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Full-Text Articles in Engineering

Volumetric Muscle Loss: The Role Of Physical Activity And Autologous Repair On Force Recovery And Signaling Pathways, Richard Perry May 2019

Volumetric Muscle Loss: The Role Of Physical Activity And Autologous Repair On Force Recovery And Signaling Pathways, Richard Perry

Graduate Theses and Dissertations

Volumetric muscle loss affects both military and civilian persons. The hallmark of this injury is incomplete muscle regeneration, excessive fibrosis, and chronic inflammatory signaling resulting in permanent functional loss. Since permanent functional loss drastically reduces quality of life, many studies have been conducted to improve force recovery. Current scientific literature considers a repair strategy of either devitalized scaffolds infused with growth factors or viable tissue plus activating factors to be the more promising interventions for optimal force recovery. PURPOSE The purpose of this study is to incorporate autologous repair and physical activity and observe the effects of muscle force recovery …


Feedforward And Feedback Signals In The Olfactory System, Srimoy Chakraborty May 2019

Feedforward And Feedback Signals In The Olfactory System, Srimoy Chakraborty

Graduate Theses and Dissertations

The conglomeration of myriad activities in neural systems often results in prominent oscillations. The primary goal of the research presented in this thesis was to study effects of sensory stimulus on the olfactory system of rats, focusing on the olfactory bulb (OB) and the anterior piriform cortex (aPC). Extracellular electrophysiological measurements revealed distinct frequency bands of oscillations in OB and aPC. However, how these oscillatory fluctuations help the animal to process sensory input is not clearly understood. Here we show high frequency oscillations in olfactory bulb carry feedforward signals to anterior piriform cortex whereas feedback from the aPC is predominantly …


Data Visualization Of Treatment Outcomes For Tuberculosis Patients, Joy Jenkins May 2019

Data Visualization Of Treatment Outcomes For Tuberculosis Patients, Joy Jenkins

Industrial Engineering Undergraduate Honors Theses

Tuberculosis is an infectious disease, and different treatments have been discovered over the years. However, patients may develop various drug resistance levels that affect the likelihood of becoming cured or dying. In this study, we sought to employ data visualization to explore the relationship between treatment trajectory, as indicated by smear and culture results in the follow-up tests and patient outcomes. A large sample of patients have been broken down by demographics including age, gender, and drug resistance status. Sankey diagrams were used to visualize the pathway progression of the patients over time split between two time periods- months 0-6 …


The Impacts Of Administering Metabolites Of Saccharomyces Cerevisiae On Broiler Performance, Yields And Salmonella Content Of Component Portions, Bill Douglas Potter May 2019

The Impacts Of Administering Metabolites Of Saccharomyces Cerevisiae On Broiler Performance, Yields And Salmonella Content Of Component Portions, Bill Douglas Potter

Graduate Theses and Dissertations

The impacts of using health-promoting Saccharomyces cerevisiae fermentation metabolites in poultry production and processing can be measured in respect to multiple measures of success. Traditionally this yeast-based compound has been administered to poultry, livestock, poultry, and other species to improve animal performance and production volume output. In addition, Saccharomyces cerevisiae fermentation metabolites have also been shown in more recent research to reduce colonization of pathogenic bacteria in the host organism’s gastro-intestinal tract. In this dissertation, the impacts of administering a functional ingredient containing Saccharomyces cerevisiae metabolites on broiler performance measures and pathogen reduction were measured. One of the studies in …


Using Peripheral Venous Pressure Waveforms To Predict Key Hemodynamic Parameters, Ali Zohair A Alalawi May 2019

Using Peripheral Venous Pressure Waveforms To Predict Key Hemodynamic Parameters, Ali Zohair A Alalawi

Graduate Theses and Dissertations

Analysis of peripheral venous pressure (PVP) waveforms is a novel method of monitoring intravascular volume. Two cohorts were used to study the hemodynamics change of the body state and its influence on the PVP using (1) dehydration setting with infants suffering from pyloric stenosis and (2) hemorrhage setting during a craniosynostosis elective surgery. The goal of this research is to develop a minimally invasive method of analyzing the PVP waveforms and find correlations with volume loss.

Twenty-three pyloric stenosis patients PVP were acquired at five stages and were divided into euvolemic, normal fluid volume, and hypovolemic, significant fluid loss. Seven …


Simulating Alternative Tuberculosis Diagnosis Methods In Underdeveloped Countries, Luke Turner May 2019

Simulating Alternative Tuberculosis Diagnosis Methods In Underdeveloped Countries, Luke Turner

Industrial Engineering Undergraduate Honors Theses

Tuberculosis is the deadliest infectious disease in the world; it is especially rampant in underdeveloped countries because they do not have the infrastructure, technology, or funding to properly combat the infection. However, the development of portable point-of-care diagnosis machines can reverse this epidemic as they far surpass conventional laboratory identification. The question now is where to place these machines, which is a difficult decision with a lack of data. Therefore, a flexible simulation model is created to test the implementation of these machines with different countries and configurations. The simulation tests the baseline model and three proposed implementations of the …


Effects Of Ambient And Laser Light On Water Evaporation From The Surface Of Polyurethane Swabs Doped With Surfactant, Collin Campbell May 2019

Effects Of Ambient And Laser Light On Water Evaporation From The Surface Of Polyurethane Swabs Doped With Surfactant, Collin Campbell

Chemical Engineering Undergraduate Honors Theses

Polyurethane swabs are a common instrument for environmental sampling in the food, medical, and forensic fields due to their high recovery of organisms like viruses, spores, and bacteria. For sampling microbes in food and medical facilities, storage of the collected samples occurs under the absence of light to promote growth for more accurate testing. In the forensic fields, microbial growth results in sample contamination so the inhibition of this growth requires the drying of the swabs. This work studies the evaporation rates of water from polyurethane swabs under zero watt incident light, 30 W fluorescent bulb, 50 mW 532 nm …


How Infant Positioning Impacts Hip Motion And The Associated Implications For Babies With Hip Dysplasia, Lauren Buchele May 2019

How Infant Positioning Impacts Hip Motion And The Associated Implications For Babies With Hip Dysplasia, Lauren Buchele

Biomedical Engineering Undergraduate Honors Theses

Developmental dysplasia of the hip (DDH) refers to a group of disorders, ranging from slight instability (Grades 1-3) to a severe dislocation (Grade 4) of the femoral head from the acetabulum [1]. In order to treat DDH in infants, a reduction procedure and the use of a lower body harness to secure the hip joint as the bones and ligaments re-form properly is typically prescribed. The Pavlik Harness is currently the “gold-standard” orthopedic device used to place hips in proper positioning. However, little research has been reported on the biomechanical affects during use of these device types.

Although the Pavlik …


Removal Of Carbamazepine From Drinking Water, Thomas Krumpolc, Juan Rodriguez, Jordan Alex Gadberry, Zach Wiese, Paola Marrero-Rivera, Adam Johnson Dec 2018

Removal Of Carbamazepine From Drinking Water, Thomas Krumpolc, Juan Rodriguez, Jordan Alex Gadberry, Zach Wiese, Paola Marrero-Rivera, Adam Johnson

Chemical Engineering Undergraduate Honors Theses

Due to the increasing prevalence of prescription medication over the past few decades, pharmaceuticals have accumulated in various water sources. This has become a public health concern because many pharmaceuticals have limited research on the effects of chronic low-level exposure. According to the World’s Health Organization (WHO), traces of pharmaceuticals products have been reported in different water sources such as surface waters, wastewater, groundwater, and drinking water.[1] One pharmaceutical of interest that has been detected in water sources is carbamazepine. Carbamazepine (CBZ) is a common pharmaceutical prescribed for the treatment of seizure disorders, neuropathic pain, and various psychological disorders. …


Determining The Effect Of Locally Delivered Bioactive Modulators On Macrophage Activation At The Implantation Site Of Different Biomaterials In Rats, Kamel Alkhatib Aug 2018

Determining The Effect Of Locally Delivered Bioactive Modulators On Macrophage Activation At The Implantation Site Of Different Biomaterials In Rats, Kamel Alkhatib

Graduate Theses and Dissertations

Altering the foreign body reaction by targeting macrophages has been of interest in the biomaterials field to improve the integration of longevity of implanted biomedical devices. The objective of this dissertation was to study the effect of locally delivered bioactive modulators on macrophage activation at the implantation site of different biomaterials in rats. Iloprost, a prostacyclin analog, was tested for its ability to direct macrophages to their pro-wound healing phenotype after the implantation of microdialysis probe in the subcutaneous space of male Sprague Dawley rats. This study showed that iloprost can shift macrophage activation states in vivo to the pro-wound …


Extraction And Analysis Of Vector Flow Imaging Data In A Pediatric Population, Bailey Stinnett May 2018

Extraction And Analysis Of Vector Flow Imaging Data In A Pediatric Population, Bailey Stinnett

Biomedical Engineering Undergraduate Honors Theses

Vector flow imaging (VFI) is a new ultrasound technology that provides real time, angle-independent visualization of flow velocities in the heart and great vessels. Thus far, VFI has been used for superficial applications due to the limited penetration depth of available transducer probes; however, this depth in smaller pediatric patients enables adequate aortic views. In this project, VFI was used to study pediatric aortic stenosis (PAS)—a congenital heart defect that results in the narrowing of the aorta and/or aortic valve. The decision to refer PAS patients for surgical or catheter-based intervention is initially based on Doppler ultrasound. VFI is potentially …


Role Of Local Renin-Angiotensin System In Altering Valve Interstitial Cell Phenotype, Sophia Scalise May 2018

Role Of Local Renin-Angiotensin System In Altering Valve Interstitial Cell Phenotype, Sophia Scalise

Biomedical Engineering Undergraduate Honors Theses

Hypertension is a disorder prevalent in adults around the world and is a common attributable cause of heart disease and mortality [1]. Calcification is much more common in the aortic valve than the other three heart valves [2]. Aortic valve interstitial cells (VICs), the principal cell type found in the human aortic valve, have been linked to disease development when they change in phenotype to become osteoblast like cells [3]. The phenotypes of these cells play a role in the development of calcification in the aortic valves [4].

Angiotensin II is a hormone in the body that has been implicated …


In-Vitro Simulation Of Acute Ischemic Stroke, Paolo Garcia May 2018

In-Vitro Simulation Of Acute Ischemic Stroke, Paolo Garcia

Biomedical Engineering Undergraduate Honors Theses

Acute ischemic stroke (AIS) is a condition that involves the occlusion of a blood vessel within the brain, effectively preventing the passage of oxygen and nutrients. AIS is highly prevalent in the United States, where nearly 795,000 strokes happen per year and 87% of those are ischemic. From a medical standpoint, the obstructing clot can be removed with the use of a stroke retrieval device. However, a need arises for testing the aforementioned devices on a patient’s specific vascular geometries in order to increase the likelihood of a successful procedure. Outlined is a process for developing a physical simulation of …


Comparison Of Varying Tissue Freezing Methods On Murine Colonic Tissue, James Hughes May 2018

Comparison Of Varying Tissue Freezing Methods On Murine Colonic Tissue, James Hughes

Biomedical Engineering Undergraduate Honors Theses

Histology often requires a tissue specimen to be embedded so that it may be sectioned, stained, and mounted on a microscope slide for viewing. One common method of tissue embedding for rapid histology is freezing, since freezing allows tissue to be stored without the need for fixing. Frozen tissue is often embedded in a medium such as Optimal Cutting Temperature (OCT) compound so that it can be sectioned using a cryostat. However, factors such as ice-crystal formation during the freezing process can cause damage to the tissue. As such, the protocol used to freeze the tissue can affect the quality …


Transportation And Distribution Of Strategic National Stockpile Supplies In A Public Health Emergency, Olivia A. Goss May 2018

Transportation And Distribution Of Strategic National Stockpile Supplies In A Public Health Emergency, Olivia A. Goss

Industrial Engineering Undergraduate Honors Theses

In the event of a public health emergency in the United States, it is important that public

authorities are equipped to distribute medical supplies to every person in need as quickly as

possible. Federal guidelines state that all persons in an area affected by a public health

emergency should receive their medical countermeasures within 48 hours of the emergency’s

declaration. While the CDC has determined a general dispensing plan for each state and county

to follow, it is ultimately up to the state and county to formalize and implement detailed plans.

A body of academic literature focuses on optimizing the …


Dispensing Medical Countermeasures In Public Health Emergencies Via Home Health Agencies And Points Of Distribution, Anna Hudgeons May 2018

Dispensing Medical Countermeasures In Public Health Emergencies Via Home Health Agencies And Points Of Distribution, Anna Hudgeons

Industrial Engineering Undergraduate Honors Theses

A major concern regarding emergency preparedness on the state government level involves the handling and dispensing of the Strategic National Stockpile (SNS) of medicinal supplies. Each state is required to update and maintain a plan of action for dispensing SNS materials that would effectively provide care to the state’s population in times of distress. This research evaluates a state’s ability to dispense an adequate amount of medicine to her population in a timely manner, specifically after it has been received by the state government. Although simulation modeling has previously been utilized to replicate the dispensing process at pre-designated points of …


Immunostimulatory Effects Of Antigen-Conjugated Inp/Zns Quantum Dot Nanoparticles In An Avian Model, Christopher Lyle May 2018

Immunostimulatory Effects Of Antigen-Conjugated Inp/Zns Quantum Dot Nanoparticles In An Avian Model, Christopher Lyle

Graduate Theses and Dissertations

Due to their unique physicochemical and enhanced immunostimulatory properties, quantum dot (QD) nanoparticles have shown increasing promise in biomedical research applications including bioimaging, drug delivery, and as vaccine adjuvants. Toxicity, however, remains a concern for the use of QD in these applications and thus, there is an increased demand for effective in vitro and in vivo systems to measure the bioactivity of QD. In this study in vitro and in vivo chicken models were used to investigate the effects of QD on innate and adaptive immunity. Chicken macrophage cultures were treated in vitro with QD to measure macrophage activation and …


Quantification Of Tumor-Associated Macrophages Following Immunomodulation Therapy In A Murine Allograft Model Of Colorectal Carcinoma, Caroline Spainhour May 2018

Quantification Of Tumor-Associated Macrophages Following Immunomodulation Therapy In A Murine Allograft Model Of Colorectal Carcinoma, Caroline Spainhour

Biomedical Engineering Undergraduate Honors Theses

Colorectal Carcinoma (CRC) is one of the deadliest cancers in the world, with 150,000 new cases annually in the United States. Traditional treatments include chemotherapy and invasive surgery; however, research has shown that only 25% of patients that undergo traditional treatment have a positive result. Immunotherapy is an emerging form of cancer treatment that utilizes the patients’immune system to fight cancer cells by targeting inflammation, which plays a large role in the proliferation and metastasis of cancer cells.

Tumor-associated macrophages (TAMs) are immune cells that affect the inflammatory microenvironment of tumors. TAMs are M1 in the early stages of tumors, …


Green Chemistry Oxidative Modification Of Peptoids Utilizing Bleach And Tempo, Jesse Leland Roberts Dec 2017

Green Chemistry Oxidative Modification Of Peptoids Utilizing Bleach And Tempo, Jesse Leland Roberts

Graduate Theses and Dissertations

Biotherapeutic drugs, derived from biological molecules such as proteins and DNA, are becoming an integral and exceptionally critical aspect of modern medicine. Compared to common pharmaceutical drugs, biotherapeutics are much larger in size and have greater target specificity, allowing them to treat many chronic diseases ranging from cancer to rheumatoid arthritis. The major issue with protein based therapeutics is that they readily undergo proteolysis, or enzymatic degradation, when administered through subcutaneous injections. Traditionally, biotherapeutic modification procedures have centered on the use of PEG derivatives. This process, called PEGylation, is unfavorable due to the increases in molecular weights of the proteins …


Optical Imaging Of Metabolic Adaptability As A Biomarker For Metastatic Potential In Breast Cancer Cells, Mason G. Harper May 2017

Optical Imaging Of Metabolic Adaptability As A Biomarker For Metastatic Potential In Breast Cancer Cells, Mason G. Harper

Biomedical Engineering Undergraduate Honors Theses

Breast cancer metastasis is the main cause for mortality in breast cancer patients. However, knowledge of metastatic recurrence is limited, and there is a need to understand metastatic recurrence in order to treat breast cancer patients more effectively. Highly invasive metastatic breast cancer has shown to exhibit metabolic adaptability, transitioning from glycolysis to oxidative phosphorylation in the presence of microenvironmental stress. NADH and FAD are naturally occurring cofactor products during glycolysis and oxidative phosphorylation, respectively, and they are of particular importance during these metabolic processes due to their endogenous fluorescence. Measuring the ratio of fluorescence intensities of these cofactors through …


Sensitivity Of Diffuse Reflectance Spectroscopy To Dose- And Depth-Dependent Changes In Tumor Oxygenation After Radiation Therapy, Daria Semeniak May 2017

Sensitivity Of Diffuse Reflectance Spectroscopy To Dose- And Depth-Dependent Changes In Tumor Oxygenation After Radiation Therapy, Daria Semeniak

Graduate Theses and Dissertations

Along with chemotherapy, immunotherapy, and surgery, radiotherapy is one of the most common treatments used against cancer. Around 50% of all cancer patients undergo radiation therapy. While for some patients radiotherapy works efficiently and lead to a complete cancer disappearance, for others treatment outcome may be less favorable due to radioresistance processes happening within a tumor on the molecular level. Radioresistance remains a big challenge for modern oncology. The ability to identify radioresistance at the early stage of radiotherapy would help physicians to improve therapy efficiency. At the current moment, despite the rapid progress in cancer understanding and diagnostic modalities, …


Exploring The Association Between Patient Waiting Time, No-Shows And Overbooking Strategy To Improve Efficiency In Health Care, Cam Tu M. Nguyen May 2017

Exploring The Association Between Patient Waiting Time, No-Shows And Overbooking Strategy To Improve Efficiency In Health Care, Cam Tu M. Nguyen

Industrial Engineering Undergraduate Honors Theses

Many primary care clinics are using overbooking as a strategy to mitigate the negative impacts on operations and performance caused by patient nonattendance of appointments, also known as “no-shows”. However, overbooking tends to increase patient waiting time and worker overtime. It is also acknowledged that patient waiting time is associated with no-show behavior, yet there is a lack of observational study to quantify the relationship. The overall goal of this research is to explore the relationships between patient waiting time, no-show behavior and overbooking strategy in terms of clinic performance. Arena® simulation software is used to create a discrete-event simulation …


Characterization Of Murine Breast Cancer Cell Lines For Anti-Cancer Vaccine, Haven N. Frazier May 2017

Characterization Of Murine Breast Cancer Cell Lines For Anti-Cancer Vaccine, Haven N. Frazier

Biological Sciences Undergraduate Honors Theses

Breast cancer is the most commonly diagnosed cancer in women and the second leading cause of cancer death among women in the United States (1). While treatments involving radiation and chemotherapy currently exist, disease must be detected early in order for the treatments to be somewhat effective, and there is no effective treatment after metastasis occurs (2). Additionally, current therapies do not mitigate tumor immunosuppression. Decreasing the tumor-associated immunosuppressive conditions while activating antitumor immunity could prevent recurrence and metastasis, possibly leading to an effective treatment for cancer (3). Tumor cell vaccines could possibly address this issue and have become a …


Detection Of Leukocytes Stained With Acridine Orange Using Unique Spectral Features Acquired From An Image-Based Spectrometer, Courtney J. Hunter May 2017

Detection Of Leukocytes Stained With Acridine Orange Using Unique Spectral Features Acquired From An Image-Based Spectrometer, Courtney J. Hunter

Biomedical Engineering Undergraduate Honors Theses

A leukocyte differential count can be used to diagnosis a myriad blood disorders, such as infections, allergies, and efficacy of disease treatments. In recent years, attention has been focused on developing point-of-care (POC) systems to provide this test in global health settings. Acridine orange (AO) is an amphipathic, vital dye that intercalates leukocyte nucleic acids and acidic vesicles. It has been utilized by POC systems to identify the three main leukocyte subtypes: granulocytes, monocytes, and lymphocytes. Subtypes of leukocytes can be characterized using a fluorescence microscope, where the AO has a 450 nm excitation wavelength and has two peak emission …


Investigation Of Cnt-Induced Escherichia Coli Lysis And Protein Release, Abdollah Mosleh Aug 2016

Investigation Of Cnt-Induced Escherichia Coli Lysis And Protein Release, Abdollah Mosleh

Graduate Theses and Dissertations

This research investigated the use of carbon nanotubes (CNTs) as a treatment to increase the permeability of a bacterial cell wall. Recombinant Escherichia coli BL21 (DE3) containing a plasmid that expressed Green Fluorescent Protein (GFP) and -lactamase were exposed to CNTs under various levels of agitation for different times. Fluorescence assay for GFP, optical absorbance for -lactamase activity, and Transmission Electron Microscopy (TEM) were used to determine the amount of released protein, and visually examine the permeability enhancement of the cells, respectively. It was found that more -lactamase was present in the culture fluid after treatment with CNTs in a …


Risk Estimation Toward A Natural History Model For Low Grade Glioma Patients, Anh Thi Hoang Pham May 2016

Risk Estimation Toward A Natural History Model For Low Grade Glioma Patients, Anh Thi Hoang Pham

Graduate Theses and Dissertations

Glioma is a common type of primary brain tumor that represents 28% of all brain tumors and 80% of malignant tumors. According to a recent study by the Centers for Disease Control and Prevention (CDC), gliomas account for 53%, 35% and 29% of all brain tumors (68%, 74% and 81% of malignant brain tumors) among children (aged 0-14), teenagers (aged 15-19) and young adults, respectively. Gliomas are often diagnosed through radiological imaging and histopathology. There are two main groups of gliomas following World Health Organization’s classification: Low grade gliomas (LGG), or grade I and II gliomas; and high grade gliomas …


Essays In Physicians Preference Items And Inventory Management Within The Healthcare Supply Chain, Mohammad A. Shbool May 2016

Essays In Physicians Preference Items And Inventory Management Within The Healthcare Supply Chain, Mohammad A. Shbool

Graduate Theses and Dissertations

This work is composed of a number of topics in the healthcare area, which are approached separately with appropriate methodologies. The two topics deal with physician preference items via two different approaches. The first one investigates stock keeping unit (SKU) proliferation in healthcare organizations due to physician preference items (PPI). It captures perspectives of physicians and supply chain professionals about this problem through two surveys. The second topic builds a decision-making framework for the PPI selection process that can be used by healthcare organizations to make more objective decisions. A Multi-criteria decision making technique is implemented to illustrate the framework.


Customization Of Titanate Nanofiber Bioscaffolds, Jared Hopkins May 2016

Customization Of Titanate Nanofiber Bioscaffolds, Jared Hopkins

Biomedical Engineering Undergraduate Honors Theses

In the field of orthopedic devices implant loosening is a major issue resulting in the majority of device failures. These failures result in the need for costly secondary procedures. To reduce device loosening an improved method of tissue anchoring is required. A previously studied titanate nanofiber bioscaffold has been shown to be safely implantable and to contribute to the differentiation of mesenchymal stem cells to osteocytes. Through the customization of both physical and chemical characteristics this titanate nanofiber bioscaffold was fabricated as a potential means to enhance tissue anchoring for use with orthopedic devices. This customization was enabled by acoustic …


Multiphoton Imaging Of Labeled Breast Cancer Cells To Quantify Intra And Extracellular Receptors, Sydney C. Wiggins May 2016

Multiphoton Imaging Of Labeled Breast Cancer Cells To Quantify Intra And Extracellular Receptors, Sydney C. Wiggins

Biomedical Engineering Undergraduate Honors Theses

Every year 200,000 women in the United States are diagnosed with breast cancer. Of the cases diagnosed, 10% -15% are classified as triple negative breast cancer (TNBC) due to the absence of estrogen, progesterone, and HER-2/Neu receptors. This breast cancer sub-type is markedly more aggressive and twice as likely to develop in premenopausal women. TNBC is resistant to endocrine therapies and current targeted agents, making clinical need for the development of validated therapeutics for TNBC a pressing matter. To initiate drug development, the internalization of directly immunolabeled epidermal growth factor receptors (EGFR) in SK-BR-3 human breast adenocarcinoma cells was quantitated …


Improving Reliability Of Medical Device Tracking Using Unique Device Identification, John A. Bonfanti May 2016

Improving Reliability Of Medical Device Tracking Using Unique Device Identification, John A. Bonfanti

Industrial Engineering Undergraduate Honors Theses

The term “disruptive innovation” has been the buzzword of industries looking to create technological advancements in their respective fields ever since the term was first coined in 1995. In order to invest in the future of the industry, companies are beginning to focus on new, innovative ideas that come into the market as a low-cost alternative to the sustaining innovations currently in place. Similar business-models can be seen in the healthcare industry, as physicians look to disruptive innovations to provide methods of diagnosis and treatment that are easier to perform and maintain. Companies, from medical device manufacturers to the hospitals …