effecting solutions. KeywordsU.S. Healthcare System; U.S. Higher Education System; Modeling and Simulation; Business Competitiveness

Educating health professionals in the early 21 st century — The basic driving forces and the role of medical simulation

This paper addresses the driving forces that shape contemporary medical and health professions education and suggests major challenges and opportunities that can be addressed through medical simulation.